Making Part B enrollment decisions with QHP coverage

Medicare and the Marketplaces

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:

  1. 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).
  2. 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. 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 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.