Marketplace / ACA Coverage & Medicare
If you have an ACA Marketplace plan, you'll need to switch to Medicare when you're eligible.
The Short Version
- You must drop your Marketplace plan when Medicare coverage starts.
- You can't get premium subsidies for a Marketplace plan once you're Medicare-eligible.
- Don't delay Medicare enrollment — Marketplace coverage doesn't protect you from penalties.
When You Turn 65
If you have a Marketplace (Healthcare.gov or state exchange) plan:
- Enroll in Medicare during your Initial Enrollment Period
- Cancel your Marketplace plan to avoid paying for coverage you can't use
- You lose eligibility for premium tax credits once Medicare-eligible
The Timing
Your Initial Enrollment Period for Medicare:
- Starts 3 months before your 65th birthday
- Includes your birthday month
- Ends 3 months after your 65th birthday
Plan ahead so there's no gap in coverage.
Important: No Penalty Protection
Unlike employer coverage, a Marketplace plan does not count as "creditable coverage" that lets you delay Medicare.
- If you delay Part B, you'll pay a permanent late enrollment penalty
- The penalty is 10% higher premiums for each 12-month period you were eligible but didn't enroll
What If I'm Under 65 on Medicare?
If you're under 65 and on Medicare due to disability:
- You may keep a Marketplace plan as secondary coverage
- You won't get premium tax credits
- It may not be worth the cost — evaluate carefully
Action Steps
- Mark your calendar for your Medicare Initial Enrollment Period
- Enroll in Medicare Parts A and B before your Marketplace plan ends
- Contact the Marketplace to cancel your plan (effective when Medicare starts)
- Decide on Part D drug coverage and/or Medigap or Medicare Advantage