In an earlier blog post, we looked at whether Congress and the Biden Administration will expand Medicare. One way to expand the program is to lower the eligibility age. Should the Medicare eligibility age be lowered to 55, more than three million people could leave the exchange markets for Medicare. We have been advocating for State-Based Marketplaces (SBM) and State policy makers to prepare for expansion and be proactive in providing current enrollees choices, allow them to compare plans and programs based on their circumstances, and should individual enrollees age in into Medicare, streamline the process so that enrollment into Medicare program from the exchange is seamless.  

Both State-Based Marketplaces and the state Medicaid departments enroll and support populations who ultimately age into Medicare. Today, there is only limited support, and few resources provided to this “Medicare Age-in” population. As trusted advocates for their residents, a state-based marketplace has the potential to play a meaningful and significant role in directing these populations to the right plan.  

But how could a state-based marketplace help enrollees shop for and transition to Medicare plan? 

One of the critical missions the “three Ms” — Medicaid, Medicare, Marketplace — are tasked with is keeping their populations’ rate of uninsured low and making sure people don’t experience gaps in coverage as they move between programs.  

If Medicare expansion is implemented, the State-Based Marketplaces (SBMs) could do their part to help the age-in population more easily transition to Medicare by providing educational resources and simply sending a series of notifications to consumers as their Medicare eligibility age approaches: six months prior, three months prior, and birthday month. This cadence of communications is in line with Medicare rules and regulations and could be fairly simple for an SBM to implement and execute.  

To take it a step further, the SBM could implement a Medicare shopping experience, giving the consumer a one stop shop. Once the consumer receives a notification, they could then come back to the Marketplace where they would: 

  • Log into their marketplace account which is personalized with their name and relevant upcoming dates. 
  • Select the Medicare tab and begin shopping for Medicare plans (or preview if they are searching before the eligibility window opens) 
  • If they need additional assistance, the consumer can easily find broker information or a call center phone number 
  • Consumers who have brokers of record and are aging in will appear on their broker’s Contacts list three months before their age-in birthday with an “Age-In” status. 
  • The consumer could then track their status through their marketplace account, making it easy for the consumer to see when their Medicare coverage becomes effective and when their marketplace plan ends 

State-Based Marketplaces have proven capable of coming up with innovative ways to match the needs of their consumers. Medicare expansion would give the states an opportunity to help guide their aging populations to enroll in the Medicare program, without coverage gaps.