Editing Medicare (United States) (section)

===Effects of the Patient Protection and Affordable Care Act===
The Patient Protection and [[Affordable Care Act]] (PPACA) of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. The most substantial provisions slowed the growth rate of payments to hospitals and skilled nursing facilities under Part A of Medicare, through a variety of methods (e.g., percentage cuts, penalties for readmissions).

Congress also attempted to reduce payments to public Part C Medicare health plans by aligning the rules that establish Part C plans' capitated fees more closely with the FFS paid for comparable care to "similar beneficiaries" under Parts A and B of Medicare. Primarily these reductions involved much discretion on the part of CMS. Examples of what CMS did included effectively ending a Part C program Congress had previously initiated to increase the use of Part C in rural areas (the so-called Part C PFFS plan) and reducing over time a program that encouraged employers and unions to create their own Part C plans not available to the general Medicare beneficiary base (so-called Part C EGWP plans) by providing higher reimbursement. These two types of Part C plans had been identified by MedPAC as the programs that most negatively affected parity between the cost of Medicare beneficiaries on Parts A/B/C and the costs of beneficiaries not on Parts A/B/C. These efforts to reach parity have been more than successful. As of 2015, all beneficiaries on A/B/C cost 4% less per person than all beneficiaries not on A/B/C. But whether that is because the cost of the former decreased or the cost of the latter increased is not known.

PPACA also slightly reduced annual increases in payments to physicians and to hospitals that serve a disproportionate share of low-income patients. Along with other minor adjustments, these changes reduced Medicare's projected cost over the next decade by $455 billion.<ref>{{cite report |title=Selected CBO Publications Related to Health Care Legislation, 2009–2010 |publisher=[[Congressional Budget Office]] of the [[United States|United States of America]] |date=December 2010 |url=http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/120xx/doc12033/12-23-selectedhealthcarepublications.pdf |page=20}}</ref>

Additionally, the PPACA created the [[Independent Payment Advisory Board]] (IPAB), which was empowered to submit legislative proposals to reduce the cost of Medicare if the program's per-capita spending grows faster than per-capita GDP plus one percent. The IPAB was never formed and was formally repealed by the Balanced Budget Act of 2018.

The PPACA also made some changes to Medicare enrollees' benefits. By 2020, it "closed" the so-called "donut hole" between Part D plans' initial spend phase coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee's' exposure to the cost of prescription drugs by an average of $2,000 a year.<ref>{{cite web|url=http://www.ratehospitals.com/blog/how-will-the-affordable-care-act-change-medicare/|title=How will the Affordable Care Act Change Medicare?|website=Ratehospitals.com|access-date=January 30, 2014|archive-url=https://web.archive.org/web/20140202095800/http://www.ratehospitals.com/blog/how-will-the-affordable-care-act-change-medicare/ |archive-date=February 2, 2014|url-status=dead}}</ref> That is, the template co-pay in the gap (which legally still exists) will be the same as the template co-pay in the initial spend phase, 25%. This lowered costs for about 5% of the people on Medicare. Limits were also placed on out-of-pocket costs for in-network care for public Part C health plan enrollees.<ref>{{cite web |title=Shining a Light on Health Insurance Rate Increases – Centers for Medicare & Medicaid Services|work=Healthcare.gov |url=http://www.healthcare.gov/news/factsheets/2011/02/medicare02102011a.html |access-date=July 17, 2013}}</ref> Most of these plans had such a limit but ACA formalized the annual out of pocket spend limit. Beneficiaries on traditional Medicare do not get such a limit but can effectively arrange for one through private insurance.

Meanwhile, Medicare Part B and D premiums were restructured in ways that reduced costs for most people while raising contributions from the wealthiest people with Medicare.<ref>{{cite web|url=http://www.kff.org/medicare/upload/8126.pdf|title=Income-Relating Medicare Part B and Part D Premiums: How Many Medicare Beneficiaries Will Be Affected? | publisher=The Henry J. Kaiser Family Foundation|work=Kff.org|date=November 30, 2010 |access-date=July 17, 2013}}</ref> The law also expanded coverage of or eliminated co-pays for some preventive services.<ref>{{cite web |url=http://www.healthcare.gov/law/features/rights/preventive-care/index.html |title=Health care law rights and protections; 10 benefits for you |work=HealthCare.gov |date=March 23, 2010 |access-date=July 17, 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130619173358/http://www.healthcare.gov/law/features/rights/preventive-care/index.html |archive-date=June 19, 2013 }}</ref>

The PPACA instituted a number of measures to control Medicare fraud and abuse, such as longer oversight periods, provider screenings, stronger standards for certain providers, the creation of databases to share data between federal and state agencies, and stiffer penalties for violators. The law also created mechanisms, such as the [[Center for Medicare and Medicaid Innovation]] to fund experiments to identify new payment and delivery models that could conceivably be expanded to reduce the cost of health care while improving quality.<ref name="ReferenceA"/>