Q: I have health insurance through the NY Health Exchange (Marketplace) plan. I’m turning 65 in September, do I need Medicare? My husband also has a Marketplace plan but is two years younger.
Answer: The Affordable Care Act and the Marketplace Exchange have changed the way many of us get our insurance. Let’s answer your questions. There are some general rules about these exchange plans and Medicare. The Affordable Care Act (ACA) requires all citizens to have health insurance from some source. Your current policy is a market plan. As you age in Medicare, your insurance must switch to a Medicare plan and your Marketplace plan must be canceled.
When you turn 65, Medicare begins on the first of the month of your birthday, with one exception. When your 65th birthday is on September 16, your Medicare coverage will begin on 01/22/09. If your 65th birthday is on September 1st, your Medicare coverage will begin on August 22nd.
The initial enrollment period (IEP) for Medicare is the three months before your birthday, the month of your birthday, and the three months after. Using the previous September 16 birthday scenario, the three months before that are August, July, and June. This is the time to evaluate insurance options and alternatives and make sure you’re signed up for Medicare. Because you have a Marketplace plan, you MUST sign up for Medicare A & B.
Initial enrollment for Medicare begins with the Social Security Administration (SSA). Once you sign up for Medicare, you can research and evaluate health insurance plans that work for you. (Part D drug coverage, supplemental plans, Medicare Advantage plans, etc.). The SSA will not assign or help you with a health plan. To sign up for Medicare, you can use the website www.SSA.gov, call SSA at 1-877-379-3079 (Jamestown) or 1-800-772-1213 (national), or go to an office at SSA (321 Hazeltine Ave. Jamestown).
Your Marketplace plan must stop and you will have to choose a Medicare option. Some of the Marketplace plan companies are very proactive and send you information in the mail prompting you to sign up for Medicare. Others do not cope well with this necessary change. It’s also time to explore your Medicare options. When evaluating your insurance options, make sure you’re looking at Medicare plans, not Marketplace plans.
It can seem like everyone knows your 65th birthday is coming up, with lots of mail from insurance companies of all kinds. Review information sent to you by companies that offer plans. They may also have local offices or representatives who will come or make house calls. You can access www.medicare.gov
There are many Medicare health insurance options available. This makes it confusing, but it also means you can find a product that is exactly what you need for your individual situation. You may also be pleasantly surprised by the cost of your insurance options. I believe Medicare is very affordable and the insurance products offered may cost less than what you are currently paying AND be more comprehensive than your current marketplace plan. So don’t worry!
Original Medicare consists of Parts A and B. You will also need to add a Part D plan (prescription drug coverage). You can stay with Original Medicare, add a Medicare Supplement plan and a stand-alone Part D plan. You can also enroll in Medicare A & B and then choose a Medicare Advantage plan that will include your prescription drug coverage . There are many options!
You asked too “What will your husband do?” Your spouse is not yet 65 and therefore not eligible for Medicare. Marketplace plans may continue to be their insurance coverage. You have a different time frame to switch insurance because you are turning 65!
Everyone should be able to purchase good and useful health insurance. I hope you find these resources helpful.
Senior Life Matters is a community-based program sponsored by Lutheran Jamestown. For questions and concerns or to contact Janelle Sluga, GCMC, call 716-720-9797 or email [email protected]