Medicare and the Marketplace

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Although you may soon become eligible for Medicare, do you now have coverage through the Health Insurance Marketplace? Most likely, you are uncertain about the future of your insurance. We’re here to guide you through this shift in your healthcare requirements and assist you to stay away from unnecessary expenses along the way.

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Are Obamacare and Medicare the Same?

Medicare and Obamacare are two distinct organizations. The Affordable Care Act, also known as Obamacare, requires that each state have a marketplace where people can purchase health insurance. Health plans are accessible to people, families, and small companies through this market who would not otherwise have access to health insurance.

There are currently 12 million people with insurance through the Marketplace, according to estimates. Nearly 3.4 million adults (aged 55 to 64) who are insured are getting close to the Medicare eligibility age.

Visit HealthCare.gov if you need to purchase insurance through the Health Insurance Marketplace.

In the United States, Medicare is currently a federal healthcare program for anyone 65 and older. It also includes disabled people under 65 who have been receiving SSDI benefits for 24 months or more and those with end-stage renal disease or amyotrophic lateral sclerosis.

How Does the Affordable Care Act Affect Medicare?

Those with Medicare coverage are unaffected by the Health Insurance Marketplace. We can assist you if you presently have a plan via the Marketplace but are aging in or are becoming eligible as a result of a disability. Until the start of your Medicare, you can continue with your current plan through the Marketplace.

Which Medicare Programs are Covered by ACA Section 1557?

Discrimination in health care provided by HHS is prohibited by Section 1557 of the Affordable Care Act. It applies to medical facilities that take Medicare, Medicaid, and Indian Health Service patients. Discrimination based on age, sex, race, color, national origin, or handicap is prohibited by this clause.

Can I Choose Marketplace Insurance Instead of Medicare?

It can be expensive to select Marketplace insurance over Medicare. You won’t be qualified for any of the discounts you previously received for your Marketplace plan after you enroll in Part A. You will therefore be required to pay the full amount. Additionally, there is a lifetime penalty if you postpone enrolling in Part B.

How Do I Switch from Obamacare to Medicare?

Enroll in Original Medicare during your Initial Enrollment Period. This seven-month window, when aging in, begins three months before and concludes three months after the month of your 65th birthday. Utilizing this enrollment window can help you avoid late fees for Parts A and B.

Find Medicare Plans in 3 Easy Steps

Up to the start of your Medicare coverage, you can continue with your Obamacare or Marketplace plan. There is no need to wait to enroll if you have worked a minimum of 40 quarters because you are eligible for Part A premium-free coverage.

When your Part A starts, your eligibility for premium tax credits and other benefits expires. This implies that you’d be paying the full cost of your Marketplace plan, thus switching completely to Medicare is advantageous. Before terminating your Marketplace plan, make sure you know when your coverage begins.

The coverage for which you currently utilize your Marketplace plan will be provided by Medicare. A Medigap plan and Part D are further options.

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

When you are granted Medicare eligibility, you can continue to use your Marketplace insurance. However, it is illegal to intentionally offer Marketplace coverage to a person who qualifies for premium-free Part A. Be mindful of this, particularly during the annual fall Open Enrollment Period.

Additionally, you may be entitled to equitable relief if you have Marketplace coverage and a federal employee advises you not to sign up for Medicare when you become eligible. Americans receiving Social Security benefits before to retirement will have Medicare enrollment taken care of for them. It is up to them to discontinue their coverage through the Marketplace. 

Is Drug Coverage Through the Marketplace Creditable Coverage for Medicare?

The Marketplace’s prescription drug coverage is not required to adhere to Part D requirements. Each year, your plan will inform you in writing if your coverage is creditable. Check your eligibility for the Extra Help program if you need help paying for your prescription plan.

You are automatically qualified for Extra Help if you already meet the requirements for a particular Medicare Savings Program.

Is Marketplace Coverage Creditable for Parts A and B?

Because it is not expected to be as excellent as Original Medicare, marketplace coverage is not considered creditable coverage for Parts A and B. This indicates that delaying coverage will result in fines after the first 12 months. It is therefore recommended to enroll during your Initial Enrollment Period or if you miss your Initial Enrollment Period, the General Enrollment Period.

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

Once you are qualified for premium-free Part A, which occurs after you have paid the tax for 40 quarters, you will no longer be eligible for premium subsidies. Your Marketplace plan must be terminated; doing so won’t do it. And if you don’t, you’ll be charged full price.

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

If the Indian Health Service is available to you, it serves as a last resort and only pays after all other expenses have been covered. IHS is not a form of health coverage. When you become eligible for Medicare as a Native American or Alaskan Native and have a Marketplace plan, you should cancel your Marketplace plan and enroll for Medicare.

You should combine Medicare and Native American Health Insurance for the broadest coverage. If you haven’t put in enough quarters of employment and aren’t eligible for Part A premium-free, that would be the lone exemption.