Healthcare.gov Individual and Family
The Marketplace is mailing paper Medicare Periodic Data Matching (PDM) notices to the household contact for consumers who may be dually – enrolled in Minimum Essential Coverage (MEC) Medicare and a Marketplace plan. If a consumer of any age has been determined eligible for or is enrolled in MEC Medicare, he or she is generally not eligible to receive financial assistance to help pay for a Marketplace plan premium or for covered services. In this round of Medicare PDM, the Marketplace will not take action to end consumers’ financial assistance or Marketplace QHP enrollment as a result of Medicare PDM. Consumers are responsible to follow the instructions in their Medicare PDM notice and take appropriate action if they have been determined eligible for or are enrolled in MEC Medicare.
Consumers who are identified as enrolled in MEC Medicare and a Marketplace plan through Medicare PDM should return to their Marketplace application and end their Marketplace coverage or Marketplace financial assistance. Consumers may have to pay back all or some of the APTC paid on their behalf for months they had both Marketplace coverage with APTC and MEC Medicare, when they file their federal income tax return.
Medicare Parts A, B And Healthcare.gov Insurance
If consumers have premium – free Medicare Part A (Hospital Insurance) but don’t have Medicare Part B (Medical Insurance), they should return to the Marketplace to end their Marketplace coverage or Marketplace financial assistance.
- Having Marketplace coverage generally duplicates their Medicare Part A coverage, and in most cases, their Medicare Part B Premiums will be less than their Marketplace plan premiums (without APTC).
- Consumers are encouraged to enroll in Medicare Part B as soon as possible.
- Consumers may have to pay back all or some of the APTC paid on their behalf for months they had both Marketplace coverage with APTC and were eligible for or enrolled in premium – free Medicare Part A, when they file their federal income tax return.
Consumers who receive this notice may have a special opportunity to sign up for Medicare Part B.
- They will have until September 30, 2017 to visit their local Social Security office to request enrollment in Medicare Part B.
- They will need to show their Medicare PDM notice to their local Social Security office when they make the request.
If consumers have Medicare Part A AND Medicare Part B OR Medicare Part C they should return to the Marketplace to end their Marketplace coverage or Marketplace financial assistance immediately.
- Having Marketplace coverage generally duplicates the benefits they already get through Medicare.
- Consumers may have to pay back all or some of the APTC paid on their behalf for months they had both Marketplace coverage with APTC and Medicare Part A or Part C, when they file their federal income tax return.
Consumers who receive this notice may be eligible to request that the penalty be reduced or removed.
- The consumer must be currently or previously dually enrolled in Marketplace coverage (with or without APTC) and Medicare Parts A and B.
- They have until September 30, 2017 to visit their local Social Security office to request removal or reduction of their Medicare Part B penalty.
- They will need to show their Medicare PDM notice to their local Social Security office when they make the request.
If consumers pay a premium for Medicare Part A (because they aren’t entitled to premium – free Medicare Part A) they should compare their benefits and total premiums under Medicare coverage (Medicare Part A, Medicare Part B, and, if applicable, Medicare Part C) with their Marketplace plan to see which one best meets their needs and fits their budget.
- Because they pay a premium for Medicare Part A, they have the option to stop all Medicare coverage and continue their Marketplace coverage with APTC, if otherwise eligible.
- However , they may have to pay back all or some of the APTC paid on their behalf for the months they were also enrolled in Medicare Part A, when they file their federal income tax return.
Consumers should contact their local State Health Insurance Assistance Program (SHIP) to learn more about Medicare. They can find their local SHIP by calling 1 – 877 – 839 – 2675 or by going to shiptacenter.org.
Review the full CMS presentation below on dually-enrolled Medicare eligible consumers with Healthcare.gov coverage.
