Are you looking to expand your medical and prescription health care coverage?
Is Medicare okay, but not enough for your healthcare needs?
What is Medicare?
Medicare is a federal program, which receives funds from the United States Government.
Have you been contemplating the health insurance market place vs Medicare?
The Affordable Care Act (ACA) Health Insurance Marketplace
This blog has you covered – you’ll learn about the benefits of the Health Insurance Marketplace vs Medicare and how you can benefit from having both including how to get drug coverage under either Part D of Medicare or with your ACA Plan through the marketplace.. You’ll learn much more about what marketplace coverage through the ACA exchange (Obamacare) offers and how it differs from both Medicare and Medicaid.
Don’t let health insurance overwhelm you – continue reading for what you need to know about the health insurance marketplace vs Medicare.
Health Insurance Marketplace vs. Medicare: A Quick Overview
The first thing you need to know is that the health insurance marketplace coverage is that, even though it is operated by the United States Federal Government, does not impact your Medicare coverage. That means that having health insurance through the market place won’t disqualify you from Medicare plans. It also means you can sign up for medicare coverage if you’re otherwise eligible for one its health plans.
Medicare open enrollment is different from the health insurance marketplace, so make sure you get your dates right:
- Medicare Open Enrollment: October 15, 2022, to December 7, 2022
- Health Insurance Market Place Open Enrollment: November 1, 2022, to December 15, 2022
If you already have Medicare or health insurance coverage, you can use that time to review your plan to see if it still fits your needs. If you already have a ACA marketplace plan when you become eligible for Medicare, you can choose to keep that plan, as well.
The only thing you need to consider is that you’ll lose any premium tax credits you receive if you sign up for both a marketplace insurance plan and a Medicare plan. But having both isn’t a bad thing if you have high medical expenses – there are limitations to Medicare. So you may want to enroll in Medicare. It’s best to discuss this with your trusted health insurance agent. However, if you decide to have both your Marketplace plan and Medicare coverage, know that you won’t be eligible for any premium tax credits or cost savings you previously got from your Marketplace plan.
Health Insurance Marketplace vs. Medicare: What You Need to Know
When deciding between the health insurance market place vs Medicare, there are a few things you need to know about how the market place and Medicare work.
1. Health Insurance Plans May Cover Some of Your Medical
Even if you have an Medicare policy, health insurance market place plans will function the same way – you’ll have a deductible, copayments or coinsurance, and an out-of-pocket maximum. Your health coverage begins after you meet your deductible.
Having a health insurance marketplace plan while using Medicare is a great way to save money for people who have higher medical costs or a lot of prescriptions each month.
Once your Medicare Part A coverage starts, you’ll no longer be eligible for any premium tax credits or other cost savings you may be getting for your Marketplace plan.
2. Health Insurance Plans Do Not Disqualify You from Having Medicare
Because you can have both a health insurance market place plan and Medicare, there is no disqualification from Medicare for having a plan through the market place. You’ll still qualify for the same health insurance premiums regardless of having both plans.
The one caveat here is losing the premium tax credit – don’t forget that you lose that if you sign up for a health insurance market place plan while you have Medicare coverage.
If you have Marketplace coverage and a federal employee tells you that you don’t need to enroll in Medicare when you’re eligible you may qualify for equitable relief . Americans receiving Social Security payments ahead of retirement will be automatically enrolled in Medicare.
3. Medicare Plans May Cover Your Medical Expenses
Depending on the type of Medicare plan you choose, you may be fully covered or not. Medicare Part A covers hospital stays and means you’re considered “fully covered” by government regulations. Medicare Part B, which is for medical coverage, does not mean you are fully covered.
These plans will pay for certain things, but you’ll be paying for both the plans and any limitations they have with no guarantee of an out-of-pocket maximum.
Health Insurance Market Place vs. Medicare: Can You Use Both?
Yes, you can use both. As mentioned, you won’t qualify for any premium tax credits for the health insurance market place plan, but beyond that, you can use both plans to cover your medical expenses. You can keep your Marketplace plan until your Medicare coverage starts, and if you want, you can keep it afterwards.
In fact, there are a few reasons you might want to use both, depending on your health situation.
Here are a few Medicare limitations where it would be useful to have a health insurance marketplace plan:
- Hospital Stays: There is a \$1,364 deductible per benefit period with Medicare, plus \$341/day for days 61-90 of a hospital stay in a single benefit period. There may be an additional $682 per day after the 90-day mark, as well. Having a health insurance market place plan could help cover some of these costs.
- Skilled Nursing Facility Stays: A skilled nursing facility stay can be expensive. While Medicare covers the first 20 days per benefit period, after that you pay \$170.50 per day through day 100, then all costs after that. This would be an excellent scenario for having a health insurance market place plan in place to cover additional medical expenses.
- Prescriptions: Unless you proactively purchase a Medicare Part D plan for prescriptions, you won’t have any prescription coverage with your Medicare plan. With a health insurance plan through the market place, prescriptions are typically covered as part of the plan. Use a health insurance market place plan to help cover high prescription costs.
These are just a few situations in which you would be better suited to having both a health insurance market place plan and a Medicare plan.
Using the health insurance market place vs Medicare doesn’t have to be a tough choice – it’s really a no brainer. Having both gives you the maximum coverage for medical situations, which can save you money in the long run. Here are three important takeaways about having both coverage types:
- Health insurance will cover hospital stays, skilled nursing facility stays, and prescriptions – these are all critical to seniors.
- Medicare requires you to purchase insurance in pieces – you may end up paying a hefty sum for all of the different coverage types you need.
- Having both a health insurance market place plan and Medicare can be beneficial – you’re not disqualified from one if you have the other.
Of course, you need to compare plans and know about what your medical expenses will be each year, but there are tools available to help you with that.
A Fiorella Insurance agent or broker can point you in the right direction.
Need help deciding which plan works best for you? Contact Fiorella Insurance Agency today to talk about the health insurance market place plans that will provide you with the most coverage.