Panel Discusses Transitions to Medicare for People with Insurance Provided through the ACA

Earlier this week, Medicare Rights joined colleagues from the Center for Medicare Advocacy, Inc. and the National Senior Citizens Law Center for a panel at the annual Home and Community Based Services Conference on the transition to Medicare for people who will gain new health care coverage through the Affordable Care Act (ACA)—including from the Health Insurance Marketplace to Medicare and from expanded Medicaid to Medicare. Panelists reviewed beneficiary and policy considerations pertaining to the following transitions: • Individual Qualified Health Plan (QHP) à Medicare • Small Business Options Program (SHOP) plan à Medicare • Expanded Medicaid à Medicare • Expanded Medicaid à Medicare/Medicaid • Expanded Medicaid à Medicare + Medicare Savings Program (MSP) + Extra Help People newly eligible for Medicare transitioning from the Health Insurance Marketplace, both QHP and SHOP plans, must consider several factors to avoid gaps in health coverage and avoid late enrollment premium penalties. Among these factors is ensuring timely enrollment in Medicare and timely disenrollment from the Health Insurance Marketplace alongside assessing eligibility for low-income assistance programs, including Medicare Savings Programs (MSPs) and Extra Help. The federal government must ensure that beneficiaries are adequately educated about when and how to enroll in Medicare as well as about critical coordination of benefits rules. For those transitioning from expanded Medicaid to Medicare, transitions are made more complicated by misaligned eligibility criteria for expanded Medicaid and traditional Medicaid. Based on income and asset tests, some may remain eligible for full Medicaid, others may be eligible for other types of cost sharing assistance, including MSPs and Extra Help, and some may only be eligible for Medicare. It is critical that federal and state governments actively enforce policies to automatically screen newly eligible Medicare beneficiaries for the health care assistance programs for which they might be eligible, and newly eligible Medicare beneficiaries must be vigilant about applying for these programs. Poorly managed transitions from new ACA coverage options to Medicare may result in gaps in health coverage and significantly increased health care costs for newly eligible beneficiaries. Anticipating potential challenges for beneficiaries will help to lessen the likelihood of these burdens.