Tips for Transitioning From an ACA Health Insurance Marketplace Plan to Medicare

As you approach your 65th birthday, one significant milestone is becoming eligible for Medicare. If you've been covered by an Affordable Care Act (ACA) Marketplace health insurance plan, transitioning to Medicare can feel like a big step. However, with a bit of preparation and understanding, you can make this transition smoothly and confidently. Here’s what you need to know.

6 Tips for Transitioning From an ACA Health Insurance Marketplace Plan to Medicare

1. Understand the Timing

Timing is everything when transitioning from an ACA Marketplace plan to Medicare. Your Initial Enrollment Period (IEP) for Medicare starts three months before your 65th birthday and ends three months after. This seven-month window is your best opportunity to enroll in Medicare without facing any penalties or lapses in coverage.

It’s crucial to enroll in Medicare during your IEP because the ACA Marketplace does not qualify as creditable coverage once you’re eligible for Medicare. If you delay your Medicare enrollment, you may face a late enrollment penalty and higher premiums.

2. Coordinate the End of Your Marketplace Plan

Once you’re enrolled in Medicare, you’ll need to terminate your ACA Marketplace plan. It’s important to coordinate the end date of your Marketplace plan with the start date of your Medicare coverage to avoid any gaps. Typically, your Medicare coverage will begin on the first day of the month you turn 65.

To end your Marketplace plan, contact the Marketplace directly. You can terminate your plan as soon as your Medicare coverage begins, ensuring there’s no overlap or lapse in your health coverage.

3. Be Aware of Financial Changes

Transitioning to Medicare can impact your finances in several ways. If you’ve been receiving subsidies to help pay for your ACA Marketplace plan, those will end once you enroll in Medicare. Keep in mind that Medicare Part B, which covers outpatient services, comes with a monthly premium that you’ll need to budget for.

You may also want to explore additional coverage options like a Medicare Supplement (Medigap) plan or a Medicare Advantage plan. These plans can help cover out-of-pocket costs such as copayments, coinsurance, and deductibles. It’s important to review and understand the costs associated with each option to ensure they fit within your budget.

4. Evaluate Your Prescription Drug Needs

Medicare Part D provides prescription drug coverage, which is separate from Original Medicare. If you had prescription drug coverage through your ACA plan, you’ll need to choose a Medicare Part D plan to ensure continued coverage for your medications.

It’s wise to compare Part D plans based on the specific medications you take, as different plans cover different drugs. Consider using the Medicare Plan Finder tool to compare options and find a plan that suits your needs.

5. Seek Assistance if Needed

Transitioning to Medicare can be complex, and it’s okay to seek help if you need it. SHIP (State Health Insurance Assistance Program) counselors provide free, personalized counseling to help you navigate your Medicare choices. You can also speak with a licensed insurance agent or Medicare expert to ensure you make the best decisions for your health coverage.

6. Keep Important Deadlines in Mind

Remember that missing deadlines can result in penalties and gaps in coverage. Mark your calendar with key dates, such as when your IEP begins and ends, when your ACA Marketplace plan needs to be canceled, and when your Medicare coverage starts.

Take Charge of Your Health Coverage Transition

Moving from an ACA Marketplace plan to Medicare is a significant step, but with the right preparation, you can ensure a smooth transition. Be proactive about understanding your Medicare options, and don’t hesitate to seek guidance if you’re unsure about the process. Your health coverage is too important to leave to chance, so take charge of this transition to maintain your peace of mind and well-being.

For more guidance and to connect with others navigating Medicare, consider taking a Medicare class on GetSetUp. You’ll find the support and information you need to make informed decisions about your healthcare.

Reviewed By: Keith Gilbert