Yes, you can usually keep a Marketplace plan you already have after you turn 65, but for most people it is a costly choice. Once you are eligible for premium-free Medicare Part A, you can no longer get the premium tax credit, so you pay the plan's full price. If you also skip Medicare Part B during your Initial Enrollment Period, Marketplace coverage does not give you a Special Enrollment Period later, and you can owe a Part B late penalty of 10% for each full 12-month period you went without it, usually for life. The main group for whom Marketplace coverage can still make sense is people who would have to pay a premium for Part A.
This guide covers who can keep a Marketplace plan, what the switch costs you if you don't make it, the exception for people without premium-free Part A, and how to move from the Marketplace to Medicare without a gap. If you want a side-by-side look at what each program covers, see our Medicare vs ACA comparison. This page answers the narrower question: can you choose one instead of the other?
The Short Answer by Situation
| Your situation | Can you keep or buy a Marketplace plan? | Premium tax credit? | Main risk |
|---|
| Turning 65, eligible for premium-free Part A, already on a Marketplace plan | You can keep it, at full price | No, once you are eligible for premium-free Part A | Part B and Part D late penalties if you skip Medicare |
| Already enrolled in Medicare (Part A or Medicare Advantage) | No one who knows you have Medicare may sell you one | No | Paying twice for coverage |
| Must pay a premium for Part A (fewer than 40 quarters of work) and not enrolled in Medicare | Yes, you can enroll | Possibly, if you otherwise qualify | Part B penalty if you enroll in Medicare later |
| Paying a premium for Part A now | You can drop Parts A and B and choose a Marketplace plan | Possibly, after Medicare ends | Penalties if you return to Medicare |
| Under 65 with a spouse turning 65 on the same plan | Yes, you stay on the plan | Yes, if you qualify | None from your spouse's switch |
Sources: HealthCare.gov, "Medicare and the Marketplace" and "Changing from the Marketplace to Medicare"; Medicare.gov, "When does Medicare coverage start?"
Why the Premium Tax Credit Ends at 65
The premium tax credit is only for people who are not eligible for other qualifying health coverage. Medicare Part A counts as that coverage. HealthCare.gov puts it plainly: you can't get savings on a Marketplace plan "once you're eligible for Medicare Part A, or once your Medicare Part A or Medicare Advantage (Part C) coverage starts."
The word "eligible" matters. For most people, Part A is premium-free because they or a spouse paid Medicare taxes for at least 40 quarters (about 10 years) of work. If that describes you, the IRS treats you as eligible for Part A whether or not you sign up. Skipping Medicare does not bring the credit back.
The rule is different if you would have to pay for Part A. IRS Publication 974 says Part A that you must pay a premium for counts against the credit only if you are actually enrolled in it. So a person who would owe a Part A premium, and who does not enroll, can still qualify for the premium tax credit if they meet the other rules.
What full price looks like
Marketplace premiums are age rated. Under the Affordable Care Act, an insurer can charge an older adult up to three times what it charges a 21-year-old for the same plan, and the oldest band starts at 64. That means the full price of a Marketplace plan at 65 is about as high as Marketplace prices get. Without the credit, many people in their 60s face premiums well above what Medicare costs them.
If the credit keeps getting paid by mistake
Marketplace coverage does not end on its own when Medicare starts, and the advance credit can keep flowing if you never report the change. HealthCare.gov warns that if you keep the premium tax credit after Medicare starts, "you'll have to pay back the premium tax credit you use when you file your federal taxes." Starting with tax year 2026, there is no longer a cap on how much excess advance credit you repay, at any income level (P.L. 119-21 sec. 71305). A year of unreported overlap can mean a large bill at tax time.
What You Lose by Choosing a Marketplace Plan
1. The subsidy
Covered above. If you are eligible for premium-free Part A, your Marketplace plan costs its full sticker price from that point on.
2. Your penalty-free window for Part B
Your Initial Enrollment Period is 7 months long: it starts 3 months before the month you turn 65 and ends 3 months after it. After that, the only penalty-free ways into Part B are Special Enrollment Periods, and Medicare.gov lists "You have or lose your Marketplace coverage" under situations that don't qualify for one.
The usual Special Enrollment Period for people who delay Part B depends on job-based coverage from current work, yours or your spouse's. Individual Marketplace coverage is not job-based, so it does not protect you. (Small-business SHOP coverage through a current employer is the exception HealthCare.gov names.) If you are still working with employer coverage, read our guide to Medicare if you are still working, because the rules there are different.
3. Money, every month, for life
The Part B late enrollment penalty adds 10% of the standard Part B premium for each full 12-month period you could have had Part B and didn't. For most people it lasts as long as they have Part B. The penalty is figured on each year's standard premium, so it grows as the premium grows.
