Retirees

Health coverage for retirees

If you’re retired and need health coverage, you can use the Marketplace to buy an insurance plan. If you don’t have coverage you may have to pay a fee.

If you have retiree health coverage, you have different choices to consider.

Have Medicare? Learn about Medicare and the Marketplace.

If you retire before age 65 without health coverage

If you retire before you’re 65 and lose your job-based health plan when you do, you can use the Health Insurance Marketplace to buy a plan.

Losing health coverage qualifies you for a Special Enrollment Period. This means you can enroll in a health plan even if it’s outside the annual Open Enrollment Period.

If you want to enroll because you lost your job-based coverage, visit this Special Enrollment Period page, enter your ZIP code, and select the button at the bottom that says you know you qualify for a Special Enrollment Period and want to apply. We’ll show you your next steps.

When you fill out a Marketplace application, you'll find out if you qualify for a private plan with premium tax credits and lower out-of-pocket costs. This will depend on your income and household size.

You’ll also find out if you qualify for free or low-cost coverage through the Medicaid program in your state.

If you have retiree health benefits

If you have retiree health benefits, you’re considered covered under the health care law. You don’t have to pay the penalty that people without insurance must pay.

If you have retiree coverage and want to buy a Marketplace plan instead, you can. But:

  • You can’t get premium tax credits and other savings based on your income. This is true only if you’re actually enrolled in retiree coverage. If you’re eligible for but not enrolled in retiree coverage, you may qualify for premium tax credits and lower out-of-pocket costs based on your household size and income.

  • If you voluntarily drop your retiree coverage, you won’t qualify for a Special Enrollment Period to enroll in a new Marketplace plan. You won’t be able to enroll in health coverage through the Marketplace until the next Open Enrollment period.

More answers: Coverage for retirees without Medicare

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.
What if I’m 65 or older but not eligible for Medicare?

You may be able to buy insurance in the Marketplace and get lower costs on monthly premiums and out-of-pocket costs based in your household size and income. If you don’t have health coverage, you may have to pay the penalty that most people without coverage must pay.

What if I retire from my job and am self-employed?
What if I had job-based insurance but lost it when I retired? Do I qualify for a Special Enrollment Period?

Yes. Losing job-based coverage qualifies you for a Special Enrollment Period. This means you can enroll in a health plan outside of Open Enrollment. You can apply to the Marketplace with a Special Enrollment Period any time from 60 days before and 60 days after your separation date.

Do my IRA or 401k withdrawals count as income?

Generally, yes. Learn more about reporting income from retirement savings funds from the IRS (PDF). See pages 24 and 25.

Can I drop COBRA and get Marketplace coverage instead and qualify for lower costs based on my income?

It depends.

  • If your COBRA coverage runs out outside Open Enrollment, you qualify for a Special Enrollment Period. This means you can enroll in a Marketplace plan outside the annual Open Enrollment Period.
  • But you can’t choose to drop your COBRA coverage outside Open Enrollment and enroll in a Marketplace plan instead. The Special Enrollment Period applies only if your COBRA coverage runs out.
  • During the annual Open Enrollment Period, you can drop your COBRA coverage even if it’s not running out and replace it with a Marketplace plan. The next Open Enrollment period, for 2016 coverage, is November 1, 2015 to January 31, 2016.

Learn more about switching to Marketplace coverage from COBRA.