Question: I have a health insurance through the NY Health Exchange (Marketplace) Plan. I am turning 65 in September, do I need Medicare? My spouse also has a Marketplace plan, but is younger by two years.

Answer: The Affordable Care Act and the Marketplace Exchange has changed the way many of us get our insurance. Let’s answer your questions. There are some general rules about these Exchange plans and Medicare. The Affordable Care Act (ACA) requires all citizens to have health insurance from some source. Your current policy is a Marketplace Plan. As you age into Medicare your insurance must switch to a Medicare plan and your Marketplace Plan should be cancelled.

When you are turning 65, Medicare begins the first of your birthday month, with one exception. When your 65th birthday is on the 16th of September, your Medicare coverage will begin 9-1-22. If your 65th birthday is on the 1st of September, your Medicare coverage will begin 8-1-22.

The Initial Enrollment Period (IEP) for Medicare is the three months before your birthday month, the month of your birthday, and the three months after. Using the previous September 16th birthday scenario, the three months before are August, July, and June. This is the time to evaluate insurance options and alternatives and be sure you have signed up for Medicare. Since you have a Marketplace Plan you MUST sign up for Medicare A & B.

The initial sign up for Medicare begins at the Social Security Administration (SSA). Once you have signed up for Medicare, you can research and evaluate health insurance plans that work for you. (Part D drug coverage, Supplemental plans, Medicare Advantage plans, etc.). SSA will not assign or help you with a health plan. To sign up for Medicare, you can use the www.SSA.gov website, call SSA at 1-877-379-3079 (Jamestown) or 1-800-772-1213 (national), or go to the SSA office (321 Hazeltine Ave. Jamestown).

Your Marketplace plan should stop and you will have to choose a Medicare option. Some of the Marketplace plan Companies are very proactive and mail you information prompting you to sign up for Medicare. Others do not do a good job of managing this required change. The time too research options related to Medicare is now. When you evaluate your insurance options, be sure you are reviewing Medicare plans, not Marketplace plans.

It may seem as though everyone knows your 65th birthday is coming up, with a lot of mail from insurance companies of all types. Review the information that is mailed to you from companies that are offering plans. They also may have local offices or representatives that will come to or call your home. You have access to the www.medicare.gov website where information is available about all the plans in your region. You can also call 1-800-MEDICARE (633-4227) and talk with the customer service staff. The website and the 1-800 number are available 24 hours a day, seven days a week. You also have resources available like Office For the Aging, or Southwestern Independent Living Center as unbiased sources of Medicare Insurance information. Senior Life Matters staff will also assist you.

There are many Medicare Health Insurance options available. That makes it confusing, but it also means you can find a product that is just what you need for your individual situation. You also may be pleasantly surprised by the cost of your insurance options. I believe that Medicare is very affordable and the insurance products available to you may cost less than you are currently paying AND be more comprehensive than your current Marketplace Plan. So don’t worry!

Original Medicare consists of Part A & B. You will also need to add a Part D plan (Prescription Drug Coverage). You could stay with Original Medicare, add on a Medicare Supplement Plan and a Stand Alone Part D plan. You could also enroll in Medicare A & B and then opt to do a Medicare Advantage Plan that would include your Prescription Drug coverage. There are lots of options!

You also asked “What will your spouse do?” Your spouse is not yet 65 and therefore not eligible for Medicare. The Marketplace plans can continue to be their insurance coverage. You have a different time frame to change your insurance because you are turning 65!

Everyone should have the opportunity to purchase good and useful health insurance. It is my hope that these resources will be useful to you.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email [email protected].

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