If You Have Medicare

If you already have Medicare, you don't need to take any action regarding the Health Insurance Marketplace®. Your Medicare coverage remains unchanged, and the Marketplace won't affect your Medicare options or benefits. Whether you have Original Medicare or a Medicare Advantage Plan (such as an HMO or PPO), you don’t need to make any changes.

Important Notice:

• The Marketplace does not offer Medicare supplement (Medigap) insurance or Medicare Part D drug plans.

Expanded Medicare Benefits: Medicare benefits have been enhanced under the health care law, including free preventive services, cancer screenings, and an annual wellness visit. Additionally, if you're in the prescription drug "donut hole," you can save on brand-name medications with available discounts.

Additional Medicare Information:

• Medicare’s Annual Open Enrollment Period: This period (October 15 - December 7) remains unchanged. It’s an opportunity to review and change your Medicare coverage if needed.
• More Details About Medicare Coverage: Learn about your Medicare coverage options and any changes that may affect you.

Frequently Asked Questions:

• What if I’m retired but don’t have Medicare? If you’re retired and not yet enrolled in Medicare, you may be eligible for a Marketplace plan until your Medicare coverage begins.

• Can I choose a Marketplace plan instead of Medicare? Generally, no. It’s illegal for someone who knows you have Medicare to sell you a Marketplace plan. However, there are exceptions:

  • If you’re paying a premium for Medicare Part A, you can drop Part A and Part B and opt for a Marketplace plan.
  • If you're eligible for Medicare but haven't signed up due to reasons such as having to pay for Part A or having a medical condition like End-Stage Renal Disease (ESRD), you may choose a Marketplace plan instead.

  Important Considerations:

  • If you delay enrolling in Medicare after becoming eligible, you may face a waiting period and possibly months without coverage. Additionally, you may incur a late enrollment penalty that increases your monthly premium the longer you wait to sign up.
  • If you’re concerned about the cost of Medicare premiums, there are programs available to help lower these costs.

• Can I get a Marketplace plan in addition to Medicare? No, it’s illegal for someone who knows you have Medicare to sell or issue you a Marketplace plan. However, if you're looking for additional coverage to help with out-of-pocket costs, you can consider purchasing a Medigap policy or adding Medicare Part D for prescription drugs. Alternatively, you can explore Medicare Advantage Plans that bundle Part A, Part B, and usually Part D, and may offer additional benefits like vision, hearing, and dental coverage.

• What if I turn 65 in the middle of the year? You can use a Marketplace plan to cover you until your Medicare coverage starts. Once your Medicare coverage begins, you can cancel your Marketplace plan.

• Can I get a stand-alone dental plan through the Marketplace if I have Medicare? In most cases, no. If your state’s Marketplace is run by the federal government, you can only purchase a stand-alone dental plan if you're also buying a health plan. However, if your state runs its own Marketplace, you may be able to buy a stand-alone dental plan separately. Check with your state’s Marketplace for details.

• Is prescription drug coverage through the Marketplace considered "creditable drug coverage" for Medicare Part D? Prescription drug coverage in Marketplace or SHOP plans may not offer the same value as Medicare Part D coverage. However, all private plans offering prescription drug coverage must inform you annually in writing whether their coverage is creditable.

• Can I delay signing up for Medicare Part B if I’m getting health coverage from an employer through the SHOP Marketplace? Yes, you can delay enrolling in Part B if you're covered through the SHOP Marketplace based on your or your spouse’s current job. You’ll have a Special Enrollment Period to sign up for Part B without penalty when your job-based coverage ends. If you miss this Special Enrollment Period, you may have to wait to sign up, which could result in a gap in coverage and a monthly late enrollment penalty.

• Can I get health coverage from an employer through the SHOP Marketplace if I have Medicare? Yes, you can get coverage through the SHOP Marketplace just like any job-based health plan. Medicare Secondary Payer rules will apply in these situations.

Learn more about how Medicare works with other types of insurance to ensure you’re making the best choices for your health coverage needs.

Transitioning from the Marketplace to Medicare

If you have a Marketplace plan, you can keep it until your Medicare coverage begins. However, it's essential to know how and when to end your Marketplace plan to avoid complications.

You have the option to keep both your Marketplace plan and Medicare. But be aware, once your Medicare Part A (Hospital Insurance) coverage starts, you will no longer be eligible for premium tax credits or other cost-saving benefits through the Marketplace. This means you'll have to pay the full price for your Marketplace plan.

If you're concerned about affording Medicare premiums, there are programs designed to help reduce these costs. Learn more about Medicare cost-saving programs.

Medicare also offers additional options to help cover out-of-pocket expenses, including prescription drug coverage and extra benefits like vision, hearing, dental, and more. Explore your Medicare coverage options to find what works best for you.

When to Sign Up for Medicare

You become eligible to sign up for Medicare three months before you turn 65. In certain cases, you may qualify for Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also known as Lou Gehrig’s disease).

Your first opportunity to enroll is during the Initial Enrollment Period, which spans seven months: starting three months before the month you turn 65 and ending three months after.

Important: Avoiding Penalties

Missing your seven-month Initial Enrollment Period could result in a monthly late enrollment penalty for Medicare Part B (Medical Insurance) that lasts as long as you have coverage. The penalty increases the longer you wait. Additionally, if you need to pay a Part A premium (Premium-Part A), you could face a similar penalty. Be sure to find out when and how to sign up based on your specific situation to avoid these penalties.

Canceling Your Marketplace Plan When Eligible for Medicare

In most cases, when you become eligible for Medicare, you'll want to cancel your Marketplace plan. If there are others on your Marketplace plan, you can choose to end just your coverage while keeping theirs active.

Notice: Important

Do not end your Marketplace plan until you know exactly when your Medicare coverage starts. Once you cancel your Marketplace plan, you won't be able to re-enroll until the next Open Enrollment Period unless you qualify for a Special Enrollment Period.