Skip to Content

Blog

What are the Health Insurance Marketplaces?

The Health Insurance Marketplaces were created by the Affordable Care Act, also known as the ACA. The Marketplaces allow people to buy insurance if they do not have insurance or if they need more insurance. You can access the Marketplace online or over the phone. Some states have their own Marketplaces, and other states use the federal Marketplace to provide coverage. Plans sold through Marketplaces are also known as Qualified Health Plans, or QHPs. Many people who have a Marketplace plan get cost assistance in the form of tax credits, which lower the plan’s monthly premium.

So, how does the Marketplace affect your Medicare coverage?

If you are eligible for Medicare, you should not use the Marketplace to get health and drug coverage. However, there are two exceptions:

  • First, if you are eligible for Medicare because you have End-Stage Renal Disease (or in other words, you have kidney disease that requires dialysis or transplant).

  •  Second, if you must pay a premium for Medicare Part A.

If one of these exceptions applies to you, you can choose to enroll in a Marketplace plan instead of Medicare. You should consider all consequences carefully before deciding to take a Marketplace plan instead of Medicare. For example, you might have a gap in Medicare coverage or a late enrollment penalty if you do not enroll when first eligible. It is helpful to discuss your options with a State Health Insurance Assistance Program (SHIP) counselor. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.  

You do not buy a Medicare Advantage Plan, Part D prescription drug plan, or Medigaps through the Marketplace. It is illegal for someone to sell you a Marketplace plan if they know you are eligible for or are enrolled in Medicare. If someone tries to sell you a Marketplace plan, let them know that you have Medicare and cannot enroll in a Marketplace plan.

How do you switch from a Marketplace plan to Medicare?

If you are currently enrolled in a Marketplace plan, you should most likely drop the Marketplace plan and enroll in Medicare when you are first eligible. There are a few reasons why:  

  • First, 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 gaps in health insurance coverage.  

  •  Second, Marketplace plans do not work with Medicare. If you keep your Marketplace plan, it may not cover you once you are eligible for Medicare.   

And third, 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.  

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 the state Marketplace to learn how and when to disenroll from the plan. Keep in mind that you want your Marketplace plan to cover you up until your Medicare starts. You do not want any gaps in coverage, so timing is important.  

Still have questions?

Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

What are the Health Insurance Marketplaces?

The Health Insurance Marketplaces were created by the Affordable Care Act, also known as the ACA. The Marketplaces allow people to buy insurance if they do not have insurance or if they need more insurance. You can access the Marketplace online or over the phone. Some states have their own Marketplaces, and other states use the federal Marketplace to provide coverage. Plans sold through Marketplaces are also known as Qualified Health Plans, or QHPs. Many people who have a Marketplace plan get cost assistance in the form of tax credits, which lower the plan’s monthly premium.

So, how does the Marketplace affect your Medicare coverage?

If you are eligible for Medicare, you should not use the Marketplace to get health and drug coverage. However, there are two exceptions:

  • First, if you are eligible for Medicare because you have End-Stage Renal Disease (or in other words, you have kidney disease that requires dialysis or transplant).

  • Second, if you must pay a premium for Medicare Part A.

If one of these exceptions applies to you, you can choose to enroll in a Marketplace plan instead of Medicare. You should consider all consequences carefully before deciding to take a Marketplace plan instead of Medicare. For example, you might have a gap in Medicare coverage or a late enrollment penalty if you do not enroll when first eligible. It is helpful to discuss your options with a State Health Insurance Assistance Program (SHIP) counselor. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.  

You do not buy a Medicare Advantage Plan, Part D prescription drug plan, or Medigaps through the Marketplace. It is illegal for someone to sell you a Marketplace plan if they know you are eligible for or are enrolled in Medicare. If someone tries to sell you a Marketplace plan, let them know that you have Medicare and cannot enroll in a Marketplace plan.

How do you switch from a Marketplace plan to Medicare?

If you are currently enrolled in a Marketplace plan, you should most likely drop the Marketplace plan and enroll in Medicare when you are first eligible. There are a few reasons why:  

  • First, 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 gaps in health insurance coverage.  

  • Second, Marketplace plans do not work with Medicare. If you keep your Marketplace plan, it may not cover you once you are eligible for Medicare.   

  • And third, 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.  

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 the state Marketplace to learn how and when to disenroll from the plan. Keep in mind that you want your Marketplace plan to cover you up until your Medicare starts. You do not want any gaps in coverage, so timing is important.  

Still have questions?

Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Supplemental Handout