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When You're Not Old Enough Yet for Medicare

Posted Jul 19 2013 8:30am

[EDITORIAL NOTE: I know a lot of people who read Time Goes By are younger than 65 and this post today is specifically for you. But 65-plus readers may want to pay attention for your children and grandchildren.]

At age 65, every American becomes eligible for Medicare and I haven't met anyone yet who doesn't like it. There is a reason some single-payer advocates shout “Medicare for All” and it's a damned good one: even with some omissions and some other relatively minor difficulties, Medicare works well.

It's those pesky years from 1 or 65 that health insurance is so difficult for many if not most Americans; it's hideously expensive and limited in its coverage. That is what the Affordable Care Act – known in shorthand as Obamacare – is supposed to remedy.

Republicans in Congress are still trying to kill Obamacare and if they can't destroy it entirely, they are doing their best to bite off chunks of it.

Even so, in less than three months, on 1 October, open enrollment in the Obamacare state-based health insurance exchanges begins. As the Kiplinger website explains :

”...it will give many older consumers their first opportunity to sign up for health insurance plans that guarantee comprehensive coverage regardless of health status, in many cases subsidized by tax credits.

“Coverage will begin January 1, 2014, when most people are required to have insurance or pay a penalty.”

This means that people are no longer tied to jobs they would rather leave due to health coverage and that the 20 percent of people age 50 to 64 who have no health insurance and therefore skip seeing physicians will be able to rest easier.

Those subsidies will be a boon for low income people plus, it was announced that in New York (and will probably be so in other states too), rates for individual coverage will drop under Obamacare by a whopping 50 percent. See a sample chart here .

As you may have noticed in the news, some states have opted out of participating in the state insurance exchanges. In those cases, the federal government will step in with a federally-operated exchange.

You can check where your state stands on exchanges in this list or map (as of 28 May 2013) from the Kaiser Family Foundation.

The Kiplinger website has done a good job of explaining the coming changes in simple language even I can understand. Here is a sampling:

Will I be required to switch plans?
If you’re covered by a plan that you purchased on the individual market, you may not have to change plans, but you may want to shop on the exchange anyway.

One big reason: premium tax credits are only available to people who enroll in plans through the exchange.

What types of plans will be available?
Plans offered on the exchange will be categorized as bronze, silver, gold or platinum, based on the percentage of health care costs that they cover for a standard population of policyholders.

A bronze plan should cover at least 60% of costs, on average; a silver plan, 70%; a gold plan, 80%; and a platinum plan, 90%.

How can I find the plan that’s best for me?
While the metal categories offer a quick gauge of a plan’s coverage, consumers shouldn’t read too much into these labels.

To get a better sense of the plan that’s best for you, consider your out-of-pocket costs and deductibles, as well as they types of services that require co-payments and co-insurance. And when comparing plans, pay attention to drug coverage and the choice of providers in the plan’s network.

You'll find more thorough answers at the Kiplinger website along with answers to other questions.

Right now, states are in the process of creating their exchange – or marketplace – websites. You can read how each is coming along by choosing your state at this page from the Kaiser Family Foundation where there are, in some cases, links to the exchange websites of the states.

You will continue to hear a lot from Republicans that Obamacare is an abomination. (They voted for the 40th time on Wednesday – unsuccessfully - to kill the program.) Ignore them.

Obamacare leaves a lot to be desired, but it is a good beginning. Three big, important changes are:

  • Denial of coverage for pre-existing conditions is gone
  • So are lifetime caps on coverage
  • Children up to the age of 26 can be kept on their parents' coverage which helps families enormously in this terrible economy for kids just out school

And here's a big ol' sheet of Obamacare facts worth knowing.

Keep in mind that when Medicare went into effect 48 years ago in 1965, it was far from perfect. Through the years there have been glitches, unintended consequences and errors that are tweaked as needed.

No program as big as Medicare nor a switch in coverage as massive this new Affordable Care Act can be as workable as originally intended by its creators without mistakes. The idea is to get it started and then make those fixes as the need becomes apparent.

Obamacare is a good thing and we should all be supportive of it. Who knows, maybe it will lead some day to a single payer system.


At The Elder Storytelling Place today, Marc Leavitt: Just One of the Guys

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