Qualified Health Plans (QHPs) are health insurance policies that meet protections and requirements set by the Affordable Care Act (ACA). They are typically not for people with Medicare. QHPs must:

  • Follow federally established cost-sharing limits
  • Provide essential health benefits

QHPs are sold in federal- or state-run forums (referred to as Marketplaces or Exchanges) where you can shop for coverage online or over the phone.

Note: People shopping for insurance may also come across short-term limited duration (STLD) plans and association health plans (AHPs) as other coverage options. These plans are not required to meet the same standards as QHPs, meaning they may not provide comprehensive coverage or may exclude certain services. Additionally, STLD plans are generally unavailable for people with pre-existing conditions.

Remember, QHPs are typically not for people with Medicare. If you are already enrolled in Medicare, you do not need to change your health coverage and you do not receive coverage through the Marketplaces.

  • No type of Medicare coverage is sold through the Marketplaces
  • It is illegal for someone to sell you a QHP if they know you have Medicare
  • In most cases, you are ineligible for cost assistance (tax credits) to help pay for your QHP premium
  • There is no guarantee that a QHP will pay for your care if you have or are eligible for other insurance—meaning you may have little or no coverage
  • You may experience gaps in coverage and incur Medicare late enrollment penalties when attempting to re-enroll in Medicare

If you currently have a QHP and are becoming eligible for Medicare, in most cases you should disenroll from your QHP and enroll in Medicare. However, there are a few circumstances in which you might choose to delay Medicare enrollment to stay in a QHP.

Note: There are different rules if you are enrolled in a Small Business Health Options Program (SHOP) plan.

Return to: Medicare Admin

This content was created and copyrighted by the Medicare Rights Center ©2020. 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 YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com 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 YourMedicare.com Licensed Sales Agent.