After a brief hiatus, The American Healthcare Act (AHCA) is back on the table. Having passed in the House of Representatives, it is now awaiting a vote by the Senate. Many people are anxiously following these developments and anticipating the effects that it may have on their own healthcare. If you or someone you love is among the senior population, you may be wondering where you fit in to the proposed healthcare changes.
The new healthcare bill stands to have a significant impact for seniors, especially those who fall into one of three groups: those not quite old enough for Medicare, those who receive Medicaid, and those with preexisting conditions.
Older Adults Not on Medicare
Most seniors can begin receiving Medicare benefits when they turn 65. Before that time, they may have health insurance benefits through an employer, or they may be responsible for their own insurance — especially if they’ve chosen to retire a few years early.
Under The Affordable Care Act, insurance companies are forbidden to charge older adults more than three times what younger adults pay for the same policy. The AHCA could change that. Although states are given the final say in determining the increase for older adults, it has been proposed that insurance companies be allowed to charge older adults as much as five times as much.
This could add up to substantial costs for older adults who are responsible for their own health insurance. For example, premiums for people over 60 would increase by about 22%, or an average of $3,192 per year (or $266 each month).
Seniors on Medicaid
The AHCA plans to repeal Medicaid expansion and make major cuts to the Medicaid budget. This has the potential to affect seniors who rely on Medicaid to pay for long term care.
As a rule, Medicare does not cover long-term care, either in the home or in a residential facility. Seniors who have exhausted their savings and who cannot pay for long-term care by any other means frequently rely on Medicaid. Nearly two-thirds of nursing home residents receive Medicaid to help pay for at least part of their care.
With cuts to Medicaid on the federal level, states will have to decide how to compensate. Possible options affecting those in need of long term care include:
- Scaling back within nursing homes in order to cut costs. This could negatively impact the quality of care offered in these settings.
- Asking patients’ spouses, children, or other family members to cover some long-term care costs.
- Limiting the number of individuals served or cutting back on home or community based services.
Seniors and others who currently receive services under ACA Medicare expansion will not lose those services as long as their coverage does not lapse.
Seniors With Pre-existing Conditions
According to The AARP, 40% of adults between 50 and 64 have a preexisting condition that could impact their eligibility for health insurance. Under The ACA, everyone is guaranteed coverage at the same rate regardless of preexisting conditions. The AHCA doesn’t move to deny coverage, but there are a few conditions.
If a person’s health insurance lapses for over two months, he or she could be required to pay significantly higher premiums for a year before being allowed to gain coverage again at the standard community rate. This could potentially make health insurance unattainable for many people just when they need it the most.
In order to counteract the effect of the higher cost of insurance for these people, it has been suggested that high risk pools be established both at the state and federal level to help lower the out-of-pocket cost of their premiums.
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