Obamacare and Medicare Advantage: What You Need to Know
Last Updated : 10/31/20194 min read
The Affordable Care Act (ACA), enacted in March 2010, is sometimes nicknamed “Obamacare” for the president who signed it into law, Barack Obama. Obamacare is known for establishing the health insurance marketplace at healthcare.gov. Obamacare is also known for expanding the Medicaid program and preventing most insurance plans from excluding people for pre-existing conditions.
Some parts of this comprehensive health-care reform law affected Medicare Advantage plans. Here’s what you need to know about Obamacare and Medicare Advantage.
Obamacare and Medicare Advantage plans: some things didn’t change
The passage of Obamacare allowed Medicare Advantage to function fundamentally as it had before. Medicare Advantage, also called Part C, is another way to get your Original Medicare (Part A and Part B) benefits through a private insurance company approved by Medicare. Medicare Advantage plans got their name in 2003 with the passage of the Medicare Modernization Act (MMA). Some Medicare beneficiaries choose Medicare Advantage plans because they might offer benefits Original Medicare doesn’t cover, such as routine dental, routine vision, and prescription drug coverage. Most Medicare Advantage plans are HMOs (health maintenance organizations). Some Medicare Advantage plans may advertise $0 plan premiums, but with Medicare Advantage, you must continue to pay your Part B premium (and Part A premium if applicable).
Obamacare and Medicare Advantage plans: healthcare.gov Marketplace
If you want a Medicare Advantage plan, you don’t need to do anything with the Marketplace during Open Enrollment because Medicare Advantage is not part of healthcare.gov.
There are a few ways you can sign up for a Medicare Advantage plan. For example:
- Contact the insurance company directly.
- Enroll through a licensed insurance broker like eHealth. You can enter your zip code on this page to get started.
- Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.
- Visit medicare.gov.
You can enroll in Medicare Advantage during your 7-month Medicare Initial Enrollment Period. This enrollment period:
- Begins three months before you turn 65
- Includes the month of your 65th birthday
- Lasts for three months after your turn 65.
If you qualify for Medicare because of a disability, this Initial Enrollment Period usually:
- Begins the first three months before your 25th month of getting Social Security or Railroad Retirement Board disability benefits
- Includes the 25th month of getting disability benefits
- Ends three months after your 25th month of getting disability benefits.
Learn about the other time periods when you may be able to sign up for a Medicare Advantage plan.
Obamacare and Medicare Advantage plans: a surprising outcome?
Medicare Advantage enrollments have increased, while premiums have decreased. In 2019, 36.7% of Medicare beneficiaries (22.6 million) will be enrolled in Medicare Advantage plans, according to the Centers for Medicare & Medicaid Services (CMS). This is a marked increase since 2009, pre-Obamacare, when Medicare Advantage enrollment was about 23% of Medicare beneficiaries (10.5 million) according to the Kaiser Family Foundation.
Medicare Advantage plans may still be affordable despite Obamacare cuts
According to the Centers for Medicare & Medicaid Services (CMS), the estimated average premium for a Medicare Advantage plan is $28 a month in 2019. In fact, Medicare Advantage premiums have been going down year by year, CMS reports. Combined with the standard Part B premium cost of $135.50 in 2019 (which can vary based on income and other factors), you could be paying about $163.50 a month for a Medicare Advantage plan and your Part B coverage. Some Medicare Advantage plans have premiums as low as $0.
An eHealth study showed that average Medicare Advantage premiums are lower than average Obamacare premiums.
The study included Obamacare plans for people aged 63-64, and Medicare Advantage prescription drug plans sold through eHealth to people aged 65-70. The data was collected in from 2017 to 2018 over a certain period of months.
You need to continue paying your Medicare Part B premium when you’re enrolled in a Medicare Advantage plan.
Would you like to see what Medicare Advantage plans are available where you live? Take a look at plans by clicking the Compare Plans buttons on this page.