Paul Sanchez
If you have Medicare, you do not need to join the Health Insurance Marketplace® as they are two separate programs. Medicare is a federal health insurance program for people 65 and older and certain younger people with disabilities. The Marketplace is for those who don't have health insurance. If you have Marketplace coverage and are eligible for Medicare, you can keep your Marketplace plan until your Medicare coverage starts, but you will have to pay full price for it. You can also keep your Marketplace plan after your Medicare coverage starts, but you won't be eligible for any premium tax credits or cost savings from your Marketplace plan. It is important to note that once you have Medicare, you cannot get a Marketplace plan as it is against the law for someone who knows you have Medicare to sell you a Marketplace plan.
| Characteristics | Values |
|---|---|
| Medicare's Open Enrollment Period | October 15–December 7 |
| Medicare coverage start date | Usually when you turn 65 |
| Medicare enrollment delay | May result in late enrollment penalties |
| Marketplace coverage | Can be kept until Medicare coverage starts |
| Medicare and Marketplace coverage | Marketplace coverage does not affect Medicare choices or benefits |
| Medicare Part A | If eligible, you should not continue with Marketplace coverage |
| Medicare Part B | Marketplace coverage is not used in place of Part B |
| Medicare Supplement Insurance | Not available through the Marketplace |
| Medicare Advantage | Not eligible for savings on Marketplace plans |
| Medicare and Marketplace coverage | Having both only applies if you had Marketplace coverage before Medicare |
| Medicare and ESRD | If you have ESRD, speak to a SHIP counsellor before deciding |
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What You'll Learn
- If you qualify for premium-free Part A, you won't get help paying your Marketplace plan premiums
- You can choose a Marketplace plan instead of Medicare if you have to pay a Part A premium
- If you have ESRD, you can get a Marketplace plan before signing up for Medicare
- Marketplace coverage doesn't end automatically when Medicare starts
- If you delay Medicare enrollment, you may face late enrollment penalties
If you qualify for premium-free Part A, you won't get help paying your Marketplace plan premiums
If you qualify for premium-free Medicare Part A, you are not eligible for cost assistance with your Marketplace plan premiums or other medical costs. This means that you will have to pay the full price for your Marketplace plan.
Medicare Part A meets the minimum essential coverage requirement, and enrolling in it means that you will not get a tax penalty. However, if you continue to receive cost assistance for your Marketplace plan premiums after becoming eligible for premium-free Part A, you may have to pay back some or all of this assistance when filing your federal income taxes.
If you are eligible for Medicare, it is generally recommended that you do not continue to use the Marketplace for health and drug coverage. This is because federal law requires you to have health insurance, and Medicare Part A meets this requirement. However, it is important to note that Medicare Part B alone is not considered minimum essential coverage, and you may face a penalty for not having adequate coverage.
If you have Marketplace coverage when you become eligible for Medicare, your Marketplace plan will not automatically end. You must end your Marketplace coverage in a timely manner to avoid an overlap or gap in coverage. You can do this by updating your Marketplace application to report your Medicare start date, which you can do up to three months in advance.
If you have End-Stage Renal Disease (ESRD) and have not signed up for Medicare, you can get a Marketplace plan. However, it is recommended that you learn about Medicare coverage for people with ESRD before making this decision.
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You can choose a Marketplace plan instead of Medicare if you have to pay a Part A premium
If you have to pay a premium for Medicare Part A, you can choose whether you want to have coverage through Medicare or the Marketplace. However, there are a few important things to consider before making this decision. Firstly, federal law requires you to have health insurance, and Medicare Part A meets the minimum essential coverage requirement. This means that enrolling in Part A will ensure you are compliant with the law and avoid any tax penalties. On the other hand, if you choose to keep your Marketplace plan, you will need to carefully consider the costs and coverage offered. You will no longer qualify for cost assistance with your Marketplace plan premiums or other medical costs, and you may have to pay back some or all of the assistance you received when filing your federal income taxes.
Additionally, timing is crucial when transitioning from a Marketplace plan to Medicare. You should aim to avoid any gaps in coverage, so it is recommended to keep your Marketplace plan until your Medicare coverage starts. Once you are eligible for Medicare, you should update your Marketplace application to end your Marketplace coverage. You can report a Medicare start date on your application up to three months before it starts, and your Marketplace coverage will end the day before Medicare coverage begins.
If you decide to delay Medicare enrollment to keep your Marketplace plan, be aware that you may have to wait until the General Enrollment Period (GEP) to sign up for Medicare, which runs from January 1 to March 31 each year. You might also incur monthly late enrollment penalties. However, if you cannot afford the monthly Medicare premiums, there are programs available to help lower the costs.
When making your decision, carefully consider the coverage and costs of both options and how they meet your specific needs and budget. If you have End-Stage Renal Disease (ESRD), it is best to speak with a State Health Insurance Assistance Program (SHIP) counselor about the outcomes of your decision.
