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A Bridge to Health: Ensuring Seamless Transitions from Health Insurance Exchanges and Medicaid to Medicare

January 2013 | Joe Baker and Ilene Stein

As states and the federal government implement the Affordable Care Act of 2010 (ACA),including expanding the Medicaid program and offering new qualified health plans through exchanges, they must develop a thoughtful and comprehensive plan to ensure that newly insured individuals have seamless health coverage as they transition to Medicare. Without such a plan, these consumers could face gaps in coverage, avoidable out-of-pocket health care costs, unnecessary premiums or premium penalties for late enrollment in Medicare. This could lead to interruptions in health care and strains on individual and family financial resources, especially for those with lower or middle incomes. Medicaid consumers face particular hurdles as they will need a re-determination of their Medicaid eligibility and assistance enrolling in other subsidy programs as they enroll in Medicare. Fortunately, there are steps states and the federal government can take to mitigate potential transition problems.