The Relationship between Medicare and the Health Insurance Marketplace

The Relationship between Medicare and the Health Insurance Marketplace

This page contains a downloadable document listing frequently asked questions (FAQs) regarding the relationship between Medicare and the Health Insurance Marketplace. Topics include: general enrollment, End Stage Renal Disease (ERSD), and coordination of benefits.

The majority of individuals with Medicare coverage have both Medicare Parts A & B and do not have other private health insurance, like a Marketplace plan.  Those individuals receive all their health insurance coverage through the Medicare program, whether they have Original Medicare or have a Medicare health and/or drug plan.  The frequently asked questions (FAQs) in this document do not apply to those individuals. 

Please note that the FAQs in the document below are meant to provide information about situations where an individual:

•      has Medicare Part A only, Part B only, or neither, but who is seeking coverage through a Marketplace plan,
•      had Marketplace coverage before becoming eligible for Medicare, or
•      has retained a Marketplace plan after enrolling in Medicare.

Check back regularly for updates including new questions and answers.

NOTE: Please bookmark this page and not the actual FAQ document so that you will always have access to the most current information.

10/3/2014 - UPDATE: We corrected the Table of Contents in addition to the prior update on 8/28/2014 which clarified the answers to questions A.3. and A.14.

6/11/2015 - UPDATE: We clarified the answers to FAQs A.6., A.9., A.10., A.14., A.15., and A.16 in order to increase awareness of the Medicare Part B late enrollment penalty.

4/27/2016 - UPDATE: We have added FAQs D.7., D.8., and D.9.

Medicare as Qualifying Health Coverage

The Affordable Care Act established the Individual Shared Responsibility provision that requires individuals to have qualifying health care coverage (QHC), also referred to as minimum essential coverage, qualify for an exemption, or make a payment when filing their tax return.

Medicare Part A (including coverage through a Medicare Advantage (MA) plan) qualifies as QHC.  Beneficiaries who had 12 months of QHC in 2017 simply need to check a box on their tax return to indicate that they had health coverage. Medicare mails this notice to people who had Medicare Part A coverage for part of the year.

Download a sample of the Qualifying Health Coverage Notice  or get this notice in Spanish.

Limited Equitable Relief for Certain Medicare Beneficiaries Dually Enrolled in Coverage Through the Marketplace for Individuals and Families

CMS is offering equitable relief to certain Medicare beneficiaries who have premium-free Medicare Part A and are currently (or were) dually-enrolled in both Medicare and the Marketplace for individuals and families. Eligible individuals can request equitable relief at any time to enroll in Medicare Part B without penalty or to reduce their Part B late enrollment penalty.  This relief will be considered on a case-by-case basis for current or previously dually-enrolled beneficiaries. Individuals who believe they are eligible for this relief should contact Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778). The fact sheet (PDF) below provides additional information about the limited equitable relief.