My client currently has Marketplace coverage but enrolled in Medicare during the General Enrollment Period. Can they keep their Marketplace plan and continue to qualify for Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs) until their Medicare coverage begins?
Yes. Federal rules allow for individuals who have enrolled in Medicare (either through an Initial Enrollment Period, Special Enrollment Period, or General Enrollment Period) and who are eligible for premium-free Part A* to stay enrolled in Marketplace coverage and continue to receive Marketplace subsidies until their Medicare coverage begins.
Once Medicare coverage begins:
- Individuals should contact the Marketplace immediately to terminate their coverage
- Individuals who remain enrolled in Marketplace coverage will no longer receive Marketplace subsidies and will be responsible for the full cost of coverage
- Individuals who continued to benefit from Marketplace subsidies after their Medicare coverage began will be asked to pay back those subsidies
*Note: Individuals who do not qualify for premium-free Medicare Part A are allowed to keep their Marketplace coverage and continue qualifying for Marketplace subsidies.