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Most seniors age 65 and over will be required to
transition their health insurance from Obamacare to Medicare. Select here for help with the transition from Obamacare to Medicare Obamacare is
a health insurance for families or an employee group health insurance. Those
under the individual/family Obamacare insurance will be required to
transition to Medicare when they turn 65. Once transitioned, Medicare
includes Part A (hospital insurance) and Part B (doctors and outpatient
insurance). It does not include prescription drug coverage. When should eligible individuals transition from
Obamacare to Medicare? The eligibility for Medicare will be determined by the
Social Security Administration. In most cases Medicare will start on
the 1st day of the month in which the member turns 65. The member
must contact the social security administration to get his/her Medicare
card. The effective dates of Medicare Part A (hospital insurance) and
Medicare Part B (doctor and outpatient insurance) will be printed on the
Medicare card. Some members will
be enrolled automatically in Medicare part A by the Social Security
Administration, once they are eligible for coverage Can I have both Obamacare and Medicare coverage at the same time? The general rule is that once a member is covered by
Medicare he/she can’t be covered by Obamacare, but there are some
exceptions.
What if I do not transition from Obamacare to Medicare once
I’m eligible?
Except for certain situations, there is a lifetime Medicare
insurance premium penalty. The penalty depends on the time passed since
the member was initially eligible for Medicare insurance and the actual
effective coverage date. Will I have the same medical and prescription drug
coverage under Medicare as I have under Obamacare? The short answer is No. Medicare is built up of many
parts. The basic coverage Original Medicare includes part A (hospital
insurance) and part B (doctors and outpatient insurance), it does not
include prescription drug insurance.
How can I add prescription drug coverage under Medicare? There are various options to purchase prescription
drug plans, all offered by private insurance companies. One option is to add
a stand-alone prescription drug plan. The other common option is to purchase the Medicare
Advantage plan which includes prescription drug coverage. Is there a change in my
out-of-pocket expenses when I transition from Obamacare to Medicare? Yes, there is. Unlike Obamacare, Original Medicare does not have out of pocket maximum on your payments for medical and prescription drug services. This is a very significant difference. For example, a member was admitted to a hospital for 2 weeks. Under Obamacare the member would only have to pay up to the out-of-pocket-limit of his/her plan. The insurance company would pick up the difference in cost. Under Original Medicare, there is limit on how much
the insurance will pay for the service, and no limit on the cost to the
member.
Can I add additional Medicare coverage on top the Original Medicare,
which will limit my medical and prescription drug cost? Yes, there are 2 major plans on the market, the
Medicare Advantage and the Medicare Supplement insurance. Medicare Advantage may include prescription drug
coverage. The main advantages: it limits the out-of-pocket expense for
medical services, the premium is relatively low, and it can be replaced each
year. The main disadvantage: most of the plans are HMO with limited number
of medical providers. The member pays deductible and co-pays for the
provided services, same as under Obamacare insurance. Medicare Supplement plans do not include
prescription drug coverage. They are PPO plans and accepted by any Medicare
provider in the USA. The premiums are more expensive, the members pay lower
or no co-pays when receiving medical services. The guarantied
acceptance period to Medicare supplement plans is limited to 6 months from
the effective date of part B, with some exceptions. Will all my covered medications while under the Obamacare
insurance be covered under Medicare? Will it cost the same? Each prescription drug plan
has a formulary, which lists the covered medications and their cost. Some medications under Obamacare are not covered under Medicare.
The cost of medication under
Obamacare insurance is based on tiers (generic, brand or other), where the
price remains the same throughout the year.
Under Medicare, the price of a medication is based on a formula and
may be different throughout the year. A major difference between
Obamacare and Medicare is that under Medicare there is no out-of-pocket
limit on your cost of medications. If I'm eligible for Obamacare's subsidy from my
state's health insurance marketplace or healthcare.gov, can I keep it? The financial help (subsidy) has been calculated based on household income, age, number of people in your household and your residence zip code. In most cases when one family member transitions to Medicare, the remaining family members lose some or all the subsidy. The household income remains the same, but there are less people covered by Obamacare. Once I transition to Medicare, can my family members
keep their Obamacare coverage? If the primary insured person is the one
transitioning from Obamacare to Medicare, the rest of the family members
will have to re-enroll on a new plan. If the person who will be
transitioning to Medicare is not the primary applicant, only his/her
Obamacare coverage will be terminated. In both cases, the premium and the
subsidies for the remaining family
members under Obamacare will be re-calculated. They will
gain or lose eligibility for certain benefits and financial help. My spouse and I have Medicaid under Obamacare. Can
we both keep it after the transition to Medicare? It is a case by case situation and depends on the
household income, state of residency and other factors. Due to the
transition to Medicare, each member’s eligibility for Medicaid will be
re-evaluated. Are there situations where the transition to
Medicare decreases the family’s cost of insurance? Yes, it is a common situation. For example: a
couple who paid Obamacare insurance without any financial help, may get a
significant break when a family member transitions to Medicare. Some
Medicare plans are relatively inexpensive. |
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