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If you have ESRD, you can get a Marketplace plan before signing up for Medicare
If you have End-Stage Renal Disease (ESRD), you can choose to get a Marketplace plan before signing up for Medicare. ESRD is permanent kidney failure requiring dialysis or a transplant. Eligibility for Medicare coverage based on ESRD is different from other types of Medicare eligibility. If you're eligible for Medicare based on ESRD and don't sign up right away, your coverage could start up to 12 months before the month you apply. For example, if you become eligible for Medicare based on ESRD in February but don't sign up until November, your Medicare coverage will start in February.
If you have ESRD and are considering whether to enrol in Medicare, it is recommended that you speak with a State Health Insurance Assistance Program (SHIP) counsellor about the outcomes of your decision. You can choose to keep your Marketplace plan with cost assistance as long as you do not enrol in Medicare. However, you should carefully consider all the consequences of choosing a Marketplace plan instead of Medicare. If you decide to enrol in Medicare later, you will have to wait for the General Enrollment Period (GEP), which runs from January 1 to March 31 each year, and your Medicare benefits will start on July 1.
If you have ESRD, you can choose between Original Medicare and a Medicare Advantage Plan for your coverage. People with ESRD who already have Medicare due to age or disability and are paying a Part B late enrolment penalty will need to sign up for Medicare again to stop paying the penalty. Contact your local Social Security office or call Social Security at 1-800-772-1213 to sign up. TTY users can call 1-800-325-0778.
Once you become eligible for Medicare based on ESRD, you can join a Medicare drug plan during the seven-month period that begins three months before the month you're eligible for Medicare and ends three months after the first month of eligibility. Your prescription drug coverage will start at the same time as your Medicare coverage or the first month after you make your request, whichever is later.
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Marketplace coverage doesn't end automatically when Medicare starts
If you have Medicare coverage, you don't need to do anything with your Marketplace plan, as Medicare isn't part of the Health Insurance Marketplace. However, if you have Medicare Part A (Hospital Insurance) or Medicare Advantage (Part C), you should end your Marketplace coverage.
If you don't end your Marketplace coverage and you qualified for the premium tax credit, you may have to pay back some or all of the premium tax credit when you file your federal taxes. If you keep your Marketplace coverage, you'll pay full price for it.
If you have End-Stage Renal Disease (ESRD) and haven't signed up for Medicare, you can get a Marketplace plan. However, you should carefully consider the outcomes of your decision and speak with a State Health Insurance Assistance Program (SHIP) counsellor.
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If you delay Medicare enrollment, you may face late enrollment penalties
If you're eligible for Medicare, you should not continue to use the Marketplace to get health and drug coverage. Medicare Part A meets the minimum essential coverage requirement, which means you will not get a tax penalty if you are enrolled in Part A. However, Medicare Part B alone is not minimum essential coverage (MEC), and you would likely get a penalty for not having minimum essential coverage.
Your first chance to sign up for Medicare (called your "Initial Enrollment Period") is usually when you turn 65. You can choose Marketplace coverage instead of Medicare if you have to pay a Part A premium. However, if you keep getting help to pay your Marketplace plan premiums, you may have to pay back some or all of the help you got when you file your federal income taxes.
If you don't sign up for Medicare when you're first eligible, you might have to pay monthly late enrollment penalties. The penalty is 10% of the cost of your monthly premium. You'll pay this extra cost every month for twice the number of years you were eligible for Medicare Part A but didn't sign up. For example, if you waited 2 full years (24 months) to sign up for Part B and didn't qualify for a Special Enrollment Period, you'll have to pay a 20% late enrollment penalty (10% for each full 12-month period that you could have signed up), plus the standard Part B monthly premium.
You may qualify for a Special Enrollment Period if you experience certain life events, such as a move or loss of other health coverage. Generally, you won't have to pay a Part B penalty if you qualify for a Special Enrollment Period. You also won't have to pay a Part D penalty if you have creditable drug coverage (coverage that's similar in value to Part D).
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Frequently asked questions
The Health Insurance Marketplace® is for people who don’t have health insurance. It is not part of Medicare and does not affect your Medicare choices or benefits.
You can keep your Marketplace plan until your Medicare coverage starts, and if you want, you can keep it afterward. However, if you decide to have both your Marketplace plan and Medicare coverage, you won't be eligible for any premium tax credits or cost savings you previously got from your Marketplace plan.
Marketplace coverage doesn't end automatically when Medicare starts. You need to update your Marketplace application to end Marketplace coverage. You can report a Medicare start date on your application up to 3 months before it starts.
No, it is against the law for someone who knows you have Medicare to sell you a Marketplace plan. This is true even if you only have Medicare Part A or Part B.
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