Medicare & the Marketplace

The Health Insurance Marketplace is designed for people who don’t have health coverage. If you have health coverage through Medicare, the Marketplace doesn't affect your Medicare choices or benefits. This means that no matter how you get Medicare, whether through  

Original Medicare

 or a 

Medicare Health Plan

, you won’t have to make any changes to your current Medicare coverage. If you have family and friends without health coverage, point them to to learn about enrolling through the Marketplace.



Important tax information for plan years through 2018

Medicare counts as qualifying health coverage and meets the law (called the individual Shared Responsibility Payment) that required people to have health coverage if they can afford it. If you had Medicare for all of 2018 (or for earlier plan years), check the box on your federal income tax form for that year. You won’t have to fill out extra tax forms and pay the fee that people without coverage might have to.

Important: Starting with the 2019 plan year (for which you’ll file taxes starting in early 2020), the Shared Responsibility Payment no longer applies when you file your federal income taxes.


If I have Medicare, do I need to do anything with the Marketplace during Medicare's Open Enrollment?

No. Medicare’s Open Enrollment isn’t part of the Marketplace. 

During the Medicare Open Enrollment Period (October 15–December 7), you can review your current Medicare health and prescription drug coverage to see if it still meets your needs. Take a look at any cost, coverage, and benefit changes that'll take effect next year. If you want to change your coverage for next year, do so during this time. If you feel your current coverage will continue to meet your needs for next year, you don’t need to do anything.  

If you have Medicare, make sure that you’re reviewing Medicare plans, not Marketplace ones.

What if I already have Medicare, and someone tries to sell me a Marketplace plan?

It’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

During Medicare Open Enrollment, there’s a higher risk for fraudulent activities. Learn how to prevent, spot, and report fraud.

What if I already have a Marketplace plan, and I will be 65 soon?

Even if you have Marketplace coverage, you should enroll in Medicare when you’re first eligible to avoid the risk of a delay in Medicare coverage and the possibility of a Medicare late enrollment penalty. Here are some important points to consider if you have Marketplace coverage:

  • You need to terminate (end) your Marketplace coverage in a timely manner to avoid an overlap in coverage.
  • Once you’re considered eligible for or enrolled in Part A, you won’t qualify for help from the Marketplace to pay your Marketplace plan premiums or other medical costs. If you continue to get help to pay your Marketplace plan premiums after you have Medicare, you may have to pay back the help you got when you file your taxes.

Once you’re eligible for Medicare, you’ll have an Initial Enrollment Period to sign up. For most people, the Initial Enrollment Period starts 3 months before their 65th birthday and ends 3 months after their 65th birthday month.

Once your Medicare Part A coverage starts, you won’t be eligible for a premium tax credit or other savings for a Marketplace plan.

If you kept your Marketplace plan, you’d have to pay full price. For this reason, in most cases, you’ll want to end your Marketplace coverage once you’re eligible for Medicare. You may get a notice from the Health Insurance Marketplace that says you may soon be eligible for Medicare & can change your Marketplace plan. Don’t wait for the notice. Be sure to sign up for Medicare once you’re eligible.

Learn more about transitioning from the Marketplace to Medicare.

Find out who to call about Medicare options, claims and more.