Medicare, Marketplace open enrollment starts soon
Bistra Nikiforova, Communications Specialist, SMAA & Kathy Jodoin, Medicare Coordinator, SMAA
Open enrollment period is a window of time that happens once a year when you can sign up for health insurance, adjust your current plan, or cancel your plan. October 15 through December 7 is the open enrollment period (OEP) for Medicare recipients, and November 1 through December 15 is the open enrollment period for the Health Insurance Marketplace (ACA, or the Marketplace for short). Immigration status impacts eligibility for enrollment in both Medicare and the Marketplace.
Who is eligible?
Eligibility for purchasing health insurance on the Marketplace is based on immigration status, length of residency, and income. For Medicare, age is also a consideration.
“For asylum-seekers, MaineHealth has two programs available – CarePartners and Free Care,” explained Carol Loffredo, a York County Supervisor for CarePartners, a program led by MaineHealth that coordinates donated health care services in Cumberland, Knox, Lincoln, Waldo, and York counties. These are among opportunities for New Mainers to access health coverage outside of or in addition to the Marketplace. “They are part of the bigger Access to Care program and can help with setting up a provider, assist with getting bills paid, and access to assistance with medication coverage.”
For asylees who have received their work authorization, Access to Care can help them get insurance through CoverMe.gov. “CarePartners Plus pairs a Marketplace insurance plan with MaineHealth Free Care, while Access to Care provides case management for navigating both healthcare and social service needs,” Loffredo said. A legal permanent resident is eligible for CarePartners, CarePartners Plus, and Free Care through MaineHealth. To learn more about MaineHealth plans for New Mainers, visit www.mainehealth.org/Patients-Visitors/Billing-Insurance/Financial-Assistance/Free-Care, or call (207) 887-5100.
Why does Medicare have a separate open enrollment period?
The open enrollment period for Medicare is specifically for Medicare recipients – people who are at least 65 years old or those who have been diagnosed with a qualifying disability. Besides immigration status, eligibility for Medicare is based on the length of time living and working in the U.S. Enrollment specialists, such as the trained volunteers with Southern Maine Agency on Aging, provide free, unbiased consultation to make sure the person is enrolled in the best Medicare plan for their situation.
Why use the Open Enrollment Period if you already have health insurance or Medicare?
There are two reasons: personal life circumstances and changes in the current insurance plan. For example, Mustafa is 45 years old, recently a naturalized U.S. citizen, and has insurance through the Marketplace. Earlier this year, he was diagnosed with high blood pressure. Also, two of his children are not qualified dependents anymore. His diagnosis and the change in the family structure are two good reasons to seek a different health plan that will offer better coverage for his high blood pressure medicine and smaller family size.
Another example is Maria, who is a 67-year-old Medicare recipient. Starting next year, her primary care physician (PCP) will no longer accept her health insurance, and she will have to pay out of pocket for her visits. Maria either has to change her PCP or find a comparable Medicare plan that includes her PCP in its network.
If you do not have current health coverage and you are not sure if you qualify based on your immigration status, organizations like Maine Equal Justice and MaineHealth can help you find which option is best.