Have you enrolled in a Medicare plan? The clock is ticking. And, we found out from Susan Samson from the SHINE Program Area Agency on Aging of Pasco-Pinellas, people continue to be confused between Medicare and the Affordable Care Act Marketplace (Obamacare).
She wrote this letter to us, worth sharing since the Dec. 7 deadline for enrolling in Medicare is a little more than a week away. Read carefully, as she offers useful tips on how to navigate enrollment.
The federal Health Insurance Marketplace that starts in 2014 is designed to help people who do not have any health coverage. If you have health coverage through Medicare, the Marketplace will not have any effect on your Medicare coverage. Here are a few examples to help you determine whether the Medicare open enrollment or Marketplace open enrollment is for you.
You are employed and already have Medicare but do not have coverage through your or your spouse's current employment. You should not make any changes to how you currently get your insurance. This means you should not enroll in a Qualified Health Plan (QHP) for individual health coverage through the Marketplace, because you already have Medicare. Although you would be allowed to join a QHP, it would not make financial sense to do so. The premiums for QHP coverage will likely be higher than for Medicare (including what you pay for drug benefits and supplemental coverage). Also, people who qualify for Medicare cannot receive any financial help to pay QHP premiums.
You already have Medicare Part B and coverage from your or your spouse's current employment. The way coverage from a current employer works with Medicare should be the same, whether or not the employer offers coverage through a Small Business Health Options (SHOP) plan in the Marketplace. A SHOP plan is an employer plan purchased through the Marketplace. Depending on the size of your employer, Medicare either pays first or second on health insurance claims. If Medicare pays first, it is especially important that you keep Medicare. If you drop your Medicare coverage when Medicare is paying first, your employer plan may give you little or no coverage at all.
Help is available
While there is much more to know and understand about Medicare and the Annual Election Period, you can breathe easy knowing there is always someone available to help through the Florida Department of Elder Affairs' SHINE (Serving Health Insurance Needs of Elders) Program. To make an appointment with a SHINE counselor, just call Florida's Elder Helpline toll-free at 1-800-963-5337.
Information and assistance on the Health Insurance Marketplace are available at the call center toll-free at 1-800-318-2596.
Note that the Health Insurance Marketplace open enrollment period (Oct. 1, 2013-March 31, 2014) overlaps the Medicare open enrollment period (Oct. 15-Dec. 7, 2013). However, Medicare's open enrollment is not part of the Marketplace.
Medicare, not Marketplace
The Medicare Annual Election Period (AEP), also called open enrollment, is the time when Medicare beneficiaries 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're satisfied that your current coverage will continue to meet your needs for next year, you don't need to do anything. If you want to change your coverage for next year, this is the time to do it. But, make sure that you're reviewing Medicare plans and not Marketplace options.
During this critical time, there are some organizations and individuals who should not be granted access to your personal information. The Medicare open enrollment period is a time when there is a higher risk for fraudulent activities. Adding to this risk is the overlap of the two different enrollment periods. It is important for Medicare beneficiaries to know that it is against the law for someone who knows that you have Medicare to sell you a Marketplace plan.
Stopping fraud requires cooperation from everybody: the federal government, state governments, health care providers, insurers, law enforcement and citizens like you. A few simple things can protect you from fraud:
• Ask questions and verify the answers you get.
• Write down and keep a record of a salesperson's name or anyone who may assist you, who he or she works for, phone number, street address, mailing address, email address and website.
• Double-check any information that is confusing or sounds suspicious.
• Don't sign anything you don't fully understand.
• If you suspect fraud, report it. Florida's Senior Medicare Patrol Program operates a toll-free fraud hotline, 1-866-357-6677, for the public to ask questions and report suspected fraudulent activity related to health care.