Avoid Health Care Confusion

by Janean Mann

October is a busy month for those interested in health care insurance. It is the beginning of open season for those without Medicare or Medicaid to seek new insurance plans under the Affordable Care Act (also known as ACA or Obamacare). It is also open season for individuals on Medicare who may want to change their Medicare Advantage plans or to change their current Medicare plan to Medicare Advantage.

Therein lies the confusion. Those with Medicare part A will see no changes in their plan and do not have to do anything in the ACA marketplace. Indeed, federal law makes it a crime for insurers to try to sell marketplace insurance to Medicare recipients. Those seeking to add Medicare Advantage plans to their regular Medicare also do not shop for it in the Obamacare marketplace. Medicare Advantage programs can be found only within the Medicare system at medicare.gov (1-800-633-4277).

The opportunity for Medicare recipients to add or change their Medicare plans runs from October 15th to December 7th, 2013. If you want to add Medicare Advantage or change your Medicare Advantage plan, you can do it at that time. Under the ACA, high quality Medicare Advantage plans get bonuses for providing good care and must spend some of the bonus money on the patient. The new law also provides more health screening and tests for Medicare recipients, including those for diabetes and heart disease.

The ACA continues to provide an automatic drug discount for those Medicare recipients caught in the coverage gap known as the donut hole – the temporary limit on what the drug plan will cover for drugs. For 2014, the discount will be 52.5 percent for brand name drugs, and there will be a 21 percent discount for generic drugs.

Approximately 9 percent of DC residents do not have health care benefits, and the ACA would require them to obtain health insurance or face fines. Other non-Medicare or non-Medicaid self-insured recipients may want to find another, perhaps less expensive, insurance plan under the ACA than what is provided in the marketplace, both of which offer a variety of plans and levels of benefits. In either case, individuals can no longer be denied insurance because of pre-existing conditions.

The open enrollment season began October 1st, 2013, and runs through March 31st, 2014. A friend of mine learned that she can obtain a comparable health insurance plan under ACA for about one-third the amount she is currently paying on a plan obtained directly through an insurance company.

Those who had health care plans individually or through their employers when the law was enacted (March 22nd, 2010), and who continue to have those plans, are not required to change. DC residents can obtain information on the DC marketplace at DCHealthLink.com, or (202) 715-7576.

Low-income residents are covered under Medicaid and will not shop in the marketplace. Undocumented aliens are also ineligible for insurance coverage under the ACA. Many families and individuals, including some middle income may be eligible for subsidies to help cover the costs of the insurance. For example, a family of four with incomes up to $88,000 may be eligible for such subsidies.

Small businesses (those with 1-50 employees) can receive up to a 50 percent tax credit for providing insurance to their employees. The DC government has received more than $82 million to help set up the medical exchange insurance programs.

For added information, you might want to attend the IONA program on Wednesday, October 9th (6:30 to 8 p.m., 5555 Friendship Blvd, Chevy Chase, Md., [email protected] or call (202) 895-9448.) or that of the Chevy Chase Community Association on Tuesday, October 15th (7:30 p.m., Chevy Chase Community Center).

Janean Mann, the president of the Northwest Neighbors Village (NWNV.org), published the original version of this article in the village’s October newsletter (PDF).