The Health Insurance Marketplace: What People with Medicare Need to Know
Medicare, the federal health insurance program for people age 65 and older, people with End Stage Renal Disease, and younger adults with disabilities, is an important source of coverage for many people living with HIV. Over the past four weeks there has been great interest in the opening of the Affordable Care Act’s Health Insurance Marketplace. As a result, some people with Medicare may have questions about how all of this affects them. Also, because the Medicare open enrollment period is overlapping with the beginning of the Health Insurance Marketplace enrollment period, many people with Medicare have questions about what they need to do to ensure their health coverage continues. (The Medicare open enrollment period runs October 15-December 7, 2013 while the Health Insurance Marketplace launched on October 1, 2013 and its open enrollment period runs through March 31, 2014). We at HIV.gov wanted to share the following information with our readers who may have questions.
Your Medicare Coverage is Protected
Medicare isn’t part of the Health Insurance Marketplace established by Affordable Care Act (sometimes called “Obamacare”), so you don't have to replace your Medicare coverage with Marketplace coverage. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.
In addition, if you have Medicare, you’re considered covered for the purpose of satisfying the health care law’s individual mandate that everyone must have health coverage.
If I’m on Medicare, What Do I Need to Do on Healthcare.gov?
In short: nothing. Medicare isn’t part of the Health Insurance Marketplace, so you don’t need to do anything in the new online Marketplace. In fact, you can’t purchase a plan in the new Individual Marketplace since it is illegal to sell Individual Marketplace coverage to Medicare beneficiaries. The Marketplace is designed to help people who don’t have any health coverage. If you have health coverage through Medicare, you’re considered covered and don’t need to replace your Medicare with coverage from the Marketplace. The Marketplace won’t have any effect on your Medicare coverage.
Note: The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies or Part D drug plans. For information on these programs, visit Medicare.gov.
To learn more, read this fact sheet, “Medicare and the Health Insurance Marketplace” .
How Does the Affordable Care Act Benefit People with Medicare?
Even though Americans with Medicare coverage won’t need to shop for coverage in the new Health Insurance Marketplace, the Affordable Care Act offers many advantages to people with Medicare. For example:
- Get more preventive care, for less: Medicare benefits have expanded under the Affordable Care Act. Medicare covers preventive services like cancer or HIV screenings for free, without charging you for the Part B coinsurance or deductible. You also can get a free yearly "Wellness" visit.
- Cheaper prescription drugs: Medicare beneficiaries can also save money if they’re in the prescription drug “donut hole,” with a discount on covered brand-name prescription drugs that’s applied automatically right at your pharmacy’s counter—so you don’t have to do anything to get it. You can also expect additional savings on generics and brand-name drugs in the years to come until the donut hole closes completely in 2020.
- Fighting Medicare fraud: The Affordable Care Act is helping the Obama Administration crack down on Medicare fraud and make Medicare even stronger. (If you are aware of any potential Medicare fraud, please contact the HHS Office of Inspector General at: 800-447-8477 or visit https://www.justice.gov/archives/opa/blog/stop-medicare-fraud.)
What More Do People with Medicare Need to Know?
Keep these important dates, web address, and numbers in mind:
- Medicare’s open enrollment period (October 15-December 7, 2013) is underway. This is your chance to review your current coverage and see if you need to make any changes, or if you’re happy sticking with the plan you have. All people with Medicare are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage, and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything.
- To learn more about Medicare coverage and choices, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.