November 2013 - Healthcare Marketplace
The Healthcare Marketplace opened October 1 and has been central in the news for months. There continues to be a lot of confusion about it, partially because it is so politicized and partly because lawmakers are barely a half-step ahead of implementation deadlines. I will try to address some key points that you should understand.
First, full disclosure, I do support the concept of affordable health care for all. I also have an adult son who does not have a job that provides healthcare, so I hope this will help him. I appreciate that we have been able to keep the kids on our policy until age 26. I’ve attended several seminars, and have gained understanding but there is still much to learn.
Most of you are covered by Medicare, so the Marketplace does not apply to you. The changes for Medicare recipients mandated by the Affordable Care Act are in place, and include additional prescription coverage in the “donut hole” and more preventive care. Some of you may find that your insurance company is discontinuing your Advantage plan because their extra subsidies were cut, or that doctors are dropping Medicare because of fears of reduced reimbursement or opposition to electronic records. You may have to change providers of medical equipment to a contracted provider. But you also may find that your primary doctor has added services to prevent hospitalization, for which they receive additional incentives.
If you are on Medicare, this is also the time to evaluate your current plan. The Medicare Open Enrollment period is October 1 to December 7. Make sure your plan covers your prescriptions and that you still want the Original or Advantage plan you chose. For help with review or changes, call SHIP at 609-924-2098.
There are also readers who may be eager to explore the Marketplace. Many of you have asked at Engaged Retirement seminars how to get affordable health insurance if you retire (or get laid off) before age 65 and your job won’t continue coverage. The Marketplace is for you. It is also for you if you retire and start Medicare, but your spouse, who was on your plan, is not yet eligible. Some of you may have been helping adult children or grandchildren pay premiums; the Marketplace may help.
Low income individuals should be particularly attentive to New Jersey’s plans for Medicaid Expansion, which will enable adults up to 133% of poverty (single $15282/yr) to receive Medicaid. For information, contact NJFamilyCare. Open enrollment began October 1.
A predictable by-product of any massive and confusing change is that scammers abound. Do not let someone tell you that your Medicare is not valid, that you need to re-enroll, that they’ll help you choose a plan. Sort the real mail from the scams. Official Medicare mail has a government seal or logo. Trust your intuition, call to verify. Don’t give out personal information such as your Medicare number and birthdate. Look up the number and call them back. Report fraud. Ask us or a trusted advisor for help.
The primary website for more information on the Marketplace is www.healthcare.gov. AARP has helpful information and Consumer Reports has created an online guide at HealthLawHelper.org, as well as a ranking of health plans (consumerreports.org/healthinsurancerankings). We’ll pass along other resources as we learn of them.
Susan W. Hoskins LCSW
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