For many adults nearing retirement, one of the biggest questions is: “I have health coverage through the Affordable Care Act (ACA) marketplace. Can I keep my plan after I turn 65, or do I need to switch to Medicare?”
The short answer: You can keep your ACA plan—but once you’re eligible for Medicare, it’s usually not in your best interest. Here’s why.
How the ACA and Medicare Work Together (or Don’t)
– ACA Marketplace Plans were designed for people under 65 who don’t have affordable coverage through work or another source. They may include premium tax credits (subsidies) to make coverage more affordable.
– Medicare is the federal health insurance program for those 65 and older (or younger with disabilities). Once you’re eligible, it becomes your primary option for coverage.
What Happens When You Turn 65?
1. You’re Expected to Transition to Medicare – Once you become eligible for Medicare, you generally cannot keep receiving ACA subsidies for your marketplace plan. If you do, you’ll likely have to repay them when you file taxes.
2. You Can Keep Your ACA Plan—But Without Subsidies – If you choose not to enroll in Medicare and keep your ACA coverage, you must pay the full, unsubsidized premium, which can be very expensive.
3. Delaying Medicare Can Be Costly – If you don’t sign up for Medicare during your Initial Enrollment Period (around your 65th birthday), you may face permanent late enrollment penalties for Medicare Part B and Part D.
Are There Any Exceptions?
The main exception is if you have employer-sponsored coverage (through your job or your spouse’s job). In that case, you can delay Medicare without penalty until that coverage ends. But ACA marketplace plans do not count as employer coverage.
Why Medicare Is Usually the Better Option at 65
– Lower Costs: Medicare premiums are often less than ACA premiums without subsidies.
– Guaranteed Coverage: You cannot be denied Medicare due to health conditions.
– Comprehensive Options: With Medicare, you can choose Original Medicare plus a supplement (Medigap) or a Medicare Advantage plan with added benefits.
Final Thoughts
While you technically can keep your ACA marketplace plan after turning 65, the reality is that Medicare is almost always the smarter choice. Transitioning on time protects you from penalties, saves you money, and ensures you have the coverage you need.
At The Tennessee Family Guide, we help families understand the transition from ACA to Medicare—making sure you don’t lose benefits, miss deadlines, or pay unnecessary penalties.
