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Medicare and the Marketplace


Do you have health insurance through the Health Insurance Marketplace, but you’ll soon be eligible for Medicare? You’re probably concerned about the future of your insurance. We’re here to help you negotiate this shift in your health-care demands while avoiding unnecessary spending.

Are Obamacare and Medicare the Same?

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Obamacare and Medicare are not the same things. The Affordable Care Act, also known as Obamacare, requires each state to have a marketplace for purchasing health insurance. Individuals, families, and small companies that might otherwise be without health insurance can now get coverage through this marketplace.

Approximately 12 million people have insurance through the Marketplace at this time. Nearly 3.4 million adults (ages 55 to 64) are approaching the Medicare eligibility age among those who are insured.

People interested in purchasing health insurance through the Health Insurance Marketplace should go to HealthCare.gov.

Medicare is now a federal healthcare program in the United States for people aged 65 and up.It also applies to disabled people under the age of 65 who have been receiving SSDI benefits for at least 24 months and who have been diagnosed with Amyotrophic Lateral Sclerosis or End-Stage Renal Disease.

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How Does the Affordable Care Act Affect Medicare?

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Medicare beneficiaries are not affected by the Health Insurance Marketplace. We can assist you if you’re currently enrolled in a Marketplace plan but are ageing in or becoming eligible due to a handicap. You can keep your Marketplace plan until your Medicare coverage begins.

Which Medicare Programs are Covered by ACA Section 1557?

Discrimination in HHS-funded health care is prohibited under Section 1557 of the Affordable Care Act. It applies to hospitals that take Medicare, Medicaid, and the Indian Health Service as payment sources. Discrimination based on age, sex, race, colour, national origin, or handicap is prohibited under this article.

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Can I Choose Marketplace Insurance Instead of Medicare?

It can be pricey to choose Marketplace coverage over Medicare. You won’t be eligible for any of the Marketplace plan savings once you’ve enrolled in Part A. This implies that you will be required to pay the whole amount. You’ll also have to pay a lifelong penalty if you put off enrolling in Part B.

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How Do I Switch from Obamacare to Medicare?

Enroll in Original Medicare during your Initial Enrollment Period. When it comes to ageing in, this seven-month period begins three months before and concludes three months after your 65th birthday. It’s a good idea to enroll at this time to avoid penalties for missing Parts A and B.

Until your Medicare coverage begins, you can keep your Marketplace, or Obamacare, plan. There’s no need to wait until you’ve worked a minimum of 40 quarters to acquire Part A premium-free coverage.

When you start Part A, your eligibility for premium tax credits and other benefits ceases. This implies you’d be paying full price for your Marketplace plan, therefore switching to Medicare is a better option. Before you cancel your Marketplace plan, be sure you know when your coverage will begin.

Medicare will cover the same things that your Marketplace plan does now. Part D and a Medigap plan are also available.

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

After you become Medicare-eligible, you can keep your Marketplace plan. It is, however, illegal to offer Marketplace coverage to someone who is entitled to premium-free Part A. Keep this in mind, especially during the annual fall Open Enrollment Period.

You may also be entitled to fair relief if you have Marketplace coverage and a federal employee informs you that you don’t need to enroll in Medicare while you’re eligible. Americans who receive Social Security benefits prior to retirement will be enrolled in Medicare automatically. As a result, they must decide whether or not to continue their coverage through Marketplace.

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Is Drug Coverage Through the Marketplace Creditable Coverage for Medicare?

Prescription drug coverage purchased through the Marketplace is not needed to meet Part D’s requirements. Each year, your plan will tell you whether your coverage is creditable in writing. Check your eligibility for the Extra Help program if you need financial support with your prescription plan.

Extra Help is immediately available if you currently qualify for certain Medicare Savings Programs.

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Is Marketplace Coverage Creditable for Parts A and B?

Because it isn’t needed to be as good as Original Medicare, Marketplace coverage isn’t considered creditable for Parts A and B. If you delay coverage for more than a year, you’ll be charged a penalty. If you miss the Initial Enrollment Period, join up during the General Enrollment Period.

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

Once you’ve paid the tax for 40 quarters and are eligible for premium-free Part A, you’ll no longer be eligible for premium subsidies. This will not cancel your Marketplace plan; you must do so. If you don’t, you’ll have to pay full price.

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

If you have access to the Indian Health Service, it serves as a last resort, paying only after all other contributions have been made. IHS is not a healthcare plan. If you’re a Native American or Alaskan who has a Marketplace plan and you become eligible for Medicare, you should cancel your Marketplace plan and enroll in Medicare.

Native American Health Insurance should be combined with Medicare for the most comprehensive coverage. Only if you haven’t worked enough quarters and don’t qualify for Part A premium-free would this be an exception.

How to Get Help Going from Obamacare to Medicare

We understand how perplexing it might be to transition to Medicare after years of Marketplace coverage. We’re here to assist you in understanding and implementing your new healthcare plan. We work with the best carriers while keeping expenses in mind. Fill out our rate form or call us at the number above. Every day, we assist clients in finding the most appropriate options for their needs and budget. We hope to be able to do the same for you.

No benefit to keeping exchange plan in addition to Medicare

Keeping your exchange plan in addition to Medicare is almost always a waste of money. Individual market exchange plans are not set up to coordinate with Medicare-like employer-sponsored plans are. As a result, the plans would give duplicate coverage.

As a result, your exchange plan would not be supplementary coverage. Instead, if you already have Medicare coverage, you won’t be required to give any coverage at all (small business plans sold through the SHOP exchanges do coordinate benefits with Medicare because they’re employer-sponsored plans, not individual market plans).

To supplement your Medicare coverage, you’ll need a Medicare Advantage plan, a Medigap plan, and a Part D plan. Here’s a tool to assist you in determining what will work best in your situation.

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