Medicare and the Marketplace
If you have Medicare
Medicare isnât part of the Health Insurance MarketplaceÂź, so if you have Medicare coverage now you donât need to do anything.
The Marketplace wonât affect your Medicare choices or benefits. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO), you wonât have to make any changes.
Medicare includes benefits for preventive care, drug coverage
- Medicare coverage includes benefits like free preventive benefits, cancer screenings, an annual wellness visit, and more.
- Medicare plans include a $2,000 cap on what you pay out-of-pocket for Part D drugs covered by your plan.
More Medicare details
- Medicareâs annual Open Enrollment Period is October 15 â December 7.
- Learn more about your Medicare coverage and choices.
More answers: If you have Medicare
Generally, no. Itâs against the law for someone who knows you have Medicare to sell you a Marketplace plan.
But there are a few situations where you can choose a Marketplace private health plan instead of Medicare:
If youâre paying a premium for Part A (Hospital Insurance). In this case you can drop Part A and Part B (Medical Insurance) and get a Marketplace plan instead.
If youâre eligible for Medicare but havenât signed up. This could be because:
- Youâd have to pay a premium for Part A.
- You have a medical condition that qualifies you for Medicare, like End-Stage Renal Disease (ESRD), but havenât signed up for Medicare coverage.
- Youâre not collecting Social Security retirement or disability benefits before youâre eligible for Medicare.
If youâre getting Social Security retirement or disability benefits before youâre eligible for Medicare, youâll automatically get Medicare when you're eligible.
Before choosing a Marketplace plan over Medicare, there are 2 important points to consider:
- If you want to sign up for Medicare after you're first eligible, you may have to wait until the General Enrollment Period (January 1 â March 31 each year) to sign up. If you miss this enrollment period, you may have to wait until Open Enrollment (October 15 â December 7) to sign up.
- In most cases, you'll also have to pay monthly late enrollment penalties for Part B and Part D. The penalties are added to your monthly premiums and go up the longer you wait.
If you can't afford the monthly premiums, there are programs to help lower the costs. Learn about Medicare cost saving programs.
No. Itâs against the law for someone who knows that you have Medicare to sell or issue you a Marketplace policy. This is true even if you have only Medicare Part A or only Part B.
If you want coverage that helps pay your out-of-pocket costs in Medicare Part A and Part B, you can buy a Medigap policy. You can also add Medicare drug coverage (Part D). Or you can join a Medicare Advantage Plan to get some extra benefits, like vision, hearing, dental, and more. These âbundledâ plans include Part A, Part B, and usually Part D.
Yes. You can get a Marketplace plan to cover you before your Medicare begins.
Marketplace coverage doesnât end automatically when Medicare starts. Update your Marketplace application to end Marketplace coverage for those starting Medicare. You can report a Medicare start date on your application up to 3 months before Medicare starts. After you submit your application update, make sure you confirm the plan for others in your household who need to keep their Marketplace coverage.
In most cases, no. If the Marketplace in your state is run by the federal government, you wonât be able to buy a stand-alone dental plan unless youâre also buying a health plan. If your state is running its own Marketplace, you may be able to buy a stand-alone dental plan. Find out if your state runs its own Marketplace.
While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP health plan doesn't have to provide the same value (creditable coverage) as Medicare Part D coverage.
But all private plans offering prescription drug coverage, including Marketplace and SHOP plans, must tell you in writing if their prescription drug coverage is creditable each year.
Yes. You can delay Part B enrollment if youâre getting health coverage through the SHOP Marketplace based on your or your spouseâs job.
You have a Special Enrollment Period to sign up for Part B without penalty:
- Any time youâre still covered by the job-based health plan based on your or your spouseâs current employment
- During the 8-month period that begins the month after the job or the coverage ends, whichever happens first
Yes. Coverage from an employer through the SHOP Marketplace is treated the same as coverage from any job-based health plan. If youâre getting health coverage from an employer through the SHOP Marketplace based on your or your spouseâs current job, Medicare Secondary Payer rules apply.