Medicare &
the Health
Insurance
Marketplace
®
If you don’t have (and don’t qualify for) Medicare, the
Health Insurance Marketplace
®
can help you nd coverage
that ts your needs and budget. Depending on your
situation, you may be able to choose the Marketplace
instead of Medicare for your health coverage.
I already have Medicare. Should I
enroll in the Marketplace?
No. The Marketplace doesn’t aect your Medicare choices
or benets. This means no matter how you get Medicare,
whether through Original Medicare or a Medicare
Advantage Plan, you don’t have to make any changes.
Can I get a Marketplace plan in
addition to Medicare?
No. It’s against the law for someone who knows you
have Medicare to sell you a Marketplace plan. This is
true even if you have only Medicare Part A (Hospital
Insurance) or only Medicare Part B (Medical Insurance).
If you want coverage to add to Original Medicare,
visit Medicare.gov to learn more about Medicare
Supplement Insurance (Medigap) policies. You can
also learn about other Medicare options, like Medicare
Advantage Plans.
Can I choose Marketplace coverage
instead of Medicare?
Generally, no. But there are some situations where you
can choose Marketplace coverage instead of Medicare:
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If you’re eligible for Medicare but haven’t signed up
because you:
Would have to pay a Part A premium
Have End-Stage Renal Disease (ESRD) and you
haven’t signed up for Medicare (go to page 3 for
more details)
Aren’t collecting Social Security benets before
you’re eligible for Medicare
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If you’re paying a premium for Part A, you can
drop your Part A and Part B coverage and get
a Marketplace plan, but you should rst see if
Marketplace coverage meets your needs and ts
your budget. In some cases, Part A will be cheaper
than a Marketplace plan without nancial help.
You can end coverage for all or some people on your
Marketplace plan, like a spouse or dependents. Your
coverage can end as soon as the day you decide to end
coverage, or you can pick a day in the future. Usually,
you’ll want your Marketplace coverage to end the day
before your Medicare coverage starts.
Log into your account at HealthCare.gov or call
the Marketplace Call Center at 1-800-318-2596
(TTY: 1-855-889-4325) to end your Marketplace
coverage. You can also visit Healthcare.gov/how-to-
cancel-a-marketplace-plan to end coverage online.
I share a plan with others in my
household. What happens if my
Marketplace coverage isn’t renewing
because I have Medicare?
Plans won’t re-enroll you in your Marketplace coverage
if they know you have Medicare. This means it will also
end coverage for everyone on your Marketplace plan,
including the people who aren’t enrolled in Medicare.
Your Marketplace plan will send you a letter that
includes information for the other people on your
plan including how to enroll in new coverage in the
Marketplace.
If someone in your household recently lost health
insurance, such as Medicaid or CHIP coverage, they
may qualify for a Special Enrollment Period to get
Marketplace coverage.
Visit HealthCare.gov/coverage-outside-open-
enrollment/special-enrollment-period to nd out if
they qualify to get coverage now. For more information,
visit HealthCare.gov or call the Marketplace Call Center
at 1-800-318-2596. TTY users can call 1-855-889-4325.
Before making either of these choices, consider these
important points:
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If you sign up for Medicare after your Initial
Enrollment Period ends, you may have to pay a
late enrollment penalty for as long as you have
Medicare.
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Generally, if you don’t sign up during your Initial
Enrollment Period, you can only get Medicare
during the Medicare General Enrollment Period
(January 1– March 31). When you sign up during
this period, your coverage starts the rst day of the
month after you sign up.
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If you get premium-free Part A after already having
Marketplace coverage, you won’t qualify for help
paying your Marketplace plan premiums.
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If you get premium-free Medicare Part A, you can’t
drop Medicare without also dropping your retiree
or disability benets (Social Security or Railroad
Retirement Board). You’ll also have to pay back all
retirement or disability benets you got and all costs
Medicare paid for your health care claims.
I have Marketplace coverage. What
should I do if I become eligible for
Medicare?
If you have coverage through an individual Marketplace
plan (not through an employer), you should sign up for
Medicare during your Initial Enrollment Period to avoid
a delay in Medicare coverage and the possibility of a late
enrollment penalty. In most cases, you’ll want to end
your Marketplace coverage. To avoid a gap in coverage,
you should end your Marketplace coverage once you
know the date your Medicare coverage will start.
