Question: I have health insurance through the NY Health Exchange (Marketplace) plan. I will be 65 in September, do I need Medicare? My spouse also has a Marketplace plan, but he is two years younger.
Answer: The Affordable Care Act and Marketplace Exchange have changed the way many of us get our insurance. Let’s answer your questions. There are general rules regarding these Exchange and Medicare plans. The Affordable Care Act (ACA) requires all citizens to have health insurance from some source. Your current policy is a Marketplace Plan. As you age in Medicare, your insurance should transition to a Medicare plan and your Marketplace plan should be canceled.
When you turn 65, health insurance begins on the first of your birthday month, with one exception. When your 65th birthday is September 16, your Medicare coverage will begin on 9-1-22. If your 65th birthday falls on September 1, your Medicare coverage will begin on 8-1-22.
The Initial Enrollment Period (IEP) for Medicare is the three months before the month of your birthday, the month of your birthday, and the three months after. Using the previous September 16 birthday scenario, the previous three months are August, July, and June. This is the time to evaluate insurance options and alternatives and make sure you have Medicare. Since you have a Marketplace plan, you MUST enroll in Medicare A & B.
Initial Medicare enrollment begins at the Social Security Administration (SSA). Once you’ve enrolled in Medicare, you can research and evaluate health insurance plans that are right for you. (Part D drug coverage, supplemental plans, Medicare Advantage plans, etc.). SSA will not assign or assist you with a health plan. To enroll in Medicare, you can use the www.SSA.gov website, call the SSA at 1-877-379-3079 (Jamestown) or 1-800-772-1213 (domestic), or visit the office of the SSA (321 Hazeltine Avenue Jamestown).
Your Marketplace plan should end and you will need to choose a Medicare option. Some of the companies in the Marketplace plan are very proactive and mail you information inviting you to enroll in Medicare. Others don’t do a good job of managing this necessary change. The time also for research options related to health insurance is now. When evaluating your insurance options, make sure you’re looking at Medicare plans, not Marketplace plans.
It might seem like everyone knows your 65th birthday is coming up, with lots of mail from insurance companies of all types. Review the information sent to you by companies that offer plans. They may also have local offices or representatives who will come to or call your home. You have access to the website www.medicare.gov
There are many Medicare health insurance options available. This makes things confusing, but it also means you can find a product that is exactly what you need for your personal situation. You might also be pleasantly surprised by the cost of your insurance options. I think Medicare is very affordable and the insurance products available to you may cost less than what you currently pay AND be more comprehensive than your current Marketplace plan. So don’t worry!
The 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 the original Medicare, add a Medicare Supplement plan and a standalone Part D plan. You can also enroll in Medicare A&B and then upgrade to a Medicare Advantage plan which would include your prescription drug coverage. There are lots of options!
You also asked “What is your spouse going to do? » Your spouse is not yet 65 and therefore not eligible for Medicare. Marketplace plans can continue to be their insurance coverage. You have a different deadline to change insurance because you are 65 years old!
Everyone should have the opportunity to purchase good and useful health insurance. I hope you find these resources helpful.
Senior Life Matters is a community program sponsored by Lutheran Jamestown. For questions or concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email [email protected].
