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Can I Choose Marketplace Coverage Instead Of Medicare

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Should You Choose Medicare Instead Of Marketplace Coverage

2021 How to use Medicare Plan Finder, step-by-step

For most seniors, cost is a critical component of the health care decision. If youre like most people, youll qualify for premium-free Medicare Part A coverage when you turn 65 years old. That means youll receive MEC without having to pay monthly premiums for hospital or skilled nursing home care.

Most people have to pay premiums for Part B, which covers doctor visits and preventive care, but the cost for Part B is much lower than any Marketplace plan. Since paying for Medicare typically lowers health care costs substantially, most people opt to cancel their Marketplace plans and enroll in Medicare as soon as possible.

According to Medicare.gov, Medicare also offers several other benefits. When you choose Medicare, youll get more preventive services for less and better treatment coordination.

In addition, unless you qualify for a special enrollment period, youll receive a financial penalty if you enroll in Medicare after your initial enrollment period. That means your Medicare coverage will only get more expensive the longer you wait to enroll.

Covered California And Medicare

Transitioning from Covered California to Medicare is an important step. Make sure you take action and keep track of important dates and deadlines to avoid unwanted consequences.

In general, people who are eligible for Medicare even if they do not enroll in it arent eligible to receive financial help to lower the cost of a Covered California health plan.

People who are eligible for Medicare must report their Medicare eligibility to Covered California within 30 days and will usually need to cancel their Covered California. Your Covered California plan wont be automatically canceled when you become eligible for Medicare, even if you enroll in a Medicare plan with the same insurance company. You must cancel your plan yourself at least 14 days before you want your coverage to end by contacting Covered California.

If you are eligible for Medicare and you keep your Covered California plan, you may face serious consequences. For example:

  • You may have to pay back all or some of your premium tax credits to the Internal Revenue Service .
  • Or, there could be a delay in your Medicare coverage start date. If you dont sign up for Medicare Part B during your initial enrollment period, you will have to wait for the general open enrollment period , and then your coverage wouldnt begin until July of that year.
  • In addition, you may have to pay lifetime penalties for late enrollment in Medicare and your premiums may increase by 10 percent or more.

What Will Happen If I Dont Pay My Part B Premium

Your Medicare Part B payments are due by the 25th of the month following the date of your initial bill. For example, if you get an initial bill on February 27, it will be due by March 25. If you dont pay by that date, youll get a second bill from Medicare asking for that premium payment. That second bill will be due by the 25th of the following month in this case, April 25.

If your second bill remains unpaid by its due date, youll receive a delinquency notice from Medicare. At that point, youll need to send in the total overdue amount by the 25th of the following month to avoid losing coverage. In our example, that would put you at May 25.

All told, youll have a three-month period to pay an initial Medicare Part B bill. If you dont, youll receive a termination notice informing you that you no longer have coverage.

Now if you manage to pay what you owe in premiums within 30 days of that termination notice, youll get to continue receiving coverage under Part B. If you dont do that, your coverage will be discontinued. At that point, youll need to sign up for Part B once again during the general Medicare enrollment period that runs from January 1 to March 31 every year.

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What If I Want To Disenroll From My Current Medicare Part D Prescription Drug Plan But Dont Want To Enroll In Another Plan

If you disenroll from a Medicare Part D prescription drug plan and wait to join another Medicare prescription drug plan at a later time and do not have creditable coverage a Part D Late Enrollment Penalty may apply. To learn more about the Medicare Part D Late Enrollment Penalty, call Medicare at . TTY users call , 24 hours a day, 7 days a week.

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What About Prescription Drug Coverage

What Is Medicare Go To Market

if you have Original Medicare, then you will still need coverage for drugs. Some private drug plans are creditable under Medicare. This means that the plans offer at least the level of coverage that Medicare prescription drug plans do.

Not all Marketplace drug plans are going to be creditable. However, there are rules in place that state that plans are required to let you know if they are creditable or not, so it should be easy to find out.

If you are interested in prescription drug coverage, then the most popular option is still Part D prescription drug plans. Medicare Part D coverage works well for most people’s situation, and is often very convenient. Nevertheless, it is good to explore some private plans as well.

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You Can’t Join A Healthcare Marketplace Plan If You Qualify For Medicare But If Your Spouse Doesn’t Qualify They Can

Obamacare plans, more officially known as Marketplace plans, are health plans available to individuals who qualify as a result of the Affordable Care Act, or ACA. The Healthcare Marketplace is a tool that allows eligible individuals to qualify for these lower-cost health plans. If you have one of these plans or are going to enroll in one, then understanding how they relate to Medicare is essential.

Well cover some general rules regarding Marketplace plans and Medicare, as well as a few specific scenarios you may find yourself in if you have one or both of these health insurance plans.

