Transitioning from Obamacare to Medicare

Timing is of great importance to make the transition smooth. Our goal is to sit down with a client going through this transition about 2-3 months prior to their Medicare starting. We then get all of the plans lined up and ready to go before helping to remind you to make the cancellations through the marketplace. If you are currently enrolled in a Healthcare Marketplace plan and receiving monthly premium tax credits, be aware that you will no longer qualify for those credits when you turn 65 and are eligible for Medicare. If you have a Marketplace plan now, you can keep it until your Medicare coverage starts. Then, you can cancel the Marketplace plan without penalty. We keep it smooth, easy, and seamless. Here are some helpful hints you will want to keep in mind:

When to apply for Medicare

Once you are eligible for Medicare (at Age 65 or through disability), you’ll have a 7- month Initial Enrollment Period to call Social Security and enroll. This 7-month initial enrollment period begins 3 months before the month you were born, the month of, and 3 months after your 65th birthday. For some, Medicare may even be automatic. In most cases it’s to your advantage to sign up for Medicare when you’re first eligible because once your Medicare Part A coverage starts, you won’t be able to keep any premium tax credits or other savings for a Marketplace plan based on your income. You’ll have to pay full price for the Marketplace plan. If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty. In addition, after your initial enrollment period ends you can only enroll in Medicare Part B during the Medicare general enrollment period (from January 1 to March 31 each year).…AND your Medicare coverage doesn’t start until July of that year. This may create a gap in your coverage if you do not keep your marketplace plan and continue paying full price for the cost of the insurance. You also cannot supplement Medicare with a Marketplace plan. It’s against the law for someone who knows that you have Medicare to sell you a Marketplace policy. This is true even if you have only Medicare Part A or only Part B.

Canceling your Marketplace plan

Every situation can be different but these are ones we commonly run into. Again, we can’t stress the importance of taking care of the Medicare enrollment with us prior to cancelling out Marketplace coverage.

  • "I’m the only member of my household enrolled on my Marketplace plan.” -You’ll simply terminate the whole application.

You can access your online account and under “My Account,” you can then cancel the plan coverage or you can do the same by phone at 1-800-318- 2596 (TTY: 1-855- 889-4325). Available 24 hours a day, 7 days a week.

  • "My spouse and I are both (or even family) enrolled in the same Marketplace plan, but only my spouse needs to cancel due to getting Medicare. I want to keep the Marketplace coverage for my spouse/family and end Marketplace coverage only for myself."

You can access your account online once again but this time you will want to “Report a Life Change” under your account. You can then remove a member of the household marking the correct sections. Many people find it easier to get help over the phone direct with the marketplace for this as you will need to complete the remaining information for the person keeping the coverage. In most cases, when you end coverage for only some people on your application, your coverage ends immediately. Be sure not to cancel your Marketplace plan before your Medicare coverage begins. Otherwise, you may have a gap in coverage.

IMPORTANT NOTE: When you end coverage for just some people on your application, their premium tax credit or other savings may change. You may need to update your household income after ending coverage for one or more people.

We hope this information has been helpful and please remember that every person may have unique circumstances so the best way to ensure a smooth transition is to work with a local agent who can walk you through the bumpy road to ensure proper coverage.


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