Can I have Medicare and Marketplace insurance at the same time?

Can you have Medicare and Marketplace insurance at the same time?

Marketplace Medicare

Generally, once you have Medicare, it is illegal for you to enroll in Marketplace plan, known as a Qualified Health Plan (QHP).  But see exceptions below.

If you already enrolled in Marketplace plan and ready for Medicare, you are entitled to keep your QHP. But this is rarely done. Typically you’ll cancel your Marketplace plan when your Medicare coverage begins. You need to notify QHP insurer at least 14 days before the start of your Medicare coverage. We’ll review below why only in rare cases you want to have Medicare and Marketplace insurance at the same time

Can Medicare beneficiaries keep a Marketplace plan? – Typical Scenario

As a rule, people with Medicare SHOULD NOT keep individual or family health coverage bought either through the exchange or directly from insurance vendors. Here are the reasons:

  • Affordable Care Act (ACA), known as Obamacare, will not replace Medicare or other governmental health care programs. There is no coordination of benefits between Medicare and Marketplace. The Marketplace plan will NOT cover your health costs if you are enrolled in Medicare.
  • People having both Medicare parts, Part A and Part B, have coverage that is compliant with ACA requirements for the health plans.  They don’t need to enroll in additional health coverage, and they will not need to pay a penalty for lack of coverage.
  • Rumors and speculations that Obamacare may affect Medicare Supplement (Medigap) plans are nothing more than rumors and speculations. There will be no changes in Medigap plans in the foreseeable future.
  • The ACA compliant plans are for people who don’t have health insurance, who buy their insurance, or for owners of small businesses. Most Medicare beneficiaries have pretty good coverage and don’t need to consider Obamacare plans (usually more expensive than Medicare).

Can Medicare beneficiaries have a Marketplace plan? – Exceptions

Below are exceptional scenarios when people can have Medicare and Marketplace insurance at the same time. Only the last of them is real exception; the first two are not exceptions because they deal with people expecting to be on Medicare soon but who are not yet on Medicare.

  • Disable people eligible for Medicare who need to wait 48 months (since disability) before the Medicare coverage will be available to them
  • People who are close to 65 but not there yet. They may use Obamacare to get health coverage until they are entitled to Medicare at 65.
  • People who are older than 65 and not entitled to Medicare, or a small number of people who currently pay the Part A premium. For them an alternative Marketplace plan may be considered; nevertheless, even then the premium for Marketplace plan may exceed Part A premium.

US Government Sources

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