Medicare and the Marketplace

If you have Medicare

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.

The Marketplace doesn’t offer Medicare supplement (Medigap) insurance or Part D drug plans.

If you have only Medicare Part B

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.

If you have only Medicare Part B, you aren't considered to have minimum essential coverage. This means you may have to pay the fee that people who don't have coverage may have to pay.

Expanded Medicare benefits for preventive care, drug coverage

  • Medicare benefits have expanded under the health care law – things like free preventive benefits, cancer screenings, and an annual wellness visit.
  • You can also save money if you’re in the prescription drug “donut hole” with discounts on brand-name prescription drugs.

More Medicare details

  • Medicare’s annual Open Enrollment Period (October 15-December 7) hasn’t changed.
  • To learn more about your Medicare coverage and choices, visit Medicare.gov.

More answers

What if I’m retired but don’t have Medicare?

Learn about your options if you’re retired but don’t have Medicare coverage.

Can I choose Marketplace coverage instead of 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. 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:
  • You’d have to pay a premium
  • You have a medical condition that qualifies you for Medicare, like end-stage renal disease (ESRD), but haven’t applied 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 be enrolled in Medicare once you’re eligible.

Before choosing a Marketplace plan over Medicare, there are 2 important points to consider:
  • If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for as long as you have Medicare.
  • Generally you can enroll in Medicare only during the Medicare general enrollment period (from January 1 to March 31 each year). Your coverage won’t start until July. This may cause a gap in your coverage.

Learn more about Medicare enrollment rules.

Can I get a Marketplace plan in addition to Medicare?

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.
What if I turn 65 in the middle of the year? Can I get Marketplace coverage to carry me over until I’m eligible for Medicare?

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.
Use our screener tool to find out if you qualify.
Learn more if you have Marketplace coverage but will soon be eligible for Medicare.
If I have Medicare, can I get a stand-alone dental plan through the Marketplace?

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.

Is prescription drug coverage through the Marketplace considered creditable prescription drug coverage for Medicare Part D?

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.
If I’m getting health coverage from an employer through the SHOP Marketplace, can I delay enrollment in Part B without a penalty?

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

If you don’t sign up during this special enrollment period:

  • You may have to pay a late enrollment penalty for as long as you have Medicare.
If I have Medicare, can I get health coverage from an employer through the SHOP Marketplace?

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.
Are Medicare Advantage plans still available?

Yes. The Medicare Advantage program isn’t changing as a result of the health care law. Learn more about Medicare Advantage plans.