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Does Medicare count as health insurance under Obamacare?

The lowdown...
  • Medicare Part A and Medicare Advantage plans meet the minimum essential coverage requirements under the Affordable Care Act
  • Medicare Part B alone does not count as coverage
  • Medicare Part D, which is optional prescription drug coverage, will also not count as minimum essential coverage on its own
  • It is not necessary to get another plan if you are covered by Medicare Part A or C but you can enroll or keep your supplemental insurance if you wish
  • You are typically eligible for Medicare when you turn 65

If you have Medicare Part A, which is hospital insurance, you are considered covered under the Affordable Care Act minimum essential coverage requirements.

You will not need to purchase a marketplace plan or any other type of plan. However, you can enroll in a supplemental health insurance plan if you wish.

If you only have Medicare Part B, which is medical insurance but does not cover hospital visits, you are not considered covered.

You will have to enroll in an additional health insurance plan or be responsible for paying the individual mandate penalty fine.

Be sure to have the correct health insurance coverage in place! Enter your zip code into our free rate comparison tool above to find the best price for the health insurance you need.

What is Medicare Part A?

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Medicare Part A covers most hospital-related services. This plan includes:

  • hospital and emergency visits
  • nursing home services
  • home health care
  • hospice

Some of these services are only covered for people with certain conditions or in certain situations. If you or your spouse paid Medicare taxes for a certain period of time while you were working, you should be eligible for Medicare without having to pay the monthly premium.

If you or your spouse did not pay Medicare taxes for the required 40 quarters, you will have to pay a monthly premium to enroll in Medicare, unless you are already receiving disability or retirement benefits for a certain period of time.

What is Medicare Part B?

Medicare Part B covers services that are considered medically necessary, as well as preventive services.

These services include:

  • durable medical equipment
  • clinical research
  • mental health services
  • laboratory tests
  • x-rays

It might also cover some ambulatory services and a limited amount of outpatient prescription drugs.

Most people have to pay a monthly premium to enroll in Medicare Part B. In some cases, you may be automatically enrolled in Medicare Part B but you may have to sign up during your open enrollment period.

The typical amount that you will pay for Medicare Part B is $134 a month in 2017. If your income is higher, you may have to pay more.

What is Medicare Part C?

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Medicare Part C plans are also known as Medicare Advantage plans.

Medicare Advantage plans meet the minimum essential coverage requirements under the Affordable Care Act and you will not be responsible for paying the individual mandate penalty fine if you are enrolled in one of these plans.

They are private insurance plans approved by Medicare for those who are enrolled in both Medicare Parts A and B. You will still need to continue paying your Medicare Part B premium after you enroll in a Medicare Advantage plan.

In addition to the benefits associated with Medicare Part A and B, Medicare Advantage plans often offer additional benefits including vision and hearing, dental services, and some prescription drug coverage. Benefits will vary depending on the plan you choose to enroll in.

What is Medicare Part D?

Medicare Part D is optional prescription drug coverage and is not considered minimum essential coverage under the Affordable Care Act requirements.

It might be a good idea to sign up for Medicare Part D if you know that you regularly take prescription drugs.

Medicare Part B will cover a limited amount of prescription drugs, but usually, only ones that a doctor must administer to you.

How do I sign up for Medicare?

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If you are eligible for Medicare when you turn 65, you will have an initial enrollment period to sign up. It is usually a 7 month period that starts three months before you turn 65 and ends three months after you turn 65.

If you are eligible for premium-free Medicare Part A, you can sign up after your initial enrollment period. However, if you have to purchase Medicare Part and B, you have to sign up during your enrollment period.

You may be able to sign up for Part B after this time period but you will have to pay a late enrollment fine.

Does Medicare count as health insurance under Obamacare?

Medicare Part A and Medicare Advantage plans, also known as Medicare Part C, count as health insurance under the Affordable Care Act. However, Medicare Part B alone and Medicare Part D do not.

You will need to get additional coverage with these plans or you will be responsible for paying the individual mandate penalty fine.

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