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Frequently Asked Questions Insurance

I am a Member of Congress or designated congressional employee aged 65 or older and enrolled in Medicare. According to the Affordable Care Act, as of January 2014, if I wish to enroll in employer-sponsored health insurance with a Government contribution, I will be required to purchase health insurance on the health care exchange. The Marketplace website states that "it is against the law for someone who knows that I have Medicare to sell me a Marketplace plan policy." How is this to be handled by those of us 65 and over?

If you have been designated by the Member for whom you work, you will be required to purchase a health benefits plan through the DC Small Business Health Options Program (SHOP) in order to receive a Government contribution towards your premium. SHOP coverage is not subject to the same limitation as the individual Exchange which precludes an individual from carrying both Medicare and an individual Exchange policy. You can continue to have Medicare coverage in addition to your employer-sponsored DC SHOP plan. The DC SHOP plan will be your primary coverage and Medicare will be secondary.  Please note that if you elect to not enroll through the DC SHOP, you may not be eligible to carry OPM-contracted FEHB coverage into retirement with a Government contribution.

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