Obamacare Vs Medicare For People With Disabilities
Summary:
If you have end-stage renal disease , you may be able to get an Obamacare plan instead of Medicare. You might be eligible for Medicare coverage in some cases if you have a disability. But just because you can get Medicare coverage, does that mean you have to take it instead of a major medical health plan under Obamacare? Thatâs what this article is all about. Some people qualify for Medicare before they turn 65, because they receive disability benefits through Social Security or the Railroad Retirement Board.
D Prescription Drug Coverage
Youve heard of the donut hole or coverage gap related to Part D Prescription Drug coverage plan. The ACA legislation enacted several changes affecting Part D and the coverage gap.
Part D recipients enter the coverage gap once they and their plans have spent a certain combined amount on covered prescription drugs. Previously, recipients were responsible for 100% of drug costs in the coverage gap.
Insurance under the ACA reduced the costs through discounts and government subsidies. Eventually in 2020, the coverage gap was closed.
The changes for Part D have helped. Since 2020, those with enrollment in Part D have paid no more than 25% of the cost of generic and brand name drugs after meeting the initial coverage threshold but before reaching the catastrophic level.
Even though technically the donut hole coverage gap no longer exists, the concept still applies to you. It will play a role in determining how much our out-of-pocket costs are counted and who will pay for the drugs.
I Was Already Enrolled In A Marketplace Plan When I Got A New Job Do I Need To Cancel It
If youre currently enrolled in a Marketplace-based health insurance plan and then get hired and your employer offers insurance, there are a few things to know. First is that now youre probably no longer eligible for any savings or subsidies on your Marketplace plan. And this is true even if you dont accept the employer-sponsored insurance and opt to continue on your Marketplace plan. If youre offered job-based insurance that meets the federal minimum standards, then you lose your eligibility for cost savings on the Marketplace. So, some people may want to cancel their Marketplace plans to enroll in job-based insurance. For many, this will best allow you to stay covered and keep your costs down.
If you want to cancel your Marketplace plan, you can log into your Marketplace account to do so.
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When To Consider Obamacare Instead Of Medicare
Editors Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in Ask Phil. Send your questions to Phil.
Parimal N.J.: I am legally blind. I lost my job on July 8. My spouse, one son and I had medical coverage from my company. As I lost my job, my medical coverage will end soon. I have applied for disability, as I am 57 and blind, so getting another job is a huge challenge. My wife and son both work part time. He is 18 and cannot be considered a child and will attend college in the fall. Can you guide us in getting health insurance? I was planning to get my medical insurance from Medicare, my sons from his college group medical plan and my wifes from Obamacare or NJ Familycare. However, I think the premiums for three separate policies will be very high and that we will not be able to afford them.
Phil Moeller: Parimal, if the safety net should work for anyone, it should work for you and your family. Having said that, you face a tricky set of variables. These things nearly always take longer to resolve than people think. For example, qualifying for Social Security disability payments can take months. And after youre on disability, it can take two years to qualify for Medicare.
John Fla.: I am retired military and am eligible for Tricare for Life when I turn 65 in 2017. My wife is two years younger. Will she be covered by Tricare for Life when she turns 65?
Is Obamacare The Same As Medical
Obamacare health insurance plans are available through the Covered California insurance marketplace and Health for California. If you sign up for insurance through Covered California, you are covered by Obamacare. Since these two options are the same, you do not have to worry about choosing between the two.
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Are Medicare And The Aca The Same Thing
The Affordable Care Act and Medicare are not the same thing. Obamacare is not so much a plan itself, but a law governing what private insurance plans cover and how much they charge. Private health plans are also typically available to all Americans.
Medicare on the other hand is not a law but a health plan that you can enroll in later in life. Original Medicare is available through the federal government, but you are typically only eligible if you have turned 65.
You also usually cannot pair a private plan with Medicare coverage. According to the U.S. Centers for Medicare & Medicaid Services, you cannot be sold a private insurance plan from the Health Insurance Marketplace if you already have Medicare.
Enrolling in a Marketplace plan is an option if you are eligible for Medicare but havent enrolled yet. But its important to remember that Medicare has late enrollment penalties, so this could cost you if you later decide you want to switch to Medicare.
