Clearing Up Medicare Confusion In New Insurance World

Q: I have a health insurance policy through The Marketplace, a Health Exchange plan. It covers myself and my spouse. I am turning 65 soon, so what should I do with Medicare?

A: The Affordable Care Act and the Marketplace Exchange have changed the way many of us get our insurance. The confusion regarding insurance choices and types is everywhere. What are Medicare plans? What are Marketplace plans? What type do I have? Can I keep this? What will my spouse do? Each situation is different but there are some general rules about these plans and Medicare. I will address this question as best I can. The Affordable Care Act makes many changes to the health insurance industry and Marketplace. The ACA requires all citizens to have health insurance from some source. You do have insurance now, but your policy is tied to your spouse. As you age into Medicare your insurance will switch to a Medicare plan and your spouse can get insurance for just themselves through the Marketplace Exchange.

That is the short answer, here is a longer explanation.

You said you are turning 65 soon. Medicare almost always begins the first of your birthday month. An exception could be that you turn 65 on the first of the month, so your coverage will begin the month before. So if your 65th birthday is on Sept. 16, your Medicare coverage will begin Sept. 1, 2014. If your 65th birthday is on Sept. 1, your Medicare coverage will begin Aug. 1, 2014.

The time to evaluate your options is now; the three months before your birthday month. So using the previous September birthday scenario, that would be August, July and June. This is the time to be sure you have signed up for Medicare, and are evaluating insurance options and alternatives. There are lots of options with Medicare, and there are also people who don’t need to sign up for Medicare A & B because of their situation.

The process to sign up for Medicare begins at the Social Security Administration. SSA handles the signing up process for Medicare, but then you research and evaluate plans using other sources. SSA does not handle all those other options, so can’t answer any of those questions.

Your situation: currently insuring through the Marketplace or Exchange plans will require that you sign up for Medicare. Your Marketplace plan will stop and you will choose from a Medicare option. Your spouse will go back to the Marketplace Exchange and find a plan that works for them. They can go see a Marketplace Navigator or go to the insurance company you are currently insured with. If you are happy with your current plan and network of providers, that may be easiest. The Navigators will be unbiased professionals who can help you understand the options with all the different insurance companies. Your current insurance company can only talk to you about the plans they offer.

This evaluation process for you and your family will be slightly different, but needs to happen at the same general time. You both can enroll in an insurance product that works for you and your situation, once you have done some more research. The Marketplace plans have an enrollment period of the 16th to the 15th of the month with coverage beginning the following month on the first. So your spouse’s plan will need to start Sept. 1, 2014, since you turn 65 in September, so they need to research their plan now and sign up sometime between July 16 and Aug. 15 to begin coverage on Sept. 1.

The Medicare plan options always begin on the first of the month as well, but their sign up period is 30 days before the start date. So to start Sept. 1, 2014, on your Medicare Plan, you must sign up between Aug. 1 and Aug. 31.

These are similar research periods, but slightly different sign up periods.

It seems as though everyone knows your 65th birthday is coming up. Review the information that is mailed to you from companies that are offering plans. Some of those companies offer meetings and seminars to review their products. They also may have local offices or representatives that will come to your home. You also have access to the website where information is available about all the plans in your region.

You can also call 1-800-MEDICARE (633-4227) and talk with the customer service staff at Medicare about the products available to you in your region. The website and the 1-800 number are available 24 hours a day, seven days a week. So don’t call Monday morning at 9, call at 6 a.m., or 3 a.m. or 9 p.m., whatever is a convenient time of day for you to sit with few distractions and look at or listen to the information provided to you.

You also have resources like Office for the Aging as an unbiased source or Medicare insurance information.

Then I would advise you to encourage your family without Medicare to get out and do some research on the products that are available to them. Everyone should have the opportunity to purchase good and useful health insurance. It is my hope that these resources will be useful to you.

Once you have Medicare, you have health insurance, MEDICARE. The Health Insurance Marketplace plans are not insurance that you will be allowed to buy or keep. Once you have Medicare, the Marketplace is not for you. When you evaluate your insurance options be sure you are reviewing Medicare plans, not Marketplace plans.

Don’t worry about your insurance with Medicare. The Medicare options are many and useful. The products offer lots of choices and alternatives. That makes it confusing, but it also means you can find a product that is just what you need for your individual situation.

To contact Janell Sluga, GCMC with questions or concerns, please call 720-9797 or email her at