Dear Marci,

I have a Qualified Health Plan (QHP) from my state’s health insurance Marketplace. I’m turning 65 soon, though. Should I enroll in Medicare if I have Marketplace coverage?

-Tina (Cortland, NY)

Dear Tina,

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions:

  • You have End-Stage Renal Disease (ESRD).
    • If you have kidney disease that requires dialysis 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.
    • For counseling regarding your insurance options, contact your State Health Insurance Assistance Program (SHIP).
  • You do not qualify for premium-free Medicare Part A.
    • If you are eligible for Medicare but would have to pay a premium for Part A, 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 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.

Here are additional notes to remember when considering whether to enroll in Medicare if you have a QHP from the Marketplace:

  • You are ineligible for cost assistance (tax credits) to help pay for your QHP premium once you are eligible for premium-free Part A.
  • It is likely not cost-effective to have both Medicare and a QHP.
  • There is no guarantee that a QHP will pay for your care if you have or are eligible for Medicare Part B, meaning you may have little or no coverage.
  • You may experience gaps in coverage and late enrollment penalties when attempting to enroll in Medicare late.

I hope this helps you with your decision to enroll in Medicare or not.


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