Hi, I'm Denise Sieron with the Centers for
Medicare and Medicaid Services. Welcome
to Marketplace Matters. A series to help
those who assist consumers with their
marketplace questions. Today's subject
Medicare in the marketplace. This
information focuses on the individual
marketplace and what consumers who have a
marketplace plan and may soon be
eligible for Medicare need to know to
make informed health care decisions the
health insurance marketplace is designed
to help consumers find and buy health
insurance that fits their budget but it
generally isn't a place for someone
eligible for Medicare to look for
healthcare coverage Medicare isn't part
of the health insurance marketplace this
presentation will walk you through some
questions that may come up when
counseling consumers who have a
marketplace plan and will be eligible
for Medicare let's start with what
happens when you have a marketplace plan
and are eligible for Medicare jim has a
marketplace plan and will be eligible
for Medicare in nine months what does
Jim need to know Jim can keep his
marketplace plan until his Medicare
coverage starts but if he's been getting
tax credits are lower out-of-pocket
costs on a plan he bought through the
marketplace these savings will end once
his Medicare Part A coverage starts he'd
have to pay full price for the
marketplace plan once he's eligible for
Medicare he'll have an initial
enrollment period to sign up which
starts three months before his 65th
birthday and ends three months after his
65th birthday it's to Jim's advantage to
sign up for Medicare when he's first
eligible because if you were to enroll
in Medicare after his initial enrollment
period ends he may have to pay a late
enrollment penalty for as long as he has
Medicare in addition after his initial
enrollment period ends Jim can only
enroll in Medicare during the Medicare
general enrollment period from january
first to March 31st each year his
coverage wouldn't start until July of
that year which may cause a gap in his
coverage he can visit medicare.gov to
learn more about his Medicare coverage
choices and how he can choose to get his
Medicare coverage can you choose
marketplace coverage instead of Medicare
Ricardo is 65 and is eligible for
Medicare he likes his marketplace plan
and wants to know if he can choose his
marketplace coverage instead of Medicare
what does Ricardo
to know there are a few situations where
Ricardo can choose a marketplace plan
instead of Medicare for example if
Ricardo would have to pay a premium for
Part A in this case he can choose a
marketplace plan instead of Medicare or
if Ricardo's eligible for Medicare but
hasn't enrolled in it and he's not
receiving Social Security retirement or
disability benefits because he'd have to
pay a premium or he has a medical
condition that qualifies him for
Medicare like end-stage renal disease
but hasn't applied for Medicare coverage
if Ricardo is getting Social Security
retirement or disability benefits he'd
automatically be enrolled in Medicare
once he's eligible if that's the case
it's against the law for someone who
knows you have Medicare to sell you a
marketplace plan before choosing a
marketplace plan over Medicare there are
two important points Ricardo should
consider if he enrolls in Medicare after
his initial enrollment period ends he
may have to pay a late enrollment
penalty for as long as he has Medicare
and he can only enroll in Medicare Part
B and Part A if he has to pay a premium
for it during the Medicare general
enrollment period which occurs from
January first to March 31st each year
this means his coverage wouldn't start
until July of that year which may create
a gap in his coverage how do you cancel
your marketplace plan once your Medicare
coverage starts Barbara is eligible for
Medicare and her coverage starts next
month she wants to know how to cancel
her marketplace plan what does Barbara
need to know once Barbara's Medicare
coverage starts she can cancel her
marketplace health plan without penalty
she can do this by contacting the
marketplace call center at 1 803 1825 96
or canceling her coverage online
if you're a professional
learning about the marketplace and
helping people apply you can get the
latest resources at marketplace CMS gov
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questions and official consumer
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