Medicare and Reform: Fifty States of Confusion

Sep 18, 2013

Seniors have significant misconceptions about healthcare reform and Medicare, which could lead them to make poor Medicare enrollment and health decisions.

Download findings from our study.

  • Medicare
  • Caregivers
  • Seniors

The infinite stream of news and opinions about the Affordable Care Act (ACA) has left many Americans overwhelmed and misinformed about healthcare reform and what it means for them. Many studies and surveys have documented this confusion among younger, uninsured Americans who will be eligible to enroll through Public Health Insurance Exchanges this fall, but none have focused on the over 65 population.

As we prepare for Medicare open enrollment, we sought to learn more about our nation’s seniors and what they know about the ACA. In August 2013, Express Scripts commissioned research consultant Kelton to poll 1,101 Americans ages 65 and older who are enrolled in a Medicare plan or are eligible to do so within the next 12 months.

As reported in USA Today, we discovered that seniors have significant misconceptions about reform and Medicare, and their fears about the affordability of healthcare could lead them to make poor Medicare enrollment and health decisions.

Medicare for All?

Many have referred to the ACA as “Medicare for all,” which may explain why 1 in 5 seniors erroneously think they are eligible to enroll in a health insurance exchange this fall, and another 17% believe health insurance exchanges could replace Medicare completely.

Another 29% think ACA increases the Medicare eligibility age, with 68 being the average age cited. And 65% are not aware that Medicare enrollment begins in October.

Results from seniors on new healthcare reforms

These misconceptions could lead seniors to spend time researching or attempting to enroll in a benefit they are not eligible for and potentially miss the open enrollment period for Medicare. If a senior misses the Medicare enrollment deadline and is not currently enrolled in a Medicare plan or healthcare coverage from another provider, he cannot enroll again until fall of 2014. Unless qualified for a special election period, there is the potential for a senior to go an entire year without any health coverage and pay a monthly penalty for late enrollment.

Financial Fears = Poor Decisions

The survey findings also show that seniors are concerned about the impact of the ACA on their ability to afford healthcare costs.

Nearly half of seniors are making changes to ensure they can afford their healthcare costs.

Infographic showing survey results from seniors

So, How Does the ACA Impact Medicare?

The ACA makes two important changes to Medicare:

  1. Closes the Coverage Gap: The Coverage Gap — also known as the donut-hole — is the portion of a Part D plan where beneficiaries pay a higher portion of their medication costs until they reach a certain dollar amount, known as an out-of-pocket maximum. Since 2010, with the help of pharmaceutical manufacturers, CMS has lowered the copayment amounts on brands and generics. Since this change began in 2010, beneficiaries have saved $1,000, on average. By 2020, the Coverage Gap will go away completely. Surprisingly, 77% do not know that the Coverage Gap is in the process of closing due to reform and are unaware of the current savings.
  2. Provides Preventive Screenings: Many preventive screenings are now fully covered by Medicare Part B, including: bone mass measurements, diabetes screenings and cancer screenings, such as mammograms and prostate exams. Also, Medicare Part B now fully covers common vaccinations such as flu, hepatitis B and pneumonia. Medicare Part D will cover vaccines necessary to prevent illness, such as meningitis and pertussis, which are not available under Part A or B.

A Roadmap for Medicare and Reform

Less than half (46%) of respondents feel knowledgeable about reform, but nearly all (89%) said they need access to more information about how healthcare reform will affect Medicare.

Express Scripts is offering a free eGuide, “Navigating Medicare and Reform: A Roadmap for Seniors and Caregivers,” available at Here seniors and caregivers can learn more about the ACA, its impact on Medicare and how they can choose a Medicare Part D benefit that's right for them.

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