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Medicare or Obamacare? It's a confusing issue for some in Oklahoma

Ray Walker, with the Oklahoma Insurance Department, answers questions about the differences in the Affordable Care Act and Medicare.
by Jaclyn Cosgrove Modified: October 30, 2013 at 10:00 am •  Published: October 29, 2013

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.”

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by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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