What if I have an ACA Plan or Obamacare?

If you're currently enrolled in an ACA Marketplace plan, also known as "Obamacare", technically you are supposed to enroll in Medicare Parts A & B upon becoming eligible at age 65. However it's not perfectly that simple, and your decision to do so will often depend on whether or not you're receiving Medicare Part A at no cost, otherwise known as "Premium-Free Part A".

I get Medicare Part A Premium-Free

As discussed earlier most people receive Medicare Part A for free, assuming they or their spouse earned ten years of tax credits (40 quarters) with Social Security. In this situation, while you're not required to cancel your ACA Marketplace plan, any subsidies you qualify for will end once you become eligible for Medicare Part A at age 65.

Should you choose to keep your ACA Marketplace plan, you would begin paying full price as you'll no longer be eligible for subsidies due to qualifying for Medicare Part A premium-free. If for any reason the Marketplace doesn't immediately adjust your premiums, you would likely need to pay back those subsidy credits when you file your federal tax return the following year.

Also, while you can keep your Marketplace coverage that's already in force, you would not be able to enroll in any new Marketplace plans now that you're eligible for Medicare. In fact, it is illegal for anyone to enroll you in Marketplace coverage knowing that you have Medicare.

I pay a premium for Medicare Part A

For those who are not eligible for Medicare Part A premium-free, the guidelines change. In this situation you can opt to keep your ACA Marketplace plan instead of signing up for Medicare. You will continue to receive any qualifying subsidies to help pay the premiums on your Marketplace plan. However that would end if you do eventually enroll in Medicare.

Be cautious in making this decision however. Should you later decide to enroll in Medicare you would need to properly time it with the General Enrollment Period and also pay Late Enrollment Penalties for both Parts A & B.

In general, if you do not qualify for Medicare Part A premium-free, but do qualify for premium subsidies with an ACA Marketplace plan, then sticking with a Marketplace plan is often the more economical decision. Should you find that your Marketplace coverage includes costly copayments or coinsurance requirements, you can better protect yourself with supplemental coverage such as a low-cost Hospital Indemnity plan.

I get Medicare Part A Premium Free

As discussed earlier most people receive Medicare Part A for free, assuming they or their spouse earned ten years of tax credits (40 quarters) with Social Security. In this situation, while you're not required to cancel your ACA Marketplace plan, any subsidies you qualify for will end once you become eligible for Medicare Part A at age 65.

Should you choose to keep your ACA Marketplace plan, you would begin paying full price as you'll no longer be eligible for subsidies due to qualifying for Medicare Part A premium-free. If for any reason the Marketplace doesn't immediately adjust your premiums, you would likely need to pay back those subsidy credits when you file your federal tax return the following year.

Also, while you can keep your Marketplace coverage that's already in force, you would not be able to enroll in any new Marketplace plans now that you're eligible for Medicare. In fact, it is illegal for anyone to enroll you in Marketplace coverage knowing that you have Medicare.

I pay a premium for Medicare Part A

For those who are not eligible for Medicare Part A premium-free, the guidelines change. In this situation you can opt to keep your ACA Marketplace plan instead of signing up for Medicare. You will continue to receive any qualifying subsidies to help pay the premiums on your Marketplace plan. However that would end if you do eventually enroll in Medicare.

Be cautious in making this decision however. Should you later decide to enroll in Medicare you would need to properly time it with the General Enrollment Period and also pay Late Enrollment Penalties for both Parts A & B. In general, if you do not qualify for Medicare Part A premium-free, but do qualify for premium subsidies with an ACA Marketplace plan, then sticking with a Marketplace plan is often the more economical decision. Should you find that your Marketplace coverage includes costly copayments or coinsurance requirements, you can better protect yourself with supplemental coverage such as a low-cost Hospital Indemnity plan.

This is a proprietary website and is not associated with, endorsed, or authorized by Medicare or the federal government.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

DBA "Avila Medicare Solutions"

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Cedar Park, Texas 78613

Texas Lic. No. 2951709

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