The U.S. healthcare system offers various coverage options, including Obamacare (Affordable Care Act – ACA) plans and Medicare. If you are approaching Medicare eligibility or already enrolled, you may wonder: Can you have both Obamacare and Medicare at the same time?
Can You Be Enrolled in Both Obamacare and Medicare?
The short answer is no. Once you become eligible for Medicare, you are generally not allowed to keep an Obamacare (ACA) marketplace plan with subsidies. The Affordable Care Act was designed to provide coverage for those who do not qualify for Medicare, Medicaid, or employer-sponsored insurance. Here’s what you need to know:
- If you have Obamacare and become eligible for Medicare, you must transition to Medicare to avoid penalties.
- You can keep your ACA plan, but you won’t receive premium tax credits or cost-sharing reductions.
- If you delay Medicare enrollment without a qualifying reason, you might face late enrollment penalties.
When Should You Transition from Obamacare to Medicare?
If you’re turning 65 or otherwise qualifying for Medicare due to a disability, you should enroll in Medicare during your Initial Enrollment Period (IEP):
- Starts 3 months before your 65th birthday
- Includes your birth month
- Ends 3 months after your birth month
Failing to enroll in time could result in higher premiums and coverage gaps.
What is the Best Secondary Insurance if You Have Medicare?
Once you transition to Medicare, you may need additional coverage to help with costs that Medicare does not fully cover. Here are your options:
1. Medicare Supplement Insurance (Medigap)
- Helps cover deductibles, copays, and coinsurance
- Available to those enrolled in Original Medicare (Part A and Part B)
- Private insurance companies offer 10 different Medigap plans (A, B, C, D, F, G, K, L, M, and N)
2. Medicare Advantage (Part C)
- Alternative to Original Medicare
- Includes Part A, Part B, and often Part D (prescription drugs)
- May offer vision, dental, and wellness benefits
3. Medicare Part D (Prescription Drug Coverage)
- Helps cover prescription medication costs
- Available as a standalone plan or included in Medicare Advantage
What is the Highest Income to Qualify for Obamacare?
Eligibility for Obamacare subsidies depends on your household income and size. In 2024, the income limits are:
- Individuals: Up to $58,320 per year (400% of the Federal Poverty Level – FPL)
- Family of 2: Up to $78,880 per year
- Family of 3: Up to $99,440 per year
- Family of 4: Up to $120,000 per year
If your income exceeds these limits, you won’t qualify for premium tax credits and may have to pay the full cost of an ACA plan.
Conclusion
You cannot have both Obamacare and Medicare at the same time if you receive premium subsidies. Once you qualify for Medicare, you should enroll to avoid penalties and coverage gaps. If you need extra protection, Medigap, Medicare Advantage, and Part D can provide valuable secondary coverage. Understanding your options will help you make the best healthcare decision for your needs.
Need help choosing the right Medicare plan? Contact our experts today for personalized guidance on Medicare enrollment and supplemental coverage options!
