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Marketplace Matters: Medicare & the Marketplace

Marketplace Matters: Medicare & the Marketplace


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 you’ll find resources for assistors training modules videos frequently asked questions and official consumer resources you can also sign up to get email updates don’t miss key dates and information about the health insurance marketplace here’s how to stay connected

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