Turning 65: Navigating Medicare and ACA Health Insurance

Introduction

As you approach age 65, it’s essential to understand the transition between Affordable Care Act (ACA) health insurance and Medicare. In this blog, we’ll discuss the key considerations and steps to ensure seamless coverage during this transition.

Medicare Eligibility

When you turn 65, you’re automatically eligible for Medicare Part A (hospital insurance) and can enroll in Part B (medical insurance). Medicare becomes your primary health insurance, replacing your ACA marketplace plan.

For Couples

If you’re married and one spouse is turning 65 while the other is younger, the younger spouse can remain on the ACA marketplace plan. However, the coverage for the spouse turning 65 will end when they enroll in Medicare.

Coverage Options for Younger Spouse

Once the spouse turning 65 enrolls in Medicare, the younger spouse has options to continue health coverage:

Special Enrollment Period (SEP): The spouse can enroll in a new ACA marketplace plan without waiting for the open enrollment period.
Continue on Existing Plan: In some cases, the younger spouse may be able to continue coverage on the original marketplace plan without special enrollment, but premium costs may be higher.

Canceling ACA Marketplace Plan

If you’re the primary contact on the ACA marketplace plan, you need to call the marketplace to cancel your coverage for the month before you enroll in Medicare. This ensures that your coverage ends on the last day of the month before your Medicare start date.

Paying Premiums

Regarding the premium for the month you enroll in Medicare, follow the insurer’s instructions. They will likely advise you not to pay the ACA marketplace premium for that month. However, if the marketplace instructs you to pay, do so to avoid coverage disruption.

Seeking Professional Help

If you’re unsure about the process or have any questions, it’s highly recommended to seek assistance from a licensed insurance agent. They can provide guidance and help you make the best decisions for your specific situation.

Conclusion

Navigating the transition from ACA to Medicare can be complex, but it’s essential to understand your options and take the necessary steps to ensure continuous coverage. By following the guidelines outlined above and seeking professional help when needed, you can ensure a smooth and successful transition.