Understanding Medicare Enrollment and Continuation of Coverage for ACA Plans

Turning 65 is a significant milestone that brings changes to your health insurance options. As you prepare to transition from an ACA marketplace plan to Medicare, it’s essential to understand the process and potential implications for your coverage.

Transition to Medicare: What Happens When You Turn 65

Upon turning 65, you become eligible for Medicare. Medicare is a federal health insurance program that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease.

When you turn 65, you will automatically be enrolled in Part A (hospital insurance) and Part B (medical insurance) of Medicare unless you opt out. Part B requires a monthly premium, while Part A is generally premium-free for those who have worked and paid into Medicare taxes for at least 10 years.

ACA Plan Continuation for Spouses Under 65

The situation described in the post involves a couple where the primary contact (the husband) is turning 65 and enrolling in Medicare. The concern is whether the spouse (who is under 65) will continue to have coverage under the ACA marketplace plan.

In this case, the spouse will be able to continue on the ACA marketplace plan, but only if they qualify for coverage on their own.

There are several factors that determine ACA plan continuation for spouses under 65:

Spouse’s income: The spouse must meet the income requirements for ACA eligibility.
Spouse’s citizenship or lawful presence: The spouse must be a U.S. citizen or legal resident.
Spouse’s residency: The spouse must live in the same state as the primary contact.

If the spouse meets these requirements, they can continue on the ACA marketplace plan until they qualify for Medicare (age 65) or have a qualifying life event (such as marriage, divorce, or loss of income).

Coordination of Medicare and ACA Coverage

It’s important to coordinate Medicare and ACA coverage to avoid gaps or overlaps in coverage. When you enroll in Medicare, you must contact the ACA marketplace and cancel your coverage effective May 1st, as the post suggests.

However, do remember to pay your May bill, as advised by the Marketplace, to ensure your coverage remains active until the transition to Medicare.

Special Enrollment for Spouses

If the spouse does not qualify for continuation of coverage under the ACA marketplace plan, they may need to enroll in a new plan during a special enrollment period (SEP). SEPs are available for qualifying events such as marriage, divorce, or loss of job-based insurance.


Transitioning from an ACA marketplace plan to Medicare can be a confusing process. By understanding the rules and regulations surrounding Medicare enrollment and ACA plan continuation, you can ensure a smooth transition and avoid any gaps in coverage. If you have any questions or concerns, it’s recommended to consult with a licensed insurance agent who can provide personalized guidance and assistance.

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