Sign Up For Health Coverage If You Need It, Despite GOP Repeal Plans

Since Republicans have plans to repeal the federal health law, should consumers still sign up for next year's coverage? And if the health law marketplaces disappear, might Medicare eligibility be expanded? Here are answers to some recent questions from readers.

It sounds like Republicans plan to repeal the health law in January once Donald Trump is sworn in. Since open enrollment goes until the end of January, should I just wait and see what happens before signing up?

No. Don't wait. The future of the health law is murky, but some things are crystal clear. If you need marketplace coverage that starts Jan. 1, you have to pick a plan by Dec. 15, two days from now. So get cracking.

Republicans have pledged that if they repeal the law they'll provide a transition period so that people won't be stuck without coverage. But if you miss the enrollment period that ends on Jan. 31, you will be cutting yourself off from coverage for the year. After that date you can't sign up for 2017 coverage on the exchange unless you qualify for a special enrollment period because you move to another state or lose your job-based coverage, for example.

I'm 60 and I have coverage on the health insurance marketplace. If they do away with Obamacare, I'm not sure what I'll do. I have diabetes and I had cancer when I was younger so I'm not an attractive insurance risk. Some people have proposed lowering the Medicare eligibility age so more people can qualify earlier. Is that really an option?

Beyond the political challenges there are also practical ones, said Dr. Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and a former health policy adviser in the Obama administration. If policymakers simply reduced the eligibility age to 60, for example, "a lot of businesses would start sending their 60-year-old [employees] to Medicare and take the savings," leading to a huge increase in costs for the program.

On the other hand, if individuals were able to buy into Medicare before age 65, even with subsidies it would probably be expensive to do so, Emanuel said. Those who would opt to buy in would likely be people with expensive health conditions like you who really need good coverage, a phenomenon called "adverse selection" that would make the program even more costly.

There is one possibility that could result in some sort of expanded Medicare in the longer term, Emanuel said. If the Republican Congress and Trump repeal Obamacare, millions of people may lose their health insurance. If that happens and current Republican proposals — state high-risk pools, for example, to provide coverage for people with expensive conditions — prove inadequate to the task, "there's going to be a lot of pressure to do something," he said.

I am 69 and have had Medicare Parts A and B since I turned 65. I also have a Medicare supplemental plan. I have recently been hired again and plan to take my employer's insurance for 2017, and I will drop my supplemental plan and Medicare Part B because I won't need them. When I start Medicare Part B again, will there be a penalty for stopping and then starting again?

In your case, you likely won't be penalized, said David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. As long as you're actively employed and work for an employer with at least 20 employees, Medicare will consider your employer coverage your primary insurance and won't penalize you for dropping and then re-enrolling in Part B, the medical insurance part of the program.

As you seem to be aware, the late-enrollment premium penalty for Medicare Part B can be hefty: 10 percent for every 12-month period when you could have signed up for Part B but didn't.

Where people sometimes get tripped up is when they retire from a job and retain their employer coverage, Lipschutz said. Because they're now retired and their coverage isn't tied to their active employment, Medicare considers their employer insurance secondary to their Medicare coverage and will penalize people who don't sign up for Part B when they become eligible.

Although you shouldn't have any trouble re-enrolling in Part B when you leave your job, your Medicare supplemental plan, often called a Medigap plan, may be a different story. When you turn 65 and enroll in Part B, you are guaranteed the right to buy any Medigap plan in your state. But after that initial six-month enrollment window, insurers can evaluate your health and decide whether to offer you a plan.

That would apply to you when you return to the Medicare market. Some states provide additional rights to buy a Medigap plan; it's worth checking to see if yours is one of them.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

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