How does Medicare work with Obamacare?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 07/05/2018

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Medicare and Obamacare: Is Medicare part of Obamacare?

While the Affordable Care Act (Obamacare) brought some changes to Medicare, it doesn’t replace Medicare.

  • Medicare isn’t part of the federal Health Insurance Marketplace (sometimes called an exchange, the Federally-Facilitated Marketplace, or just the Marketplace).
  • If you have Medicare – whether through Original Medicare (Part A and Part B) or through Medicare Part C (the Medicare Advantage program)—you don’t have to make any changes relating to the Affordable Care Act (ACA).

How are Medicare and Obamacare programs different?

Original Medicare (Part A and Part B) is a federal government health insurance program for those who qualify by age or disability. The Affordable Care Act, also known as Obamacare, is a federal health-care reform legislation with several purposes, including extending health coverage to those who otherwise can’t afford it and requiring that health-care plans meet certain minimum coverage standards.

Can I get health insurance from Medicare and from Obamacare at the same time?

If you are currently enrolled in the Medicare program, you cannot enroll in an Obamacare plan from the Marketplace (called a Qualified Health Plan, or QHP, under Obamacare) to supplement your Medicare coverage. In fact, it’s illegal for an insurance agent or producer who knows you have Medicare to sell you a Marketplace plan. There are some situations when you can enroll in a QHP and drop your Medicare coverage; these are discussed later in this article.

However, if you’re already enrolled in a Marketplace plan when you become eligible for Medicare, you can generally keep your QHP. Be aware that there is no coordination of benefits between the two programs. The Marketplace plan doesn’t have to cover your health-care costs if you’re enrolled in Medicare.

If you get retiree health benefits through a Small Business Health Options Program (SHOP) Marketplace plan, you can generally keep the SHOP plan along with Medicare.

Should I switch from Obamacare to Medicare coverage?

If you become eligible for Medicare (by turning 65, for example) while you have an Obamacare plan, you may want to enroll in Original Medicare (Part A and Part B) and cancel your Marketplace plan when your Medicare coverage begins.  You should notify the insurer who provides your Marketplace plan coverage at least 14 days prior to the start of your Medicare coverage.

It may be to your advantage to switch to Medicare coverage once you qualify.  You’ll lose the advance premium tax credit of the Marketplace plan once you qualify for Medicare Part A.    Also, you might run the risk of a gap in coverage and late enrollment penalties that might increase your Medicare Part A, Part B, and/or Part D (prescription drug coverage) premiums if you decide to change from a Marketplace plan to Medicare coverage later.

Can I opt for Obamacare over Medicare?

Generally, you can’t sign up for Marketplace coverage (under the Affordable Care Act, also known as Obamacare) after you qualify for Medicare. But in some situations, you can choose Marketplace coverage instead of Medicare. For example:

  • You have to pay a premium for Medicare Part A. Many beneficiaries qualify for premium-free Part A – if you’ve worked at least 10 years while paying Medicare taxes, you don’t pay a premium.
  • You’re enrolled in Medicare Part B only, and you’d have to pay a premium for Part A. You can drop Part B and sign up for a Marketplace plan.
  • You have a certain health condition that makes you eligible for Medicare, such as end-stage renal disease (ESRD, which Medicare defines as “permanent kidney failure that requires a regular course of dialysis or a kidney transplant”). You can sign up for a Marketplace plan instead of Medicare if you haven’t yet signed up for Medicare.
  • You’re not receiving Social Security retirement benefits yet and you’re not yet eligible for Medicare. However, please note that you’re typically enrolled in Original Medicare (Part A and Part B) automatically if you’re receiving Social Security benefits when you become eligible for Medicare.
  • You qualify for Medicare because of a disability, but you’re still in the waiting period before Medicare coverage starts.

You can learn more about the Health Insurance Marketplace coverage and Medicare’s rules for coordinating benefits by visiting Medicare.gov.

What if I’m not eligible for Medicare? Can I get Obamacare?

If you’re not eligible for Medicare or employer-based insurance, you can generally get coverage through the Health Insurance Marketplace exchange (the “Marketplace”). If you meet the qualifications based on income and family size, you may be eligible for cost-saving subsidies, too. To learn more about qualifications and cost-saving subsidies, visit Healthcare.gov.

Can I get financial help with my health-care costs?

Your state health insurance department may be able to help you find insurance affordability programs to assist you with some of your medical, prescription and coverage expenses.  During the interview process, a certified application counselor or “navigator” may screen you to see if you qualify for a program such as Medicaid or the Medicare Savings Program.  These programs can help people with low incomes receive health-care services and insurance coverage.

If you’re a Medicare beneficiary who needs help with prescription drug costs, Extra Help is a program that might help you pay for your prescription drug plan premium and coinsurance. You cannot apply for the Extra Help through the Marketplace, however.  In order to apply for Extra Help, you must visit www.ssa.gov/prescriptionhelp or call 1-800-MEDICARE (TTY users should call 1-877-486-2048). Medicare representatives are available 24 hours a day, seven days a week. If you qualify, you may be able to enroll in a stand-alone Medicare Part D Prescription Drug Plan outside of one of the ordinary Medicare election periods.

Can I go to the Health Insurance Marketplace to get a plan to supplement my Medicare coverage?

No. The Health Insurance Marketplace does not offer Medicare Supplement insurance plans (also called Medigap plans), which are sold by private insurance companies. The Marketplace also does not sell any other Medicare coverage offered by private insurance companies approved by Medicare, such as Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans.

NOTE: As of the writing of this article, there are various proposals for Congress to repeal or replace Obamacare, so the situation may change.

If you want to learn more about your Medicare coverage and options, feel free to let me help you.

  • You can use one of the links below to request personalized information from me by email.
  • You can also do some research on your own to get familiar with Medicare plan options in your area by clicking on the “Compare Plans” button on this page.

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