The Oregon Health Insurance Marketplace is a way for people to get health coverage. If you have Medicare, you do not need to get coverage through the Marketplace. Below are important things to remember about Medicare and Marketplace coverage.
If I have Medicare, do I need to do anything?
If you currently have Marketplace coverage, you should cancel your coverage as soon as you are eligible for Medicare. If you don't cancel and you are getting financial help through the Marketplace, you may have to pay it back.
If you do not currently have coverage through the Marketplace, you do not need to do anything. Marketplace coverage is different than Medicare.
Does Medicare coverage meet the requirement to have health insurance?
If you have Medicare Part A (hospital coverage), you have minimum essential coverage. This means you do not need to get coverage through the Marketplace and are meeting the requirement. Having Medicare Part B (medical insurance) alone does not meet this requirement.
Can I get a Marketplace plan in addition to Medicare?
No. It is against the law for someone who knows that you have Medicare to sell you a health plan through the Marketplace. This is true even if you have either Medicare Part A or Part B. If you want extra coverage for your Medicare, call the Senior Health Insurance Benefit Assistance (SHIBA) program at 800-722-4134 (toll-free). SHIBA can help you understand your options, including Medicare Advantage, Medigap, and prescription drug coverage. You can also find your options by visiting Medicare.gov.
Can I choose Marketplace coverage instead of Medicare?
For most people, no. However, there are a few exceptions:
- You can choose a plan through the Marketplace if you are eligible for Medicare, but have not enrolled because of either of the following:
- You would have to pay a premium for Part A
- You are not collecting Social Security benefits.
- If you have a premium for Part A, you can get a plan through the Marketplace. You can choose to cancel your Part A and Part B to enroll through the Marketplace.
- Lawfully present individuals who do not have work credits to qualify for premium-free Part A can enroll through the Marketplace.
Financial help may be available, depending on your household income and other factors. Find out what plan options and savings you may qualify for at
OregonHealthCare.gov/WindowShop.
Before making a choice, there are two points to consider:
- If you enroll in Medicare after your initial enrollment period ends, you may have to pay a late enrollment penalty for as long as you have Medicare.
- Typically you can enroll in Medicare only during the Medicare general enrollment period (Jan. 1 to March 31). Your coverage won't begin until July of that year.
What if I become eligible for Medicare after I join a Marketplace plan?
You can get a health insurance plan through the Marketplace before your Medicare begins. You can then cancel your health insurance plan when your Medicare coverage starts. You must call the Marketplace (800-318-2596 toll-free) and report that you are getting Medicare to cancel your Marketplace plan.
Once you are eligible for Medicare, you have an initial enrollment period to sign up. For most people, the initial enrollment period for Medicare starts three months before their 65th birthday and ends three months after their 65th birthday.
In most cases, it is to your advantage to sign up when you are first eligible because:
- Once you are eligible for Medicare, you won't be able to get financial help for a Marketplace plan.
- If you enroll in Medicare after your initial enrollment period ends, you will pay a late enrollment penalty for as long as you have Medicare.
Note: You can keep your Marketplace plan after your Medicare coverage starts. However, once your Part A coverage starts, you are no longer eligible for financial help through the Marketplace.
Can I get a stand-alone dental plan through the Marketplace?
No. However, you can purchase a dental plan directly from a health insurance company.
Contact an insurance agent to learn more about dental plan options.
Questions?
Call SHIBA at 1-800-722-4134 (toll-free) or visit Medicare.gov or call 1-800-MEDICARE (toll-free).
Note: Much of this information also applies if you are considering buying a plan outside of the Marketplace. Contact SHIBA for information.