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Medicare and the MarketplaceInformation about theMarketplace for those whocounsel people with MedicareJuly 20141
The Marketplace andPeople with Medicare This presentation will help you to explain theMarketplace to people With Medicare Aging into Medicare Getting Social Security disability benefits When they may get coverage in theMarketplace, and when they can’t Medicare Prescription Drug Coverage (Part D)July 2014Medicare and the Marketplace2
Medicare and the Marketplace Medicare isn’t part of the Marketplace If you have Medicare you’re covered and don’tneed to do anything related to the Marketplace Marketplace doesn’t offer Medigap or Part D plans It’s against the law for someone who knows youhave Medicare to sell you a Marketplace plan Even if you only have Part A or Part BJuly 2014Medicare and the Marketplace3
Medicare and the Marketplace (Continued) People with minimum essential coverage arecovered and won’t have to pay a fee Part A is considered minimum essential coverage Part B only is not considered minimum essentialcoverage If you retire before you’re 65 You may use the Marketplace to buy a planJuly 2014Medicare and the Marketplace4
Marketplace and BecomingEligible for Medicare You can get a Marketplace plan before your Medicarecoverage begins You may cancel the plan when Medicare coverage starts, or You may keep the plan, but once your Part A coverage startsyou won’t be able to get lower costs for your Marketplaceplan Sign up for Medicare during your Initial EnrollmentPeriod Or, if you enroll later, you may have to pay a late enrollmentpenalty for as long as you have MedicareJuly 2014Medicare and the Marketplace5
Choosing Marketplace Instead of Medicare You can’t choose Marketplace coverage over Medicare unless1. You pay or you’d have to pay a Part A premium You can drop Part A and B and may be eligible to get a Marketplaceplan2. You have a medical condition that qualifies you for Medicare (likeESRD) but haven’t applied for Medicare3. You’re not collecting Social Security retirement or disability benefitsbefore you’re eligible for Medicare If you delay enrolling in Medicare after your Initial EnrollmentPeriod (IEP) ends, a late enrollment penalty may apply You’d only be able to enroll during the Medicare General EnrollmentPeriod (January 1 to March 31, coverage starting July 1)July 2014Medicare and the Marketplace6
Medicare for People with Disabilitiesand the Marketplace You may qualify for Medicare based on a disability You must be entitled to Social Security disability insurance(SSDI) benefits for 24 months On the 25th month, you’re automatically enrolled in MedicarePart A and B If you’re getting SSDI, you can get a Marketplace planto cover you during your 24 month waiting period May qualify for premium tax credits and reduced cost-sharinguntil your Medicare coverage startsJuly 2014Medicare and the Marketplace7
Medicare and Coverage through theSmall Business Health Options Program (SHOP)and Eligible for Medicare Medicare Secondary Payer rules apply You may delay your Part B enrollment while covered You’ll have a Special Enrollment Period (SEP) to sign up forPart B Any time you’re still covered based on your/your spouses’current employment During 8-month period after employment/coverage ends If you don’t sign up for Part B during the SEP You may have to pay a late enrollment penalty as long asyou have Medicare You can only enroll during the General Enrollment PeriodJuly 2014Medicare and the Marketplace8
The Marketplace and Medicare prescription drug coverage (Part D) Prescription drug coverage in Marketplace plans (includingSHOP) isn’t required to be creditable Plan is required to let you know each year, in writingYou may have to pay a late enrollment penalty for Part D ifyou enroll after your Initial Enrollment Period Stand-alone vision and/or dental coverage for adults Covered by some Marketplace plans July 2014People with Medicare generally can’t join a stand-aloneMarketplace dental or vision plan unless in a State-basedMarketplace and the state allows you to join (check withyour state)Medicare and the Marketplace9
Check Your Knowledge – Scenario 1Jim has Medicare Part A only. He didn’t enroll in Part B during hisInitial Enrollment Period (IEP). He signed up for Part B in January2014, during the General Enrollment Period, and his coveragewill begin on July 1.Can he enroll in a Marketplace plan whilehe waits for his Part B to take effect?July 2014Medicare and the Marketplace10
Check Your Knowledge – Scenario 1 DiscussionNo. Medicare Part A is considered minimum essential coverage.Jim can’t get a Marketplace plan since he already has minimumessential coverage.Remember, it is illegal for anyone to sell you a Marketplace planif you have Medicare.July 2014Medicare and the Marketplace11
Check Your Knowledge – Scenario 2Barbara works part-time and isn’t getting Social Securityretirement benefits yet. Her employer doesn’t offer healthcoverage, so she enrolled in a Marketplace plan. Her MedicareInitial Enrollment Period ends next month, but she decided tokeep her Marketplace plan and wait to sign up for Medicare.Will Barbara have a late enrollment penalty whenshe signs up for Medicare Part B?What about Part D?What else should you tell her?July 2014Medicare and the Marketplace12
Check Your Knowledge – Scenario 2 DiscussionBarbara can choose Marketplace coverage if she’s eligible forMedicare but hasn’t enrolled in it (because she would have to pay apremium, or because she’s not collecting Social Security benefits).Before making this choice, there are two importantpoints for Barbara to consider:1.2.If she enrolls in Medicare after her IEP ends, shemay have to pay a late enrollment penalty for aslong as she has Medicare.Generally she can enroll in Medicare only during theMedicare General Enrollment Period (from January1 to March 31). Her coverage won’t begin until Julyof that year.July 2014Medicare and the Marketplace13
Check Your Knowledge – Scenario 2Discussion ContinuedIf her Marketplace plan’s prescription drug coverage is notcreditable, she may also have to pay a late enrollment penalty(LEP) for Medicare Part D coverage if she waits to enroll afterher IEP.Barbara should consider enrolling in Medicareto be sure she doesn't get an LEP for Part Band/or Part D. She can also choose to keepMarketplace coverage and also enroll inMedicare. In that case, Barbara won’t be eligiblefor tax credits and there's no coordination ofbenefits, but it’s her choice.July 2014Medicare and the Marketplace14
Marketplace.cms.govGet the latestresources tohelp peopleapply, enroll,and getcoverageJuly 2014Medicare and the Marketplace15
Ways to Connect with the Marketplace1. Sign up for updates at HealthCare.gov/subscribe orCuidadoDeSalud.gov/es/subscribe2. Twitter.com/HealthCareGov – Follow @HealthCareGov3. Facebook.com/HealthCareGov4. Youtube.com/HealthCareGov5. The Health Insurance Blog: HealthCare.gov/blog/6. Federal training for agents and brokers, Navigators, inperson assisters, and certified application omJuly 2014Medicare and the Marketplace16
CMS National Training ProgramThis training module is provided byThe CMS National Training ProgramFor questions about training products, e-mailTraining@cms.hhs.govTo view all available NMTP materialsor to subscribe to our listserv, ionalTrainingProgram/index.htmlJuly 2014Medicare and the Marketplace17
marketplace.medicarelearningnetworklms.com Ways to Connect with the Marketplace July 2014 Medicare and the Marketplace . CMS National Training Program This training module is provided by The CMS National Training Program For questions about training products, e-mail
