Health Insurance Marketplace, Medicare open enrollment cause confusion and leave seniors vulnerable to scams

Tuesday, September 17, 2013

When it comes to health insurance and Medicare, we all know there’s plenty of room for confusion. News about the Affordable Care Act’s new Health Insurance Marketplace (also called exchanges) has dominated the headlines recently and is causing some confusion among seniors who are preparing for Medicare’s open enrollment period.  

Starting October 1, certain groups of Americans can visit the marketplace website,, fill out an online application, see their options for health insurance coverage, and enroll in a plan. 

But what about seniors on Medicare?  Should they visit the website? Does the marketplace include Medicare Advantage Plans or Part D (prescription drug) plans?  

The answer is no and as the date for Medicare's open enrollment (Oct. 15) quickly approaches, the government is trying to help seniors who are eligible for Medicare understand what they need to do and where they should go for information.

In a recent article from Kaiser Health News, Michele Patrick, Medicare’s deputy director for communications, said, “We want to reassure Medicare beneficiaries that they are already covered, their benefits are not changing and the marketplace doesn’t require them to do anything.”

And, when Medicare beneficiaries receive their 2014 Medicare & You handbook this month, they’ll see an important message about Medicare and the Health Insurance Marketplace: “The Health Insurance Marketplace, a key part of the Affordable Care Act, will take effect in 2014.  It’s a new way for individuals, families, and employees of small businesses to get health insurance.  Medicare isn’t part of the Marketplace.

Part of the confusion lies in the close proximity of the dates for open enrollment in both the Health Insurance Marketplace and Medicare – just 15 days apart.  And, many insurance companies offering plans in the marketplace also offer Medicare Advantage and Part D plans. 

Medicare open enrollment, which runs Oct. 15 – Dec. 7, is a time when Medicare beneficiaries can make changes to their Medicare coverage.  They can: 

  • Switch back and forth from Original Medicare to a Medicare Advantage Plan
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
  • Join, drop or switch Medicare Prescription Drug Plans 

Additionally, there’s nothing in the Affordable Care Act or on the marketplace website that actually prevents seniors from enrolling in marketplace plans.  In fact, for a small number of wealthy Medicare beneficiaries who pay higher premiums for Medicare coverage based on their income, the marketplace plans may offer a better value.  But, according to the Kaiser Family Foundation, for the majority of seniors, Medicare’s benefit package is better and more affordable than marketplace coverage.

All the changes in the health care system have Medicare officials concerned about the opportunity for scams.  There have already been reports that seniors have been contacted and asked to provide their Social Security numbers and other confidential information for a new “national insurance card.”  No such card currently exists or is planned. As always, seniors should never provide confidential information, including Medicare, Social Security or credit card numbers over the phone. 

Where can seniors go for information about Medicare open enrollment and their plan options?  The best source is Medicare itself, either through the website or by calling 1-800-Medicare (633-4227).  The Medicare website allows beneficiaries to enter their health information and find health and drug plans available in their area that best meet their needs and budget.  They can find out if health related tests, items or services are covered by Medicare.  

Council on Aging of Southwestern Ohio (COA) partners with MB Senior Solutions to provide assistance to area seniors who are making important decisions about their Medicare and prescription drug coverage.  Through this partnership, Medicare eligible older adults can access free services including a review and analysis of individual health plan and prescription needs, and help with plan enrollment and annual renewals.  Access these free services by contacting Council on Aging at (513) 721-1025. 

COA also offers onsite appointments with a volunteer from the Ohio Senior Health Insurance Information Program (OSHIIP).  The trained volunteer is available to: help seniors make decisions about Medicare coverage; facilitate appeals for denied coverage; and act as a mediator between patients and providers when coverage problems arise.  Call (513) 721-1025 for information.

OSHIIP also offers a number of Medicare Check Up events across the state to help beneficiaries understand Medicare and the Part D drug benefit.  Most events offer onsite enrollment. 

Additional Information:

What’s not part of the Health Insurance Marketplace (health exchanges):

  1. Medicare Advantage Plans
  2. Medicare prescription drug plans (Part D plans)
  3. Supplmental Medigap plans
  4. Private managed care plans for dual-eligibles (people who are eligible for both Medicare and Medicaid)

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