Navigating Medicare Transition for Couples on Marketplace Health Plans


Turning 65 is a significant milestone that often brings about changes in health insurance coverage. For individuals enrolled in Marketplace health plans, aging into Medicare can be a confusing time. This blog aims to provide clarity on the transition process for couples where one spouse is turning 65 and enrolling in Medicare.

Medicare and the Marketplace

Medicare is a federal health insurance program for individuals aged 65 and older, as well as those with certain disabilities or end-stage renal disease. The Marketplace, also known as the Health Insurance Marketplace, is a government-run platform where individuals and families can purchase health insurance plans.

Transitioning from Marketplace to Medicare

When a spouse who is the primary contact on a Marketplace health plan turns 65 and qualifies for Medicare, it’s important to notify the Marketplace and cancel their coverage for themselves. However, the coverage for the other spouse (who is not turning 65) should continue uninterrupted on the same Marketplace plan.

Conflicting Information

It’s not uncommon to receive conflicting information from different sources. In this case, the Marketplace and the insurer may provide varying instructions. It’s always advisable to follow the instructions provided by the Marketplace, as they are the official source of information regarding Marketplace coverage.

What to Do

For the Spouse Turning 65

Cancel Marketplace Coverage: Contact the Marketplace and cancel your Marketplace health insurance coverage effective May 1st, the day before your Medicare Part A coverage begins.
Enroll in Medicare Part B: You will automatically be enrolled in Medicare Part A (hospital insurance) but may need to enroll in Medicare Part B (medical insurance). Contact Social Security to inquire about enrolling in Part B.

For the Spouse Not Turning 65

Continue Marketplace Coverage: Your coverage on the Marketplace health plan will continue as is. You should continue paying your monthly premiums.
Do Not Cancel Coverage: Do not cancel your Marketplace coverage or make any changes to your plan, as this could disrupt your coverage.

General Guidelines

Seek Professional Assistance: If you have any concerns or need further guidance, do not hesitate to contact a licensed health insurance agent who can provide personalized assistance.
Avoid Uninterrupted Coverage: Ensure that you have continuous health insurance coverage throughout the transition. Gaps in coverage can result in penalties or uncovered medical expenses.
Review Your Coverage: Once both spouses have enrolled in their respective plans, review your coverage and ensure that your needs are met. You may need to make adjustments to your Medicare coverage or Marketplace plan in the future.

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