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For individuals currently covered through the Health Insurance Marketplace, transitioning to Medicare may seem overwhelming. However, with proper planning and understanding of the process, you can ensure a seamless shift to Medicare without gaps in coverage or unnecessary penalties.
The Health Insurance Marketplace is primarily intended for those who do not yet qualify for Medicare or other government-sponsored programs.
However, once you reach the age of 65 or qualify for Medicare due to a disability, Medicare typically becomes your primary insurance. It is important to understand that staying on a Marketplace plan after becoming Medicare-eligible could lead to complications.
For example, you will no longer qualify for tax credits or subsidies that reduce the cost of your plan, making Medicare a more affordable and comprehensive choice.
When to enrol
Enrollment in Medicare should occur during your Initial Enrollment Period, which begins three months before your 65th birthday, includes your birthday month, and extends three months afterward.
This seven-month window is the ideal time to sign up for Medicare Part A and Part B, ensuring you avoid late enrollment penalties.
If you are under 65 and qualify for Medicare due to a disability, the timing of your enrollment depends on when your eligibility begins. It is critical to enroll promptly during this period to secure uninterrupted healthcare coverage.
After enrolling in Medicare, you must end your Marketplace plan to avoid overlapping coverage. Overlapping insurance could lead to higher out-of-pocket costs, as Medicare would automatically become your primary coverage.
To cancel your Marketplace plan, you can to your , select your plan, and terminate it. It's essential to coordinate the end date of your Marketplace coverage with the start date of your Medicare plan to prevent any gaps.
Once you transition to Medicare, you may need additional coverage to meet your healthcare needs. Original Medicare covers hospital and outpatient services, but it does not include coverage for prescription drugs, dental, vision, or hearing care.
Exploring supplemental options such as Medicare Advantage plans, standalone Part D prescription drug plans, or Medigap policies can help provide more comprehensive protection. Each option comes with its own benefits and costs, so it is important to evaluate which plan suits your health and financial situation.