You also arent eligible for help paying premiums on your private plan if you qualify for premium-free Part A. If you are not eligible for premium-free Part A, you can drop Medicare coverage to enroll in a private plan.
When Can You Opt for a Marketplace Health Plan over Medicare?
- If you are eligible for Medicare but havent enrolled yet
- If you arent eligible for premium-free Part A
You can also look into Medigap, which is supplemental insurance and can handle a lot of the costs associated with Medicare.
Is Employer Coverage An Alternative To Medicare
Since Part A is premium-free for almost everyone, it doesnt make sense not to enroll when you become eligible. When it comes to Part B, you can choose to delay enrollment if you have through your employer.
You have the choice to keep your employers group health insurance plan if youre still working when you first become Medicare-eligible. Medicare works with employer health insurance depending on the size of your employers company.
If youre working for a company with 20+ employees, your group coverage is primary. The coordination of benefits determines which plan pays first.
Small business group insurance is for companies with fewer than 20 employees. If you work for a smaller organization the coverage is not considered credible under Part B, and you could face a Part B penalty for not enrolling.
Make sure to compare both Medicare Supplement plan and Part B premiums with your employers deductions from your paycheck. Consider medication costs as well as deductibles and copayments. If Medicare plus Medigap offers lower prices dropping your employer insurance may make sense.
If youre covered by your spouses plan through their employer, the same rules apply for delaying enrollment and creditable coverage.
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If My Income Is Less Than Expected This Year I Might Be Eligible For Medicaid What Can I Do To Cover My Bases
Home> FAQs> If my income is less than expected this year, I might be eligible for Medicaid. What can I do to cover my bases?
- Health insurance & health reform authority
Q. Im self-employed, so my income varies from one year to the next. I enrolled through the exchange and projected an income that makes me eligible for premium subsidies, but what if my income actually ends up being low enough that I would have been eligible for Medicaid instead? Will I have to pay back those subsidies? What if I dont take monthly subsidies and use my savings to pay premiums, hoping my income will increase? Whats the best strategy for me right now?A. Income volatility and its impact on subsidy eligibility have been addressed by various provisions of the ACA and IRS regulations. But since 2021, the rules have become more consumer-friendly for people who would otherwise be caught in the coverage gap in states that have not expanded Medicaid.
Can I Choose Marketplace Insurance Instead Of Medicare
Choosing Marketplace coverage instead of Medicare can be a costly decision. Once youre enrolled in Part A, you wont be eligible for any of the savings you once got for your Marketplace plan. This means youll have to pay the full price. Also, if you delay enrollment in Part B, youll have to pay a lifelong penalty.
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You Can’t Join A Healthcare Marketplace Plan If You Qualify For Medicare But If Your Spouse Doesn’t Qualify They Can
Obamacare plans, more officially known as Marketplace plans, are health plans available to individuals who qualify as a result of the Affordable Care Act, or ACA. The Healthcare Marketplace is a tool that allows eligible individuals to qualify for these lower-cost health plans. If you have one of these plans or are going to enroll in one, then understanding how they relate to Medicare is essential.
Well cover some general rules regarding Marketplace plans and Medicare, as well as a few specific scenarios you may find yourself in if you have one or both of these health insurance plans.
What Will Happen If I Dont Pay My Part B Premium
Your Medicare Part B payments are due by the 25th of the month following the date of your initial bill. For example, if you get an initial bill on February 27, it will be due by March 25. If you dont pay by that date, youll get a second bill from Medicare asking for that premium payment. That second bill will be due by the 25th of the following month in this case, April 25.
If your second bill remains unpaid by its due date, youll receive a delinquency notice from Medicare. At that point, youll need to send in the total overdue amount by the 25th of the following month to avoid losing coverage. In our example, that would put you at May 25.
All told, youll have a three-month period to pay an initial Medicare Part B bill. If you dont, youll receive a termination notice informing you that you no longer have coverage.
Now if you manage to pay what you owe in premiums within 30 days of that termination notice, youll get to continue receiving coverage under Part B. If you dont do that, your coverage will be discontinued. At that point, youll need to sign up for Part B once again during the general Medicare enrollment period that runs from January 1 to March 31 every year.
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How Can I Get Assistance Paying My Health Care Costs
If you have a limited income, you may be able to get assistance with your health care costs through certain programs:
- Medicaid: If you have a low monthly income and minimal assets, you may be eligible for coverage through Medicaid to pay Medicare costs, like copays and deductibles, and for health care not covered by Medicare, such as dental care and transportation to medical appointments.
