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  1. Health

Q&A: Medicare and the marketplace

Published Sep. 28, 2013

Health policy experts and advocates have worried for months that older and disabled Americans who get their insurance through Medicare could get swept up in all the talk about the new Obamacare marketplaces. Though myths about Medicare have featured prominently in the health care debate, the fact is that the marketplaces have virtually no impact on how older and disabled Americans will buy their insurance.

Still, Medicare was at the heart of more reader questions about the marketplaces sent to the Tampa Bay Times than any other topic.

Here's the bottom line: If you are on Medicare, nothing changes for you when the marketplace opens Oct. 1, because it doesn't sell Medicare coverage. You continue to buy insurance as you always have.

Whether you choose original Medicare and supplemental policies, or an all-in-one Medicare Advantage policy, your essential sources of information are still the official Medicare & You handbook and, even better, medicare.gov. The website is updated continually and allows you to search for plans according to your health needs and budget.

Your open enrollment period this year, as usual, is Oct. 15 to Dec. 7. The Times' annual Medicare section will appear Oct. 23.

Here is a sample of the Medicare-related questions our readers are asking:

My wife and I have Medicare. Should I drop my current coverage and seek coverage in the Affordable Care Act marketplace?

Don't drop your Medicare! You might risk financial penalties and coverage gaps. However, if you want to shop for plans that are more affordable or cover your needs more completely, you can do that during your annual open enrollment period. The marketplace does not offer Medicare Advantage, Medicare supplement (Medigap) or Part D (prescription drug) plans. Check out your options at medicare.gov.

We're a retired couple and we spend $776 a month on premiums for Medicare, plus prescription drug, vision and supplemental policies. Can we get lower prices through Obamacare?

The Affordable Care Act is already helping out Medicare beneficiaries with provisions such as closing the dreaded "doughnut hole'' in Part D drug coverage, and also making more preventive services free to patients. But again, the Obamacare marketplaces do not sell Medicare products.

Still, you may be able to find more economical alternatives to your current coverage, such as a Medicare Advantage plan, or a less costly supplemental policy. Depending on your income, you also may qualify for special government programs to help you pay your premiums and co-insurance. Go to medicare.gov and click on the blue tab that says "Your Medicare costs'' to find out more.

If you need more help, contact Serving the Health Insurance Needs of Elders, or SHINE, a free, volunteer-based health insurance counseling program administered by the Florida Department of Elder Affairs, Office of Volunteer and Community Services. The toll-free help line is 1-800-963-5337.

Another good resource is the Medicare Rights Center, a national, nonprofit advocacy group that runs a toll-free help line at 1-800-333-4114 and offers lots of useful resources at its website — medicarerights.org.

Can I use my Obamacare subsidy on my Medicare supplement policy?

No, because people who already are insured under Medicare, Medicaid and most employer-sponsored plans are not eligible for subsidies (actually, tax credits). These are meant to help people of low and moderate income who would otherwise get no help from the government or an employer with insurance costs. Medicare beneficiaries who need help with insurance costs have their own programs (see question above).

Are people 55 to 64 going to be able to buy into Medicare when the ACA goes into effect? I thought I had heard that when they first started putting Obamacare together.

Some people did suggest expanding Medicare, arguably the federal government's most popular program, to cover all Americans. But the Affordable Care Act expands the private insurance market instead. People ages 55 to 64 will purchase private insurance in the marketplace just as younger people will. The eligibility age for Medicare remains 65, unless you qualify for it through disability.

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