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Medicare and the Marketplace


Do you currently have coverage through the Health Insurance Marketplace but you’re soon-to-be Medicare-eligible? You probably have questions about the future of your coverage. We’re here to help you navigate this change in your health care needs and avoid superfluous costs along the way.

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Are Obamacare and Medicare the Same?

Obamacare and Medicare are two different entities. The Affordable Care Act or Obamacare mandates the availability of a marketplace for the buying of health insurance in each state. Through this marketplace, health plans are available to individuals, families, and small businesses who otherwise lack health care coverage.

Currently, an estimated 12 million people have insurance through the Marketplace. Within those insured, nearly 3.4 million people (ages 55 to 64) are nearing the Medicare eligibility age.

People who need to buy coverage through the Health Insurance Marketplace should visit HealthCare.gov.

Now, Medicare is a federal health care program in the U.S. for those age 65 and over. It also covers disabled individuals under 65 receiving SSDI benefits for 24 months or more and those diagnosed with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease.

How Does the Affordable Care Act Affect Medicare?

The Health Insurance Marketplace doesn’t affect those with Medicare coverage. If you’re currently on a plan through the Marketplace but are aging in or are becoming eligible due to a disability, we’re here to help. You can keep your plan through the Marketplace until the start of your Medicare.

Which Medicare Programs are Covered by ACA Section 1557?

Section 1557 of The Affordable Care Act is the provision that prohibits discrimination in HHS-funded health care. It applies to hospitals accepting Medicare, Medicaid, and the Indian Health Service. This provision outlaws discrimination based on age, sex, race, color, national origin, or disability.

Can I Choose Marketplace Insurance Instead of Medicare?

Choosing Marketplace coverage instead of Medicare can be a costly decision. Once you’re enrolled in Part A, you won’t be eligible for any of the savings you once got for your Marketplace plan. This means you’ll have to pay the full price. Also, if you delay enrollment in Part B, you’ll have to pay a lifelong penalty. 

How Do I Switch from Obamacare to Medicare?

Use your Initial Enrollment Period to enroll in Original Medicare. When aging in, this seven-month period starts three months before the month of your 65th birthday and ends three months after. It’s beneficial to use this enrollment period to avoid penalties for delaying Parts A and B

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You can keep your Marketplace, or Obamacare, plan until your Medicare coverage begins. If you’ve worked a minimum of 40 quarters, you get Part A premium-free, so there’s no need to delay enrollment.

Your eligibility for premium tax credits and other savings ends when your Part A begins. This means that you’d be paying full price for your Marketplace plan, so it’s beneficial to entirely switch to Medicare. Be sure you know when your coverage starts before ending your Marketplace plan.

Medicare will provide the coverage for which you now use your Marketplace plan. You can also buy Part D and a Medigap plan

Can I have Medicare and Marketplace Coverage at the Same Time?

You’re able to keep your Marketplace plan after becoming eligible for Medicare. But it’s against the law for someone to knowingly sell a Marketplace policy to someone eligible for premium-free Part A. Be aware of this, especially during the fall Open Enrollment Period each year.

Also, if you have Marketplace coverage and a federal employee tells you that you don’t need to enroll in Medicare when you’re eligible you may qualify for equitable relief. Americans receiving Social Security payments ahead of retirement will be automatically enrolled in Medicare. Therefore, it’s up to them to drop their coverage through Marketplace.    

Is Drug Coverage Through the Marketplace Creditable Coverage for Medicare?

Prescription drug coverage through the Marketplace isn’t required to meet the standards of Part D. Your plan will let you know whether your coverage will be creditable in writing each year. If you need financial assistance with your drug plan, check eligibility for the Extra Help program.

If you already qualify for specific Medicare Savings Programs, you’re automatically eligible for Extra Help.

Is Marketplace Coverage Creditable for Parts A and B?

Marketplace coverage isn’t creditable coverage for Parts A and B because it’s not required to be as good as Original Medicare. This means that you’ll need to pay penalties after the first 12 months if you delay coverage. So it’s best to sign up during your Initial Enrollment Period or the General Enrollment Period if you miss your Initial Enrollment Period.

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Will I Lose My Marketplace Subsidy When I Become Eligible for Medicare?

You’ll no longer be eligible for premium subsidies once you’re eligible for premium-free Part A – meaning when you’ve paid the tax for 40 quarters. This won’t end your Marketplace plan; you’ll need to terminate it. And, you’ll pay full price if you don’t.

What happens When a Native American Has Marketplace Insurance and Becomes Eligible for Medicare?

If you have access to the Indian Health Service, it acts as a last resort and pays after all other contributions. IHS is not health insurance. If you’re a Native American or Alaska Native with a Marketplace plan and become eligible for Medicare, you should drop your Marketplace plan and sign up for Medicare.

For the most comprehensive coverage, you should pair Native American Health Insurance with Medicare. The only exception would be if you haven’t worked enough quarters and don’t get Part A premium-free.

FAQs

Is Medicare considered Marketplace insurance?
No, Medicare isn’t affiliated with, nor are Medicare plans available through, the ACA Marketplace.
If one spouse is eligible for Medicare, can the other remain on Obamacare?
If you’re eligible for Medicare and your spouse is not, or vice-versa, the other spouse can remain on Obamacare. You’ll have to end Obamacare coverage for one person, but coverage can continue for the other people in the household.
Can I enroll through the Marketplace to supplement my Medicare insurance?
No, you can’t use the Marketplace to buy supplemental coverage for your Medicare. But, you can buy a Medigap policy for extra coverage.
What changes did the Affordable Care Act make to Medicare?
The ACA helped decrease spending for prescription drugs, which ultimately closed the “doughnut hole” for Medicare Part D. It also helped boost Part B and Part D premium payments for beneficiaries with higher incomes.
How is Obamacare different from Medicare?
Medicare is a federal program, which receives funds from the government. The Affordable Care Act is a set of laws that govern the U.S health care industry. Additionally, Obamacare plans are sold through private insurance companies.
Can you keep Obamacare after age 65?
Generally, yes since Marketplace plans no longer end once you turn 65. If you make the decision to keep your Marketplace plan, your premium subsidies will end when you can enroll in Premium-free Medicare Part A.

 

How to Get Help Going from Obamacare to Medicare

We know that the process of starting Medicare after years of Marketplace coverage can be confusing. We're here to help you understand and set up your new health care. We work with top carriers and keep costs in mind at the same time. Call us at the number above or fill out our rate form. Every day, we help people find the best plans to fit their needs and budget. We look forward to doing the same for you.

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

2 thoughts on “Medicare and the Marketplace

  1. Excelent report . I would need to contact you or somebody from your team. May I have your email or phone number? Thanks a lot . Beatriz Laino

    1. Thank you, Beatriz! To get in contact with us, you can call the number located at the top of the webpage or complete this form to be connected with an agent.

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