Understanding the Difference between Medicare and the Marketplaces

by Ron Pollack

(Editor's Note: Ron Pollack is the executive director of Families USA, the national organization for health care consumers.)
If you have Medicare, you may be confused by the buzz surrounding the launch of the new health insurance marketplaces, which are part of the Affordable Care Act (also known as Obamacare). What do these marketplaces mean for you? It's important to understand that Medicare and the marketplaces are entirely separate. If you have Medicare, you should make the same kinds of decisions about your Medicare coverage that you make every year during open enrollment. You should not sign up for a marketplace plan. But if you know people who don't have insurance, they should look into this new option. Here are some frequently asked questions about Medicare and the marketplaces.
Q: If I have Medicare, should I look for insurance in my state's marketplace?

A: No. The marketplaces are intended to help people who don't have health insurance. If you have Medicare, you already have health insurance. You should make the same kinds of decisions about your Medicare coverage that you make ever year.
Q: If I have Medicare, do I need to worry about the new requirement to have health insurance?

A: No. If you have Medicare, you already meet the requirement that people have insurance starting in 2014. This is true even if you have only Medicare Part A. You do not need to buy any supplemental coverage to comply with anything in the Affordable Care Act.
Q: So what should I do about my Medicare coverage?

A: Similar to last year's schedule, Medicare's open enrollment period runs from Oct. 15 to Dec. 7, 2013. During Medicare open enrollment, you can decide whether to change plans, join a new plan, or keep the same Medicare coverage you have. If you have a Medicare Advantage or Part D prescription drug plan, you should check to see if your plan will be changing in 2014, and you should assess whether your medication needs have changed. If you have traditional Medicare, you can think about whether you want to join a Medicare Advantage plan. And thanks to the Affordable Care Act, Part D drug coverage will continue to improve in 2014, and Medicare will continue to cover most preventive benefits with no co-payments.
You can learn about your Medicare choices by going to the Medicare web site at www.medicare.gov or by calling 1-800-MEDICARE. For personalized counseling, ask for a referral to your local State Health Insurance Assistance Program (SHIP).
Q: What if I have Medicare and someone tells me I need to get a new plan because of Obamacare?

A: This is not true. Watch out! Dishonest people may try to take advantage of consumers by telling them they need to buy a plan when they don't need to. In fact, it is against the law for anyone to sell you a marketplace plan if he or she knows you have Medicare. Also, remember that Medicare supplemental ("Medigap") plans are not sold through the marketplaces. Never give your Medicare number or Medicare card to someone you don't know. You can report suspected Medicare fraud at www.StopMedicareFraud.gov.
Q: What about people I know who do not have Medicare or other health insurance?

A: There is good news for these folks! People who do not have insurance will be able to buy health plans through the marketplaces, or they may qualify for expanded Medicaid. Coverage starts on Jan. 1, 2014. Many people will also be eligible for financial assistance to help pay their premiums. These folks include early retirees who are waiting for Medicare coverage, or they could be your adult children or grandchildren. Help your friends and loved ones by letting them know they have new options. They can learn what's available by going to www.healthcare.gov or by calling 1-800-318-2596.