Gene and MariaBy now almost everyone is familiar with the existence of the Affordable Care Act but what many people are still unclear about is what it will mean for them.

AARP New Mexico will be conducting a series of discussions over the next few months about the new law to help people learn more about it. The first such session took place at the New Mexico Conference on Aging held in August at the Isleta Resort and Casino.

“The Affordable Care Act is a new way of insurance coverage,” said Leonel Garza, AARP New Mexico Legislative Council Chairman. “The basic premise of the law is we are going to cover people who for whatever reason don’t have coverage.”

 “We really don’t know how the precise implementation is going to work out and some of the laws being implemented take place in the future, so those regulations have yet to be written,” he said.

For some groups of people the law won’t have much of an affect. Its main impact will be on individuals who don’t have insurance at all or are not already enrolled in a government insurance program.

“If you are currently enrolled in Medicaid—there’s no change. For Medicare, if you are currently enrolled you don’t need to do anything. People in other government insurance programs do not need to do anything,” Garza said.

“People in other group insurance plans don’t need to do anything now. You might be affected if, for example, your employer decides to drop coverage,” he said.

“People eligible for Medicaid Expansion – about 170,000 individuals – will need to fill out an application. To be eligible, an individual must be at 138 percent or below of the poverty level. The New Mexico Human Services Department will be spearheading the expansion,” Garza said.

People who are able to buy insurance outside of the exchange program will need to decide if they want to buy those plans or use another mechanism to get insurance coverage.

There are some benefits from the ACA that are already in effect that help most people.

  • Insurance companies can’t drop your coverage if you get sick.
  • It eliminates lifetime and annual coverage limits
  • There’s more coverage for preventative services.
  • It extends coverage to young adults who can stay on the family plan until age 26 regardless of the circumstances.
  • It also provides help paying for insurance starting in 2014. A family of 4 making less than $94,000 a year can receive assistance. The income eligibility requirements must be met.

AARP New Mexico Lead Volunteer Luciano Baca told the group that some portions of the ACA will impact Medicare.

“By 2020, the Doughnut Hole will have disappeared. Between now and then it will gradually be reduced,” Baca said.

In the Medicare prescription drug program, people reach the Doughnut Hole once their total drug costs reach $2,970. They are then responsible for their own drug costs. Once their out-of-pocket drug costs reach $4,750 they then only have to pay 5 percent of drug costs for the remainder of the year. Changes to the Doughnut Hole by the ACA will eventually eliminate that coverage gap.

“There will be some changes for those people who have Medicare Advantage plans but there is a guarantee that basic Medicare benefits are protected. Those individuals may have to choose either a Medicare Advantage plan or original Medicare. Plus those plans will be rated on quality of service,” Baca said.

The expectation is that the benefits provided by Medicare Advantage plans won’t be impacted but the amount paid to the companies that provide the plans might be reduced, he said.

The ACA also will help individuals with long-term care:

  • There will be more information available on nursing homes
  • Includes an increase in consumer protections

The ACA is a constantly evolving law as more sections of it are to be implemented and changes continue to be made. For more information on the ACA go to www.healthlawansers.org

(Photo Caption: Maria Naranjo, of Santa Fe, asks a questions about the Affordable Care Act. Also shown is Gene Varela, AARP NM State Director.)

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