Government Watch / Your Medicare Advisor

Don’t Confuse Medicare With Obamacare

from WSJ – by Jennifer Waters – Covered by Medicare? Don’t Give the New Health Insurance Marketplace Another Thought.

October is an important medical-insurance sign-up month for millions of Americans, both under and over 65 years old.

The annual Medicare open-enrollment period, which runs from Oct. 15 through Dec. 7, overlaps this year with the initial registration for the Health Insurance Marketplace, a cornerstone of the Affordable Care Act (aka Obamacare).

But don’t confuse the two. They serve different populations.

If you’re already covered by Medicare, you needn’t give the Marketplace another thought. That’s for people under the age of 65 who don’t have any health insurance. Enrollment starts Oct. 1 and runs through March 31.

“We want to reassure Medicare beneficiaries that they are already covered, that their benefits aren’t changing and that the Marketplace doesn’t require them to do anything different,” says Richard Olague, spokesman for the Centers for Medicare and Medicaid Services. “Specifically, they do not have to change their Medicare coverage or enroll in any Marketplace plan.”

The Medicare open-enrollment period is the window for the 50 million covered to review their policies for any modifications in costs, coverage and benefits.

“It’s the one time of the year to look at other options available and make a change for a new plan that will take effect Jan. 1,” says Paula Muschler, manager of the Allsup Medicare Advisor, a Medicare plan selection service.

Even if you’re comfortable with the plan you have, study it to make sure it hasn’t been reworked. Ms. Muschler helped a woman last year switch to another plan, saving $7,000 in out-of-pocket expenses when her first plan did away with covering costly brand-name medications she regularly used.

The Medicare open-enrollment period also differs from the initial enrollment requirements. For those new to Medicare, there is a seven-month window to register that starts three months before your 65th-birthday month and ends the third month after your birthday month.

These enrollment periods are also prime time for swindlers to rip you off, so take heed to this warning from CMS: “It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.”

More information is available at or at 1-800-Medicare (1-800-633-4227).

Q: I just turned 65 and work full time with health-care benefits through my employer. I have a high deductible with a health savings account.

My wife is 66 and started receiving her Social Security benefit at age 62.

She has declined Part B of Medicare but has Part A and is covered by my employer. Because I am working and will continue to contribute to my HSA, do I decline Medicare Parts A and B? If so, how do I accomplish this?

Russel K.

Milwaukee, Wis.

A: Medicare doesn’t know you have other insurance or coverage, so you have to tell it by signing up for Part A now. But first ask your company how it deals with Medicare.

In most instances, the company continues to take on primary insurance responsibilities with Medicare in a secondary position.

There’s an initial enrollment questionnaire, which can be filed at Those answers will help Medicare set up your file to make sure claims are paid correctly.

Once your employment coverage ends, you and your wife have eight months to join Part B without penalty. If you don’t, you will each be facing a 10% penalty for each 12-month period you could have had Part B but didn’t.

Sign up for Medicare coverage a few months before your insurance ends so you’re not left without coverage for any stretch of time.

Q: When I turn 68 my wife will be 66. I would like to file and suspend [my Social Security retirement benefit]
and have my wife collect as my spouse, limiting her benefit to no more than half my benefit even though her benefit on her work record would be greater.

My wife would then file and suspend, and I would collect as her spouse, limiting my benefit to no more than half her benefit even though my benefit on my work record would be greater.

Abraham F.

Totowa, N.J.

A: Nice try, but sorry, no can do.

What you’re trying to do by both filing for your retirement benefits and suspending them is to receive half of each other’s benefits while yours each are growing at an 8% annual clip until you both turn 70.

Sounds like a good way to maximize your benefits. But the Social Security Administration doesn’t see it that way: “Only one member of a couple can apply for retirement benefits and have payments suspended so his or her current spouse can collect benefits.”

Your best bet would be to do the math on whose 50% is the greatest and whose delayed credits will be the highest.



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8 years ago

I am 55 years old and have been on my wife’s health insurance plan fully covered through her job. In January she goes on Long Term Disability so will effectively be no longer working. I understand she will get Medicare as she will be classified ‘Disabled’ and get Medicare/caid? and some social security disability, but I will need to get some kind of health insurance as I’m self-employed. I need it just for me but would consider one for both of us. Just don’t know where to start.

8 years ago

If you wrote an article about life we’d all reach engtehienmlnt.

roger cook
9 years ago

Is there any rebate money availiable to help us medicare retires buy suplimental insurance

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