Health Insurance Exchanges Begin October 1: What Do People on Medicare Need to Do?

The short answer is: nothing.

To recap: the Patient Protection and Affordable Care Act (known as “ACA,” “the health care reform law,” or “Obamacare”), enacted into law in 2010, effects major changes in how health care in the United States will be delivered and paid for.

Beginning January 1, 2014, health insurance companies are prohibited from declining to extend coverage to persons who have pre-existing conditions. Essentially, this means that no one who seeks health insurance can be denied health insurance due to health reasons.

This also means that no one without health insurance can simply wait until he or she is sick before purchasing coverage. This is sometimes referred to as the “individual mandate” to have health insurance.

Put another way, starting January 1, 2014, health insurance companies are required to sell; and individuals are required to buy or pay a “penalty.”

Recently, the Obama Administration announced that businesses were given an extra year, or until 2015, to extend health insurance coverage to their employees. This extension does not affect the individual mandate to obtain insurance, however.
Individuals without health insurance can shop for a policy on their state’s Health Insurance Marketplace (formerly called an “exchange,” the government is calling now them a “marketplace”). The Health Insurance Marketplace Open Enrollment period runs from October 1, 2013, to March 31, 2014. Provisions in the Affordable Care Act provide financial support for people who need help paying for health insurance. More information about the health care law and Marketplaces can be found at HealthCare.gov.

Who Is Not Affected by the “Individual Mandate”
People who already have health insurance are unlikely to have been affected or will be affected by the Affordable Care Act. One such group of people – a large group of approximately 50 million Americans – are those who are on Medicare.

Last week the U.S. Centers for Medicare & Medicaid Services (CMS) issued a FAQ about Medicare and the Marketplace and the potential for confusion between the two.

In the FAQ document, CMS asserts unequivocally: “The Marketplace won’t have any effect on your Medicare coverage.”

Medicare Open Enrollment begins October 15 and ends December 7, 2013. During this time, people with Medicare should review their current health and prescription drug coverage, including any changes in costs, coverage and benefits that will take effect next year. People on Medicare who are satisfied with their current coverage don’t need to do anything.

People on Medicare who want to change coverage for next year must do it at this time, or they will have to wait until next year’s Open Enrollment period. For more information on Medicare Open Enrollment, visit Medicare.gov or call 1-800-MEDICARE.

Medicare-Marketplace FAQ
To view the CMS FAQ (a PDF document), click on this link:
http://www.cms.gov/Center/Special-Topic/Open-Enrollment/Downloads/Medicare-Marketplace-FAQs.pdf

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