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Medicare Rights Responds to CMS Questions about People who have Medicare and Marketplace Coverage

The Affordable Care Act (ACA) requires Marketplace plans to keep people unless they ask to disenroll or stop paying their premiums under a consumer protection called “guaranteed renewability.” This means that people have a right to keep a plan that they are in and their plan cannot drop them because they become older or sicker.

In a recently proposed rule, the Centers for Medicare & Medicaid Services (CMS) asks whether this protection conflicts with a longstanding Medicare law that prohibits a health plan from selling a policy to a person who already has Medicare. Medicare Rights responded that guaranteed renewability should be maintained, based on both the simple reading of the law and on fundamental fairness.

Medicare Rights referred to the fact that “renewing” a policy is not the same as “selling” one—the former is about allowing people who have a plan to keep it, and the latter is about new enrollees. The rules are not in any conflict.

Additionally, Medicare Rights commented that allowing Marketplace plans to drop people who are eligible for Medicare could have significant consequences for individuals, possibly leading to higher health care cost and gaps in coverage. For example, a person who mistakenly misses their initial Medicare enrollment window already faces many such consequences—which would only be made worse if they lost Marketplace coverage altogether.

Most people with coverage in the Marketplace should, when they become eligible for Medicare, enroll in Medicare Part A and B and drop their Marketplace coverage.  However, given that people are not well informed about this obligation and easily mis-manage this complicated transition, CMS should be mitigating against the potentially dire consequences, rather than allowing Marketplace plans to make them more severe.

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