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Medicare FAQs

  • › If I am already covered by Medicare do I need to make a change now that these Affordable Care Act (ACA) or marketplace plans are available? Will my Medicare be recognized by law?

    The government recognizes Medicare coverage as insurance coverage, thereby satisfying the individual mandate that all adults need to carry health insurance. You will not be penalized if you choose to stay covered by Medicare.

  • › What if I am covered by Medicare, but would like to purchase one of the ACA plans? Is that an option or would you suggest keeping my Medicare coverage?

    We suggest keeping your Medicare coverage, as the companies who sell ACA plans are actually prohibited from selling them to you if they are aware that you are covered by Medicare. If you drop Medicare so that you may enroll in an ACA plan – you may face a penalty for late enrollment. It would be best to remain with Medicare. Premiums for ACA plans may vary by age and state. Though a few states prohibit adjustments to premiums based on age, most states’ premiums for those over 65 years old could cost up to three times more than it would for a person in their early 20s.

  • › If I am covered by Medicare and my annual income is $30,000, do I qualify for a premium tax credit to help me pay for my health insurance coverage?

    No. Anyone covered by Medicare, regardless of income level, is ineligible for premium tax credits.

  • › I am over 65 and a legal U.S. resident, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the ACA marketplace?

    Yes. Generally speaking, anyone aged 65 or older who is not eligible for Medicare may purchase ACA coverage. If your income is between about 100% and 400% of the federal poverty level (about $11,770 to $47,080 for an individual in 2015) you may be eligible for premium tax credits.

  • › I am over 65 years old and work for a large employer who offers excellent health insurance coverage. I plan on working for several more years and would like to continue using my employer’s healthcare plan. Does the ACA affect me?

    No, the ACA will not affect your ability to use your employer’s health insurance. As long as you are covered by insurance, you are satisfying the individual mandate, that all adults need to carry health insurance. You will not be penalized if you choose to stay covered by your employer’s plans. However, you should plan to sign up for Medicare when you decide to stop working, or if you lose employer coverage, since you are already eligible for it.

  • › I am in my early 60s and plan to sign up for a Marketplace plan until I qualify for Medicare at age 65. What should I do when I am eligible for Medicare?

    You may begin the sign-up process for Medicare three months before you turn 65 years old. You should alert your ACA plan providers that you will be making the switch. Make sure not to drop your ACA plan until your Medicare coverage is active, in order to avoid gaps in coverage. Keep in mind that any premium tax credits you receive on you ACA plan will end when your Medicare plan begins.

  • › Can I purchase Medicare Advantage plans, Medicare Part D drug plans or Medigap policies through the ACA marketplace?

    No, Medicare plans will continue to be available as they have been. You may enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare website or directly through the Wooten Agency or any other company who offers these plan. Feel free to reach out to the experts at the Wooten Agency today to learn more about Medicare coverage options, including Medicare Advantage Plans, Part D drug plans, and Medigap supplements.

  • › If I am enrolled in a Medicare Part D drug plan, were changes made to my Medicare drug coverage as a result of the Affordable Care Act?

    Yes, the ACA includes changes that may help you save on prescription drug costs over the years. If you have very high drug costs on your Medicare Part D plan, you may benefit from the new law. The gap in coverage will be phased out between now and 2020. For example, in 2014, after your total drug costs reach more than $2,850, you will pay 47.5% of the cost of your brand-name drugs and 72% of the cost of your generic drugs. The ACA ensures that these amounts will gradually be lowered to 25% for both brand-name and generic drugs by 2020.

  • › If I am enrolled in a Medicare Advantage plan, were changes made to my program as a result of the Affordable Care Act?

    Yes. The Medicare Advantage (MA) plan is an alternative to traditional Medicare, in which MA recipients enroll in a private plan in order to receive Medicare benefits. The ACA reduced payments to these private plans to bring them closer to the average costs of traditional Medicare, while providing additional compensation to plans that earn high quality ratings. New protections for those enrolled in this type of plan limit how much companies are allowed to charge for cost sharing, administrative expenses, and profits. However, your plan may charge higher premiums, increase cost-sharing amounts, reduce the number of providers in its network, or reduce additional benefits as a result of this.

Do you have further questions about the ACA and Medicare, or your Medicare eligibility? Call the Wooten Agency today to learn more!

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