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What happens when PPACA plan users turn 65?

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State insurance regulators are getting ready to think harder about whether they, or federal agencies, should be doing more to help 64-year-old consumers understand their health coverage options.

Bonnie Burns, a policy specialist at California Health Advocates, is preparing to give the Consumer Liaison Committee at the National Association of Insurance Commissioners (NAIC) a briefing on the Medicare eligibility transition Nov. 21 in National Harbor, Md., at the NAIC’s fall national meeting.

The NAIC chooses people to represent consumers’ interests in NAIC proceedings and, when the consumer reps will accept NAIC financial support, it gives the reps help with paying to travel to NAIC meetings.

The Consumer Liaison Committee brings the consumer reps together with insurance regulators. The chair of the committee is Marguerite Salazar, the Colorado insurance commissioner.

In meeting packet materials, Burns has included copies of documents illustrating the kinds of Medicare transition issues that have come up in recent years.

One concern is that the country has no standardized way of informing people who are about to turn 65 that they are eligible for Medicare, what Medicare eligibility means, or what happens if they make non-standard choices, such as deciding to continue to work and keep their employer-sponsored coverage after they turn 65, according to the documents.

Patient and consumer advocacy groups have noted that even new Patient Protection and Affordable Care Act (PPACA) individual exchange system and the PPACA Small Business Health Options Program (SHOP) exchange system have no standard Medicare eligibility notification process.

One letter in the packet, addressed to the heads of the U.S. Department of Health and Human Services, the U.S. Labor Department, and the Social Security Administration, expresses some Democratic House members’ belief that the agencies should make sure people with COBRA benefits, retiree insurance, small group health plans and PPACA exchange coverage understand what their options are.

The agencies also need to make sure people that are getting kidney dialysis, who are eligible for Medicare, understand their options, the lawmakers said.

Another document in the packet, by Stacy Sanders, a policy specialist at the Medicare Rights Center, talks about the traps that face consumers who put off taking either Medicare Part A or Medicare Part B without fully understanding the penalties they might face. Sanders suggests that the government needs to provide better education, and more flexibility for helping people who have made honest mistakes.

See also: The Medicare Challenge: How to Find the Best Coverage for Your Clients


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