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Medicare and the Health Insurance Marketplace


If you don’t have nor qualify for Medicare, the Health Insurance Marketplace (Marketplace) can help you find coverage to fit your healthcare needs. However, there may be situations where you can choose Marketplace coverage instead of Medicare.

The Marketplace is for those who don’t have health insurance. As such, there’s no need to join the Marketplace if you have Medicare.

This article explores common questions associated with Medicare and the Marketplace.

Who Is Eligible for Medicare?

In general, Medicare is for people 65 and older. However, you may be able to acquire Medicare if you have a disability, end-stage renal disease, or Lou Gehrig’s disease.

Can I Have a Marketplace Plan in Addition to Medicare?

No. It is against the law for someone who knows you have Medicare to sell you a Marketplace plan.

If you want to add coverage to Original Medicare (Part A and Part B), you can purchase a Medicare Supplement Insurance policy, also referred to as Medigap. Alternatively, you could choose a Medicare Advantage Plan that may offer more benefits than Original Medicare.

Can I Choose Marketplace Coverage Instead of Medicare?

In general, no. However, you can choose Marketplace coverage if you would have to pay a Part A premium. Additionally, if you aren’t already collecting Social Security benefits before being eligible for Medicare, you could choose Marketplace coverage instead of Medicare when you become eligible for Medicare.

Before making any changes, you need to check which plan best fits your needs and budget, as there may be trade-offs.

What Happens if I Don’t Enroll in Medicare When First Eligible?

If you become eligible for Medicare and do not sign up immediately, you might have to wait to enroll. That can result in you having to pay monthly late enrollment penalties.

Furthermore, if you miss your initial enrollment period, you can only then enroll in Medicare during the general enrollment period, which runs from Jan. 1 through March 31. Coverage starts the first day of the month after you enroll.

What if I Can’t Afford My Medicare Costs?

If you can’t afford the monthly Medicare premiums or other costs, programs offered through your state Medical Assistance (Medicaid) office can help lower your costs. Click here to learn more about available resources.

What Should I Do if I Have a Marketplace Plan and Become Eligible for Medicare?

If you have coverage through a Marketplace plan, you should sign up for Medicare during your initial enrollment period to avoid penalties and health coverage delays. To avoid a coverage gap, you should end your Marketplace coverage once you know the date your Medicare coverage will begin.

What Happens if I Enroll in Medicare but Share a Marketplace Plan With My Household?

Your Marketplace plan won’t reenroll if you have Medicare, ending coverage for others on the Marketplace plan. The Marketplace plan will send a letter with information on how the other people can enroll in new Marketplace coverage.

Where Can I Get More Information?

Visit HealthCare.gov to learn more about Medicare and the Marketplace and available options. To learn specifically about Medicare coverage and resources, check out Medicare.gov. Our team of agents is happy to help you not only navigate your options but also sign you up accurately, at no additional cost!

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