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Helping Health Connector households with members who are newly eligible for Medicare

January 23, 2019

As a reminder, those who are eligible for health insurance coverage that meets Minimum Essential Coverage (MEC) standards are not eligible for Health Connector subsidized coverage.

This includes coverage through a job, spouse or partner, and public programs such as Medicare or MassHealth. If an individual is found to be eligible for Medicare during the benefit year, they will lose eligibility for subsidies for the rest of the year.

In addition, special rules apply to individuals who are eligible for Medicare but are seeking unsubsidized coverage through the Health Connector. 

As before, individuals eligible for Medicare but who do not already have coverage through the Health Connector cannot sign up for new coverage, including unsubsidized coverage. Now, due to updates in federal law, Medicare-eligible individuals may no longer renew their unsubsidized coverage through the Health Connector. 

As a result, Health Connector renewal policies have changed for 2019. Members who were identified as Medicare eligible during the 2019 redeterminations and renewals process: 

  • Were able to remain enrolled in Health Connector health coverage (QHP) through the end of 2018 only, they could not renew their Health Connector coverage or change their 2018 plan.
    • This change impacted both subsidized and unsubsidized Health Connector members
  • These members were able to continue their enrollment in Dental plans

These members may have been able to renew directly with their carrier, if the carrier offered the same policy or plan off the Exchange 

Please review the sample Medicare letter that was sent to members who have been found to be newly eligible for Medicare benefits. In addition to this letter, members have been notified that they will no longer be eligible for coverage in 2019 in either their Preliminary Eligibility notice or their Final eligibility notice.

What if other members of the household still need health insurance coverage?

If the subscriber of a plan becomes newly eligible for Medicare, there are important steps to take in order to maintain enrollment in coverage for the other household members enrolled with them. 

  1. Memberscan login to their online account to update their application or call Health Connector Customer Service to report a change. 
  2. Within the application, they should indicate that the newly Medicare eligible person no longer needs insurance coverage. 
  3. Then re-shop for a plan for the household members that seek to continue Health Connector coverage.

For instructions and the impacts of making application changes visit: 

https://www.mahealthconnector.org/help-center-answers/reporting-changes

 

Where to get help with understanding Medicare options

Individuals and families can get free help with understanding Medicare through the SHINE Program (Serving the Health Insurance Needs of Everyone). 

To make an appointment with a counselor call: 1- 800-AGE-INFO (1-800-243-4636) and press 3. Individuals can also call their town's Council on Aging for help.

Enrolling in Medicare

If someone hasn't enrolled in Medicare yet, we recommend that they do this as soon as possible. If they don't sign up during their Initial Enrollment Period for Medicare, they could end up paying a late enrollment penalty later on.

They can contact the Social Security Administration at 1-800-772-1213 for help with enrolling. Learn more about the Initial Enrollment Period and find more information about Medicare by visiting: Medicare.gov

If they already face a late penalty or lock-out of Medicare due to failure to enroll in Medicare on time, they should contact the SHINE Program for assistance with Equitable Relief.

Please review the detailed talking points for SHINE counselors for more information.