Medicare And “Marketplace Plans” - What's The Deal?


Federal officials are eager to get the word out that seniors and disabled individuals enrolled in Medicare Part A -- which covers hospitalization and limited nursing home care and is free for most beneficiaries – do not need to buy a marketplace plan, because they are already meeting the insurance requirements.

Changes in healthcare can get a tad confusing, so it is wise to know what is required and what isn't. For example, did you know there's a new law that makes selling unnecessary “marketplace” coverage to seniors on Medicare illegal?

Kaiser Health News recently addressed this concern in an article titled “Selling Marketplace Plans To Medicare Beneficiaries Will Be Illegal.

Problem: Medicare Part A is free for most beneficiaries and goes toward hospitalization and limited nursing home care. Since this fulfills the insurance requirements set by law, those on Medicare do not need anything in addition. For some 20-odd years it has been illegal for private insurers to try and sell their plans to individuals known to be Medicare recipients. This is the result of an effort to keep insurers from taking advantage of Medicare recipients.

Of course, Medicare recipients are not prevented from purchasing marketplace coverage, which is part of the difficulty.

The Medicare enrollment period starts next month and runs from October 15 to December 7. Coincidentally, the first healthcare marketplaces (the “exchanges”) will also start selling online next month with the requirement for such plans to become effective as of the beginning of 2014.

Seniors need to know the difference between Medicare “enrollment” and marketplace purchasing. Unfortunately, the timing of the two is not helping matters.

Bottom line: Medicare recipients should not buy on the marketplace what they get by enrollment all because of a mix-up. Hopefully, the legal penalties will scare off those insurance sellers who might try to confuse seniors.

To talk to Terry Bertram, an estate planning attorney about your estate planning needs, visit

Reference: Kaiser Health News (September 13, 2013) “Selling Marketplace Plans To Medicare Beneficiaries Will Be Illegal

Categories: Uncategorized