Medicare and Maryland Health Connection Marketplace

IMPACT TO THOSE ON MEDICARE

The Marketplace, created by the Affordable Care Act, is not for individuals on Medicare, regardless of age. The Maryland Health Connection, Maryland’s Individual Marketplace, was primarily created to help those under 65 who are uninsured, underinsured or who do not have access to affordable health care.

For individuals, who are under age 65 and have been receiving SSDI due to a disability for less than 25 months, the Marketplace is an important option to obtain affordable insurance. The Open Enrollment for the Marketplace is from November 1 through December 15, however, one may qualify for a Special Enrollment Period. To learn more call the Consumer Support Center at 1-855-642-8572. For personal assistance to select a Qualified Health Plan, one may contact HealthCare Access for a navigator at 1-877-223-5201.

Medicare beneficiaries, whether over or under 65, have health insurance. Even if they only have Medicare Part A, this is still considered to be “minimum essential health coverage” under the Affordable Care Act, and they cannot be penalized for a lack thereof. Actually, it is illegal for someone to sell an Individual Marketplace Plan—also called a Quality Health Plan (QHP)—to an individual enrolled in premium-free Medicare A.

Medicare Supplement Insurance, also known as Medigaps, and Medicare Advantage Plans function the same as they did before the Affordable Care Act. Medicare Supplements or Advantage Plans cannot be purchased through the Maryland Health Connection.

TRANSITION FROM THE MARKETPLACE TO MEDICARE

Anyone who has purchased a Marketplace Plan and then becomes eligible for Medicare will be allowed to keep their Quality Health Plan. However, as soon as Medicare Part A takes effect, they will automatically lose any Marketplace premium tax credits or subsidies (the plan will send them a notice explaining these changes). The loss of this financial assistance will typically make the QHPs too costly to continue. Therefore, it is important to be sure to sign up for Medicare on time (during the Initial Enrollment Period) to avoid a Part B late-enrollment premium penalty. The Initial Enrollment period includes the three months before the 65th birthday, the month of the birthday and the three months after. For those on SSDI, Medicare will automatically start the 25th month that one actually receives an SSDI check. Once enrolled in Medicare, they will need to contact their QHPs to disenroll, since the plans cannot automatically disenroll anyone.

Those who were eligible for and enrolled in the expanded Adult Medical Assistance will lose this benefit whenever they become eligible for Medicare. They should receive a letter of notification regarding the possible loss of the benefit 60 days prior to their 65th birthday. At this time, they will need to contact Social Security to enroll in Medicare during the Initial Enrollment Period as noted above. They will also need to contact the State Health Insurance Assistance Program, SHIP, office to be screened for possible enrollment in the Medicare Savings Programs (QMB and SLMB), Extra Help for prescription drug costs, and to select a Part D prescription plan through either a stand alone Medicare Part D plan or a Medicare Advantage Plan. Or they may directly contact Social Services for QMB and SLMB, Social Security for Extra Help and Medicare for a Part D Plan. Those on SSDI who are new to Medicare will need to follow similar steps to assess eligibility for the Medicare Savings Programs, Extra Help, and select a Part D Prescription plan or a Medicare Advantage plan.

Drug coverage in the Marketplace may not be credible coverage, which means that it may not be as good as the Medicare Part D basic benefit. Therefore, anyone who gets coverage through the Individual Marketplace or through the Small Business Health Options (SHOP) Marketplace should ascertain whether their coverage is credible. If it is not, they will need to enroll in Medicare Part D when they become eligible for Medicare to avoid paying a lifetime Part D late-enrollment penalty.

A small number of people have not earned the 10 years of work credits to make them eligible for premium- free Part A. If they want Part A, they will need to pay up to $437 per month. This group may want to weigh paying for Medicare versus buying a Marketplace plan. However, if they elect to later purchase Medicare, they will have to pay a late-enrollment penalty for not enrolling in Medicare when they were initially eligible.

For any questions, please contact the Baltimore County SHIP-SMP office at 410-887-2059.

CAN I CHOOSE MARKETPLACE COVERAGE INSTEAD OF MEDICARE?

Generally, no. It is against the law for someone who knows you have Medicare to sell you a Marketplace plan. But there are several situations where you can choose a marketplace private insurance plan instead of Medicare:

If you're paying a premium for Part A. In this case you can drop your Part A and Part B coverage and get a Marketplace plan instead.
If you're eligible for Medicare but haven't enrolled in it. This could be because you'd have to pay a premium; you had a medical condition that qualifies you for Medicare, like end-stage renal disease, but you haven't applied for Medicare coverage; or you are not collecting Social Security retirement or disability benefits before you're eligible for Medicare.
If you get Part A for free, you can't drop Medicare without also dropping your retiree or disability benefits and paying back all retirement or disability benefits (Social Security or Railroad Retirement) you have received and all costs spent for your care by the Medicare program.

Before choosing a Marketplace plan over Medicare, there are two important points to consider:

If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for as long as you have Medicare.
Generally you can enroll in Medicare only during the Medicare General Enrollment Period (from January 1 to March 31 each year). Your coverage will not start until July. This may cause a gap in your coverage.