Do the Health Insurance Marketplaces (Also Known As Exchanges) Affect My Medicare Coverage?

The Marketplaces do not affect your Medicare. Medicare Advantage Plans, Part D plans, and Medigap policies are not sold through the Marketplace. If you are eligible for Medicare, you should not use the Marketplace to get health and drug coverage, with two exceptions. If you are eligible for Medicare because you have End-Stage Renal Disease (kidney disease that requires dialysis or transplant) or you have to pay a premium for Medicare Part A (hospital insurance), you can choose to enroll in a Qualified Health Plan (QHP) through the Marketplace instead of Medicare. Note that you should consider all consequences carefully before deciding to take a Marketplace plan instead of Medicare. You cannot have any part of Medicare when purchasing a Marketplace plan. If you decide to enroll in Medicare later, you may have to wait for the General Enrollment Period (GEP) to sign up. Using the GEP to enroll means you may experience gaps in coverage and incur late enrollment penalties.

If you enroll in a Marketplace plan before you qualify for Medicare, make sure to disenroll from the Marketplace plan and enroll in Medicare when you first qualify to avoid gaps in coverage or late enrollment penalties.

The Small Business Health Options Program (SHOP) allows small businesses to help their employees get health insurance. If you have a SHOP plan through a current employer, it works with Medicare in the same way as any other current employer insurance.

It is important to remember that plans offered through the Marketplace are not the same as Medicare, even though the Marketplace enrollment period overlaps with Medicare’s Annual Open Enrollment. You should use the Medicare Annual Open Enrollment Period to review and make changes to your Medicare health and drug coverage. You should not use the Marketplace open enrollment period.

Read Next: What Are My Options for Changing My Coverage This Year?
Find Out: If I Have Questions About the Annual Enrollment Period Who Can I Contact?
Return to: Medicare 2021 takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a Licensed Sales Agent.

This content was created and copyrighted by the Medicare Rights Center ©2021. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from and may not be distributed, modified or edited without Medicare Rights’ consent.