State Health Insurance Marketplaces Not For Seniors

State Health Insurance Marketplaces Not For Seniors

On August 26, a Kaiser Health News article clarified the fact that those on Medicare should not be shopping for health insurance on the new insurance marketplaces which are open as of October 1st. This is correct. People on Medicare should not shop on the new state insurance exchanges. The Wall Street Journal recently reported that IBM retirees on Medicare will be shopping for their retiree coverage on private exchanges but those private exchanges have nothing to do with the state exchanges established under Obamacare.

The Kaiser Health news article referred to the annual enrollment period for millions of Medicare beneficiaries. The annual enrollment period begins October 15th and ends December 7th. Let’s clarify what those on Medicare can do at that time.

Enroll in a Part D plan if they haven’t already

Enroll in a private Medicare Advantage Plan which is an alternative to Medicare

Change Advantage Plans or Part D plans

Disenroll from an Advantage Plan to return to original Medicare

Is this complicated? Yes, so you should know what your situation is.

The Kaiser Health article goes on to say that an individual on Medicare can buy a supplemental Medigap plan during this period as well, but that issue deserves clarification. If you are disenrolling from a Medicare Advantage Plan, which is an alternative to original Medicare, yes, you can buy a Medigap plan in your state. But let’s say you were simply on Medicare Part A and Part B for several years without a supplement and now want to buy one. Medigap plans or Medicare Supplements (these terms are synonymous), are private insurance products that supplement Medicare. Supplements are regulated by state governments as well as the Federal government and state rules can differ. In New York, one can decide to buy a Medicare supplement at any time but if it isn’t during one’s Initial Enrollment Period or a Special Enrollment Period, there is a six-month waiting period. In some states, like Florida, Texas and California, you can be denied, due to pre-existing conditions,if you didn’t purchase a supplement during an Initial or Special Enrollment Period.

As of 2014, non-Medicare coverage will not take pre-existing conditions or health status into account but it’s unclear if that change in policy will affect (or will one day affect) Medicare supplements.

The annual enrollment period in the fall affects those who are already enrolled in Medicare Part A and B. Go to for information on enrolling in Medicare Part A and B which is done through the Initial Enrollment Period at age 65, the Special Enrollment Period, or a distinct annual General Enrollment Period which is the first quarter of every year.

Finally, there is an additional enrollment period not mentioned in the Kaiser Health News article, which begins January 1 and ends February 14th of 2014. During this time, if you are on a Medicare Advantage plan, you can leave your plan and switch to original Medicare and also enroll in a Part D plan, but you cannot switch from one Medicare Advantage Plan to another.

Medicare rules are complicated. For additional information, review the website, call 1-800-Medicare or consult your Medicare and You book which is sent to Medicare beneficiaries every year.