Many seniors on Medicare don’t know repeal of the Affordable Care Act could mean some of their benefits would disappear, advocates for seniors say.
An annual wellness visit, cancer screenings and discounts on prescription drugs could be in jeopardy if the law, also known as "Obamacare," is repealed without preserving key parts for seniors.
Almost 12 million seniors and people with disabilities on Medicare nationwide have saved more than $26 billion through discounts on prescription drugs since 2010 when the health law was passed, according to the Centers for Medicare & Medicaid. The average savings to each senior has been $2,200.
Seniors in Florida have saved almost $1.8 billion since 2010, which includes a one-time rebate of $250 and additional discounts on what they pay out-of-pocket when they reach the coverage gap known as the “donut hole” in the Medicare Part D program.
Seniors who reach the “donut hole” coverage gap, which depends on how many medications they take, receive larger discounts each year for both brand-name and generic medications. The coverage gap is scheduled to disappear after 2020 under the health care law.
AARP in Florida is tracking the fast-paced campaign among Republican leaders in Congress to repeal the law.
Yet more lawmakers are realizing that such a repeal is easier said than done and would affect a wider swath of the American population than the 20 million who have gained health coverage since its passage, said Bill Clark, associate AARP state director in St. Petersburg.
“They are beginning to see it’s a challenge,” Clark said. “Everybody’s health is at stake.”
If the Medicare benefits of preventive health and cancer screenings, and the discounted drugs are not kept in place, there’s harm to seniors’ pocketbooks who are on tight budgets and that can mean harm to their health, said Leslie Fried, senior director for benefits with the National Council on Aging, a consumer’s group in suburban Washington, D.C.
They may go back to practices before the discounts of not filling prescriptions or splitting dosages, which contributes to their health deteriorating.
“It’s worrisome,” Fried said. “People before the (health law) was passed knew when they were falling into the coverage gap.”
The Medicare Part D program for outpatient medications began in 2006. The “donut hole” coverage gap kicks in when what seniors spend in combination with their drug plan reaches $3,700 this year. They get out of the gap after the combined spending reaches $4,850.
Many seniors who take few prescriptions don’t ever reach the coverage gap, but that often changes as they get older and develop multiple illnesses requiring medications.
For instance, about 344,000 Medicare enrollees in Florida last year alone hit the coverage gap and received discounts averaging $1,068 on their prescriptions. That’s against a backdrop of more than 4 million seniors on Medicare statewide.
The total savings for 2016 alone was nearly $368 million in Florida, where the pharmaceutical companies provided the discounts.
Three other states heavily populated with seniors have saved more than Floridians through the drug discounts: California, where more than 400,000 elders in the coverage gap saved $472 million last year; New York, where more than 348,000 elders saved $460 million; Texas, where 333,000 seniors saved $381 million.
Counselors with the Area Agency on Aging in Southwest Florida educate seniors about their benefits and their out-of-pocket expenses under Medicare Part D but not the origins of discounts for prescriptions. That’s not part of their task to discuss legislative matters, said Camilita Aldridge, a counselor in Fort Myers.
“If you are on a very limited income and you can save $10, it is something you can (use elsewhere),” Aldridge said. “You are not looking for the source of where you are getting that $10. That is what we see.”
Fried, with the national council on aging, said some members of Congress recognize the importance of staying the course on phasing out the coverage gap and Democrats talk it up but it isn’t hitting home with the elderly.
“It’s not resonating,” she said.
Sen. Bill Nelson, D-Fla., filed legislation to continue the discounts and closing the coverage gap yet it failed when the Republican Congress voted to repeal the health law earlier this month.