Medicare and Health Insurance Marketplaces
The Health Insurance Marketplaces were created by the Affordable Care Act. The Marketplaces allow people to buy insurance if they do not have insurance or do not have enough insurance. Some states have their own Marketplaces, and other states use the federal Marketplace. Plans sold through Marketplaces are also known as Qualified Health Plans.
How does the Marketplace affect my Medicare coverage?
If you are currently enrolled in a Marketplace plan, you should most likely disenroll from it and enroll in Medicare when you are first eligible (with two exceptions, listed on the next page).
If you are eligible for Medicare, you should usually not use the Marketplace health and drug coverage. It is illegal for someone to try to sell you a Marketplace plan if they know you are eligible for or enrolled in Medicare. You do not use the Marketplace to buy Medicare plans.
How do I change from a Marketplace plan to Medicare?
If you are enrolled in a plan through the federal Marketplace, contact the Marketplace to disenroll at least 14 days before you want your coverage to end.
If you are enrolled in a plan through your state’s Marketplace, contact it directly to learn how and when to disenroll from the plan.
You want your Marketplace plan to cover you up until your Medicare starts. You should avoid any gaps in coverage, so timing is important.
Why should I switch to Medicare when I become eligible?
If you do not enroll in Medicare when you are first eligible, you may have a late enrollment penalty when you sign up later. You may also experience coverage gaps.
Marketplace plans do not work with Medicare. If you keep your Marketplace plan, it may not cover you once you are eligible for Medicare.
Once you are eligible for premium-free Medicare Part A, you will no longer be eligible to receive cost assistance for your Marketplace plan. Although you may keep your Marketplace plan after becoming eligible for Medicare, it can be very expensive without cost assistance.