Medicare and the Marketplace
If you have Medicare
isn’t part of (and doesn't work with) the Health Insurance Marketplace®. If you have Medicare, you don't need Marketplace coverage.
- Once you have Medicare Part A (Hospital Insurance) or Part C (Medicare Advantage), you won’t qualify for any savings to help lower your costs in a Marketplace plan.
- Marketplace coverage doesn’t lower your Medicare out-of-pocket costs and isn’t used in place of Medicare Part B (Medical Insurance).
- The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) or Medicare drug plans.
- The Marketplace doesn’t affect your Medicare choices or benefits. Medicare’s annual Open Enrollment Period is October 15-December 7. Learn more about your Medicare coverage and choices.
Medicare benefits include preventive care and drug coverage
- Medicare coverage includes benefits like free preventive benefits, cancer screenings, an annual wellness visit and more. Get a list of Medicare-covered preventive services.
- Medicare drug plans include a cap on what you pay out-of-pocket for Part D drugs covered by your plan. Learn more about Part D drug costs.
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 you're 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. If you miss this enrollment period, you may have to wait until Open Enrollment (October 15–December 7) to sign up.
- In most cases, you'll also have to pay monthly late enrollment penalties for Part B and Part D. The penalties are added to your monthly premiums and go 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 you can join a Medicare Advantage Plan 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.
Marketplace coverage doesn’t end automatically when Medicare starts. Update your Marketplace application to end Marketplace coverage for those starting Medicare. You can report a Medicare start date on your application up to 3 months before Medicare starts. After you submit your application update, make sure you confirm the plan for others in your household who need to keep their Marketplace coverage.
In most cases, no. If the Marketplace in your state is run by the federal government, you won’t be able to 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.