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FAQ: What Retirees And Seniors Need To Know About The Affordable Care Act

Filed by KOSU News in Health.
October 11, 2013

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to We may use it in a future on-air or online segment.

I am on Medicare. Do I need to use one of the new health insurance exchanges?

No. Medicare is not part of the health insurance exchanges. The exchanges won’t be selling so-called “Medigap” policies that supplement the coverage seniors get through Medicare.

Seniors will still get health coverage through Medicare’s traditional fee-for-service program or Medicare Advantage plans, private health insurance plans that are approved by Medicare. Those who are enrolled in Medicare Part A, which covers hospital care, or the Advantage plans will meet the health law’s mandate for individuals to have insurance.

Does the health care law offer any new benefits for Medicare beneficiaries?

Beneficiaries receive more preventive care services – including a yearly “wellness” visit, mammograms, colorectal screening, and more savings on prescription drug coverage. By 2020, the law will close the Medicare gap in prescription drug coverage, known as the “doughnut hole.” Seniors will still be responsible for 25 percent of their prescription drug costs.

Does the health law require higher-income Medicare beneficiaries to pay more for their Medicare prescription drug coverage?

It does. Currently, Medicare beneficiaries who earn more than $85,000 ($170,000 for a couple) pay more for their Medicare Part B premiums, which cover physician and outpatient services. The health law brought that same sliding-scale approach to beneficiaries’ prescription drug coverage in Medicare Part D for those with incomes of more than $85,000 ($170,000 for a couple). Those income thresholds will be frozen through 2019.

If I’m retired and my former employer offers me insurance, can I shop on the exchange to get a better deal?

Even if your former employer offers coverage, you can opt to buy a plan on the exchange. However, you may not be eligible for a subsidy.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured

All About Health Insurance Exchanges And How To Shop At Them

A Young Adult’s Guide to New Health Insurance Choices

How Obamacare Affects Employers And How They’re Responding

Where Medicaid’s Reach Has Expanded — And Where it Hasn’t

Additional coverage from NPR Member Stations:

California (KQED, San Francisco)

California (KPCC)

California (KXJZ Capital Public Radio, Sacramento)

Colorado (Colorado Public Radio)

Massachusetts (WBUR, Boston)

Minnesota (Minnesota Public Radio)

Georgia (WABE, Atlanta)

New York (WNYC)

Oregon (Oregon Public Broadcasting)

Pennsylvania (WHYY

Texas (KUHF)

Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente. [Copyright 2013 NPR]

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