The Affordable Care Act (ACA) has sparked a lot of questions from those eligible for Medicare as to how ACA Marketplace plans and Medicare coverage work together.
In a nutshell, they really don’t.
If you are already on Medicare, nothing changes for you. You are considered covered under the health care law and do not have to explore other options through the Marketplace.
In fact, it is against the law for anyone who knows you have Medicare to sell or issue you an individual Qualified Health Plan (QHP) — either through the Exchange (also known as the Marketplace) or off-exchange in the individual market.
While we are therefore unable to find individual coverage for anyone who already has Medicare, we are happy to provide the following Questions and Answers to help clear up any confusion you may have:
| Q | Can I buy an individual Qualified Health Plan (QHP) — on or off the Exchange — to supplement my Medicare coverage? |
| A | No. An individual QHP — whether bought on or off the Exchange — is not designed as supplemental insurance for Medicare recipients. The Marketplace does not offer supplement (Medigap) insurance or Part D drug plans. |
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Can I get a Marketplace Plan or other individual QHP if I already have Medicare? |
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No. Even if you have only Medicare Part A or Part B, you can’t get an individual plan — on or off the Exchange. In fact, it is illegal for anyone who knows you have Medicare to sell you an individual health insurance plan. |
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If I’m already enrolled in an individual health insurance plan through the Exchange and later enroll in Medicare, can I keep my Exchange coverage? |
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Yes, but once your Medicare Part A coverage begins, any premium tax credits and/or reduced cost-sharing you receive through the Exchange will be discontinued. |
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Can I choose a Marketplace (Exchange) plan instead of Medicare? |
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Generally, No. But there are situations in which it may make sense to choose an individual Marketplace plan instead of Medicare: 1. If you’re paying a premium for Part A. In this case, you could drop Part A and Part B coverage and get an Exchange plan instead.2. If you’re eligible for Medicare, but have yet to enroll. This could be because:
IMPORTANT: Before you drop your Medicare or choose a Marketplace plan over Medicare, consider these points:
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If I am eligible for Medicare, but haven’t signed up yet, can I enroll in an individual ACA health plan? |
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Yes. Unless you are entitled to Medicare Part A or are actually enrolled in Medicare Part B, you may purchase an individual health plan, on or off of the Exchange. |
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If I have Medicare Part B only (medical insurance) does that satisfy the legal requirement to have health insurance under the Affordable Care Act? |
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No. Medicare Part B alone does not constitute minimum essential coverage under the Affordable Care Act. If you have only Medicare Part B, you are subject to a penalty tax for not having coverage. |
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Will I pay a late enrollment penalty if I delay my enrollment in Medicare because I have coverage through a Marketplace plan? |
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Yes. If you fail to enroll in Medicare during your Initial Enrollment Period (for either Part B or Premium Part A) you will only be able to enroll during a general enrollment period and may be subject to late enrollment penalties. |
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What if I already have a Marketplace plan but will be eligible for Medicare soon? |
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You can keep your Marketplace plan until your Medicare coverage starts. Then you can cancel your Marketplace plan. You can keep your Marketplace plan if you wish, but any tax credits or lower cost-sharing you have on your plan will end once your Medicare Part A coverage begins. You would then be paying the full price for your Marketplace plan. |
| Q | If I am enrolled in both Medicare and an individual Marketplace plan, will there be coordination of benefits? |
| A | No. In this case, Medicare is the primary payer and Medicare does not provide coordination of benefits. |
| Q | If I am on Medicare, can I purchase a stand-alone dental plan through the individual Marketplace? |
| A | No. Only those individuals who have purchased a comprehensive QHP may buy a separate dental plan on the Federal Exchange. However, you may buy a stand-alone dental plan outside the Federal Marketplace (or on your state exchange if your state allows it). |
For more information on Medicare coverage, please visit Medicare.gov.
