Can I keep my marketplace plan if I like my doctors?

No, you must transition to Medicare when you become eligible at age 65. Once Medicare-eligible, you cannot purchase or maintain marketplace coverage. You can look for Medicare plans that include your preferred doctors in their network.

What if my marketplace plan costs less than Medicare?

You cannot keep marketplace coverage regardless of cost differences. Federal law prohibits marketplace plans from being sold to Medicare-eligible individuals. However, many people find that Medicare costs are comparable or lower, especially when factoring in the loss of premium tax credits.

Do I lose my marketplace plan immediately on my 65th birthday?

You should coordinate the transition so your marketplace coverage ends when your Medicare coverage begins. Contact your marketplace plan and Medicare to align the dates and avoid gaps or overlap.

Can I go back to marketplace coverage if I don't like Medicare?

No, once you are eligible for Medicare, you cannot return to marketplace coverage. You can change your Medicare plan during the appropriate enrollment periods, but the marketplace is no longer an option.

What happens to my HSA if I have a marketplace HDHP?

You must stop contributing to your Health Savings Account when you enroll in Medicare. You can still use existing HSA funds tax-free for qualified medical expenses, including Medicare premiums, but new contributions are not allowed.

Can my spouse keep marketplace coverage if I switch to Medicare?

Your spouse may be able to keep marketplace coverage if they are under 65 and not eligible for Medicare. They can continue to receive premium tax credits based on their own eligibility.

Medicare and Marketplace Plans: Can You Have Both?

If you're turning 65 and currently have health insurance through the ACA marketplace, you need to understand one critical rule: you cannot have both Medicare and marketplace coverage at the same time. Federal law prohibits it, and failing to transition properly can result in penalties and coverage gaps.

You cannot have both Medicare and marketplace health insurance simultaneously.

Key facts:

The ACA specifically excludes Medicare beneficiaries from purchasing marketplace plans
Premium tax credits end when you become Medicare-eligible
You must enroll in Medicare during your Initial Enrollment Period
Coordinate your transition to avoid gaps in coverage

Why You Cannot Have Both Medicare and Marketplace Plans

Federal law prohibits having both Medicare and marketplace health insurance simultaneously. The Affordable Care Act specifically excludes Medicare beneficiaries from purchasing marketplace coverage, and insurance companies cannot sell you marketplace plans if you are eligible for Medicare.

This applies even if you haven't actually enrolled in Medicare yet — eligibility alone is enough to disqualify you from marketplace coverage and premium subsidies.

Transitioning from Marketplace to Medicare Coverage

When you turn 65, you must cancel your marketplace health insurance and enroll in Medicare during your Initial Enrollment Period. Your marketplace coverage should end the day before your Medicare coverage begins to avoid any gaps in insurance protection.

Your Initial Enrollment Period is a 7-month window that starts 3 months before the month you turn 65 and ends 3 months after. Enrolling in the 3 months before your birthday month ensures coverage starts on time.

Loss of Premium Tax Credits with Medicare

Marketplace premium tax credits end when you become eligible for Medicare, regardless of your income level. These subsidies are specifically designed for people who do not have access to affordable employer coverage or government programs like Medicare.

If you continue receiving tax credits after becoming Medicare-eligible, you may have to repay them when you file your taxes. This can result in a significant unexpected tax bill.

Medicare vs. Marketplace Plan Coverage Differences

Feature	Medicare	Marketplace Plan
Hospital coverage	Part A — $1,736 deductible (2026)	Varies by plan
Doctor visits	Part B — $202.90/month premium	Included in premium
Prescription drugs	Part D — separate plan or MA	Usually included
Premium subsidies	Income-based (IRMAA surcharge)	Tax credits (lost at 65)
Out-of-pocket cap	$2,100 for Part D drugs in 2026	Annual max varies by metal tier
Dental/vision	Limited (MA may include)	Often included

What Happens If You Keep Both Coverages

Maintaining both Medicare and marketplace coverage creates serious compliance and payment issues. Insurance companies may refuse to pay claims if you have unauthorized duplicate coverage, leaving you responsible for the full cost of medical care.

Additionally, if the marketplace discovers you are Medicare-eligible, they will terminate your plan and may seek repayment of any premium tax credits you received after your eligibility date.

Special Circumstances and Exceptions

No exceptions allow you to maintain both Medicare and marketplace coverage simultaneously. However, if you have qualifying employer group health coverage from a company with 20 or more employees, you may be able to delay Medicare Part B enrollment without penalty.

This employer coverage exception does not apply to marketplace plans — only to actual employer-sponsored group health insurance through active employment.

Steps for Proper Transition Planning

Start planning your transition from marketplace to Medicare coverage at least three months before your 65th birthday:

Enroll in Medicare Part A and Part B during the first three months of your IEP
Choose your Medicare coverage path: Original Medicare + Medigap + Part D, or Medicare Advantage
Contact the marketplace to cancel your plan, timing the end date to match your Medicare start date
Stop HSA contributions if you have a Health Savings Account
Notify your doctors so they can update your insurance information