For seniors age 65 and older, the open-enrollment period for Medicare runs from Oct. 15 through Dec. 7. With the simultaneous rollout of the Affordable Care Act, there is confusion about who is affected by what and who needs to act. The actions required by seniors 65 and older are different than those actions required by the under-65 crowd.
It is important for seniors to know that Medicare and the Medicare open-enrollment period are NOT part of the new Washington Health Benefit Exchange. The Health Benefit Exchange was rolled out in October as part of the Affordable Care Act (ACA). Except for a few employed seniors with special workplace coverage, it is illegal for an agent to sell a Benefit Exchange health-care plan to someone who is on Medicare and older than 65.
64 and younger: ACA
First, did you know that the ACA and “Obamacare” are one and the same? You might think it odd of me to ask this question, but national surveys indicate a real “disconnect” and a lack of understanding about the transition our health-care system is undergoing.
When the ACA was signed into law on March 23, 2010, the overall goal was to make health care affordable and accessible for all Americans. Only time will tell if this legislation can achieve these lofty goals.
First off, the ACA applies to everyone who is younger than 65. Within the ACA is a mandate that everyone younger than 65 must enroll in a health-insurance plan by March 31, 2014, or pay a penalty. To facilitate this, Washington state has established a “health-insurance marketplace” called the Washington Health Benefit Exchange.
In this government-sponsored marketplace, individuals, families and businesses can shop for and purchase market-rate health insurance. For individuals and families, the Health Benefit Exchange can calculate and tell you if you are eligible for subsidies that would pay a portion your health-insurance premium; subsidies are based on income qualifications. This might be particularly beneficial to people ages 60 through 64, who have been negatively affected by the economy — lost their jobs, are underemployed or are retired.
In addition, Washington state has chosen to extend Medicaid coverage to the poorest of the poor. The net result of this Medicaid expansion: free medical coverage for those who can least afford it.
Since the Health Benefit Exchange is only for residents of Washington state, if you travel or spend considerable time outside of the state, you’ll want to closely examine the coverage and medical benefits available to you when outside the state.
Many providers with whom we are familiar (examples: Premera, Group Health, LifeWise) have medical plans available through the Health Benefit Exchange. If you want to continue to receive care through a particular local provider such as Virginia Mason or Providence, check to see if the plans you are considering allows this.
In our state, the health plan marketplace is accessible online at www.wahealthplanfinder.org. Detailed information on the Health Benefit Exchange is online at www.wahbexchange.org.
Insurance can also be purchased from the Health Benefit Exchange by mail, by phone (1-855-923-4633) or in-person at community workshops with the assistance of state-trained facilitators.
Instead of using the state-sponsored benefit exchange, health insurance can be purchased on the open market directly from insurance companies or from insurance agents. You may choose to go this route if you are not eligible for a premium subsidy through the exchange.
Beware: There are a number of websites with names similar to the state-sponsored health-plan finder or exchange. These websites are private vendors who are trying to corral business through somewhat-deceptive marketing. Premium subsidies and Medicare coverage for low-income individuals and families are only available through the state-sponsored Washington Health Benefit Exchange.
65 and older: Medicare
With everything going on right now, scammers are at work — seniors need to be wary. Phone calls from people categorizing themselves as health-care market representatives may ask for personal information. Do NOT share Social Security numbers or Medicare identification numbers with anyone unknown to you.
If you receive Medicare because of your age (65 or older) or if you assist someone who receives Medicare due to age, remember that the Affordable Care Act (“Obamacare”) and the Washington Health Benefit Exchange are not for people age 65 and older. Therefore, anyone 65 or older should NOT apply for or enroll in the Washington Health Benefit Exchange.
Instead, there are actions that should be taken during the Medicare open-enrollment period ending Dec. 7. This open-enrollment period is the opportunity for people 65 and older to save money and to fine-tune their Medicare coverage. Supplemental insurance can be purchased, or plans can be changed.
Plans and premiums from insurance providers have changed; doctors have changed which Medicare Advantage plans they will accept. Check the premiums, deductibles and copayments; compare expenses from 2013 to what costs will be in 2014.
FYI: Some supplemental insurance providers have plans with $0 premiums.
To get advice that will help you choose the right plan for your situation and your individual needs, I recommend talking to an insurance agent who specializes in Medicare supplemental insurance.
Here is a list of changes that can be made to Medicare during the open-enrollment period:
•Enroll in a Medicare Advantage plan;
•Switch from one Medicare Advantage plan to another Advantage plan;
•Join a Medicare prescription-drug plan (Part D); and
•Switch from a current Medicare prescription-drug plan to another Medicare drug plan.
Before making changes, consult a Medicare insurance expert, but don’t delay. This year’s deadline is approaching quickly.
There are many too many details to the ACA and changes to Medicare to cover them all, but I hope this outline helps. Everyone needs to understand the age separator that determines which health coverage plans apply to them.
MARLA BECK is the founder and president of Andelcare Inc., which provides in-home eldercare. Beck was recognized by the U.S. Small Business Administration as Washington’s 2012 Small Business Person of the Year. Submit questions by calling (206) 838-1844 or via e-mail to firstname.lastname@example.org.