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Another Perspective — Marketplace and Medicare

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If you haven’t already, you’re going to hear a lot over the next few months about the Health Insurance Marketplace, a new and convenient way to shop for health care coverage.

The initial enrollment period kicks off on Oct. 1 and runs through March 31, 2014. During that time, the Marketplace is likely to turn into a household word, as health insurance becomes the topic of TV and radio shows, newspaper articles, Internet messages and everyday conversations.

If you’re enrolled in Medicare, you may think that you’re affected by this new program and that you need to do something in response to everything you’re hearing and reading.

Relax.

The Marketplace is designed to help people without health insurance. You have insurance through Medicare. No matter how you get Medicare, whether through the traditional fee-for-service program or a private Medicare Advantage plan, you won’t have to make any changes.

But you also won’t want to turn a deaf ear to all the talk about the Marketplace because you may have family members and friends without health insurance who could benefit.

A few words from you could alert them to this new way of buying insurance and, especially with those who think they can get by without it, persuade them to sign up for health care coverage.

• Your spouse, for example, may need coverage because he or she isn’t 65 yet and can’t qualify for Medicare. Maybe your spouse has even tried to buy insurance but been turned down because of some pre-existing medical condition. The Marketplace can help.

People will have guaranteed coverage regardless of a medical issue. Insurers won’t be able to deny them coverage or charge them more because they have, say, diabetes or high blood pressure.

The Health Insurance Marketplace will give people access to affordable, comprehensive coverage. They’ll be able to go to one website to learn about insurance plans available to them, check on their benefits and out-of-pocket costs and then comparison shop.

• Maybe your grown children or grandchildren aren’t insured because they just don’t see the need. Many young adults tend to think of themselves as invincible. They don’t realize that a broken leg from an accident could end up costing them thousands of dollars in hospital and doctor bills.

The private, individual health plans sold through the Marketplace will provide a package of 10 essential benefits, including emergency services, hospital care, doctor visits, prescription drugs and preventive care. The benefits are similar to what’s typically covered in an employer-provided plan.

• Maybe your adult children or grandchildren do understand the importance of health insurance but can’t fit the monthly premiums into their already stretched budget. As much as they’d like to have the peace of mind that comes with health care coverage, there are other demands on their pocketbook.

Again, the Marketplace can help.

People with incomes up to 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for families of four) may qualify for tax credits they can use right away to lower their premiums. Some may also qualify for help with co-payments, deductibles and other out-of-pocket costs.

If you’re on Medicare, you know that health insurance can make a big difference in the quality of life. Just as your family and friends have watched out for you, now you can return the love and affection by suggesting they look into this new health care coverage option.

The best place to go for the latest and most accurate information on the Marketplace is the New Mexico Health Insurance Exchange’s website, www.nmhix.com. That’s where New Mexico residents will apply for coverage, compare health plans and enroll.

If family members or friends are uninsured, sit down and have a conversation with them today and then remind them to sign up for coverage this fall.

Bob Moos is the Southwest public affairs officer for the Centers for Medicare & Medicaid Services. He may be reached by email at Bob.Moos@cms.hhs.gov