Medicare & the Marketplace

If you qualify for Medicare, in some cases you can’t enroll in a Marketplace plan, and in other cases the cost of a Marketplace plan may be higher.

Get information about your options based on your situation:

• You already have Medicare

  • You have original Medicare Part A (Medical Insurance) and Part B (Hospital Insurance); a Medicare Advantage Plan (like a PPO or HMO, known as Part C); or another Medicare health plan
  • You have ONLY Part A
  • You have ONLY Part B
  • You pay a premium for Part A
  • One spouse has Medicare and the other doesn’t

• You’re about to be eligible for Medicare

  • You want to enroll in Medicare
  • You want to enroll in a Marketplace plan instead
  • You want to end your Marketplace plan when Medicare starts (for one spouse or both)
  • You want to keep your Marketplace plan after Medicare coverage starts

• You’re already eligible for Medicare but haven’t enrolled

  • You want to enroll in Medicare
  • You want to enroll in a Marketplace plan instead

• You’re 65 or older but not eligible for Medicare

  • You want to enroll in a Marketplace plan

You already have Medicare

You have original Medicare Part A (Medical Insurance), and Part B (Hospital Insurance); a Medicare Advantage Plan (like an HMO or PPO, known as Part C); or another Medicare health plan

• You can’t enroll in a Marketplace plan. (It’s against the law for anyone to sell one to you.)
• You can’t drop Medicare and enroll in a Marketplace plan without paying significant penalties (including losing retiree or disability Social Security/Railroad Retirement benefits, and having to pay back any Social Security/Railroad Retirement benefits and Medicare claims payments you’ve received). See the exception if you’re paying a premium for Part A coverage.

What to do: Continue your Marketplace application for anyone in your household who needs Marketplace coverage and tell us you have Medicare coverage when we ask.

You have ONLY Part A

• You can’t enroll in a Marketplace plan to supplement Part A. (It’s illegal for anyone to sell you a Marketplace plan).
• You can’t drop Part A and enroll in a Marketplace plan without significant penalties (including losing retiree or disability Social Security/Railroad Retirement benefits, and having to pay back any Social Security/Railroad Retirement benefits and Medicare claims payments you’ve received). See the exception if you’re paying a premium for Part A.

What to do: Continue your Marketplace application for anyone in your household who needs Marketplace coverage and tell us you have Medicare coverage when we ask.

You have ONLY Part B

• For plan years through 2018, you’re not considered to have qualifying health coverage under the health care law. You may have to pay a penalty for not being covered. Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies.
• You can’t enroll in a Marketplace plan to supplement your Part B. (It’s illegal for anyone to enroll you in a Marketplace plan).
• You can end your Part B and enroll in a Marketplace plan during the yearly Marketplace Open Enrollment Period instead.

What to do: Continue your Marketplace application for anyone in your household who needs Marketplace coverage. Tell us you have Medicare coverage when we ask, unless you’re dropping Medicare Part B to enroll in a Marketplace plan instead.

You pay a premium for Part A

• You can drop your Part A coverage (and Part B, if you have it) and enroll in a Marketplace plan instead – and be eligible for income-based savings.
• The same applies if you have a Medicare Advantage Plan (Part C) and pay a premium for Part A.

What to do: Continue your Marketplace application for yourself if you pay a premium for Part A and want a Marketplace plan instead, and for any others in your household who need Marketplace coverage.

One spouse has Medicare and the other doesn’t

What to do: Continue your Marketplace application to enroll the spouse without Medicare (and any household members who need coverage) in a Marketplace plan.

• Include in your household both spouses and all dependents, and include both spouses’ income. (Marketplace savings are based on income for the household, not just those who need coverage.)
• Be sure to state that the spouse with Medicare doesn’t need Marketplace coverage.
• The spouse with Medicare can’t drop it to get a Marketplace plan, except as described in the sections above.

You’re about to be eligible for Medicare

You want to enroll in Medicare

• If you’re getting Social Security retirement or disability benefits, you’ll usually be automatically enrolled in Medicare once you’re eligible.
• In other cases, you may need to take action to enroll in Medicare.
• Don’t enroll in Marketplace coverage, unless you want coverage only until your Medicare starts.

What to do: Continue your Marketplace application for anyone in your household who needs Marketplace coverage, including yourself if you need coverage before your Medicare starts. Learn more about enrolling in Medicare at Medicare.gov.

