What does MACRA do to Seniors?

What does MACRA do to Seniors

What does MACRA do to Seniors? Passed in 2015 with bipartisan support, MACRA stands for Medicare Access and CHIP Reauthorization Act of 2015. The CHIP in the full MACRA name stands for the Children’s Health Insurance Program, for which MACRA extends funding.

MACRA was designed to eliminate the fee-for-service system, replacing it with a system that rewards high-value patient care and efficiency. But what does MACRA do to Seniors in everyday life?

what does macra do to seniors fee for service

MACRA  does many things, but most importantly it establishes new ways to pay doctors for caring for Medicare beneficiaries. The law also includes new funding for technical assistance for doctors, funding for development and testing, it enables new programs and requirements for data sharing and establishes new federal advisory groups. It is comprehensive legislation that has the potential to significantly restructure US healthcare.

In the simplest possible terms, MACRA repeals the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B payment rates for doctors and replaces it with new ways of paying for care.

Under MACRA, participating providers will be paid based on the quality and effectiveness of the care they provide. A growing percentage of physician payment will be based on value – not on volume.

What does MACRA do to Seniors?

Through December 31, 2019, anyone who’s on Original Medicare — either A, B, or both — will be able to purchase Medigap Plans F, C, or high-deductible F. These 3 plans pay for the Medicare Part B yearly deductible.

Congress has decided that if people who have Medigap plan F, C or High F are more likely to use medical services because they don’t have to pay anything out of pocket. To stop this from being a further problem they are simply removing this option for newly eligible people.

Due to MACRA, on January 1, 2020, Medicare Supplement plans with Part B deductible coverage (Plans C, F, and high deductible F) cannot be purchased by “newly eligible” Medicare recipients.

The following guaranteed issue plans will be accessible for “newly eligible” Medicare recipients: Plans D, G, and high deductible G (which is brand new!)

What is the meaning of “newly eligible” Medicare recipients?

People who are 65 years of age or become first eligible for Medicare because of age, disability or end-stage renal sickness on or after January 1, 2020, are considered “newly eligible”.  If you already have Medicare part A and B and are reading this in 2019, then you are NOT considered “newly eligible” and the MACRA rules do not apply to you.

How are present enrollees in Plans C, F, and High Deductible F influenced by these changes?

Current enrollees (those qualified for Medicare before January 1, 2020) with Plan C, F, or High Deductible F are able to keep their plan. What’s more, they can keep on purchasing Plans C, F, and High Deductible F after January 1, 2020. Current enrollees will likewise have the capacity to purchase the new Plan High Deductible G on or after January 1, 2020.

What about Guaranteed Issue Medigap?

Medicare Supplement Plans D and G will be two of the guaranteed issue plans for “newly eligible” beneficiaries on or after January 1, 2020. As stated before, current enrollees can stay with their purchased Plans C, F, and High Deductible F. Even after 2020, People who don’t fall inside the category of “newly eligible” will still have the capacity to buy Plans C, F, and High Deductible F for the first time as well. 

When you hear rumors that “plan F is going away” those statements are misleading because Medigap plan F will always be available to current enrollees.

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