Tuesday, September 3, 2013

What Medicare Beneficiaries need to know about the New Health Insurance Marketplaces


What are Health Insurance Marketplaces


Over the next two months consumers will be bombarded with information about Health Insurance Marketplaces (sometimes called “exchanges.”) The marketplaces will be a great place for many consumers to shop for, compare, and purchase health insurance. It’s a new way for individuals, families, and employees of small businesses to get health insurance.

Beginning Oct. 1, consumers will be able to enroll in a private health insurance plan through a marketplace. You can do this by going online at www.HealthCare.gov or by calling 1-800-318-2596, 24 hours a day, 7 days a week. Open enrollment starts October 1, 2013. Plans and prices will be available then. Coverage will not start until at least January 1, 2014.

Each state will have its own separate marketplace. For now, the federal government will run the marketplace in Pennsylvania.

When you use your state’s Health Insurance Marketplace, you will fill out an application and see all of the health plans available in your area. You'll find out if you can get lower costs on your monthly premiums for private health insurance. You'll learn if you qualify for lower out-of-pocket costs.

The Marketplace will also tell you if you qualify for free or low-cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP).

By August the Pennsylvania insurance department had issued preliminarily approval for a group of substantial insurers to participate in the Pennsylvania marketplace. They include:

  • Aetna 
  • Capital BlueCross
  • Blue Cross of Northeastern Pennsylvania
  • Geisinger Health System
  • HealthAmerica PA (subsidiary of Coventry, which was acquired by Aetna in 2013)
  • Highmark
  • Keystone Health Plan and QCC Insurance Company (subsidiaries of Independence Blue Cross)
  • University of Pittsburgh Medical Center
The Marketplaces are designed to make health insurance more attainable and affordable. They will be particularly helpful for people who are currently uninsured and for individuals with low or middle incomes. Nearly 900,000 Pennsylvania residents will be eligible for tax credits to help them pay for coverage purchased through the health insurance marketplace, according to Families USA. 

The marketplaces may be especially welcome for older adults 55-64 who have lost their employer based health insurance but are too young for Medicare.

For more information on how the marketplaces will work see the following government YouTube video: http://www.youtube.com/watch?v=zsqu_Ce8qec&feature=youtu.be


What if I have Medicare?

Should seniors visit the health insurance marketplace to shop for Medicare Coverage? The answer is “No.” If you have Medicare, you already have health insurance coverage. The marketplace is not designed for you.

Medicare is not part of the Health Insurance Marketplace. You don’t need to, and should not go there to shop for Medicare coverage. Medicare insurance will not be available through the marketplaces. 


You will continue to get your Medicare including your choice of Original Medicare or Medicare Advantage, as well as Part D and Medicare Supplement (Medigap) coverage outside of the marketplace. For information on these Medicare programs, visit www.Medicare.gov.

The Marketplace won’t affect your Medicare benefits and will not change them. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll will still have the same benefits and security you have now. You won’t have to make any changes.

Medicare has its own separate open enrollment period during which you can shop for coverage. This is different from the enrollment period for the marketplaces. Medicare’s open enrollment period runs from October 15 – December 7, 2013. During that time you can review your health and prescription drug coverage and make a change to your coverage for next year, if you want to.

When you are considering your Medicare enrollment options, make sure that you are reviewing Medicare Plans and not Marketplace options. If you are satisfied with your current Medicare coverage you don’t need to do anything.

Note: a few high income Medicare beneficiaries – those who are paying special premiums based on their high incomes - might conceivably decide to choose a marketplace plan over Medicare according to an article in Kaiser Health News. I personally think that most high income beneficiaries should be able to easily afford the extra Medicare premiums and are best advised to stick with Medicare. In any event, the vast majority of Medicare beneficiaries should just ignore their state’s health insurance marketplace.


Beware of Scams

The risk of scams is likely to increase during the confusing enrollment periods ahead of us. The United States Department of Health and Human Services gives the following cautionary advice to people with Medicare coverage:

- The Medicare open enrollment period is a time where there’s a higher risk for fraudulent activities.

- It’s against the law for someone who know that you have Medicare to sell you a Marketplace plan

- DO NOT share your Medicare number or other personal information with anyone who knocks on your door or contacts you uninvited to sell you a health plan.

Obamacare Benefits People on Medicare


The health insurance marketplace is an important aspect of Obamacare that will benefit millions of Americans. It’s just not designed for people on Medicare.

But Obamacare is already providing other very important advantages to Medicare beneficiaries. For example, Medicare benefits have already expanded under the health care reform law to include things like free preventive benefits, cancer screenings, and an annual wellness visit. Obamacare is also saving money for seniors who are in the prescription drug “donut hole” with discounts on brand-name prescription drugs.


Further Reading

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

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