Medicare and the Marketplace
If you have Medicare
Medicare isn’t part of the Health Insurance Marketplace®, so if you have Medicare coverage now you don’t need to do anything.
The Marketplace won’t 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 won’t have to make any changes.
Expanded Medicare benefits for preventive care, drug coverage
- Medicare benefits have expanded under the health care law – things like free preventive benefits, cancer screenings, and an annual wellness visit.
- You can also save money if you’re in the with discounts on brand-name prescription drugs.
More Medicare details
- Medicare’s annual Open Enrollment Period (October 15-December 7) hasn’t changed.
- Learn more about your Medicare coverage and choices.
More answers: If you have Medicare
Generally, no. It’s 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 you’re 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 you’re eligible for Medicare but haven’t signed up. This could be because:
- You’d 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 haven’t signed up for Medicare coverage.
- You’re not collecting Social Security retirement or disability benefits before you’re eligible for Medicare.
If you’re getting Social Security retirement or disability benefits before you’re eligible for Medicare, you’ll automatically get Medicare when 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-March 31 each year) to sign up. This means you have have months without medical coverage.
- In most cases, you'll also have to pay monthly late enrollment penalties. The penalty is added to your monthly premiums, and it goes 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. It’s 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 to get some extra benefits, like vision, hearing, dental, and more. These “bundled” plans include Part A, Part B and usually Part D.
Yes. You can get a Marketplace plan to cover you before your Medicare begins. You can then cancel the Marketplace plan once your Medicare coverage starts.
In most cases, no. If the Marketplace in your state is run by the federal government, you won’t be able buy a stand-alone dental plan unless you’re 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 you’re getting health coverage through the SHOP Marketplace based on your or your spouse’s job.
You have a special enrollment period to sign up for Part B without penalty:
- Any time you’re still covered by the job-based health plan based on your or your spouse’s 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 you’re getting health coverage from an employer through the SHOP Marketplace based on your or your spouse’s current job, Medicare Secondary Payer rules apply.