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Kevin Ramos
December 28, 2022

How does the ACA impact Medicaid & Medicare?

The Affordable Care Act, also known as Obamacare, has had a significant impact on Medicaid and Medicare, two major healthcare programs in the United States. Understanding these impacts is important for anyone who is enrolled in or considering enrolling in these programs.

Medicaid is a government-funded healthcare program that provides coverage to low-income individuals and families, including children, pregnant women, elderly adults, and people with disabilities. The Affordable Care Act expanded Medicaid to cover more people, particularly those with incomes below 138% of the federal poverty level.

Prior to the Affordable Care Act, Medicaid eligibility was determined by each state individually, and many states had strict eligibility requirements that excluded many low-income individuals and families. Under the Affordable Care Act, states were given the option to expand Medicaid to cover more people, and many states chose to do so. As a result, millions of additional people have gained Medicaid coverage since the Affordable Care Act was implemented.

The Affordable Care Act also made significant changes to the way Medicaid is funded and administered. Under the ACA, the federal government provides financial assistance to states to help cover the cost of Medicaid expansion. This has helped to make Medicaid more financially sustainable for states, and it has also helped to reduce the burden on state budgets.

In addition to expanding Medicaid, the Affordable Care Act also made changes to the Medicare program, which is a healthcare program for seniors and certain disabled individuals. The ACA implemented several measures to improve the quality of care and lower costs for Medicare beneficiaries, including:

Closing the "doughnut hole," a gap in Medicare Part D coverage that required beneficiaries to pay a significant portion of their prescription drug costs out-of-pocket. The ACA gradually closed the doughnut hole, reducing out-of-pocket costs for prescription drugs.

Implementing value-based payment models, which incentivize healthcare providers to deliver high-quality care at a lower cost. These payment models have helped to reduce the growth of Medicare spending and improve the quality of care for beneficiaries.

Creating the Center for Medicare and Medicaid Innovation, which is responsible for testing and implementing new payment and service delivery models that can improve the efficiency and effectiveness of the Medicare and Medicaid programs.

Overall, the Affordable Care Act has had a significant impact on Medicaid and Medicare, expanding access to healthcare for millions of Americans and improving the quality of care for beneficiaries. If you are enrolled in or considering enrolling in these programs, it is important to understand how the ACA has affected them and how they may benefit from these changes.

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