Changing from ACA to Medicare: What You Need to Know

You’ve probably spent your whole life navigating the health insurance industry, learning the ins and outs of how to find a reliable coverage option. And over the years, your health insurance needs have more than likely changed, meaning you had to adapt accordingly. Whether you enrolled in your company’s plan or learned to shop for health insurance on the Marketplace, you might consider yourself an expert on the subject after years of engaging with insurance providers. But for many Americans, it’s now time to explore Medicare options. And that can be entirely new territory for even the most insurance-savvy consumers. If you’re expecting to change from an ACA health insurance plan to Medicare this year, here are three suggestions and details to help get you started.

Understanding Your Qualification Requirements & Timelines

There’s no sense in worrying about Medicare if you’re not in a position to qualify just yet. The guidelines are specific, so you’ll want to be sure you understand the Medicare enrollment qualifications. Here’s what you will need to know about qualifying for Medicare and any applicable timelines to act. Not acting within the specified enrollment periods can result in penalties or gaps in coverage.

You Have an Upcoming 65th Birthday
For most Americans, Medicare eligibility occurs with the onset of a 65th birthday. Additionally, most who are planning to reach this age milestone will have an Initial Enrollment Period to get signed up for coverage. This timeline can occur three months prior to the birthdate and extend up to three months after, as well.

Younger Americans with Disabilities
Another group of individuals who qualify for Medicare is one comprised of younger Americans with disabilities. If you or a household family member experiences a life-altering event that results in a permanent disability, eligibility requirements are met. And everyone who qualifies for Social Security Disability Insurance (SSDI) is also eligible for Medicare. A 24-month qualifying period applies before you can enroll in Medicare.

Individuals with End Stage Renal Disease
Those Americans who are diagnosed with End Stage Renal Disease (ESRD) and are required to have routine dialysis are eligible for Medicare. Those who are required to have a kidney transplant also qualify. Typically, Medicare coverage will begin on the first day of the fourth month following the first dialysis treatment.

Choosing the Right Medicare Plan

Once you can verify that you do qualify for Medicare or will be eligible soon, it’s time to choose a plan. Medicare options can be confusing, especially if it’s your first time browsing. There are a few basic definitions you may want to understand in order to make the best Medicare plan decision for you.

What Medicare Plans Include
Medicare Plans can vary and will offer different coverage options. You can expect to choose a Medicare Advantage Plan, which is structured more like an umbrella coverage. But other plans exist, including Medicare Cost Plans, Pilot Programs, and Programs of All-Inclusive Care for the Elderly, also called PACE.

Understanding Parts of Medicare
There are different Medicare parts that may sound familiar to you. Medicare Part A provides specific coverage for inpatient hospital care. Medicare Part B offers protection for outpatient medical coverage. Part C describes alternative ways to leverage your Medicare benefits, while Part D refers to prescription drug coverage.

Medicare Advantage Plans
Medicare Advantage Plans can sometimes be referred to as “Part C” or “MA Plans.” It’s an alternative to traditional Medicare, and private companies that are approved will back these plans. Subscribing to one of these bundled plans will ensure you’re still enrolled in Medicare. You’ll have hospital insurance, medical insurance, and prescription drug coverage combined.

Canceling Your Marketplace Insurance

Part of transitioning from an ACA plan to Medicare means also canceling your Marketplace-based insurance. There are some timelines you’ll need to know and a few tips to ensure your change-over is a smooth one. And it’s always a good idea to call your current insurance provider to ask about any specific processes to which you might need to adhere as part of your cancelation efforts.

Knowing When to Cancel a Marketplace Plan
Don’t jump the gun too soon or pull the plug on your ACA coverage right away. Ending it prematurely can mean a lapse in coverage. Wait until you have a confirmation of your Medicare coverage start date. You can then be sure you maintain consistent health insurance protection between plans.

How to End Coverage for Yourself
If you need to cancel your coverage through your ACA plan, you can set your cancellation to take effect immediately or schedule a future date. However, in most instances, coverage does end right away. There are different requirements for different policies. So it’s always best to connect with your current provider to understand the guidelines before officially canceling.

Special Enrollment Period for Others on Your Plan
You may be ready to qualify and enroll in a Medicare Plan, but someone else on your current ACA policy is not. In which case, your eligibility to cancel presents an opportunity for the other members to qualify for a special enrollment period. To know what timelines apply, you’ll want to connect with your provider to avoid a lapse in coverage. And you can browse W3LL to explore new Marketplace plans for those remaining members of your household.

When it comes time to change from an ACA plan to Medicare, don’t stress. There can be complexities to understanding your eligibility, choosing a Medicare plan, and canceling your coverage via the ACA. But hopefully, these tips and suggestions can help get you started in the right direction.

For anyone else in your family who qualifies for a special enrollment period, now’s the time to shop for a new ACA plan. You will likely be able to find a more affordable provider, considering you’re covering one less person with your transition to Medicare. Start looking through available ACA plans with W3LL. Answering a few short questions about your health insurance needs is all it takes to get browsing. You can calculate any available premium tax credits, compare plans, and enroll in an easy-to-use and totally free platform.