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Who qualifies for medicare coverage under ObamaCare?

Here's what you need to know...
  • Medicare has several parts: Part A, Part B, and Part D. There are also Medicare Advantage plans that you can enroll in.
  • ObamaCare did not replace Medicare. It expanded some components to the program.
  • Some people are automatically enrolled in Medicare. Others can apply XX

Medicare is a program that provides health insurance for most people over 65 and some people under 65. It has several components, including hospital insurance, medical insurance, and prescription drug coverage. ObamaCare did not significantly change Medicare, but it did expand the coverage of preventive services and lower the cost of prescription drugs. If you’re applying for a Medicare Advantage program, which takes the place of Medicare Part A, B, and sometimes D, you can weigh the advantages of different types of plans. If you’re looking for a plan on the Marketplace, you’ll find several different options as well. Compare health insurance rates now by using our FREE tool above!

Part A

Part A is considered hospital insurance. In addition to covering in-patient hospital stays, it also pays for skilled nursing facility care, hospice care, and some types of home health care. Part A is free for most people who qualify for Medicaid. You’re eligible to receive premium-free Part A if you’re 65 or over and:

  • You already receive or are eligible to receive retirement benefits from Social Security or the Railroad Retirement Board (RRB)
  • You or your spouse had Medicare-covered government employment
  • You’re the dependent parent of a deceased child who was fully insured
  • You or your spouse have worked at least 10 years while you paid Medicare taxes

If you’re under 65, you can receive Part A for free if:

  • You have received Social Security or RRB disability benefits for at least 24 months
  • You have end-stage renal disease
  • You receive disability because of Lou Gehrig’s Disease, or ALS.

If you’re over 65 and didn’t work for at least 10 years, you can pay for Part A coverage.

Part B

Part B insurance covers medical insurance. It pays for visits to the doctor, outpatient care, medical supplies, and preventive services. If you qualify for Part A, you also qualify for Part B. This type of coverage is optional in many cases. You may not need Part B if:

  • You have insurance through your employer or union
  • You have TRICARE, and you or your spouse are on active duty
  • You have veterans’ benefits

Part B generally comes at a cost to patients. The standard premium is $121.80. This will be higher if you make more than $85,000. After you meet your deductible, which is $166, you’ll pay 20% for most doctor services, outpatient care, and medical supplies.

Part C

Part C is also known as the Medicare Advantage plan. It’s a type of plan that’s administered by a private company. A Medicare Advantage plan essentially takes the place of Part A and Part B. A Medical Advantage Plan can be a:

  • Health maintenance organization plans
  • Preferred provider organization plans
  • Private fee-for-service plans
  • Special needs plans
  • Medical savings account plans

You can enroll in a Medicare Advantage plan between October 15 and December 7. These types of plans vary in terms of cost, so you need to carefully consider your options. There are different premiums, deductibles, and limits on out-of-pocket costs. If you’re on a limited budget, these differences could add up to be significant.

Part D

A Part D plan can be added on to your Medicare insurance. It gives you prescription drug coverage, administered by a private company.

Some Medicare Advantage plans also include prescription drug coverage.

There are a number of fees associated with Part D, so anyone interested in signing up for coverage should spend some time comparing plans. They may offer coverage for different premiums and may have varying deductibles and copayments.

Retiree Coverage

Many people receive insurance through their retirement program. If you’re enrolled in one of these programs and Medicare, Medicare will generally pay your bills before your other insurance.

How ObamaCare Affects Medicare

The passage of ObamaCare expanded certain elements of Medicare coverage. It does not raise premiums for Medicare.

If you’re enrolled in Part B, you can get a free wellness visit each year. Your annual appointment includes:

  • A discussion of your Health Risk Assessment
  • Measurements of height, weight, and blood pressure
  • Health advice
  • A review of risk factors and treatment options that may apply to your condition
  • A review of your current prescriptions
  • The development of a screening schedule
  • You can also receive many preventive services at no cost.

The preventive services that you can receive under Part B include:

  • Alcohol misuse screenings and counseling
  • Cardiovascular disease screenings
  • Depression screenings
  • Diabetes screenings and self-management training
  • Glaucoma tests
  • Hepatitis C screening test
  • HIV screening
  • Mammograms
  • Obesity screenings and counseling
  • Screenings for cervical, colorectal, lung, prostate, and vaginal cancers
  • Flu, hepatitis B, and pneumococcal shots

Prescription drug costs are set to decrease each year through 2020.

  • In 2016, you’ll pay 45% of the cost of brand-name drugs in the coverage gap and 58% of the cost of generic drugs in the coverage gap
  • In 2017, you’ll pay 40% of the cost of brand-name drugs in the coverage gap and 51% of the cost of generic drugs in the coverage gap
  • In 2018, you’ll pay 35% of the cost of brand-name drugs in the coverage gap and 44% of the cost of generic drugs in the coverage gap
  • In 2019, you’ll pay 30% of the cost of brand-name drugs in the coverage gap and 37% of the cost of generic drugs in the coverage gap
  • In 2020, you’ll pay 25% of the cost of brand-name drugs in the coverage gap and 25% of the cost of generic drugs in the coverage gap

You’ll be in the coverage gap after you and your plan have spent a certain amount on drugs in a calendar year. In 2016, the limit is $3,310. There is generally a cap on out-of-pocket spending somewhere above that amount. If a Medicare Advantage plan covers prescription drugs, you should take some time to review the payment terms.

Automatic Enrollment

People in one of the following four categories are automatically enrolled in Medicare.

  1. Those who live in Puerto Rico and receive Social Security benefits or benefits from the RRB.
  2. Those who have Lou Gehrig’s Disease, or ALS.
  3. Those who are under 65, have a disability and have been receiving disability benefits for at least 24 months.
  4. Those who already receive Social Security benefits or RRB benefits. They’ll receive their benefits the month that they turn 65.

Applying for Medicare

If you’re not automatically enrolled in Medicare, you can apply for the program. You can use the application page, found on Social Security website. You can also apply by phone or in-person at your local Social Security office. To apply for Medicare, you have to be at least 64 years and 9 months old.

People who are not Eligible for Medicare

If you are over 65 and are not eligible for Medicare, you can sign up for a plan through the Marketplace. If you don’t sign up for any sort of plan, you’ll be fined either and be responsible to pay whichever is the higher amount.:

  • $695 for each uninsured adult
  • 2.5% of your household income above the tax return filing threshold

Cost Assistance

Based on your income, you may qualify for government assistance. Some people with Medicare can receive Medicaid benefits to help with prescription drug costs. Other programs include:

  • Medicare Savings Programs
  • The Program of All-inclusive Care for the Elderly
  • A provision for extra help with prescription drug costs
  • Supplemental Security Income

Medicare continues to serve Americans over 65 who have worked over 10 years while paying Medicare taxes or who have or had a spouse who worked those years. People with certain disabilities also are eligible for the program. Under ObamaCare, preventive services have expanded, and the cost of prescription drugs is gradually decreasing. People who are not eligible for Medicare can sign up for a plan through the Marketplace after comparing their options. People who are eligible for Medicare can also choose to enroll in a Medical Advantage plan. These plans vary in coverage, and it’s best to shop around for the optimal plan. Enter your zip code in our FREE tool below to compare health insurance rates instantly!

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