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MEDICARE-RELATED QUESTIONS

Q 80: Whom should consumers contact with questions about Medicare, Medicare Supplement insurance, or Medicare Advantage plans?

Medicare coverage, Medicare Supplement insurance, and Medicare Advantage plans are not available through Maine’s Health Insurance Marketplace. Consumers eligible for Medicare can buy other coverage through Maine’s Health Insurance Marketplace, but aren’t eligible for premium tax credits or cost-sharing reductions. Direct questions involving the ACA and Medicare, Medicare Supplement insurance, or Medicare Advantage Plans to Maine’s State Health Insurance Program (SHIP) at one of the five Area Agencies on Aging, 1-877-353-3771 or http://www.maine.gov/dhhs/oads/aging/community/ship.shtml. The federal government’s Medicare website,  www.medicare.gov, also has more information about health reform and Medicare changes.

Q 81: Is there anything consumers and their dependents who are already on Medicare and have employer-based coverage need to do because of the ACA?

Generally, there’s nothing consumers need to do because of the ACA if they’re already on Medicare and have employer- based coverage. If consumers have coverage through an employer, and that employer’s current benefits pay first and Medicare pays second, the ACA doesn’t change that.

If the employer changes the benefits that cover consumers or their dependents, they will send consumers a notice about those changes. Consumers can ask their employer’s human resources department how those changes work with Medicare.

Maine’s State Health Insurance Program (SHIP) at one of the five Area Agencies on Aging, 1-877-353-3771 or http://www.maine.gov/dhhs/oads/aging/community/ship.shtml should be able to give consumers more information about how their existing coverage works with Medicare.
Q 82: Is there anything consumers and their dependents who are already on Medicare and have retiree coverage from an employer need to do because of the ACA?

The ACA doesn’t change those benefits. Consumers should contact their employer’s human resources department for help. If they need more information about how Medicare and retiree benefits work together, they can contact Maine’s State Health Insurance Program (SHIP) at one of the five Area Agencies on Aging, 1-877-353-3771 or http://www.maine.gov/dhhs/oads/aging/community/ship.shtml.

Q 83: Will consumers with Medicare Supplement insurance be affected by the ACA?

No. The ACA doesn’t change the cost sharing for Medicare supplement policies.

Q 84: How will consumers’ Medicare prescription drug “donut hole” be affected?

In most Medicare Part D plans, the consumer is responsible for 100% of expenses below the deductible, and 25% of expenses above the deductible within the basic coverage level. The consumer’s coinsurance share goes down to 5% for any expenses above the catastrophic coverage threshold. However, the basic coverage is capped so that once the basic coverage is exhausted, the consumer is once again responsible for 100% of expenses until they reach the catastrophic level. This has the effect of a second deductible, and is commonly referred to as the “donut hole.”

The ACA began narrowing the “donut hole” in 2011, and it’s expected that the “donut hole” will be closed by 2020. This means that Medicare beneficiaries whose prescription drug costs are greater than the Part D deductible will only need to pay the basic 25% coinsurance rate until their expenditures reach the catastrophic level. The “donut hole” is being closed by combining a 50% discount on the cost of brand-name drugs and a gradual increase in the share of prescription drug costs for both generics and brand-name drugs that Medicare pays.

Q 85: Will consumers with Medicare Advantage plans be affected by the ACA?

Yes. The ACA implemented quality incentives for Medicare Advantage plans. Also, it limited plans’ ability to require cost- sharing on certain high-cost services, so some Medicare Advantage plans may cover more costs. The ACA also cut the Medicare Advantage program to line up payments to insurers for Medicare Advantage plans more closely with the costs of the traditional Medicare program. This may mean higher premiums or reduced coverage under some Medicare Advantage plans.

Q 86: What about long-term care insurance policies?

Maine’s Health Insurance Marketplace doesn’t include long-term care insurance policies, and policies sold on the Marketplace typically don’t cover long-term care services. Insurance agents and brokers still sell long-term care insurance outside the Marketplace. For more information about long-term care insurance, see the Bureau of Insurance website:  http://www.maine.gov/pfr/insurance/consumer/2012_ltc.htm, http://www.maine.gov/pfr/insurance/consumer/ltc_tax_qualified.htm http://www.maine.gov/pfr/insurance/consumer/LTC_Partnership_Program_Guide_08_2012.html
http://www.maine.gov/pfr/insurance/LTCPartnership.html
http://www.maine.gov/pfr/insurance/consumer/NAICLong.htm
http://www.maine.gov/pfr/insurance/consumer/long_term_care.htm

 

 

Last Updated: October 9, 2013