The overlap in enrollment for both Medicare and Obamacare seems to be causing some confusion, insurance officials say.
Ray Walker, who works at the Oklahoma Insurance Department, said his office has received calls from residents who aren't sure whether they should enroll in Medicare or the private insurance plans available through the federal government's health insurance marketplace.
The confusion is likely because of the similar enrollment dates for the two programs. On Oct. 1, Oklahomans could begin enrolling in the federal insurance marketplace, which was created under the Affordable Care Act, also known as Obamacare. Meanwhile, open enrollment for Medicare began Oct. 15.
Walker, the Insurance Department's divisional director for the Medicare Assistance Program, answered a few questions to clarify what Oklahomans 65 and older need to keep in mind while enrolling and updating Medicare coverage.
Q: Should Medicare beneficiaries enroll in a plan through the marketplace?
A: Generally, no.
Walker said as long as Medicare-eligible residents have Medicare, they don't have to sign up for any coverage through the marketplace.
“However, they still need to do what we ask them to do every year, and that is — review their current coverage, particularly their Part D prescription drug plan to make sure that plan is still the best plan for them in the coming year,” Walker said.
And if someone is eligible for Medicare, they automatically do not qualify for any of the tax incentives that are available through the marketplace, Walker said. These tax incentives, also called subsidies, are available for some residents and families that have household incomes between 100 percent and 400 percent of the federal poverty level.
Q: Are there any exceptions of people who are older than 65 who might sign up for the marketplace?
A: The exception is people who are 65 and older but haven't worked long enough to qualify for Part A without paying a premium. Part A covers hospital care, skilled nursing facility care, home health and other services.
“Most people, if they've worked 10 years in the system, paying Federal Insurance Contributions Act taxes, they get Part A at no cost per month,” Walker said. “If a person, however, has worked less than 10 years, or 40 quarters, they actually have to pay for their Part A. Those people qualify to get a plan through the marketplace. But most people get their Part A premium free and therefore would not qualify.”
Q: What questions have you received about confusion over Medicare enrollment?
A: One question that Walker has received relates to pre-existing conditions.
Under the Affordable Care Act, a person cannot be denied coverage based on a pre-existing condition when they sign up for a private insurance plan through the health insurance marketplace.
However, this isn't the case for supplemental Medicare plans. Medicare supplement insurance, or Medigap, is sold by private insurance companies and covers some of the health care costs that original Medicare doesn't cover, like co-payments, coinsurance and deductibles, according to Medicare.gov.
“Supplemental policies are not considered health insurance,” Walker said. “They're considered supplemental policies, and therefore they can still have a pre-existing condition clause.”
Q: What are you advising people who are on disability?
A: A person who is on disability has to be on a disability for 24 months before qualifying for Medicare.
Walker said while people are waiting to qualify for disability, they could enroll in a private insurance plan through the federal marketplace.
“We're telling those folks if you don't qualify for Medicare yet, go ahead and sign up for something on the marketplace,” Walker said. “But be aware — when you turn 65 and you are eligible for Medicare, those tax incentives will go away, and therefore you need to be prepared to get enrolled in Medicare and whatever products offered through the Medicare system to assist them.”
Q: What are some scams to watch out for?
A: Walker said this year, some Oklahomans have received calls from people claiming to offer them a “new” Medicare card.
The caller will ask the Medicare beneficiary for their Medicare number, telling them they need it because Medicare is switching out its paper cards for plastic cards.
“What we would try to stress to individuals is — why would Medicare call you and ask your Medicare number? They've got it,” Walker said. “ ... In the hands of the right person, your Medicare number is as good as any credit card.”
Anyone enrolling in Medicare who has questions can contact the Oklahoma Insurance Department at (800) 763-2828 or visit http://www.ok.gov/oid/.