Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Affordable Care Act (ACA)

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Introduction

As an HHS Champion for Coverage, the Center for Medicare Advocacy is committed to implementing the Affordable Care Act (ACA) for the people we serve, including older adults and people with disabilities. ACA has already strengthened Medicare by gradually closing the Part D doughnut hole and providing some free preventative services, among other reforms. Although ACA became law in 2010, many of its key features are only now coming into effect.

The first open enrollment on the new health insurance Marketplaces created by the Affordable Care Act began October 1st, 2013 and ran until March 31st, 2014. Next year's open enrollment is November 15th, 2015 to January 15th, 2016. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events.  The Marketplaces can help consumers who are uninsured find affordable health insurance coverage. To visit the Marketplace to find out if you qualify for coverage, including information on Special Enrollment Periods, go to www.healthcare.gov/marketplace.  

People with Medicare do not need to visit the Marketplace — their Medicare coverage, whether they receive it through a Medicare Advantage plan or Original Medicare, isn’t changing because of the Affordable Care Act and the Marketplaces.  According to the Department of Health and Human Services, it is illegal to sell someone with Medicare a Marketplace plan (also called a Qualified Health Plan or a QHP).

The Medicare Annual Coordinated Election Period (AEP) period runs from October 15th to December 7th but is not connected to the ACA Marketplace open enrollment period.  During the AEP, people with Medicare can change Medicare Advantage or Part D plans.  People with Medicare can visit www.medicare.gov/find-a-plan to review their coverage options and make sure they plan they have is still right for them. Medicare beneficiaries can also call their local State Health Insurance Assistance Program (SHIP). The SHIPs have Medicare experts that can counsel beneficiaries on Part D and Medicare Advantage choices.

If someone is having trouble affording their Medicare benefits including their Part B or D premium and co-insurance, they can apply for Medicaid, the Medicare Savings Program and the Part D Low Income Subsidy. To apply for Medicaid and the Medicare Savings Program, beneficiaries can contact their state Medicaid office. To apply for the Part D low income subsidy, visit the Social Security Administration at www.ssa.gov/prescriptionhelp/.

For more information on Medicare and the Affordable Care Act, see:

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