Is Employer Coverage An Alternative To Medicare

Since Part A is premium-free for almost everyone, it doesnt make sense not to enroll when you become eligible. When it comes to Part B, you can choose to delay enrollment if you have through your employer.

You have the choice to keep your employers group health insurance plan if youre still working when you first become Medicare-eligible. Medicare works with employer health insurance depending on the size of your employers company.

If youre working for a company with 20+ employees, your group coverage is primary. The coordination of benefits determines which plan pays first.

Small business group insurance is for companies with fewer than 20 employees. If you work for a smaller organization the coverage is not considered credible under Part B, and you could face a Part B penalty for not enrolling.

Make sure to compare both Medicare Supplement plan and Part B premiums with your employers deductions from your paycheck. Consider medication costs as well as deductibles and copayments. If Medicare plus Medigap offers lower prices dropping your employer insurance may make sense.

If youre covered by your spouses plan through their employer, the same rules apply for delaying enrollment and creditable coverage.

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If You Enroll In Drug Coverage Thats Equivalent To Medicare Part D

If you enroll in TRICARE, VA coverage, or another plan that offers comprehensive prescription drug benefits and you have a Medicare Advantage plan that includes prescription drug coverage then you can leave your Medicare Advantage plan and return to Original Medicare.

  • Youll want to check with your prescription drug plan to make sure that it provides you with credible drug coverage.
  • You can do this at any time, but your ability to enroll in the alternative creditable drug coverage may be limited by that plans rules.

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Getting Medicare If You Already Have Marketplace Coverage

Medicare Basics: Parts A, B, C & D

Even if you have coverage through the Marketplace, you should generally sign up for Medicare when youre first eligible to avoid a delay in Medicare coverage and the possibility of a Medicare late enrollment penalty.

Once youre eligible to sign up for Part A:

  • Your Marketplace plan may not renew your coverage at the end of the year. This means you and your family could have a gap in your coverage starting January 1 of next year.
  • You wont qualify for help from the Marketplace to pay your Marketplace premiums or other medical costs. If you keep getting help to pay your Marketplace plan premiums after youre eligible for Part A, you may have to pay back all or part of the help you got when you file your federal income taxes.

Once you sign up for Medicare, you need to drop your Marketplace coverage the day before your Medicare coverage starts, to avoid an overlap in coverage.

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Can You Have Both

Although the answer is more complicated and we will provide further details below, the simple answer is no. Generally speaking, you cannot have both Medicare and a plan purchased on the Healthcare Marketplace. This may also be referred to as an Affordable Care Act plan, an ACA plan, or an Obamacare plan.

Lets take a look at how this breaks down in a few specific scenarios.

Can You Have Both Medicare And Marketplace Coverage

As a general rule, you cant have Medicare coverage and a plan from the Health Insurance Marketplace. Thats because Medicare has put several precautions in place to protect recipients. If an insurance agent knows that you have Medicare, he or she cant legally sell you a plan from the Marketplace.

  • Employer-Sponsored Marketplace Plans: If you have a Marketplace plan through your employer, you can maintain your employer-sponsored plan and delay Medicare Part B enrollment. Youd typically have to pay a fee for late enrollment. Losing employer health care upon retirement, however, grants you a special enrollment period.
  • Individual Marketplace Plans: If you have an individual Marketplace plan but youll qualify for Medicare coverage soon, you can cancel your Marketplace plan as soon as youve enrolled in Medicare. Dont cancel it until your new Medicare coverage begins, though. You dont want to risk getting a fine for lack of coverage or incurring medical bills during a gap period between policies. Theres no charge for canceling your Marketplace plan when you choose a Medicare plan.

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If Your Ma Plan Stops Providing Benefits In Your Area

If your MA plan stops providing benefits in your area at the end of the year, you have the right regardless of age or health condition to join another MA plan if one is available where you live, or to return to Original Medicare and join a Part D plan. Your Special Election Period is from December 8 of the current year through the end of February of the next year.

Note that this SEP gives you another chance to enroll in an MA or Part D plan in addition to the Annual Election Period, also known as Open Enrollment, from October 15 through December 7, when you can switch, enroll in or disenroll from MA and Part D plans. Any plan changes made before December 31 are effective January 1. Plan changes made after December 31 are effective the first day of the following month. If you switch to a new MA plan, make sure your doctor, the medical group that provides your care and your local hospital are all in the new MA plan network and plan to stay in it. If you find you need to switch doctors, make sure the doctor you choose is taking new patients.

Insurance companies must let you buy 1 of these 8 standardized Medigap plans A, B, C, F , K, L, M or N regardless of your health condition, unless you are younger than 65 and have end-stage renal disease .

