Can I Have a Marketplace Plan and Medicare?

You can get a Marketplace plan that covers you before your Medicare starts. You can then cancel the Marketplace plan once your Medicare coverage begins. Delaying enrollment in Part B is possible if you are receiving health coverage through the SHOP Marketplace, depending on your job or that of your spouse. An employer's coverage through the SHOP Marketplace is treated the same way as coverage under any employment-based health plan. If you are receiving health coverage from an employer through the SHOP Marketplace based on your current employment or that of your spouse, Medicare secondary payer rules apply.

The Medicare Advantage program remains unchanged due to the health care law. If you are worried about getting Medicare and canceling your Marketplace plan, don't be. As long as you have at least Medicare Part A (hospital coverage), you meet the coverage requirements and you don't need a Marketplace plan. It is illegal for someone who knows you have Medicare to sell you a Marketplace plan, even if you have only Part A or only Part B. While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP health plan is not required to be at least as good as Medicare Part D (creditable) coverage. Once you've enrolled in Part A, you won't be eligible for any of the savings you've ever earned for your Marketplace plan.

If you have end-stage renal disease (ESRD) and haven't enrolled in Medicare, you can get a plan from the Marketplace. The Affordable Care Act or Obamacare requires the availability of a marketplace for purchasing health insurance in each state. However, if you choose to have both your Marketplace plan and Medicare coverage, know that you will not be eligible for any tax credits for premiums or cost savings that you previously earned from your Marketplace plan. It's important to note that the Marketplace does not offer Medicare Supplemental Insurance (Medigap) or Part D drug plans. Furthermore, Marketplace coverage is not creditable coverage for Parts A and B because it is not required to be as good as Original Medicare. You can keep your Marketplace plan until your Medicare coverage starts, and if you want, you can keep it later.

It is illegal for someone who knows you have Medicare to sell or issue you a Marketplace policy. No matter how you get Medicare, whether through Original Medicare or through a Medicare Advantage plan (such as an HMO or PPO), no changes are necessary. If your state's marketplace is managed by the federal government, it won't be possible to buy a standalone dental plan unless you also buy a health plan. Through this marketplace, health plans are available to individuals, families, and small businesses that otherwise don't have health care coverage.

Elise Woehl
Elise Woehl

Subtly charming student. Award-winning twitter practitioner. Incurable coffee scholar. Friendly thinker.