You want to enroll in a Marketplace plan instead

• If you’re not enrolled in Medicare yet, you can choose Marketplace coverage instead. But you won’t be eligible for savings on a Marketplace plan based on your income. You’d have to pay full price for the Marketplace plan. See the exception if you’ll pay a premium for Part A coverage.
• Before choosing Marketplace coverage over Medicare, also consider:
  • If you enroll in Medicare later, after your Initial Enrollment Period (3 months before your 65th birthday month, your birthday month, and the 3 months after your birthday), you may have to pay a late enrollment penalty for as long as you have Medicare.
  • Generally, you can enroll in Medicare only during the Medicare General Enrollment Period (from January 1 – March 31). Your coverage won’t begin until July 1 of that year.

What to do: Continue your Marketplace application for yourself and anyone else in the household who needs Marketplace coverage. To learn more about your options, visit Medicare.gov.

You want to end a Marketplace plan when Medicare starts (for one spouse or both)

If you and/or your spouse have coverage through a Marketplace plan and are about to become eligible for Medicare, you should end your Marketplace coverage and enroll in Medicare during your Initial Enrollment Period. This avoids a delay in Medicare coverage and possibly a Medicare late enrollment penalty.

What to do: Follow both steps below.

TO END YOUR MARKETPLACE COVERAGE

Once you know your Medicare start date, you’ll need to take 2 steps:

1. Report your new Medicare coverage to the Marketplace.
2. Cancel your Marketplace plan.

These are separate processes and you need to do both. You can do them online or by phone.

Take these actions at least 15 days before the date you want your Marketplace coverage to end.

Step 1: Report your Medicare coverage to the Marketplace

• Log in to HealthCare.gov.
• Select “Continue.”
• Click on your name in the top right of the screen and select “My Applications & Coverage.”
• Select your application under “Your Existing Applications.”
• Select “Report A Life Change” from the left-hand side.
• Select the “Report A Life Change” button at the bottom of the page.
• Select the button that says “Report A Change In My Household’s Income, Size, Or Other Information,” then click “Continue.” You’ll be taken to your current application.
• As you move through the pages of your application, you’ll come to the questions about health coverage.
• When asked if you have other health coverage, select “Medicare,” even if it hasn’t started yet.
• Continue through the rest of your application, and submit it.

If other people are on your Marketplace application, you may continue Marketplace coverage for them. Their options and savings may change.

Step 2. Cancel your Marketplace plan:

It’s important to also cancel your Marketplace plan, which is a separate process.

Visit this cancellation page and under “Choose the reason you’re ending health coverage,” select “You become eligible for Medicare.”

You want to keep your Marketplace plan after Medicare coverage starts

You can continue to stay enrolled in your Marketplace plan. But there are important things to consider:

• You’ll lose any premium tax credit and other savings you get for your Marketplace plan. You’ll have to pay full price for the Marketplace plan. This is true even if you have only Part A or Part B.
• If you want additional coverage to supplement your Medicare coverage, many Medicare Supplement Insurance (Medigap) plans provide affordable options. Learn about supplement plans at Medicare.gov.

What to do: Continue your Marketplace application for yourself and anyone else in your household who needs Marketplace coverage.

You're already eligible for Medicare but haven't enrolled

You want to enroll in Medicare

What to do: Learn about enrolling in Medicare, visit Medicare.gov.

You want to enroll in a Marketplace plan

• You may want to do this in certain cases, like if you’d have to pay a Medicare premium, or if you’re not collecting Social Security benefits.
• If you choose a Marketplace plan instead of Medicare, you won’t be eligible for savings on a Marketplace plan based on your income. You’d have to pay full price. See the exception if you’re paying a premium for Part A.
• Before choosing Marketplace coverage over Medicare, also consider:
  • If you enroll in Medicare after your Initial Enrollment Period (3 months before your 65th birthday month, your birthday month, and the 3 months after your birthday), you may have to pay a late enrollment penalty for as long as you have Medicare.
  • Generally, you can enroll in Medicare only during the Medicare General Enrollment Period (from January 1 – March 31). Your coverage won’t begin until July 1 of that year.

What to do: First, learn about Medicare benefits and the advantages of enrolling when you’re first eligible. If you want to enroll in a Marketplace plan instead, continue with your Marketplace application for yourself and anyone else in the household who needs Marketplace coverage.

You’re 65 or older but not eligible for Medicare

You want to enroll in a Marketplace plan

If you don’t qualify for Medicare at all (due to immigration status or another reason), you may have options in the Marketplace.

• You can apply for insurance in the Marketplace and may be eligible for lower costs on monthly premiums and out-of-pocket costs based in your income. You could also be eligible for Medicaid coverage.
• If you don’t have health coverage, you may have to pay a penalty.

What to do: Continue your Marketplace application for yourself and anyone else in the household who needs Marketplace coverage.