For Professionals: Health Care Reform

How Does Covered California™ Affect People with Medicare?

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Aug 19, 2013

Soon you’ll start to hear about Covered California™, our state’s insurance marketplace, and wonder if you need to buy insurance. If you have Medicare, the answer is no. The marketplace, also called health benefit exchange, is an implementation of the Affordable Care Act (ACA). Its aim is to ensure Americans with no health insurance have access to affordable coverage. Enrollment for insurance through Covered California™ begins October 1, 2013. Coverage is effective January 1, 2014. If you have Medicare, you don’t need to do anything. Medicare is not part of this insurance marketplace, and if you have Medicare, you are considered covered.

Some people with Medicare may feel confused as the enrollment period for Covered California™ overlaps with Medicare’s Annual Election Period (AEP), commonly referred to as fall Open Enrollment, from Oct 15- Dec 7. As with previous Annual Election Periods, Medicare beneficiaries need to review and evaluate their Medicare options and make any changes for 2014 during the AEP. Anyone who tries to convince you otherwise (i.e. that you need to buy new coverage through Covered California™) has false information or is possibly pushing a scam. If you need help reviewing your Medicare options or if you find questionable marketing activities, please contact your local HICAP (details below).

ACA Expands Medicare benefits for preventive care, drug coverage

  • Medicare benefits have expanded under the ACA, like eliminating cost-sharing for many preventive services and offering a new annual wellness visit. In the first 6 months of 2013, 16.5 million people with Original Medicare received a preventive service with no cost-sharing.
  • The ACA is also shrinking the Part D prescription drug “donut hole.” If you enter the “donut hole,” you get a discount on brand-name prescription drugs and a subsidy on generic drugs. Since January 2013, over 6.6 million people have saved $7 billion on drug costs as a result of this provision in the Affordable Care Act, an average savings of $1,061 per beneficiary.

Medicare Reminders

  • Medicare’s fall Open Enrollment Period (October 15-December 7) hasn’t changed.
  • Covered California™ isn’t for Californians who have Medicare, so don’t drop your Medicare coverage.
  • To learn more about your Medicare coverage and choices, call your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP is the Medicare benefits counseling program administered by the state. There are 25 local programs that provide information & assistance for seniors, people with disabilities and their caregivers throughout the state. You can also visit Medicare.gov, or call Medicare at 1-800-Medicare.

Beware of False Claims

Advertising or insurance agents may try to convince you to buy or change your health insurance coverage through Covered California. If you have Medicare, do nothing without first calling your local HICAP. Also inquire how to prevent, detect and report Medicare (healthcare) fraud. If you suspect fraud, report it to our California Senior Medicare Patrol (SMP) at 1-855-613-7080.

Information for people without Medicare or Medi-Cal

If you have family and friends who do not have Medicare or Medi-Cal or other health insurance, or if they want to explore new health plan options, tell them to call Covered California™ at 1-888-975-1142, or go to healthcare.gov or coveredca.com.

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Medicare Counseling:

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1-800-434-0222

California Health Advocates: the best source of unbiased Medicare information for California beneficiaries.