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Monday, September 16, 2013

Expert Q&A: Know the Difference between Medicare and the Marketplaces

Marc Steinberg

Deputy Director of Health Policy

Ron Pollack

Executive Director

This is the first blog in our Expert Q&A series on the Affordable Care Act. Our experts will answer common questions that people may have about open enrollment, which starts on October 1.  

People with Medicare may be confused by the launch of the new health insurance marketplaces this fall (part of the Affordable Care Act, or Obamacare) and wonder what it means for them. It’s important to understand that Medicare and the marketplaces are entirely separate. If you have Medicare, you should not sign up for a marketplace plan. You should make the same decisions about your Medicare coverage that you make every year. But if you know people who don’t have insurance, you should certainly encourage them to look into the new options. Here are answers to some frequently asked questions:

Q: If I have Medicare, should I look for insurance in the new marketplaces?

A: No. The new marketplaces are intended to help people who don’t have health insurance. If you have Medicare, you already have health insurance. You should make the same decisions about your Medicare coverage that you make every year.

Q: If I have Medicare, do I need to worry about the new requirement to obtain health insurance?

A: No. If you have Medicare, you are already complying with the requirement that you have insurance starting in 2014. You do not need to buy any supplemental coverage to comply with anything in the Affordable Care Act. Most people with Medicare have Parts A and B, either through traditional Medicare or a Medicare Advantage plan. Either way, they are in compliance. Even someone who has only Medicare Part A will not be required to get any additional coverage.  

Q: So what should I do about my Medicare coverage?

A: Medicare’s open enrollment period runs from October 15 to December 7, 2013. That’s similar to last year. If you have a Medicare Advantage or Part D prescription drug plan, you should check to see if your plan is changing in 2014. You can decide to change plans, join a new plan, or keep the same Medicare coverage you have now. Thanks to the Affordable Care Act, Part D prescription drug coverage continues to improve, and Medicare continues to cover most preventive benefits with zero copayments. You can learn about your Medicare choices at or by calling 1-800-MEDICARE. For personalized counseling, ask for a referral to your local State Health Insurance Assistance Program (SHIP).

Q: What if I have Medicare and someone tells me I need to get a new plan because of Obamacare?

A: This is not true. Dishonest people may try to take advantage of consumers by telling them they need to buy a plan when they don’t need one. In fact, it is against the law for someone to sell you a marketplace plan if they know you have Medicare. Don’t let someone sell you a marketplace plan by telling you it’s a Medicare Supplemental (“Medigap”) plan. Medigap plans are not sold through the marketplaces. Never give your Medicare number or Medicare card to someone you don’t know, such as an unsolicited caller or a salesman at your door. If you think something unsavory is going on, you can learn how to report suspected fraud at

Q: What about people I know who do not have Medicare or other health insurance?

A: This is where there is big news. People who do not have insurance will be able to purchase coverage through the marketplaces, or they may qualify for expanded Medicaid. Coverage starts January 1, 2014, and many people will be eligible for financial help. These folks include early retirees who do not yet qualify for Medicare coverage. Or they could be your adult children or grandchildren. For example, AARP has started a new campaign to encourage older Americans to get their children to check out the new options. You can help your friends and loved ones by letting them know they that have new options. They can start learning what’s available by going to or by calling 1-800-318-2596.