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Are Medicare-eligible individuals eligible for coverage within the ACA’s health insurance exchanges?

Q: Are Medicare-eligible individuals eligible for coverage within the ACA’s health insurance exchanges?

A: Many seniors have probably heard that the Affordable Care Act helps them with their health coverage.  That is true, but the improvements to Medicare are unrelated to the exchanges.  Those with Medicare do not access it – or supplemental coverage – through the ObamaCare exchanges.  Instead the law provides some security and benefit enhancements for those with Medicare.

First, preventive care access is improved with coverage for services like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly “Wellness” visit.

Also, you can save money on brand-name drugs. If you’re in the donut hole, you’ll only pay 45 percent of the plan’s cost for Part D-covered brand-name prescription drugs in 2016. This amount is steadily decreasing, and will reach 25 percent by 2020. For generic drugs, Medicare Part D enrollees pay 58 percent of the plan’s cost while in the donut hole in 2016.

Perhaps most importantly, your Medicare coverage is protected. Under the ACA, your existing Medicare-covered benefits won’t be reduced or taken away. You also will continue to be able to choose your own doctor and the life of the Medicare Trust fund has been extended to at least 2029.

Most seniors who are Medicare-eligible do purchase some sort of supplementary or alternate coverage (Medigap, Medicare Part D, or Medicare Advantage), or they have supplementary coverage from an employer or spouse’s employer. The availability of those supplementary plans was not impacted by the ACA, and the supplementary coverage is not sold on the ACA’s health insurance exchanges. The coverage available on the exchanges is individual major medical health insurance, and it cannot be sold to anyone who is enrolled in Medicare (this is a long-standing provision that protects seniors against duplicate coverage; it has nothing to do with the ACA).

Read more FAQs about health reformhealth insurance exchanges, and Medicare.

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