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John
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Not sure which type of law category this fall into. I was

Customer Question

Not sure which type of law category this fall into.

I was just made aware that Obamacare only applies to those who are under 65, because at age 65, Medicare takes over regarding health insurance.

So, my questions are this:
1) For seniors over 65, can Medicare supplemental policies rate people higher for pre-existing conditions?
2) For seniors over 65, are there still pre-existing conditions?
3) Do seniors over 65 have unlimited lifetime caps on health care as there are under Obamacare?
4) How, if at all, does Obamacare affect those in the over 65 year old health care category?
Submitted: 10 months ago.
Category: Legal
Expert:  John replied 10 months ago.
Hi, My name is XXXXX XXXXX I’m happy to assist you with your question today.

The short and simple answer to your question is that Medicare/Medicaid are exempt from the Affordable Care Act (Obamacare) and so are Medicare supplemental plans (a/k/a Medi-gap). Medicare technically provides all the "essential services" and "costs" that are mandated by the ACA. Thus the Medicare supplemental plans are consider "non-essential" coverage and not required to follow the ACA requirements.

The specific answers to your questions:

1) For seniors over 65, can Medicare supplemental policies rate people higher for pre-existing conditions? -- Yes, as it is not a plan regulated by the ACA, it can charge more for pre-existing conditions.

2) For seniors over 65, are there still pre-existing conditions? -- Yes, supplemental plan can still have a pre-existing condition requirement.

3) Do seniors over 65 have unlimited lifetime caps on health care as there are under Obamacare? Technically, Medicare has always provided unlimited lifetime caps. I think you want to know whether a Medicare-supplemental plan can limited lifetime caps, and the answer is yes. But, I've never encountered one that does limit lifetime benefits, they generally just coordinate with Medicare.

4) How, if at all, does Obamacare affect those in the over 65 year old health care category? -- Medicare is being altered a bit. First prescriptions should cost less - there is less cost-sharing under Medicare Part D, meaning that recipients pay less in total. More free basic coverage - including yearly wellness exams, free screenings for major diseases (heart, cancer etc). These are the only changes to Medicare.

I believe this answers your question. However, if you need clarification or have follow-up questions regarding this matter, I will be happy to continue our conversation – simply reply to this answer. If you are otherwise satisfied with my response, please leave a positive rating as it is the only way I am able to get credit for my answers. Thank you, XXXXX XXXXX wish you all the best with this matter.


John, Attorney
Category: Legal
Satisfied Customers: 2879
Experience: Licensed and practicing attorney.
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Customer: replied 10 months ago.

Why don't seniors get the same "protection" that those under 65 will be getting?

Expert:  John replied 10 months ago.
Jean,

I believe the thinking is that Medicare offers all the basic coverages that are mandated by the ACA (e.g., a requires insruance, with limits on co-pays and premiums, basic coverages, and unlimited lifetime coverage). Thus, in the logic of the ACA any "supplmental" plan is just extra and not regulated as such.

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