How to Transition from Health Insurance Marketplace to Medicare at 65: A Guide

Marketplace to Medicare transition: If you are currently covered through the Health Insurance Marketplace and are about to become eligible for Medicare, you might feel a bit too much by the transition. But with a little planning and understanding, you can make the shift smoothly without gaps in coverage or facing penalties.

What is the Health Insurance Marketplace?

The Health Insurance Marketplace which is created by the Affordable Care Act (ACA), helps individuals find and purchase health insurance. It is designed for people who do not yet qualify for Medicare or other government-sponsored programs. According to Clear Match Medicare these plans are often subsidized by the government, meaning they come at a lower cost than other plans in the open market.

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Can You Have Both Medicare and Marketplace Insurance?

In most cases, no. Once you turn 65 or qualify for Medicare because of a disability, Medicare becomes your primary health insurance. You can no longer stay on your Marketplace plan and receive the same benefits. If you do, you will not be eligible for premium tax credits or subsidies, which help lower the cost of your Marketplace plan.

Since Medicare offers a more affordable coverage option, it is a better choice once you are eligible. Continuing to use a Marketplace plan after you qualify for Medicare can lead to complications, like higher out-of-pocket costs and confusion about which plan should cover you.

When Should You Enroll in Medicare?

Your Enrolment Period for Medicare begins 3 months before you turn 65, includes your birthday month, and lasts for three months after. This 7 month window is the best time to sign up for Medicare Part A (hospital insurance) and Part B (medical insurance). By enrolling during this period, you can avoid late enrolment penalties and ensure you have continuous coverage.

If you are under 65 and qualify for Medicare due to a disability, your enrollment timeline will be different based on when your eligibility begins. It is crucial to enroll on time to avoid any gaps in healthcare coverage.

Cancelling Your Marketplace Plan

After enrolling in Medicare, it is important to cancel your Marketplace plan to avoid overlapping coverage. If you keep both, Medicare will become your primary insurance, and you may end up paying higher costs for both plans.

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To cancel your Marketplace coverage, simply log into your account, select your plan, and terminate it. Make sure the end date of your Marketplace plan lines up with the start date of your Medicare plan to avoid any gaps in coverage.

More Coverage Options

While Original Medicare (Part A and Part B) covers most hospital and outpatient services, it does not cover everything. For example, Medicare does not include prescription drug coverage, dental, vision, or hearing care.

To make sure you are fully covered, you can explore additional options like Medicare Advantage plans, standalone Part D prescription drug plans, or Medigap policies. Each of these has its own benefits and costs, so it is important to consider which one fits your healthcare needs and financial situation.