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How Do I Switch From Obamacare To Medicare

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Use your Initial Enrollment Period to enroll in Original Medicare. When aging in, this seven-month period starts three months before the month of your 65th birthday and ends three months after. Its beneficial to use this enrollment period to avoid penalties for delaying Parts A and B

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You can keep your Marketplace, or Obamacare, plan until your Medicare coverage begins. If youve worked a minimum of 40 quarters, you get Part A premium-free, so theres no need to delay enrollment.

Your eligibility for premium tax credits and other savings ends when your Part A begins. This means that youd be paying full price for your Marketplace plan, so its beneficial to entirely switch to Medicare. Be sure you know when your coverage starts before ending your Marketplace plan.

Medicare will provide the coverage for which you now use your Marketplace plan. You can also buy Part D and a Medigap plan.

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Making The Move From Obamacare To Medicare

Your transition from ACA-compliant coverage won’t be automatic, but ‘shifting gears’ to new coverage doesnt have to be traumatic.

Q: When is the best time to enroll in Medicare? A: The best time to enroll is during the open enrollment window around your 65th birthday preferably in the three months before the month you turn 65, so that you’ll have Medicare coverage by the time you turn 65.

Enrollment dates for Medicare are critical. Missing an enrollment date could cost you higher premiums down the line or it could cost you coverage entirely.

Can I Choose Marketplace Coverage Instead Of Medicare

Generally, no. You can choose Marketplace coverage instead of Medicare if you have to pay a Part A premium. Before making this decision, check if Marketplace coverage meets your needs and fits your budget. Also consider:

  • If you dont sign up for Medicare when youre first eligible , you might have to wait to sign up. You might also have to pay monthly late enrollment penalties.

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What Happens When A Native American Has Marketplace Insurance And Becomes Eligible For Medicare

If you have access to the Indian Health Service, it acts as a last resort and pays after all other contributions. IHS is not health insurance. If youre a Native American or Alaska Native with a Marketplace plan and become eligible for Medicare, you should drop your Marketplace plan and .

For the most comprehensive coverage, you should pair Native American Health Insurance with Medicare. The only exception would be if you havent worked enough quarters and dont get Part A premium-free.

Can I Get A Dental Plan Through Marketplace

5 Things Medicare Doesn’t Cover (and how to get them covered)

Medicare doesnt cover dental benefits at all, so many people end up finding a private dental plan once they receive Medicare coverage. If you have Medicare and qualify to purchase a Marketplace plan, you may be able to purchase a dental plan through Marketplace.

If your state runs Marketplace through the federal government, then you will not be able to buy a standalone dental plan through Marketplace, only a complete health plan. However, some states run their own Marketplace, in which case you may be able to buy a standalone dental plan if one is available.

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Is Marketplace Coverage Creditable For Parts A And B

Marketplace coverage isnt for Parts A and B because its not required to be as good as Original Medicare. This means that youll need to pay penalties after the first 12 months if you delay coverage. So its best to sign up during your Initial Enrollment Period or the General Enrollment Period if you miss your Initial Enrollment Period.

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Up to the start of your Medicare coverage, you can continue with your Obamacare or Marketplace plan. There is no need to wait to enroll if you have worked a minimum of 40 quarters because you are eligible for Part A premium-free coverage.

When your Part A starts, your eligibility for premium tax credits and other benefits expires. This implies that youd be paying the full cost of your Marketplace plan, thus switching completely to Medicare is advantageous. Before terminating your Marketplace plan, make sure you know when your coverage begins.

The coverage for which you currently utilize your Marketplace plan will be provided by Medicare. A Medigap plan and Part D are further options.

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Exchange Subsidies End With Medicare Eligibility

You are not required to cancel your exchange plan when you enroll in Medicare, but if youre getting premium subsidies, theyll end when you become eligible for premium-free Medicare . And if you keep your individual market exchange plan and dont sign up for Medicare when you first become eligible, youll have to pay higher Medicare Part B premiums for the rest of your life, once you do enroll in Medicare, due to the late enrollment penalty.

When you have coverage in the exchange for the full year or only part of the year your total premium subsidy amount for the year is based on your total income for that year relative to the poverty level , and the cost of the benchmark plan in your area. This is explained in more detail here, and illustrated on Form 8962, which is the tax form that you use to reconcile your premium subsidy on your tax return after the year is over. So although your premium subsidy ends when you switch to Medicare, this does not affect the subsidy amount that you can receive for each of the months prior to that transition.

Because Medicare has a fairly long initial enrollment window, with varying effective dates depending on when you enroll, the exact date that your premium subsidy terminates will depend on when you enroll in Medicare. The details for this are clarified in a that CMS published in July 2020.

If youre not already receiving retirement benefits, youll need to enroll in Medicare.

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