The Health Insurance Marketplace was established by the Affordable Care Act (ACA) and opened to new enrollees in 2014. It allows people who don’t have health insurance through an employer, Medicare, or Medicaid to buy insurance online at HealthCare.gov.
Medicare is a federal health insurance program for people who are 65 years of age and older and those with certain health conditions or disabilities.
Medicare and the Health Insurance Marketplace are two separate health insurance systems. If you already have Medicare, you don’t need to worry about Marketplace insurance.
If you already have Medicare coverage, it’s illegal for an insurance provider to knowingly sell you a plan through the Marketplace. People interested in adding more coverage to their Original Medicare can add a Medigap policy or switch to Medicare Advantage (Part C).
If you have Marketplace coverage when you turn 65 years old and become eligible for Medicare, you should still sign up for Medicare coverage during the initial enrollment period. Doing so prevents coverage delays and possible penalties for late enrollment.
In general, if you’re eligible for Medicare, you can’t choose Marketplace coverage instead. However, you may opt for Marketplace coverage in cases where you’re eligible for Medicare but don’t qualify for premium-free Part A.
You can also stick with your Marketplace coverage if you haven’t yet enrolled in Medicare. But doing so opens you up to the potential delays and penalties mentioned above.
In the United States, all U.S. citizens are required to have health insurance. If you’re enrolled in Medicare Part A, you’re considered to have met this requirement and do not need additional insurance.
But you do have options for expanding your coverage beyond what’s included in Original Medicare if you wish. Whether this makes sense for you depends on your personal health and financial needs.
If you have health insurance through an employer when you turn 65 years old, you can opt to delay enrolling in Medicare Part B. If you enroll while still working, Medicare will be your primary payer, and your employer insurance will cover any remaining costs.
Individuals who require coverage for things like vision, hearing, and dental care may wish to explore Medicare Advantage. Private insurance providers provide these plans and include additional benefits to Original Medicare.
Third-party companies also offer Part D prescription drug plans and help you pay for medications. Individuals with Original Medicare could consider Medigap for help covering out-of-pocket costs.