Most people should disenroll from their health insurance Marketplace plan and enroll in Medicare when they become eligible.
Contact the Social Security Administration to enroll in Medicare.
Individuals in certain circumstances may have additional considerations when deciding whether to enroll in Medicare or keep a Marketplace plan.
When becoming eligible for Medicare, some people may face decisions around their Marketplace plan and Medicare enrollment. Learning about the Marketplace to Medicare transition can be helpful as you consider your coverage options. In many instances, failing to enroll in Medicare and disenroll from a Marketplace plan can have consequences to your finances and coverage. Read on to learn more and watch our short tutorial below.
What are the Marketplaces?
The Marketplaces (also known as Exchanges) are shopping forums created by the Affordable Care Act where individuals and small business owners can compare and purchase health insurance plans. Each state has its own Marketplace and can choose how to operate it. For more information on a state’s Marketplace, you can contact your State Health Insurance Assistance Program (SHIP) or State Department of Insurance. To find a SHIP, call 877-839-2675 or visit www.shiphelp.org.
What are Qualified Health Plans (QHPs)?
Qualified Health Plans (QHPs) are health insurance policies that meet protections and requirements set by the Affordable Care Act. QHPs are sold the Marketplaces. Medicare-eligible people should be aware of the following about QHPs:
- Most people who are eligible for premium-free Medicare Part A will be ineligible for the cost assistance that many people receive to help pay for QHP premiums.
- There is no guarantee that a QHP will pay for an individual’s care if they have or are eligible for other insurance—meaning an individual who is eligible for Medicare may have little or no coverage from a QHP.
- An individual will likely experience gaps in coverage and have to pay premium penalties if they delay enrolling in Medicare to stay in their QHP.
Note that considerations are different for those who do not qualify for premium-free Part A, individuals eligible for Medicare due to ESRD, and those with SHOP plans from the Marketplace. These individuals may want to keep their QHPs even if they are eligible for Medicare. Contact your SHIP to learn more. To find a SHIP, call 877-839-2675 or visit www.shiphelp.org.
How can I disenroll from a QHP?
You should notify a state or federal Marketplace representative of your intent to disenroll from your QHP at least 14 days before your Medicare coverage begins. Request that the end date of your Marketplace coverage be the day before your Medicare coverage begins.
- If you are enrolled in a QHP through the federal Marketplace, you should contact the Marketplace Call Center at 800-318-2596 or visit www.healthcare.gov.
- If you are enrolled in a QHP through your state’s Marketplace, you should contact the state marketplace to learn how and when to disenroll from the plan.
- If you are enrolled in a family plan, you should ask for disenrollment steps from a Marketplace representative to ensure you do not unintentionally end coverage for other members on the Marketplace plan.
How can I enroll in Medicare?
Once becoming eligible for Medicare, you may be automatically enrolled in Medicare. If so, you should receive a package in the mail with your new Medicare card three months before your coverage starts. You will be automatically enrolled if:
- You are receiving Social Security retirement or Railroad Retirement benefits
- You become eligible for Medicare because of a disability and have been receiving SSDI or railroad disability annuity checks for 24 months
If you are eligible for Medicare but not for automatic enrollment, you can use your Initial Enrollment Period (IEP) to actively enroll. Your IEP is a seven-month period, which includes the three months before, the month of, and the three months following your 65th birthday. The date when your Medicare coverage begins depends on when in your IEP you sign up. To actively enroll in Medicare, you can do one of the following:
- Call Social Security at 800-772-1213
- Apply online at www.ssa.gov
- Visit your local Social Security office
- Mail a signed and dated letter to Social Security that includes your name, Social Security number, and the date you would like to be enrolled in Medicare
If you miss your IEP and need to enroll in Medicare, you likely will have to enroll during either a Special Enrollment Period (SEP) or the General Enrollment Period (GEP). Enrolling during the GEP, which takes place January 1 through March 31 of each year, means your coverage will start on July 1. Until that time you will not be covered by Medicare. Enrolling during the GEP also means you may have to pay a Part B premium penalty.
You may be able to avoid this premium penalty if you qualify for a Medicare Savings Program. Learn more and see if you qualify for this benefit, which helps to pay for your Medicare costs.
Start planning your transition from Marketplace to Medicare early
In summary, most people with Marketplace plans should disenroll from their plan and enroll in Medicare when they become eligible. Consider your options more carefully if you do not qualify for premium-free Part A, have a SHOP plan, or are eligible for ESRD Medicare. Start thinking about this transition early and don’t be afraid to seek personal counseling from a SHIP counselor.
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