Making the transition from Marketplace to Medicare

If you buy your own health insurance, it is likely you purchased it on the Marketplace, also known as the Exchange (in PA.) Once you reach age 65 you are eligible to enroll in Medicare, assuming you have sufficient work history. There are other ways to qualify for Medicare, notably being disabled for 24 months. The intent of this article is to help you understand the transition from Marketplace to Medicare.

The Marketplace does not handle Medicare, Medigap, Medicare Advantage or Medicare Prescription Drug Plans. You will deal with the Social Security Administration, Medicare, or the issuing insurance company, directly, for these policies. You can consult with APPRISE about Medicare Part A, Part B, Part C (Medicare Advantage) and Part D, including an estimate of their cost.

Another very important consideration is to know your Medicare dates, especially the Initial Enrollment Period (IEP). This period includes the three months prior to the month in which you turn 65, the month in which you turn 65, and the three months after you turn 65, seven months in total. For example, if you will turn 65 in September, your IEP runs from June 1 through December 31.

Equally important to know is that if you enroll in Medicare during the three months prior to turning 65, your Medicare effective date will be the first of the month of your 65th birthday (September 1 in the previous example). If you enroll in the month you turn 65, or any of the three months after (September through December in the example) your Medicare effective date will be delayed. For example, if you wait until September to enroll, your Medicare effective date will be October 1. This may leave you without coverage in September. If you enroll in October, your Medicare will be delayed two months and become effective December 1. If you enroll in November, your Medicare will be delayed three months and become effective February 1. If you enroll in December, your Medicare will be delayed three months and will become effective March 1. This is true for anyone in their IEP. Not good! Speaking for all APPRISE counselors, please come in early to see us. A month or two prior to your IEP is not too soon.

If you fail to enroll during your IEP, you can enroll later, but with several risks and possible penalties, the subject perhaps of another article. Yet another article might cover those who continue to work past 65 and are covered by an employer plan or who are covered by a spouse’s plan. These folks should see a counselor, as well, to make sure they understand the rules. There are a lot of rules.

As you enter your IEP, your goal is to transition from Marketplace to Medicare with no gap in coverage. Now that you understand your Medicare effective date, you will want to call the Marketplace, 800318-2596, and cancel your coverage effective the day your Medicare coverage begins. For example, if your Medicare coverage is to begin September 1, cancel your Marketplace plan effective August 31. You can also do this online at www.healthcare.gov.

Can you keep your Marketplace plan after you enroll in Medicare? Yes, but it is unlikely to be in your best interests. All Marketplace subsidies end when you enroll in Medicare Part A. Part A is considered minimum essential coverage, so there is no need to be concerned about fines. Keep in mind that it is unlawful for anyone to sell you a Marketplace plan if they know that you have Medicare. There are exceptions here that apply to a small number of people. If you qualify for Medicare due to a chronic disease, such as end stage renal disease(ESRD), or you must pay for Part A (up to $411 per month), you can elect to purchase a Marketplace plan instead of enrolling in any part of Medicare. Be sure to get some advice if you are in one of these unusual circumstances as you could be liable for late enrollment penalties if you subsequently enroll in Medicare.

Remember, once you are eligible for Medicare, you will no longer be dealing with the Marketplace. Keep in mind the different Open Enrollment Periods for Marketplace and Medicare. The Marketplace Open Enrollment Period is from November 1, 2016, through January 31, 2017. The Medicare Annual Open Enrollment Period is October 15 through December 7 every year. The Medicare General Enrollment Period (GEP), mostly for those who are enrolling late in Medicare, is January 1 through March 31 each year, with an effective date of July 1. Enrollment during the GEP could result in a gap in your coverage, and any penalties incurred will stay with you for as long as you are on Medicare.

One last piece of advice from your APPRISE counselors: If you receive mail from CMS (Centers for Medicare and Medicaid Services), or your insurance company (if you have Medicare Advantage, Medigap or Medicare Prescription Plan), please open and read it. Failure to do so results in many of the problems we hear about, including penalties and fines. If you need assistance with transitioning from Marketplace to Medicare, APPRISE counselors are available to answer any Medicare-related questions. You can contact a counselor by calling your local senior center to set up an appointment, or by leaving a message on the APPRISE Helpline at 610344-5004. You can also email us with questions at apprisechesco@outlook. com.

Special thanks to Ted Trevorrow; APPRISE Counselor, and Enrollment & Outreach Coordinator/ Navigator at LCH, Kennett Square, PA.

The Chester County Department of Aging, through its APPRISE program of trained Medicare counselors, helps Medicare beneficiaries to understand the health care options specific to their health needs and financial resources. This is one, in a series of articles, prepared by APPRISE volunteer counselors to help Medicare beneficiaries navigate this complex system.