Tag: marketplace

Is the open enrollment period the same for Medicare and the Marketplaces?

There is some overlap in the enrollment periods for Medicare and the Marketplaces, but this year they are not the same.  The Medicare open enrollment period runs from October 15 through December 7 each year.  For Marketplace coverage in 2019, the open enrollment period will run from November 1, 2018 through December 15, 2018 in states that use the HealthCare.gov website.  Some states that run their own Marketplaces will have a somewhat longer Open Enrollment period for 2019 coverage.  Check with your state Marketplace for more information.

If you are covered by Medicare, and you are interested in reviewing and comparing your Medicare coverage options, make sure the plans you are considering during the open enrollment period are Medicare plans, not Marketplace plans.  Medicare plans are not sold through the federal or state Marketplace websites.  You can review and compare your Medicare options on the Medicare website (www.Medicare.gov) or by calling 1-800-MEDICARE.

I am over age 65 and covered by Medicare, but I’m wondering if I can purchase one of the health plans offered through the Marketplace and drop my Medicare coverage? Is that an option for me or should I keep my Medicare?

If you have Medicare, you should keep it.  In fact, companies that sell Marketplace plans are prohibited from selling these plans to you if they know you are covered by Medicare.  If you do drop Medicare, and choose to re-enroll later, you can only re-enroll during the Medicare general enrollment period (from January 1 to March 31), and your coverage would not begin until July of that year.  You also may face a penalty for late enrollment.  If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then sign up again later, your monthly Part B premium may go up 10% for each year that you could have had Part B, but didn’t.  You may also owe a late enrollment penalty for Part D drug coverage, which is equal to 1% of the national average premium amount for every month you didn’t have coverage as good as the standard Part D benefit.

My spouse is an early retiree with affordable retiree health benefits from his former employer, but I’m not eligible to be on his plan. Can I apply for coverage and subsidies in the Marketplace?

Yes, assuming you meet the other requirements, you can apply for health plans and premium tax credits in the Marketplace. Your spouse’s eligibility for early retiree coverage will not affect your ability to seek coverage and financial help in the Marketplace.

I’m 63 and enrolled in a retiree health plan from my former employer. Can I look for better coverage and subsidies in the Marketplace?

Yes, as long as you do so during the Open Enrollment period.

People with employer-provided retiree health benefits should know that most early retiree health plans are considered minimum essential coverage, and thus meet an individual’s requirement for coverage.

If you are enrolled in such coverage, you can also look at coverage options through the Marketplace, and if your income is between 100% and 400% of the Federal Poverty Level, you may qualify for premium tax credits. However, there’s one exception. Some employers may provide retired employees with access to an account, called a health reimbursement arrangement (or HRA) that the retiree may use to reimburse medical expenses, including an individual policy through a Marketplace or in the non-group market. A retiree that signs up for an HRA offered by a former employer is considered to have minimum essential coverage from an employer and would therefore would not be eligible to claim a premium tax credit if he or she enrolled in a Marketplace plan.

Remember that outside of Open Enrollment, you cannot voluntarily drop your retiree coverage and replace it with other Marketplace coverage.

I’m eligible for health benefits at work. However, unfortunately, I forgot to turn in my enrollment papers on time during the company open season, so now I’m not covered. Can I get policy in the Marketplace instead? Can I apply for subsidies?

If you missed your opportunity to enroll in your employer plan during the company’s open enrollment season, you can still apply for coverage in the Marketplace during open enrollment. You can also apply for subsidies but you will have to provide information on the health coverage you are eligible for at work, even if you’re not enrolled in the plan. If the plan employer offered meets standards for affordability and minimum value, you will not be eligible for premium tax credits or cost-sharing reductions.

The prescription drug benefit under my employer’s health plan only covers generic drugs. Does that mean it doesn’t have minimum value? Can I shop for better coverage and subsidies on the Marketplace?

Whether your employer’s health plan meets minimum value will depend on a number of factors. Some employer plans might be able to meet the minimum value standard even if they don’t provide coverage for brand name prescription drugs.  The Marketplace application includes a form with questions about job-based coverage. You should take this form to your employer and ask them to fill it out. With that information the Marketplace will determine whether the plan meets minimum value. If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

I’m offered health benefits at work, but they’re not very good. I’m applying for better coverage and subsidies in the Marketplace. The application asks whether I’m offered job-based health coverage that meets minimum value. What does that mean?

The term “minimum value” means that your job-based plan would cover at least 60% of an average group of people’s covered health costs.   In addition, employer plans must provide substantial coverage for hospitalization and for physician care to meet the “minimum value” test.  Most employer plans will meet this test, but some may not.  The Marketplace application includes a form with questions about job-based coverage.  You should take this form to your employer and ask them to fill it out.  With that information the Marketplace will determine whether the plan meets minimum value.  If it doesn’t, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.

Apparently my family isn’t eligible for subsidies in the Marketplace because I am eligible for self-only coverage at work that is considered affordable and my family is also offered coverage but the cost of family coverage is not affordable. But we can’t afford to buy Marketplace coverage on our own. Will I have to pay a penalty because my family members are uninsured?

No. Starting in 2019, there is no tax penalty for not having health insurance.

My employer offers health benefits but doesn’t contribute much toward the premium. I can’t afford my share. Can I apply for coverage and subsidies in the Marketplace instead?

You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t qualify for premium tax credits in the Marketplace unless your employer coverage is considered unaffordable. If your share of the premium for self-only coverage in your employer plan is 9.86% or more of your 2019 household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.

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