Effects of Health Care Reform

When the Affordable Care Act was passed in 2010, Medicare was strengthened. People age 65 and older now have access to many preventive health services with no out-of-pocket costs. The law also gives seniors discounts on drugs when individuals are in the coverage gap known as the “donut hole.” Plus, the law helps protect seniors by taking action on fraud, abuse, and waste.

Preventive Services Under Medicare

If you have Original Medicare, the following services are covered if you get them from a doctor or other health care provider that accepts assignment:

  • Annual wellness exams
  • Tobacco cessation counseling
  • Flu shots and certain immunizations
  • Various screenings, including:
    • Bone mass measurement
    • Certain Colorectal cancer screening
    • Cervical cancer screening
    • Cholesterol and cardiovascular screenings
    • Diabetes screening
    • HIV screening
    • Mammograms
    • Medical nutrition therapy to manage diabetes or kidney disease
    • Prostate cancer screening

You don’t pay for some preventive services, but you may have co-insurance for the office visit when you get the services. It’s also important to know that your first annual wellness exam can’t take place within 12 months of your “Welcome to Medicare” preventive visit.

Important: If you are enrolled in a Medicare Advantage Plan, be sure to check with your plan to see if preventive services are covered at no charge.

Learn more about preventive services.

Prescription Drug Discounts

Health care reform made Medicare prescription drug coverage (Part D) easier to afford. Eligible seniors who are in the “donut hole” coverage gap receive automatic discounts on prescription drugs. This discount began in 2011 and continues into the future. It gradually closes the gap in prescription drug coverage.

You can get these discounts if:

  • You are enrolled in a Medicare Prescription Drug Plan or if you are enrolled in an employer group health plan, a waiver plan, or a Medicare Advantage Plan that includes coverage for prescription drugs.
  • You do not receive support from Extra Help.
  • You have reached the coverage gap.

If you reach the Part D donut hole, you will automatically get a discount on brand-name drugs and generic drugs. Until you reach the “catastrophic coverage phase” in your Part D plan, the discount applies to prescription drugs you buy in pharmacy as well as those you get through the mail. The discount varies each year, so visit the Medicare website for more details.

Learn more about prescription drug discounts.

Protecting Medicare

The U.S. government is cracking down on Medicare payment errors, waste, fraud, and abuse. This action will help slow the cost of Medicare and provide you with savings on future premiums and co-insurance. To see steps you can take, visit the Stop Medicare Fraud website.


Medicare has neither reviewed nor endorsed this information.