How the Affordable Care Act May Affect Medicare and Medicaid Benefits

elderly man and younger man discussing healthcare policy and costs

The federal electronic medical records (EMR) mandate will affect every healthcare facility that participates in Medicare and Medicaid re-imbursements. As a result, over 58 million patients will also be affected in one way or another. Understanding more about the upcoming changes can help patients and their families plan ahead. Better understanding the pertinent topics may also help patients and their families clarify questions to ask their healthcare providers before the changes go into full effect in January 2014.

The Big Picture More Accurate and Accessible Records:

Overall, the adaptation of electronic medical record keeping will bring about positive results when it comes to using the information to promote better patient care. These benefits include:

  • More accurate and complete information

Electronic health records will give providers the precise information they need, in real-time, to provide the best possible patient care. In emergency situations this can save lives by providing complete access to current medications and conditions, any possible drug allergies or other complicating issues.

  • Better access to information

Electronic health records will be able to be viewed by all providers and other pertinent professionals such as a pharmacist who can prevent problems caused by an incomplete record of medications the patient currently takes. Information will always be current, which should contribute to much more efficient coordination of care.

  • Patient empowerment

Electronic health records can help patients and their families play a more active role in healthcare. Patients will be able to receive electronic copies of medical records which they may be securely shared over the Internet with their families and other health professionals of their choosing, such as nutritionists or other specialists.

The Implications for Coverage:


The Affordable Care Act requires all states to maintain the same Medicaid eligibility levels, policies, and procedures that existed prior to the enactment of the Affordable Care Act (March 2010) through the transition to the new policies. Other Medicaid guidelines affected by the Affordable Care Act:

  • States have the ability to expand their Medicaid programs to cover nearly all individuals under the age of 65 with incomes below 133 percent of the federal poverty level.
  • For those over 65, eligibility will remain unchanged.
  • For newly eligible participants through this expansion, the federal government will cover 100 percent of costs for 2014 through 2016; coverage falls to 90 percent in 2020. The federal contribution will remain at 90 percent after that.
  • States have the option to implement this expansion sooner.


The main adjustments in Medicare will involve operational and administrative changes that should improve the efficiency and effectiveness of the entire system. The shift in Medicare guidelines as a result of the Affordable Care Act that may directly impact patients include:

  • Closing of the “donut hole” (coverage gap) by 2020 .
  • Annual wellness exam will be no cost to patient.
  • 50% discount on brand-name drugs in the donut hole in 2011.
  • No copayment for certain preventive services.

At the state level, there will be a variety of services patients can explore to assist them in covering gaps in costs. Income guidelines and citizenship requirements will have to be documented to receive assistance. Every state will have designated information specialists available to answer questions through local health departments.

The federal mandate for electronic medical records will affect providers and their patients in a variety of ways. Individual states will play a direct role in the effectiveness of the changes. Patients and their families will gain better access to medical records which can help empower individuals to take a greater role in personal healthcare and informed decision-making. Local healthcare providers and information specialists at local health departments can assist with individual questions regarding healthcare changes as a result of the upcoming federal mandate.

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