If you’re confused about the Affordable Care Act – a.k.a. Obamacare – and how and if it will affect you, don’t blame your bewilderment on age. According to a poll conducted in September by the Kaiser Family Foundation, more than half of those surveyed still have questions about exactly how the ACA will play out for them.
So, Senior Planet sought out the experts and asked:
- If you’re 60 to 64 (pre-Medicare eligible), what do you need to know?
- If you’re 65-plus (on Medicare), what do you need to know?
Here’s the crash course, with lots of links to more information if you yearn to know more.
Obamacare for 60-to-64-Year Olds
Will I have to pay more? Most likely, no. In fact, people ages 60 to 64 may benefit greatly from the ACA, says Kate Wilber, Ph.D., the Mary Pickford Foundation Professor of Gerontology at the University of Southern California. “They are potentially the real winners,” she says. Here’s why.
- The ACA prohibits denying coverage based on pre-existing conditions (high blood pressure, heart problems, etc.). In the past, many in this age category were likely to run into problems trying to get an individual plan, she says, with coverage denied. There also is no longer an annual or lifetime cap on what an insurer will pay out.
- ACA limits age-banding – the common practice whereby insurers charge older people more than younger ones. Under ACA, the premiums for those under 65 can’t be more than three times what they are for younger people.
- Subsidies may also help some in this age bracket, says Tricia Neuman, Sc.D., senior vice president and director of the Kaiser Program on Medicare Policy for the Kaiser Family Foundation. They’re available for those with what she calls ”relatively modest incomes.” A Kaiser Foundation calculator helps you figure out if you’re eligible for a subsidy (click here). As an example, a 62-year-old non-smoker in New York state with an annual income of $40,000 can expect to pay 52 percent of the total premium, or $3,800 per year, with the government contributing $3,484 as a tax-credit subsidy.
Who stands to benefit the most? If you are in one of these groups, you are most likely to pay less than if you had to buy an individual plan, whether or not your premium is subsidized.
- People in their early 60s who retire early and don’t have continued benefits
- People who retire from a job that didn’t offer them benefits
- People whose COBRA has expired
- People who are self-employed, part-time or small business owners, or whose employers don’t provide insurance.
What’s a Health Insurance Marketplace? Health Insurance Marketplaces are online marketplaces where people who don’t receive insurance from an employer can estimate their subsidy, compare insurance plans, pick the best one for them and order it online. Because the risk to the insurer is spread across millions of people in that marketplace – just like in a big company – rates are lower than in an individual plan for an older person.
What if I have trouble using the website? The new Health Insurance Marketplace site, healthcare.gov, has had teething problems – if you’re having trouble with it, try again in a couple of weeks after technical issues have been fixed. If you don’t know how to use the site or need help figuring our your options, look for the Live Chat button on the bottom right of the website’s homepage or click here to find out where you can get help locally. (In New York, click here instead.)
What are the four tiers of coverage? The four “metals” – Bronze, Silver, Gold and Platinum – offer a range of premium vs. coverage. At the lowest level, Bronze offers the least expensive premium, but you’ll pay a larger percentage of your medical costs. Some insurers who offer lower premiums have a smaller network of doctors.
What if I have retiree health benefits? If you retired early with retiree health benefits, you can still comparison shop on your state healthcare exchange and figure out which plan is better for you, then decide whether to keep what you have or buy from the exchange, Neuman says.
What if I don’t want to buy insurance? If you don’t have health coverage and don’t enroll for it, you may have to pay a fee or penalty at tax time. Open enrollment in ACA marketplaces started Oct. 1 and continues through Mar. 31, 2014. If you don’t buy insurance during this open enrollment period, you’ll be locked out until the next enrollment period. Coverage begins Jan. 1, 2014.
Obamacare for People 65-Plus
Medicare is not part of the health insurance marketplace – and don’t believe anyone who tells you otherwise.
Watch out for scammers who are hard at work, calling those already insured by Medicare (as well as others) and telling them they will send you your new insurance card – but first they need your social and other personal information. It’s not true. (To keep a step ahead of the scammers, sign up for the Better Business Bureau’s scam alerts.
I’m on Medicare – what do I need to do? You don’t need to do anything, Neuman says. That applies whether you are on traditional Medicare or a Medicare Advantage Plan (which are offered by private companies that contract with Medicare such as HMOs, etc).
Still, even though you don’t have to do anything under ACA if you’re on Medicare, it’s still worth reviewing your Medicare plan annually and comparing it to other Medicare plans. The time to do it is during the Medicare open enrollment, October 15 to December 7.
Has Medicare been affected by Obamacare? Although there were fears that Medicare Advantage would be negatively impacted, that has not been the case. Medicare will be paying less to some Medicare Advantage plans when the ACA takes effect, so the plans may change your copayments or other details. But according to Time magazine, “the average Medicare Advantage monthly premium will increase only $1.64 in 2014, compared with in 2013.”
What else should I know?
- Many Medicare benefits have expanded under the law, such as free preventive benefits, cancer screenings and an annual wellness visit.
- The ”donut hole” is shrinking. By 2020, the gap in drug coverage under Medicare Part D will be closely completely. According to Neuman, if your total drug costs under Part D are more than $2,850 in 2014, you’ll pay 47.5 percent of the cost of your brand-name drugs and 72 percent of the cost of generic drugs. These percentages will be gradually to 25% for both brand-name and generic drugs by 2020.
For up-to-date Medicare information, click here
Have you visited the Healthcare Marketplace yet? What was your experience? Share it in the comments below.