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.

Let’s block ads! (Why?)

Republicans in Congress say they’ll vote to repeal much of the Affordable Care Act early next year — even though they don’t yet have a plan to replace it.

But they also insist that they don’t want to harm any of the millions of people who got their health insurance under the law.

The lawmakers’ strategy? Vote to repeal, and fulfill their top campaign pledge. But delay the changes, and keep running Obamacare for as long as two years while they figure out how to fill the hole they’ll create in the insurance market.

“We will move right after the first of the year on an Obamacare replacement resolution,” Senate Majority Leader Mitch McConnell told reporters Monday, using terminology that refers to the type of vote lawmakers will take to defund the health care law.

“Then we will work expeditiously to come up with a better proposal,” he added.

House Speaker Paul Ryan has said the plan will protect patients.

“There needs to be a reasonable transition period so that people don’t have the rug pulled out from under them,” he told reporters at a news briefing at the U.S. Capitol last week.

But repealing the law that essentially created an entire market for health insurance that didn’t exist before — and then expecting that insurance market to remain healthy — may be fantasy, according to health insurance consultants.

“I don’t think the Republicans have come to grips yet that it’s going to be their responsibility to keep the wheels on Obamacare,” Robert Laszewski, president of Health Policy and Strategy Associates, told Shots.

Republicans keep saying the Obamacare exchanges are collapsing, Laszewski said. But by voting to kill the law, they may actually speed up that process.

“They’re arguing that the thing is in death throes; that the insurance companies are losing tons of money; and it’s not sustainable,” Laszewski said. “Why do they think the insurance companies are going to provide the insurance policies in that scenario?”

An estimated 20 million people have obtained health insurance over the last three years via provisions in the Affordable Care Act. Some get coverage through the insurance exchanges, but millions are covered because of the expansion of Medicaid in most states, and because the law allows young adults to stay on their parents’ insurance policies up to age 26.

Laszewski isn’t the only one who’s skeptical of the “repeal but delay replacement” strategy.

Last week America’s Health Insurance Plans — the trade group that represents health insurance companies — circulated a memo on Capitol Hill warning that a sudden repeal of Obamacare could threaten the expanded health coverage for those millions.

“Making sudden, significant changes now, or mid-year, will jeopardize the coverage they depend on,” the letter said.

AHIP asked lawmakers to keep in place many of the financial incentives that are central to the law — including the provision of subsidies for people to buy insurance and cover copayments, and the elimination of some taxes on insurers.

The American Academy of Actuaries also weighed in, warning in its own letter that a repeal of the ACA without replacing it would be dangerous to the long-term health of the insurance market.

“Insurers are in a situation right now where they’re trying to determine whether or not they’re going to participate in 2018,” said Cori Uccello, a senior fellow at the American Academy of Actuaries. “And part of that depends on whether, in the long run, it makes sense for them to participate in the market. And that long run depends on what’s going to happen, not just in 2018, but in the years after 2018.”

The big problem is that through Obamacare, the government plays a huge role in helping people pay for insurance on the individual market. Many insurance companies are already losing money on those policies, so if they think the government won’t keep offering subsidies, insurers may just stop selling individual policies altogether.

They won’t necessarily wait to find out what Congress is hoping to do at some point in the future.

Insurers “will have to see more than the repeal element,” Shubham Singhal, head of the health care practice at McKinsey, who consults with health insurance companies, told Shots. “They’ll have to see, if it’s delayed, then what’s the transition plan? That’s going to be quite important for them, to understand whether it creates a stable marketplace or not.”

Another complication is that Republicans won’t be able to repeal the law outright because — in order to pass a regular piece of legislation in the Senate — they would need the support of Democrats to overcome a filibuster.

So they will have to use a special legislative maneuver that allows them to pass any bill related to taxes or the budget with a simple majority. That means lawmakers can defund Obamacare, but leave some provisions in place, including a requirement that insurers cover people who have pre-existing medical conditions.

Most experts believe having that requirement in place with no mandate for healthy people to buy insurance will lead companies to quit writing individual insurance policies altogether.

So, even people who had insurance before the Affordable Care Act became law, and who pay for it without subsidies, could lose their coverage.

“I don’t think the Republicans are taking this anywhere seriously enough,” Leszewski says. “They could get themselves into a real hole.”

Let’s block ads! (Why?)