Navigating health insurance choices can be complex, especially when considering Medicare and the Health Insurance Marketplace (Marketplace). While the Marketplace is generally for those without health insurance or who don’t qualify for Medicare, specific situations might allow you to choose Marketplace coverage over Medicare.
This article aims to clarify common questions regarding Medicare and the Marketplace to help you make informed decisions.
Who Qualifies for Medicare?
Typically, Medicare is available to individuals aged 65 and older. However, you may also be eligible if you have a qualifying disability, end-stage renal disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Can You Have Both a Marketplace Plan and Medicare?
No. It is against the law for anyone to knowingly sell you a Marketplace plan if you already have Medicare. If you wish to supplement Original Medicare (Part A and Part B) coverage, you have options like purchasing a Medicare Supplement Insurance policy (Medigap) or choosing a Medicare Advantage Plan, which may offer additional benefits.
Can You Choose Marketplace Coverage Instead of Medicare?
Generally, no. However, there are two key exceptions:
- If you would be required to pay a premium for Medicare Part A.
- If you are not yet collecting Social Security benefits when you become eligible for Medicare.
Before making any such choice, it’s crucial to compare plans carefully to determine which best fits your needs and budget, as trade-offs may exist.
What Happens if You Don’t Enroll in Medicare When First Eligible?
If you become eligible for Medicare but do not enroll immediately, you could face two significant consequences:
- Enrollment Delays: You may have to wait until the general enrollment period (January 1 through March 31) to sign up, with coverage not beginning until the first day of the month after you enroll.
- Late Enrollment Penalties: You might incur permanent monthly late enrollment penalties, increasing your premiums for as long as you have Medicare.
What if Medicare Costs Are Unaffordable?
If you struggle to afford your monthly Medicare premiums or other associated costs, state-level Medical Assistance (Medicaid) programs may offer financial assistance to help lower your expenses. Contact your state Medicaid office for more information on available resources.
What if You Have a Marketplace Plan and Become Medicare Eligible?
If you currently have a Marketplace plan, you should enroll in Medicare during your initial enrollment period. This helps you avoid future penalties and coverage gaps. To ensure seamless coverage, it’s advised to terminate your Marketplace plan once you know the start date of your Medicare coverage.
What if You Enroll in Medicare But Share a Marketplace Plan?
If you enroll in Medicare, your Marketplace plan will not automatically re-enroll you or continue coverage for others on the same plan. The Marketplace will typically send a letter explaining how other household members can enroll in new Marketplace coverage to maintain their insurance.