Medicare Corner
Medicare and Health Insurance Marketplaces The Health Insurance Marketplaces were created by the Affordable Care Act. It is also known as the ACA. The Marketplaces allow people to buy insurance if they do not have insurance or do not have enough insurance. Some states have their own Marketplaces, and other states use the federal Marketplace. Plans sold through Marketplaces are also known as Qualified Health Plans, or QHPs. How does the Marketplace affect my Medicare coverage? • If you are currently enrolled in a Marketplace plan, you should most likely disenroll from it and enroll in Medicare when you are first eligible (with two exceptions, listed on the next page). • If you are eligible for Medicare, you should usually not use the Marketplace health and drug coverage. It is illegal for someone to try to sell you a Marketplace plan if they know you are eligible for or enrolled in Medicare. • You do not use the Marketplace to buy Medicare plans. Why should I switch to Medicare when I become eligible? • If you do not enroll in Medicare when you are first eligible, you may have a late enrollment penalty when you sign up later. You may also experience coverage gaps. • Marketplace plans do not work with Medicare. If you keep your Marketplace plan, it may not cover you once you are eligible for Medicare. • Once you are eligible for premium-free Medicare Part A, you will no longer be eligible to receive cost assistance for your Marketplace plan. Although you may keep your Marketplace plan after becoming eligible for Medicare, it can be very expensive without cost assistance. The exceptions: You can choose to enroll in a Marketplace plan instead of Medicare if either:
• You are eligible for Medicare due to End-Stage Renal Disease. • You are eligible for Medicare and have to pay a premium for Part A.
Contact your State Health Insurance Assistance Program to learn more about your options. Your local SHIP contact information is on the final page of this document.
What are SHOP plans? Marketplaces also provide coverage through the Small Business Health Options Program (SHOP). This program lets small businesses provide health insurance to employees. If you have a SHOP plan through a current employer, you may still need to enroll in Medicare. The timing depends on the size of your employer and how you qualify for Medicare. Contact your State Health Insurance Assistance Program (SHIP) to learn more. Your local SHIP contact information is on the final page of this document. Should I use the Marketplace if I have Medicare? No. You cannot buy a Medicare Advantage Plan, Part D prescription drug plan, or Medigaps through the Marketplace. It is illegal for someone to sell you a Marketplace plan if they know you are eligible for or are enrolled in Medicare. If someone tries to sell you a Marketplace plan, let them know that you have Medicare and cannot enroll in a Marketplace plan.
January 2023, Never Too Late | Page 5
Pima Council on Aging
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