In general, if you're a senior citizen and you aren't using
either Medicare or Medicare Advantage, you're in a fairly limited number
of circumstances. In general you:
• Don't qualify for Medicare (usually because you haven't lived in the US for five consecutive years before turning 65),
• Already have insurance other than Medicare (usually in the form of retiree health benefits), or
• You have no health coverage (almost always because you missed the opportunity to apply for Medicare during the first 7 months of the year.)
Let's cover how the Affordable Care Act benefits each of these groups, working from the bottom up.
If You Have No Health Coverage
Obamacare will levy a tax penalty against you if you fail to acquire health insurance by the beginning of the next year. On one hand, that's not great -- but on the other hand, the penalty is generally smaller than the cost of acquiring health coverage, and on the other hand, having insurance is pretty darn important if you're 65 or more years old in the first place. (The penalty for not having insurance in 2015 is 2% of your yearly household income.)
Fortunately, the process for obtaining healthcare coverage under the ACA is pretty easy. Every state has a new health insurance marked known as an 'exchange' that is run by either the state or the Federal government. Each exchange offers a variety of insurances tailored to that state's laws and to the local healthcare economy.
So, in short, the primary benefit of Obamacare if you don't have health coverage is to make it easy for you to obtain insurance. As an added benefit, if you don't have health insurance because you can't afford it, you may qualify for a tax subsidy that will make a low-end health plan easy to afford!
If You Have Health Insurance Already
Seniors who already have health coverage that qualifies for Obamacare's restrictions (which, by now, 100% of all insurance plans should) benefit less directly from the ACA, but they do benefit.
• Coverage Doesn't End for 'Essential Benefits': Preventive care, hospital visits, chronic disease care, and a few other 'essential benefits' cannot be capped by your insurance policy anymore.
• You Don't Pay More for Pre-Existing Conditions: Having a disease when you purchased your insurance used to mean you either wouldn't get insurance, or you'd pay through the nose for your insurance. No longer, thanks to the ACA.
• Free Preventive Care Benefits: The ACA ensures that all health insurance must provide a wide array of annual preventive care benefits at no cost to you.
If You Don't Qualify for Medicare
If you don't qualify for Medicare for any reason, but you are over the age of 65, you are treated exactly like anyone else who has no medical coverage (above.) But there is a critically important note that needs to be made here: be absolutely certain that you don't qualify for Medicare before you go shopping on the exchanges -- because if you do qualify, it's a crime for anyone to sell you a non-Medicare health plan.
• Don't qualify for Medicare (usually because you haven't lived in the US for five consecutive years before turning 65),
• Already have insurance other than Medicare (usually in the form of retiree health benefits), or
• You have no health coverage (almost always because you missed the opportunity to apply for Medicare during the first 7 months of the year.)
Let's cover how the Affordable Care Act benefits each of these groups, working from the bottom up.
If You Have No Health Coverage
Obamacare will levy a tax penalty against you if you fail to acquire health insurance by the beginning of the next year. On one hand, that's not great -- but on the other hand, the penalty is generally smaller than the cost of acquiring health coverage, and on the other hand, having insurance is pretty darn important if you're 65 or more years old in the first place. (The penalty for not having insurance in 2015 is 2% of your yearly household income.)
Fortunately, the process for obtaining healthcare coverage under the ACA is pretty easy. Every state has a new health insurance marked known as an 'exchange' that is run by either the state or the Federal government. Each exchange offers a variety of insurances tailored to that state's laws and to the local healthcare economy.
So, in short, the primary benefit of Obamacare if you don't have health coverage is to make it easy for you to obtain insurance. As an added benefit, if you don't have health insurance because you can't afford it, you may qualify for a tax subsidy that will make a low-end health plan easy to afford!
If You Have Health Insurance Already
Seniors who already have health coverage that qualifies for Obamacare's restrictions (which, by now, 100% of all insurance plans should) benefit less directly from the ACA, but they do benefit.
• Coverage Doesn't End for 'Essential Benefits': Preventive care, hospital visits, chronic disease care, and a few other 'essential benefits' cannot be capped by your insurance policy anymore.
• You Don't Pay More for Pre-Existing Conditions: Having a disease when you purchased your insurance used to mean you either wouldn't get insurance, or you'd pay through the nose for your insurance. No longer, thanks to the ACA.
• Free Preventive Care Benefits: The ACA ensures that all health insurance must provide a wide array of annual preventive care benefits at no cost to you.
If You Don't Qualify for Medicare
If you don't qualify for Medicare for any reason, but you are over the age of 65, you are treated exactly like anyone else who has no medical coverage (above.) But there is a critically important note that needs to be made here: be absolutely certain that you don't qualify for Medicare before you go shopping on the exchanges -- because if you do qualify, it's a crime for anyone to sell you a non-Medicare health plan.
Peter Mangiola, RN MSN has been in the health and wellness
industry for over three decades. He has served in Emergency, Recovery,
Cardiac Care, and Electrophysiology departments, as well as three years
as an Oncology Director, three years as director of an adult cystic
fibrosis program, eight years as Charge Nurse for a cardiovascular
nursing unit, and several years as owner/operator of two well known New
Jersey Senior Care agencies. Peter has been a regular speaker for many
groups and organizations over the years covering a wide range of topics.
He has also been a consultant, speaker, and educator in areas such as
Dementia, Alzheimer's, cognitive/behavioral issues, disabled children
& adults and obesity counseling. Learn more at http://www.petermangiola.com
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