- Medicare Savings Programs : If you do not qualify for Medicaid but still have problems paying for health care, you may qualify for an MSP, a government-run program that helps cover Medicare costs. There are three types of MSP, and all of them pay the monthly Medicare Part B premium. The Qualified Medicare Beneficiary program covers deductibles and coinsurances as well.
- Extra Help: Also known as the Part D Low-Income Subsidy , this is a federal program that helps pay for some to most of the costs of Medicare Part D prescription drug coverage. You may be eligible for Extra Help if you meet the income and asset limits. Also, in many cases, enrollment in an MSP automatically leads to enrollment in Extra Help.
- State Pharmaceutical Assistance Programs: SPAPs are offered in some states to help eligible individuals pay for prescriptions. Most SPAPs have income guidelines. Many also require you to enroll in a Medicare Part D plan and to apply for Extra Help.
Can You Stay On Obamacare Instead Of Medicare
You can keep your individual Marketplace plan when you turn 65, but premium subsidies will terminate when you become eligible for Medicare Part A.
If you are already receiving Social Security benefits, the government will automatically enroll you in Medicare Part A when you turn 65. If you are not receiving these benefits, you have a 7 month window where you can enroll in Medicare. The window is 3 month prior to your birth month, your birth month, and 3 months after your birth month.
Even though you have 7 months to enroll in Medicare, you should do so as early as possible.
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Obamacare Vs Medicare: What You Should Know
Original Medicare 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. Its for things like extending health coverage to those who otherwise cant afford it and requiring that health-care plans meet certain coverage standards.
Medicare is not part of the ACAs Health Insurance Marketplace. No matter how you get Medicare, youll still have the same benefits and security you have now. You wont have to make any changes.
If you have Medicare Part A, Part B, or Medicare Part C, youre considered to have minimum essential coverage and wont owe the fee for not having health insurance.
Understanding The Health Insurance Marketplace
The Health Insurance Marketplace is an insurance exchange that allows you to buy plans that are subsidized by the government through the Affordable Care Act. These plans will only be available to qualifying individuals, and will usually come at lower costs than other plans available on the broader market.
Many features of the Healthcare Marketplace could be discussed, but well focus only on those that relate to Medicare coverage.
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Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
Note: When completing the forms CMS-40B and CMS-L564:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
What Happens If I Have To Pay A Premium For Part A
The rules are different for those who arent eligible for premium-free Medicare Part A. If you or your spouse worked for at least 40 calendar quarters, the equivalent of 10 years, and had Medicare taxes deducted from your pay, you wont pay premiums for Part A.
If you or your spouse paid Medicare taxes for 30 to 39 quarters, you may have to pay Part A premiums of $274 a month in 2022, an amount often less than the least expensive marketplace premiums without a subsidy.
That amount increases to $499 a month if youve worked fewer than 30 quarters.
People who dont qualify for premium-free Medicare Part A can opt to keep their ACA marketplace health insurance rather than sign up for Medicare at 65. Youll continue to receive subsidies to help pay the premiums, but they end if you enroll in Medicare.
Think carefully before making this decision: If you decide to sign up for Medicare later, you may need to wait until the general enrollment period and have to pay a late-enrollment penalty for Part A in addition to a Part B late penalty.
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When Should I Cancel My Aca Plan
You will want to avoid any gaps in health coverage. Contact the ACA plan and request that it be canceled the day before your Medicare benefits begin.
Dont be tempted to gamble with your health by canceling your ACA plan early. If you have more than a 63-day window between when your ACA plan ends, and your Medicare begins, then when you enroll in a Medigap plan, they can impose a waiting period for pre-existing conditions.
Everyone who enrolls in Part B is given a 6-month Medigap Open Enrollment window to enroll in any Medigap plan they want. Its better to use this window when you first activate Part B and have your ACA plan coverage terminate the day before your Medicare and Medigap plan begins.
Coverage from Medicare and a Medicare Supplement Plan G would give you comprehensive benefits where you will pay nothing but the Part B deductible for Medicare-approved services and your monthly premiums.
Can we help you with an insurance plan like that today? Dont hesitate to contact us.
