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obamacare-replaces-medicare

The first thing to know is that, while the ACA did alter Medicare, it does not replace Medicare. Seniors and others who have Medicare can keep their coverage, and still enjoy the protections provided by Obamacare.

If you will soon be eligible for Medicare - if it is three months before your 65th birthday, or you have reached your 25th month of disability - you should review the process of cancelling your ACA coverage. If you have private health insurance, you should discuss transitioning to Medicare with a member of your employer’s human resources team or your insurance broker, or plan provider.

Do I Join Medicare through the ACA Marketplace?

You don’t use the Obamacare Marketplace to buy healthcare insurance – and you are not allowed to purchase supplementary health including dental - insurance on the Marketplace if you have Medicare. Duplicating Medicare benefits is prohibited, and it is actually illegal for an insurer to sell you a plan through the Marketplace if you’re eligible for Medicare.

If you are now eligible for Medicare, you can sign up by visiting the Social Security website or calling your local Social Security office. If you would prefer to talk to someone face-to-face, you can schedule an appointment to speak with a person at your local Social Security office on the Social Security website.

If you already have a health plan purchased through the Marketplace when you become eligible for in Medicare, you will no longer qualify for tax credits and other ACA subsidies when you enroll in Medicare Part A. If you are covered by an ACA plan, talk to someone at Social Security to determine how you can best transition to Medicare.

Is Medicare a “Qualified Healthcare Plan”?

Under the ACA, every American citizen needs to be covered by a health plan that is “certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act.”

If you do not have a qualified plan, and can afford health coverage, you must pay a fee called the individual shared responsibility payment or "individual mandate." You pay the fee when you file your federal tax return for the year you don’t have coverage.

Original Medicare is comprised of parts A (hospitalization coverage) and B (physician coverage). Fortunately, if you have Medicare Part A, you have a qualified plan. But Medicare Part B alone does not count as essential coverage and does not fulfill the requirement.

Original Medicare covers, on average, about 80 percent of an enrollee’s health costs, but there is no ceiling for out-of-pocket costs. Consequently, almost ninety percent of Medicare recipients have opted for either a Medigap or a Medicare Advantage plan.

Medigap supplements your Original Medicare benefits. The plans are sold by private companies and can help cover the copayments, coinsurance, and deductible costs associated with Medicare. Some policies provide extended benefits such as medical care when you travel outside the U.S.

Medicare Advantage plans are sold by private companies who have contracted with the government. These plans cover your Part A and Part B benefits, and may also offer prescription drug coverage, dental and vision care and other benefits.

You pay a premium for a Medicare Advantage plan, along with the cost of Medicare’s $104.90 per month (that cost rises to $121.80 per month for new enrollees in 2016, and more for people with high incomes).

The average Medicare Advantage monthly premium is expected to drop by $1.19 or 4 percent next year when compared to 2016. The average premium is expected to be $31.40 in 2017, compared to this year’s average of $32.59.

Medicare now includes Part D, a Prescription drug coverage plan. Costs for the Medicare Part D program will remain stable. In 2017, the average monthly premium for a Medicare prescription drug plan will cost beneficiaries about $34 per month.

Does Medicare Cover Dental?

Medicare does not provide dental coverage. But that doesn’t mean that you can purchase a stand-alone dental insurance plan on the ACA Marketplace, even though such a plan would not duplicate Medicare benefits.

Why? Because you can only purchase a dental plan on the federally-run Marketplace in conjunction with purchasing a qualified health plan. Since you can’t purchase a health plan when you are a Medicare beneficiary, you cannot currently buy a stand-alone dental plan through the Marketplace. However you can purchase a standalone dental insurance plan through a state-run Market or through a private insurance company.

Some Medicare Advantage plans do provide dental coverage. Unfortunately, even if you do have dental insurance, it can be a struggle to fit dental care into your budget. Here are the average costs for common dental treatments:

  • Dental Crown: $1400 - $1800
  • Root Canal (front tooth): $1200 - $1800
  • Root Canal (molar): $1400 - $1850
  • Bridge: $3800 - $5300
  • Dental Implant (single tooth): $5500 - $6800
  • Dentures (upper or lower): $1500 - $2500
  • Dentures (full set): $3000 - $5000

The costs above are for zip code 33135 (Miami) and will vary somewhat according to location. Additionally, the cited cost includes only the fee associated with the specific treatment, not the additional procedures that are typically required. For example, a root canal often requires a dental crown too, to protect and restore the tooth.

Dental insurance only covers $1000-$1500 per year in dental costs. One root canal, and your coverage for the year is exhausted.

If you want an affordable alternative to insurance, consider dental savings plans. These plans can save you 1-%-60% on the cost of dental treatment, have no annual spending limits, and no restrictions regarding age or pre-existing conditions. Since you are not required to buy dental insurance under the ACA, you can join a dental savings plan and save money while taking the best possible care of your health.
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