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As an HHS Champion for Coverage, the Center for Medicare Advocacy is committed to implementing the Affordable Care Act (ACA) for the people we serve, including older adults and people with disabilities. ACA has already strengthened Medicare by gradually closing the Part D doughnut hole and providing some free preventative services, among other reforms. Although ACA became law in 2010, many of its key features are only now coming into effect.
The first open enrollment on the new health insurance Marketplaces created by the Affordable Care Act began October 1st, 2013 and ran until March 31st, 2014. Next year's open enrollment is November 15th, 2015 to January 15th, 2016. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. The Marketplaces can help consumers who are uninsured find affordable health insurance coverage. To visit the Marketplace to find out if you qualify for coverage, including information on Special Enrollment Periods, go to www.healthcare.gov/marketplace.
People with Medicare do not need to visit the Marketplace — their Medicare coverage, whether they receive it through a Medicare Advantage plan or Original Medicare, isn’t changing because of the Affordable Care Act and the Marketplaces. According to the Department of Health and Human Services, it is illegal to sell someone with Medicare a Marketplace plan (also called a Qualified Health Plan or a QHP).
The Medicare Annual Coordinated Election Period (AEP) period runs from October 15th to December 7th but is not connected to the ACA Marketplace open enrollment period. During the AEP, people with Medicare can change Medicare Advantage or Part D plans. People with Medicare can visit www.medicare.gov/find-a-plan to review their coverage options and make sure they plan they have is still right for them. Medicare beneficiaries can also call their local State Health Insurance Assistance Program (SHIP). The SHIPs have Medicare experts that can counsel beneficiaries on Part D and Medicare Advantage choices.
If someone is having trouble affording their Medicare benefits including their Part B or D premium and co-insurance, they can apply for Medicaid, the Medicare Savings Program and the Part D Low Income Subsidy. To apply for Medicaid and the Medicare Savings Program, beneficiaries can contact their state Medicaid office. To apply for the Part D low income subsidy, visit the Social Security Administration at www.ssa.gov/prescriptionhelp/.
For more information on Medicare and the Affordable Care Act, see:
- Resources for people with Medicare that have questions about the ACA Marketplaces
- Frequently Asked Questions Regarding Medicare and the Marketplace (Updated June 2015)
- Health Law Answers (AARP)
- How will the Affordable Care Act Affect Seniors? (PBS News Hour Video)
- Obamacare Seniors (Rep. Jan Schakowsky, D-IL)
- A Bridge to Health (the Medicare Rights Center)
- Suspect a Healthcare Scam? Here’s what to do. (The Federal Trade Commission)
- Expert Q & A: Know the Difference Between Medicare and the Marketplaces (Families USA)
- "Myths and Facts about the ACA"
- Medicare Facts and Fiction: Quick Facts to Combat Spin (CMA)
- Obamacare Myths (FactCheck.org)
- The $700 billion Medicare Myth (CMA)
- Press coverage on Affordable Care Act implementation for people with Medicare
- Beneficiaries of Medicare Left Confused by Exchanges (10/14/2013, NY Times)
- In New Health Law, A Bridge to Medicare (NY Times 9/9/2013)
- Survey: Some Seniors Confused about Law and Medicare (USA Today 9/17/2013)
- FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces (Kaiser Health News 9/23/2013)
- Officials work to clarify for seniors effects of health-care shifts on Medicare (Washington Post, 9/13/2013)
- Amid ObamaCare Marketing Push, Confusion About Medicare (The Connecticut Mirror, 9/24/13)
- Information on tax credits for people with ESRD and people entitled only to Premium Part A
- http://www.irs.gov/pub/irs-drop/n-13-41.pdf(The Internal Revenue Service)
- High Risk Pool Enrollees
- marketplace.cms.gov – the latest resources for professionals learning about the Marketplace and helping people apply.
- Download the full text of the Patient Protection and Affordable Care Act (Note: Large .pdf file approximately 900 pages.)
- Health Reform Frequently Asked Questions (The Kaiser Family Foundation)
- CMA Alert, October 18, 2017 – Nursing Home Rights Roundup; ACA Stabilization; More October 18, 2017
- CMA Alert – Joint Replacement Model Undermines Care; OTC Hearing Aids Legislation Passed; More August 23, 2017
- CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More August 16, 2017
- Health Repeal Myths & Facts: The Fight Continues July 5, 2017
- The Affordable Care Act in 2017: Myths and Facts March 15, 2017
- CBO Report Confirms ACA Repeal Legislation Will Reduce Health Coverage, Care and Undermine Medicare March 15, 2017
- American Health Care Act (AHCA): A Repeal and Regress Plan March 7, 2017
- President Trump’s Address to Congress Brings No New News on Health March 1, 2017
- Back to the Future: High Risk Pools Annotated Bibliography February 22, 2017
- Repealing Medicaid Expansion Could Lead to Thousands of Deaths in the U.S. Annually February 22, 2017
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