PPACA and Medicare: One Very Positive Development

The PPACA Helps Married Couples

The Patient Protection and Affordable Care Act (PPACA) is known by the term “Obamacare.” The term “Obamacare” itself evokes an emotionally-charged response ranging from elation to rage. You may have noticed that Maximize Your Medicare has almost no political statements or opinions. We are not going to resolve the debate, and it is not the intent of this book to settle this complicated, highly politicized matter. That said, there is definitely one very good outcome for married couples facing a particular situation.

Pre-Medicare Spouses Can Opt Out in 2014

Under employer-sponsored plans, one spouse may be Medicare-eligible, and the employer-sponsored plan may be very expensive, or have significant out-of-pocket expenses. Nevertheless, the married couple stays with the employer-sponsored plan because the other spouse may have required very good health insurance due to his/her health situation. In the past, the spouse may not have been able to do this, because the spouse may have been denied individual health insurance coverage due to pre-existing conditions. That is no longer the case under the PPACA. Insurance companies cannot deny coverage based on medical facts, which means that the barrier that may have prevented the Medicare-eligible spouse from enrolling in a Medicare Advantage plan or Medigap plan no longer exists.

Depending on the state, the spouse that is not Medicare-eligible will be able to shop for an individual plan that may be cheaper or provide superior coverage. In the past, this may not have been possible, with the exception of those states that had already disallowed denial of coverage due to medical conditions. The bottom line: couples that had no other viable choice than stay enrolled in an employer-sponsored plan can choose freely under the PPACA. You will need to examine the premiums and plan-specific cost sharing details in order to make the correct choice. Nevertheless, this is an unequivocally better situation than before the PPACA was enacted. In addition, the spouse who is not yet Medicare-eligible may face lower premiums due to the structure of the PPACA and the limitations placed on insurance companies. So while the “Obamacare” debate does not seem like it will ever end, married couples facing the situation described above may be able to benefit greatly.

This Happens
There are many different scenarios which describe how Medicare decisions may vary, depending upon the situation of the household. This is just one, and will be included in the 2014 edition of Maximize Your Medicare. The new version will be released on October 15th, the beginning of the Medicare Annual Election Period.