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Medicare and the Marketplace


Are you currently enrolled in a plan through the Health Insurance Marketplace and 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 unwanted costs along the way.

Are Obamacare and Medicare the Same

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 for individuals, families, and small businesses who otherwise lack health coverage. People that 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 aged 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

Those with Medicare coverage aren’t affected by the Health Insurance Marketplace. 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 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. 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.

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.

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

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 get help with making Medicare more affordable for me?
There are various Medicare Savings Programs available that help eligible recipients with premiums, deductibles, and coinsurance costs.
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.

How to Get Help Moving 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 cost 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.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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