Making the move from Obamacare to Medicare

Your transition from ACA-compliant coverage won't be automatic, but 'shifting gears' to new coverage doesn’t have to be traumatic.

  • By
  • Contributor
  • July 9, 2015

For some exchange enrollees, Medicare is just around the corner. And while people have been transitioning from individual coverage to Medicare for decades, the process is a little different now that Obamacare has been enacted.

If you’re already receiving Social Security or Railroad Retirement benefits, the government will automatically enroll you in Medicare Part A the month you turn 65. Otherwise, you’ll have a seven-month window during which you can enroll in Medicare.  It starts three months before the month you turn 65, includes the month you turn 65, and then continues for another three months.

Most people pay no premiums for Medicare Part A, based on immigration status and work history. Medicare Part B has a monthly premium, as do Medicare Part D and Medigap.

No automatic plan termination

Prior to 2014, coverage in the individual market generally terminated automatically when an enrollee reached age 65. Age was a limiting factor for enrollment – people 65 and over typically could not obtain coverage in the individual market, nor could they keep it once they reached 65, even if they were not eligible for Medicare.

That has changed under the Affordable Care Act, so you’ll need to actively cancel your exchange coverage in order to transition to Medicare.

Subsidies end with Medicare eligibility

You are not required to cancel your exchange plan when you enroll in Medicare, but if you’re getting premium subsidies, they’ll end when you become eligible for premium-free Medicare. (Note that while you’re allowed to keep your exchange plan – at full price – after you become eligible for Medicare, it’s illegal under the Social Security Act for anyone to sell you an exchange plan after you’re already eligible for Medicare).

Keeping exchange plan would be overkill

And in virtually all cases, keeping your exchange plan along with Medicare would be overkill. The plans would provide duplicate coverage, and exchange plans are not set up to coordinate with Medicare.

What you’ll need instead is a Medicare Advantage plan or a Medigap plan and Part D plan to supplement your Medicare coverage. Here’s a resource to help you figure out what would work best in your situation.

When you’re ready to cancel your exchange plan:

If you’re enrolled in a plan through, you can follow these directions for cancelling your exchange plan so you can transition to Medicare. Or you can remove only yourself from the policy if you have other family members who need to stay on the exchange plan.

If you’re in a state with a state-run exchange, you’ll need to follow the steps outlined by your exchange. Regardless of what state you’re in, if in doubt, ask for help. Contact the exchange call center or your broker if you have one. Document the call and keep a record of your cancellation request.

Cancelling your exchange coverage to switch to Medicare should be relatively simple, but we have seen cases where cancellation requests weren’t transmitted to the carrier in a timely manner. For that reason, it may be wise to switch from bank draft to paper billing prior to submitting your cancellation request.

That way, if something goes wrong when the cancellation request is being processed, you won’t end up with premiums being auto-drafted from your bank account after your coverage was supposed to be terminated.

When should you cancel your plan?

The standard advice is to avoid any gaps in coverage. So if your Medicare will start August 1, you would schedule your exchange plan to terminate July 31. But while that’s undoubtedly the safest course of action, some people feel comfortable taking a gamble during their last month or two before Medicare kicks in, and they cancel their coverage early.

Be cautious about this approach if you have pre-existing conditions however. If you’re going to enroll in Medicare A and B, you’re probably going to want a Medigap plan to supplement your coverage. Medigap plans are guaranteed issue during your initial six month enrollment period, but they can impose a pre-existing condition waiting period if you’ve had a break in prior coverage of more than 63 days.

Once you’ve taken steps to enroll in Medicare and schedule the cancellation of your exchange plan, take some time to familiarize yourself with the various coverage options that can improve upon the basic coverage provided by Medicare. And then enjoy your Medicare – you’ve earned it!