Already have Marketplace health insurance and approaching 65? You may be wondering whether to keep your current plan, switch to Medicare, or carry both.

The answer needs a little explanation: You may be able to keep an existing Marketplace plan after Medicare starts, but it isn’t a Medicare supplement. For most people, a coordinated transition makes more sense than overlapping coverage. (healthcare.gov)

Keeping a Plan Is Different From Buying One

Once you have Medicare, someone who knows that cannot legally sell you a new Marketplace health plan; even if you have only Part A or only Part B.

Keeping an existing plan is different, but you generally must pay its full premium once Medicare Part A begins. Don’t assume it will pay Medicare’s deductibles or coinsurance. Your insurer may also end your Marketplace coverage. (Medicare)

What Happens to Your Financial Assistance?

Eligibility for premium-free Medicare Part A, which covers hospital care, generally ends eligibility for Marketplace premium tax credits and other savings. Postponing Medicare doesn’t preserve those savings indefinitely. The exact cutoff can depend on your enrollment timing. (Medicare)

Tax credits received for months you weren’t eligible may have to be repaid when you file your federal return. Report changes promptly, and ask a tax professional about any overlap or retroactive Medicare coverage. (Medicare)

There’s an important exception: If you would have to pay for Part A and haven’t enrolled in Medicare, you may choose Marketplace coverage instead and qualify for savings if you meet the other requirements. Consider potential Medicare late-enrollment penalties before deciding. (IRS)

When Should You Sign Up for Medicare?

For most people turning 65, the Initial Enrollment Period lasts seven months: the three months before your birthday month, your birthday month, and the three months afterward. Don’t wait for fall open enrollment; your first enrollment opportunity is tied to your eligibility. (Medicare) If your birthday is on the 1^st of the month, you are Medicare eligible the month prior to your birthday.

Some people are enrolled automatically, while others must apply through Social Security. Confirm which applies to you rather than assuming your coverage will begin automatically. (Medicare)

Marketplace insurance is not the same as group coverage through current employment. It generally does not protect you from Part B late-enrollment penalties. That matters even if you’re still working or self-employed and buy your own Marketplace policy. (Medicare)

How Do You Avoid a Coverage Gap?

First, confirm when your Medicare hospital, medical, and chosen prescription coverage will start. Then arrange for your Marketplace coverage to end the day before your Medicare coverage begins.

For example, if Medicare starts July 1, schedule your Marketplace coverage to end June 30, not June 1.

Marketplace coverage does not automatically stop when Medicare starts. Update your application and keep confirmation of the termination date. Don’t simply stop paying the premium. (healthcare.gov)

Before switching, review your doctors, prescriptions, and upcoming appointments so you understand how they will be covered under your new arrangements.

Can Your Spouse Stay on the Marketplace?

Yes. Your spouse or other eligible family members can keep Marketplace coverage when you move to Medicare. End coverage only for the person transitioning and not the entire family. (healthcare.gov)

However, ending your Marketplace coverage is different from removing yourself from the household application. You generally still need to be listed as a household member, and your income still counts when determining your spouse’s or dependent’s financial assistance.

Update the application, identify who still needs coverage, and review the remaining family members’ eligibility and premium. Their savings may change. (HealthCare.gov)

What Coverage Can You Choose With Medicare?

You have two main ways to receive Medicare benefits.

Original Medicare includes Part A for hospital coverage and Part B for medical coverage. You can add a separate Part D prescription drug plan and may purchase a Medicare Supplement policy, also called Medigap, to help pay certain out-of-pocket costs.

Medicare Advantage, or Part C, is a private plan alternative for receiving your Part A and Part B benefits. Most plans include prescription coverage. You must have both Part A and Part B to join. Provider networks, costs, and coverage rules vary, so check your doctors and medications before choosing. (Medicare)

These Medicare choices are separate from Marketplace coverage. Compare monthly premiums, deductibles, copayments, and prescription costs, not just a plan’s advertised benefits.

Make Your Transition a Plan, Not a Guess

The goal isn’t simply to cancel one policy and start another. It’s to line up coverage dates, update financial assistance, protect your family’s coverage, and choose benefits that fit your needs.

At Crawford Benefits, we’re here to help you understand your options and prepare for the switch. Bring your current insurance information, medication list, and doctor names to your consultation so we can focus on what matters to you.



Approaching 65? Let’s talk before your Medicare start date, not after a coverage problem appears.