Once you’re considered eligible for Part A or already
have it, you won’t qualify for help from the Marketplace
to pay for your Marketplace plan premiums or other
medical costs. If you continue to get help paying for
your Marketplace costs after you have Medicare, you
may have to pay back some or all of the help you got
when you le your federal income taxes.
Is prescription drug coverage through
the Marketplace considered creditable
prescription drug coverage for
Medicare Part D?
It depends on the plan. While prescription drug coverage
is an essential health benet, prescription drug coverage
in a Marketplace plan isn’t required to be at least as
good as Medicare Part D coverage (creditable). But all
private insurance companies that oer prescription drug
coverage, including Marketplace plans, must determine
if their prescription drug coverage is creditable each year
and let you know in writing.
If you go 63 days or more in a row without Medicare
drug coverage or other creditable prescription drug
coverage, you may have to pay a penalty if you sign up
for Medicare drug coverage later. Visit Medicare.gov for
more information on creditable coverage.
If I have Medicare coverage, can I get
help paying for my Medicare costs?
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If you need help with your Part A and B costs, you
can apply for a Medicare.gov/medicare-savings-
programs.
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Call your State Medical Assistance (Medicaid) oce.
To get their phone number, visit Medicaid.gov/about-
us/beneciary-resources/index.html#statemenu, or
call 1-800-MEDICARE (1-800-633-4227). TTY users can
call 1-877-486-2048.
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If you need Extra Help to pay for Medicare
prescription drug costs, visit SSA.gov/extrahelp to
apply, or call Social Security at 1-800-772-1213.
TTY users can call 1-800-325-0778.
Where can I get more information?
n
Visit SSA.gov, or call 1-800-772-1213 for information
about Medicare enrollment.
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To learn more about Medicare coverage and plan
choices, visit Medicare.gov, or call 1-800-MEDICARE.
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If you have family and friends who don’t have
health coverage, or if they want to explore health
plan options, tell them to visit HealthCare.gov.
I have End-Stage Renal Disease (ESRD),
and I haven’t signed up for Medicare.
Can I get a Marketplace plan?
Yes. People with ESRD aren’t required to sign up for
Medicare. If you have ESRD and don’t have either
Medicare Part A or Part B, you can get a Marketplace
plan. You may also be eligible for help with paying your
Marketplace plan premiums or other medical costs. But
if you sign up for Part A and your coverage starts, any
nancial help you get through the Marketplace will stop.
I have Medicare coverage because of
ESRD. Can I drop my Medicare coverage
and choose a Marketplace plan?
Generally, no. Once you apply for Medicare, your
Medicare coverage will end one year after you stop
getting regular dialysis or 36 months after a successful
kidney transplant. However, you may withdraw your
original Medicare application. You would have to
repay all costs Medicare covered, pay any outstanding
balances, and refund any benets you got from Social
Security or the Railroad Retirement Board. Once you
repay all Medicare-covered costs, Medicare will process
the withdrawal as though you never had Medicare.
If I have Medicare, can I get a stand-
alone dental plan through the
Marketplace?
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In most cases, no. If the Marketplace in your
state is run by the federal government through
HealthCare.gov, you won’t be able to buy a stand-
alone dental plan unless you’re also buying a health
plan.
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If your state runs its own Marketplace, you may
be able to buy a stand-alone dental plan, if one’s
available. Visit HealthCare.gov/marketplace-in-
your-state for a list of states that run their own
Marketplace.
CMS Product No. 11694
October 2023
This product was produced at U.S. taxpayer expense.
Health Insurance Marketplace
®
is a registered service mark of
the U.S. Department of Health & Human Services.
How can I learn more?
To learn more about coverage through the Marketplace or your benets and
protections, visit HealthCare.gov or call the Marketplace Call Center at
1-800-318-2596. TTY users can call 1-855-889-4325.
You have the right to get your information in an accessible format, like large print, braille, or audio.
You also have the right to le a complaint if you feel you’ve been discriminated against.
Visit CMS.gov/About-CMS/Agency-Information/Aboutwebsite/CMSNondiscriminationNotice
or call 1-800-318-2596. TTY users can call 1-855-889-4325.
