A Qualified Health Plan (QHP) is a health insurance plan sold through the ACA Marketplace (Healthcare.gov or a state exchange) that meets the coverage standards set by the Affordable Care Act. Many people use QHPs with premium tax credits (subsidies) to afford coverage before they reach Medicare eligibility at age 65. Once you become eligible for Medicare, the rules change significantly.
You Cannot Receive ACA Subsidies Once You Are Medicare-Eligible
This is the most important rule: once you are eligible for Medicare Part A (even if you have not enrolled), you lose eligibility for premium tax credits on a Marketplace QHP. If you continue receiving subsidies after becoming Medicare-eligible, you may have to repay them when you file your taxes. The IRS considers Medicare-eligible individuals ineligible for the premium tax credit regardless of whether they actually enroll in Medicare.
Eligibility, Not Enrollment, Is What Matters
You lose ACA subsidy eligibility the moment you become eligible for Medicare Part A, not when you actually enroll. For most people, this is the month they turn 65. If you delay enrolling in Medicare but are still eligible, you cannot legally receive premium tax credits on a QHP.
What to Do When You Turn 65
| Step | Action | Timing |
|---|---|---|
1 | Enroll in Medicare Parts A and B | 3 months before your 65th birthday month |
2 | Notify the Marketplace of your Medicare enrollment | As soon as you enroll in Medicare |
3 | Cancel your QHP | Effective the day before your Medicare coverage begins |
4 | Choose additional coverage (Medigap + Part D, or Medicare Advantage) | During your Medigap Open Enrollment Period or IEP |
Special Enrollment Period for Losing QHP Coverage
When you voluntarily cancel your QHP to enroll in Medicare, this does not trigger a Medicare Special Enrollment Period. Your Medicare enrollment is governed by your Initial Enrollment Period (the 7-month window around your 65th birthday). If you are already past your IEP, you may need to wait for the General Enrollment Period (January 1 through March 31) and could face late enrollment penalties.
Can You Keep a QHP Alongside Medicare?
Technically you can keep a QHP after enrolling in Medicare, but it is almost never beneficial. You will not receive subsidies, so you will pay full unsubsidized QHP premiums on top of your Medicare premiums. Medicare will be primary, and the QHP will be secondary. In most cases, a Medigap plan or Medicare Advantage plan is a far more cost-effective way to supplement Medicare.
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