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Affordable Care Act prevention benefits increasing access, lowering costs for people with Medicare


More than 150,000 people with Medicare part B already received annual wellness visits; Expanded coverage of preventive services will lower premiums, cost sharing

Today, the Department of Health and Human Services (HHS) released a new report showing that in less than two months, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This is a preventive benefit now covered by Medicare free of charge when obtained by a participating health care professional, thanks to the Affordable Care Act, along with many other recommended preventive services. The report also shows that this enhanced preventive benefits coverage will lower costs, including lowering Medigap premiums for employers, states and people with Medicare. Many more people with Medicare are expected to receive annual wellness visits and other recommended preventive services thanks to the Affordable Care Act.

“The Affordable Care Act is bringing new preventive benefits and savings to millions of Medicare beneficiaries this year,” said Secretary Sebelius. “Seniors and others with Medicare are already taking advantage of these important preventive services and wellness visits, which can help lower costs, prevent illness, and save lives.”

The report released today shows that, thanks to the Affordable Care Act, an average of 2,800 people with Medicare have received an annual wellness visit per day between January 1 and February 23, 2011. Because Congress has eliminated the part B coinsurance and deductibles for the annual wellness visit and many other preventive services, the report says that the use of these services should increase.

This will make a big difference for people with Medicare who, like most Americans, tend to use preventive services at roughly half the recommended rate. For example, only 43 percent of women with Medicare received a mammogram in 2008. The Affordable Care Act encourages beneficiaries to use more preventive services by waiving the usual coinsurance and deductible requirements for services recommended by the United States Preventative Services Task Force (USPSTF) as well as for an annual wellness visit. If those recommended services are obtained from qualified and participating health care providers, there are no out of pocket costs. For example, cancer screenings such as mammograms and colonoscopies as well as tobacco cessation counseling may now be obtained free of charge. To learn more about the new Medicare benefits in 2011, visit

In addition to improving the use of preventive services and creating additional savings for beneficiaries, Medicare’s enhanced prevention benefits will lead to lower premiums for employers who now fill this gap in coverage. The same is true with states that fill-in Medicare’s benefit gaps and cost sharing for low-income seniors through Medicaid. Lastly, many seniors buy Medigap insurance to cover Medicare’s cost sharing. With Medicare now paying for annual wellness visits and the part B cost sharing for many preventive services, Medigap premiums should be lower.

This is just one of the many ways the Affordable Care Act is helping improve the Medicare program. The law helps Medicare beneficiaries directly by taking on the rising cost of prescription drugs and providing important relief for beneficiaries who fall into the coverage gap – also known as the “donut hole.” In addition, Medicare’s use of the new tools provided by the Affordable Care Act and better management of the program have stabilized premiums for Medicare’s coverage of prescription drugs (Part D) and increased the number of prescription drug plans that voluntarily help fill the donut hole. Along with other efforts to improve care for people with Medicare, the Affordable Care Act will generate billions of dollars in savings for Medicare, extend the life of the Medicare Trust Fund by 12 years, and help cut costs for seniors and keep them healthy.

To read the report, visit


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