Making Part B enrollment decisions with QHP coverage

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage).  eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions:

1. You have End-Stage Renal Disease (ESRD).

   • If you have kidney disease that requires dialysis dialysis Dialysis is the treatment used to artificially cleanse your blood of toxins when your kidneys no longer work. or transplant and are eligible for Medicare, you have the choice to enroll in or stay enrolled in a QHP with cost assistance (tax credits).
   • Be sure to consider how the QHP’s coverage and costs compare to Medicare before deciding to delay Medicare enrollment enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan. .
   • For counseling regarding your insurance options, contact your State Health Insurance Assistance Program (SHIP).

2. You do not qualify for premium-free Medicare Part A.

   • If you are eligible for Medicare but would have to pay a premium premium A premium is an individual’s monthly payment to a Medicare or other health insurance plan for coverage. for Part A Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. , you can keep your QHP with cost assistance as long as you do not enroll in any part of Medicare.
   • You should consider all consequences carefully before deciding to keep a QHP instead of Medicare. If you ever decide to enroll in Medicare, you may have to wait for the General Enrollment Period (GEP) to sign up. Using the GEP to enroll means you may experience gaps in coverage gaps in coverage Gaps in coverage are services or costs that are not covered by Original Medicare, such as vision, dental, and hearing care, as well as deductibles and coinsurance. and incur a late enrollment penalty (LEP).

If you qualify for premium-free Part A, you should not continue using the Marketplace to get health and drug coverage. Enroll in Medicare when you are first eligible and disenroll from your QHP in a timely manner to avoid paying extra premiums.

Disenrolling from QHP coverage

To disenroll from QHP coverage:

• Notify a state or federal Marketplace representative of your intent to disenroll from your QHP at least 14 days before your Medicare coverage begins.
  • If you are enrolled in a QHP through the federal Marketplace, contact the Marketplace Call Center at 800-318-2596 or visit www.healthcare.gov.
  • If you are enrolled in a QHP through your state’s Marketplace, contact the state marketplace to learn how and when to disenroll from your plan.
  • Ask for disenrollment disenrollment Disenrollment is leaving a Medicare Advantage Plan or Part D plan. steps from a Marketplace representative if you are enrolled in a family plan.

Be aware that if you delay Medicare enrollment, you will likely experience gaps in coverage and incur an LEP. It is likely not cost-effective to have both Medicare and a QHP.

Note: There are different rules if you are enrolled in a Small Business Health Options Program (SHOP) plan.