How to Avoid Mistakes When Switching From an Exchange Health Plan to Medicare

How to Avoid Mistakes When Switching From an Exchange Health Plan to Medicare

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If you get your health insurance on the public market and are nearing age 65, don’t forget about Medicare.

The general rule is that when you reach that age, you should enroll unless you have qualifying coverage elsewhere – and count plans through exchanges (federal or state).

“You need to be prepared for this change,” said Karen Politz, senior researcher at the Kaiser Family Foundation. “Otherwise, you might face [costs] For registering late for Medicare and leaving the market late.

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Of the 12 million or more people with health insurance coverage in the market, around 3.4 million are aged 55 to 64, meaning some of them are approaching eligibility for health insurance. Medicare and must register. Will be

Danielle Roberts, co-founder of insurance company Boomer Benefits, said: “If you got grants on a Marketplace plan… Uncle Sam could charge you dollars for all the grants you received from $ 65. years. .

People who are already receiving Social Security benefits, that is, who started receiving these benefits before full retirement age as defined by the government, will usually automatically enroll in Medicare, but they can still be marketed. You’ll have to cancel your coverage, Politz said.

Your initial Medicare enrollment period begins three months before the month you turn 65 and ends three months after (seven months in total).

While most people pay no premium for Part A (hospital coverage), Part B (outpatient care) does not. For 2021, that standard amount is $ 148.50 per month, although high earners pay more.

In addition to Parts A and B, also known as Original Medicare, there is Part D, which covers prescription drugs. There is also an additional monthly fee for high income beneficiaries (see table).

Some people choose to stick with basic Medicare and combine it with a stand-alone Part D plan and perhaps a Medicare supplement plan (aka “Medigap”). Others choose an Advantage plan (Part C), which includes your Part A and B benefits, and usually Part D, plus a few extras like limited dental and vision benefits.

Late registration penalties are associated with some aspects of Medicare.

For Part B, if you do not register when required, you risk a penalty equal to 10% of the basic monthly Part B premiums for each 12 month period you are registered. Should have gone, but didn’t. And these punishments are usually for life.

you can face [costs] For registering late for Medicare and leaving the market late.

Karen politz

Senior Fellow of the Kaiser Family Foundation

Although Part D is optional, you could face penalties if you decide you want coverage after not purchasing the first time you qualify. This late registration fee is 1% of the monthly National Base Premium ($ 33.06 in 2021), for which you should have been covered, but you didn’t. Like the Part B penalty, this amount usually lasts as long as you have drug coverage.

Whether you’ll pay more or less than your current Marketplace plan depends on factors such as the amount of financial aid you’ve received.

For 2021 and 2022, the grants available in the market have been extended, which means that many more people are eligible for assistance than before. Some pay little or nothing for the premium and may benefit from cost-sharing assistance, such as deductibles or co-payments. Of course, if your income is low enough, you may be eligible for reimbursable expense assistance programs under Medicare.

Plus, your Medicare coverage options also determine what you pay for. Medigap plans come with monthly premiums that can range from $ 100 to around $ 400, depending at least in part on the specifics of the plan. These policies typically cover most of the sharing costs covered by Medicare Parts A and B, including reimbursement insurance or coinsurance.

Advantage plans may or may not have premiums on top of what you pay for Part B. However, research from Politz’s organization shows that half of all Medicare Advantage registrants will spend more for a stay in the. five-day hospital as original Medicare beneficiaries. for different cost structures. For a 10 day stay, Advantage will pay an additional 72% registration.

“When you’re healthy, the Advantage plan is cheaper than Original Medicare, but if you get really sick that can change,” Politz said.

To compare your drug coverage options or your Advantage plans, you can visit the Medicare Plan Finder.

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