Friday, November 1, 2013

Medicare is not part of the Health Insurance Marketplace!

Your Medicare insurance is separate from the federal Health Insurance Marketplace. The Marketplace was designed to help people who do not have any health coverage and it does not have any effect on your Medicare coverage. Susan Samson, from the Area Agency on Aging of Pasco-Pinellas, has shared the following information to help you determine whether the Medicare open enrollment or Marketplace open enrollment is for you:

You are employed and already have Medicare but do not have coverage through your or your spouse’s current employment. You should not make any changes to how you currently get your insurance. This means you should not enroll in a Qualified Health Plan (QHP) for individual health coverage through the Marketplace, because you already have Medicare. Although you would be allowed to join a QHP, it would not make financial sense to do so. The premiums for QHP coverage will likely be higher than for Medicare (including what you pay for drug benefits and supplemental coverage). Also, people who qualify for Medicare cannot receive any financial help to pay QHP premiums.

You already have Medicare Part B and coverage from your or your spouse’s current employment. The way coverage from a current employer works with Medicare should be the same, whether or not the employer offers coverage through a Small Business Health Options (SHOP) plan in the Marketplace. A SHOP plan is an employer plan purchased through the Marketplace. Depending on the size of your employer, Medicare either pays first or second on health insurance claims. If Medicare pays first, it is especially important that you keep Medicare. If you drop your Medicare coverage when Medicare is paying first, your employer plan may give you little or no coverage at all.

While there is much more to know and understand about Medicare and the Annual Election Period, you can breathe easy knowing there is always someone available to help through the Florida Department of Elder Affairs’ SHINE (Serving Health Insurance Needs of Elders) Program. To make an appointment with a SHINE counselor, just call Florida’s Elder Helpline toll-free at 1-800-96-ELDER (1-800-963-5337). There is also help to get more information and assistance with the Health Insurance Marketplace. Call the Health Insurance Marketplace call center at 1-800-318-2596. 

Note that the Health Insurance Marketplace open enrollment period (October 1, 2013–March 31, 2014) overlaps the Medicare open enrollment period (October 15–December 7, 2013). However, Medicare’s open enrollment is not part of the Marketplace.

The Medicare Annual Election Period (AEP), also called open enrollment, is the time when Medicare beneficiaries are encouraged to review their current health and prescription drug coverage, including any changes in costs, coverage, and benefits that will take effect next year. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything. If you want to change your coverage for next year, this is the time to do it. But, make sure that you’re reviewing Medicare plans and not Marketplace options.

A volunteer SHINE counselor can help you to review your coverage, compare options, and enroll—in person, by phone, or at a public event in your community. To find out more about the enrollment process or to get free help, call Florida’s Elder Helpline toll-free at 1-800-96-ELDER (1-800-963-5337). For a list of SHINE community events in your area, please visit the SHINE website at

Medicare, and its authorized agents like the SHINE Program, is a trusted source for information during this critical time. However, there are some organizations and individuals who should not be granted access to your personal information. The Medicare open enrollment period is a time when there is a higher risk for fraudulent activities. Adding to this risk is the overlap of the two different enrollment periods. It is important for Medicare beneficiaries to know that it is against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

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