The Health Insurance Marketplace is a Federal Insurance Exchange where individuals and families can find information about health coverage options, compare health plans (based on costs, benefits, and other important features), choose a plan, and enroll in a plan.
Information is available regarding eligibility for help with paying premiums and reducing out-of-pocket costs. Small businesses can use the Small Business Health Options Program (SHOP) Marketplace to provide health insurance for their employees. Marketplace services are provided through websites, call centers, and in-person help. In some states the Marketplace is run by the state. In Wisconsin, it is run by the Federal Government. To be eligible to enroll in health coverage through the Marketplace, an individual must live in the United States, be a U.S. Citizen or national (or be lawfully present), and cannot be incarcerated.
To learn more about the Health Insurance Marketplace, eligibility for coverage, plan options and enrollment time frames, go to the website HealthCare.gov
Medicare and the MarketplaceAn individual enrolled in a Marketplace plan can keep that plan until Medicare coverage begins. At that time, a person can end Marketplace coverage. If an individual remains with their Marketplace plan after Medicare begins, that person will no longer be eligible for any premium tax credits or other cost savings being received with their Marketplace plan and will pay full price for the Marketplace plan. Marketplace coverage is not designed to supplement Medicare. It is against the law for an insurer to sell a Marketplace plan to someone with Medicare.
The Marketplace will not automatically disenroll an individual who begins coverage under Medicare. Individuals with Marketplace plans who become eligible for Medicare should contact the Marketplace and request disenrollment from their plan just before Medicare coverage begins. If an individual requests disenrollment by the 15th of the month prior to Medicare starting, Marketplace coverage will end on the last day of the current month. If a person requests disenrollment after the 15th of the month, Marketplace coverage will not end until the last day of the following month, and that person will be responsible for the full cost of their plan premium for the month covered by both Medicare and the Marketplace plan.
In most cases, it’s to a person’s advantage to sign up for Medicare when first eligible to avoid a potential late enrollment penalty or prevent a gap in coverage. There are a few, very limited situations where a person can choose a Marketplace plan instead of Medicare such as a someone who has to pay a premium for Medicare Pt A or a person who has a medical condition (such as End-Stage Renal Disease-ESRD) but has not yet enrolled in Medicare.
