Effects to Medicare, Medicaid & Veteran Plans Under the Affordable Care Act

f you have Medicare, you won't need to buy additional insurance on top of that. Your plan counts as minimum essential coverage under the health care law. You don't have to do anything different; you'll still go to Medicare.gov to sign up for plans and won't use the Health Insurance Marketplace

However, the health care law included broad reforms to the Medicare system, intended to cut waste and curb costs. Here are some highlights:

More preventative care services:

You can now get a free yearly "wellness" exam. Several preventative measures like screenings (for example, mammograms and diabetes screenings) and vaccines are now fully covered.

Savings on prescription medicines:


The gap in coverage in some prescription drug plans, nicknamed the "donut hole," will narrow each year and close fully by 2020. In the meantime, you will receive discounts on brand-name and generic drugs while you're in the gap, and the discounts will grow each year until the gap closes.

Changes to Medicare Advantage

In an effort to control the cost of Medicare, the health care law started to reduce certain subsidies the government was paying to the private companies offering Medicare Advantage Plans. The payments will gradually be reduced to bring costs more in line with the cost of Original Medicare. A possible effect of this is that insurance companies will have to choose how to deal with this and may decide to change benefits or costs. In a further effort to curb costs, some high-cost health care plans (ones that have lower copays and deductibles and offer a wider menu of services than most plans) will be subject to a 40-percent tax for the amount over and above the traditional cost of insurance, starting in 2018. Some Medicare Advantage Plans could be among these so-called Cadillac plans.

Effects to Medicaid

An important element of health care reform is expanding the Medicaid system to cover new patients. Michigan's expanded program is expected to ultimately pull in more than 400,000 new low-income Michigan residents.

Reforms to the Medicaid program include a number of enhanced benefits. All Medicaid enrollees will receive a package of benefits that includes the minimum essential benefits offered in marketplace plans. Furthermore, new services are provided in the areas of:

  • prescription drugs
  • tobacco cessation services for pregnant women
  • family planning
  • hospice care for children
  • preventative and obesity-related services

Insurance plans for kids in low-income households

Michigan's health insurance programs for children, MIChild, which is a low-cost health insurance plan for children under age 19, and Healthy Kids, which is a free health insurance plan for children under age 19 and pregnant women, will not change due to health care reform. Remember: Starting in 2014, private insurers are no longer allowed to deny a child coverage because of a pre-existing condition.

To get more information on either program or to apply, go to HealthCare4MI.com or call 888-988-6300.

Effects to veteran coverage

If you're a veteran already enrolled in a health care plan from the U.S. Department of Veterans Affairs or TRICARE, you don't need to take additional steps to meet coverage standards under the health care law. The health care law does not change your benefits.

If you wish, you may supplement your existing plan with coverage purchased on the Health Insurance Marketplace. Your family members who are not covered by your health plan can now use the marketplace to get coverage and may be eligible for discounts.

AARP, American Public Health Association, Centers for Medicare & Medicaid Services, Consumer Reports, FAIR Health, Inc., HealthCare.gov, Internal Revenue Service, Kaiser Family Foundation, Medicaid.gov, Michigan Department of Community Health, Michigan Department of Insurance and Financial Services, U.S. Chamber of Commerce, U.S. Department of Health and Human Services, U.S. Department of Veterans Affairs.

Every effort was made to provide clear, accurate information about health care reform. We verified any information we had with first-tier sources – those who are involved in this change and its effect on our health care system. We also relied on well-respected national nonprofits, some who've done a masterful job of providing clear information to consumers. Our primary source of information was the Affordable Care Act's official website, HealthCare.gov. If you need additional information about how health care reform affects you, that would be your best place to start.

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