If you currently have health insurance through the Health Insurance Marketplace and you’re approaching age 65, it’s important to understand how becoming eligible for Medicare may affect your current coverage. The transition involves more than simply ending one plan and starting another, since your Medicare enrollment and coverage start dates need to be considered before making changes to your Marketplace coverage.
Medicare advises people who have Marketplace coverage, or other individual health coverage that isn’t based on current employment, to sign up for Medicare when they’re first eligible, usually around age 65, to avoid a possible delay in coverage or Medicare late enrollment penalties. Medicare
Know Your Medicare Dates Before Changing Your Coverage
For most people who become eligible for Medicare at 65, the Initial Enrollment Period lasts seven months, beginning three months before the month they turn 65, including their birthday month, and ending three months afterward. However, when Medicare coverage actually begins can depend on when you enroll and your individual circumstances. HealthCare.gov
Some people are automatically enrolled in Medicare Part A and Part B, while others need to sign up themselves. For that reason, it’s important to confirm your Medicare enrollment and coverage start date before making changes to your Marketplace plan. Medicare
Marketplace Coverage Doesn’t End Automatically
Marketplace coverage does not automatically end when Medicare begins. If you’re transitioning to Medicare, you’ll need to update your Marketplace application to end Marketplace coverage for the person starting Medicare, while making sure the coverage dates are properly coordinated. HealthCare.gov
This is why you shouldn’t choose a Marketplace termination date based only on your 65th birthday. First, confirm when your Medicare coverage will actually begin, then coordinate the end of your Marketplace coverage accordingly.
Pay Attention to Marketplace Financial Assistance
If you receive financial assistance through the Marketplace, this is especially important. Once you’re eligible to enroll in premium-free Medicare Part A, you no longer qualify for Marketplace help with premiums or other medical costs. Continuing to receive that assistance when you’re no longer eligible could mean having to repay some or all of it when you file your federal income taxes. Medicare
Not every situation is the same, however. Medicare has different rules for certain people who must pay a premium for Part A, so it would not be accurate to assume that everyone loses Marketplace financial assistance simply because they turn 65. Medicare
What If Other Family Members Have Marketplace Coverage?
If you’re the person transitioning to Medicare while other members of your household still need Marketplace coverage, you don’t necessarily need to end coverage for everyone. When you update your Marketplace application, you can end coverage for the person starting Medicare and confirm coverage for other household members who still need it. HealthCare.gov
The most important step is to verify your dates before making changes. Medicare eligibility, enrollment, and coverage start dates can vary depending on individual circumstances, so confirm your situation before ending your current health insurance coverage.
