Medicare isn’t part of the Health Insurance Marketplace, so if you have Medicare coverage now you don’t need to do anything. If you have Medicare, you’re considered covered.
The Marketplace won’t affect your Medicare choices or benefits. No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO), you won’t have to make any changes.
If you have Medicare Part A (Hospital Insurance), you’re considered covered under the health care law and don’t need a Marketplace plan.
But having only Medicare Part B (Medical Insurance) alone doesn’t meet this requirement.
Learn about your options if you’re retired but don’t have Medicare coverage.
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. In this case you can drop your Part A and Part B coverage and get a Marketplace plan instead.
If you’re eligible for Medicare but haven’t enrolled in it. This could be because:
If you’re getting Social Security retirement or disability benefits before you’re eligible for Medicare, you’ll automatically be enrolled in Medicare once you’re eligible.
Before choosing a Marketplace plan over Medicare, there are 2 important points to consider:
Learn more about Medicare enrollment rules.
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 designed to supplement Medicare, you can find out more about Medigap policies.
You can also learn about other Medicare options, like Medicare Advantage Plans.
For prescription drug coverage, you can buy a Medicare Part D drug plan.
Yes. You can get a Marketplace plan to cover you before your Medicare begins. You can then cancel the Marketplace plan once your Medicare coverage starts.
Still need coverage for 2015?
February 15 was the last day to enroll in or change a Marketplace plan for 2015. You can still get coverage if you qualify for a Special Enrollment Period due to a life change like marriage, moving to another state, or losing other coverage.
In most cases, no. If the Marketplace in your state is run by the federal government, you won’t be able 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 purchase a stand-alone dental plan.
While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP health plan isn’t required to be at least as good as (creditable) Medicare Part D coverage.
But all private plans offering prescription drug coverage, including Marketplace and SHOP plans, must report to you in writing if their prescription drug coverage is creditable each year.
Learn more about creditable coverage.
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:
If you don’t sign up during this special enrollment period:
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.
Learn more about how Medicare works with other insurance.
Yes. The Medicare Advantage program isn’t changing as a result of the health care law. Learn more about Medicare Advantage plans.