The Enid News and Eagle, Enid, OK

Local and State News

November 11, 2013

Area Medicare recipients hear about changes

ENID, Okla. — Love it or hate it, the Affordable Care Act ushered in changes everyone on Medicare should know about, Integris’ director of legislative affairs said Monday.

Anne Roberts spoke at Oakwood Mall about provisions of the ACA. So many Enid area residents wanted to hear how Medicare recipients were affected by the health care law that a second session had to be scheduled for them.

Roberts said “one of the biggest and best things” that has happened because of the ACA is that Medicare recipients are entitled to one free wellness visit each year, with as many as 20 preventive screenings or services to go along with it.

“You can make one visit a year to your primary care physician, and your physician is paid to sit and talk with you,” Roberts said.

Roberts said she was her mother’s caregiver for eight years and learned that it’s helpful for a physician to review the overall status of the patient’s health. It can catch problems such as conflicting prescriptions ordered by different physicians.

When making an appointment for the annual wellness exam, the physician’s office must use the proper codes so there is no charge for it.

“You have to tell your doctor, ‘This is my annual wellness exam,’” Roberts said. “That way, they’ll code it so there’s no charge to you.”

Other changes that affect Medicare recipients include Medicare Advantage Plans must spend at least 85 cents of each dollar the insured person pays on actual health care services. Insurance companies no longer can spend as much as they want on salaries, advertising and the like, Roberts said.

A quality initiative to improve care and reduce costs of care, as well as authority and resources to stop fraud, also are changes under the ACA.

The “doughnut hole” in Part D plans that creates a coverage gap will be slowly eliminated over the next few years, Roberts said.

“By 2020, you’ll have seamless coverage for your drug benefit,” Roberts said.

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