The 2026 standard Part B premium is $202.90 a month (CMS, November 2025). CMS has not published the 2027 Part B premium yet, so the table below uses the 2026 figure.
| Full 12-month periods without Part B | Penalty | Penalty per month (2026) | Total Part B per month (2026) |
|---|
| 1 | 10% | about $20.29 | about $223.19 |
| 2 | 20% | about $40.58 | about $243.48 |
| 3 | 30% | about $60.87 | about $263.77 |
| 5 | 50% | about $101.45 | about $304.35 |
People with income above the IRMAA thresholds pay more for Part B, and the penalty adds on top. For the full calculation, see our Medicare late enrollment penalty guide.
4. A gap in coverage when you finally switch
If you miss your Initial Enrollment Period, you generally have to wait for the General Enrollment Period, January 1 to March 31. Coverage starts the first of the month after you sign up. If your Marketplace plan ends or gets too expensive in the middle of the year, you can end up with neither.
5. Possibly a Part D penalty too
If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, a Part D penalty applies once you join a drug plan: 1% of the national base beneficiary premium for each full month you went without. The base premium is $38.99 for 2026 and $41.33 for 2027 (CMS). Two years without creditable coverage would add about $9.90 a month in 2027, for as long as you have Part D. Don't assume your Marketplace plan's drug coverage counts as creditable. Ask the insurer in writing.
6. Medicare's protections and help programs
Medicare comes with things a Marketplace plan at 65 does not give you: a 6-month Medigap Open Enrollment Period, starting when you are 65 and have Part B, when insurers cannot turn you down or charge more for health reasons; the 2026 Part D out-of-pocket cap of $2,100 (rising to $2,400 in 2027); and Medicare Savings Programs, which can pay the Part B premium for people with limited income and resources (2026 resource limits: $9,950 single, $14,910 married, per Medicare.gov). Our guide to benefits when turning 65 covers these help programs in more detail.
Can You Have Medicare and a Marketplace Plan at the Same Time?
Technically, yes, if you already had the Marketplace plan before Medicare started. HealthCare.gov says you can keep it "but you'll pay full price for it," and your insurer might end it. In practice, it rarely makes sense: you would be paying a full-price Marketplace premium on top of Medicare for overlapping coverage.
What you can't do is buy a new one. HealthCare.gov: "It's against the law for someone who knows you have Medicare to sell you a Marketplace plan."
The Exception: When a Marketplace Plan Can Make Sense
The Marketplace can be the better fit if you are not eligible for premium-free Part A. This mostly affects people with fewer than 40 quarters of work, their own or a spouse's, such as people who worked mostly outside the US, started working late, or spent years as caregivers.
In 2026, buying Part A costs $565 a month with fewer than 30 quarters, or $311 a month with 30 to 39 quarters (CMS 2026 fact sheet). Add the $202.90 Part B premium and Medicare can cost a lower-income person more than a subsidized Marketplace plan.
| What you'd pay in 2026 | Fewer than 30 quarters | 30 to 39 quarters | 40 or more quarters |
|---|
| Part A premium | $565 | $311 | $0 |
| Part B standard premium | $202.90 | $202.90 | $202.90 |
| Premium tax credit possible? | Yes, if you don't enroll in Medicare and otherwise qualify | Yes, if you don't enroll in Medicare and otherwise qualify | No |
Weigh three things before choosing the Marketplace in this situation:
- Part B penalties still apply if you turn to Medicare later. Not having premium-free Part A does not create a Part B Special Enrollment Period.
- Your quarters may grow. If you keep working, you may reach 40 quarters and become eligible for premium-free Part A. From then on, the credit ends.
- Immigration status affects the credit. For 2027 coverage, the premium tax credit is limited to citizens, green card holders, Cuban and Haitian entrants, and citizens of Micronesia, the Marshall Islands and Palau. Refugees, asylees, TPS holders, parolees and visa holders can still buy a Marketplace plan for 2027, but at full price.
Also remember that the premium tax credit counts all of your Social Security benefits as income, including the untaxed part.
If you already pay a premium for Part A, HealthCare.gov says you can drop Parts A and B and choose a Marketplace plan. Coordinate the dates so your Marketplace plan starts before Medicare ends.
What If You Already Get Social Security?
If you are getting Social Security retirement benefits before 65, you are enrolled in Parts A and B automatically. You can turn down Part B, but that triggers the same penalty risk described above. Premium-free Part A works differently: you generally cannot drop it without also giving up your Social Security benefits and paying back what you received, plus anything Medicare paid. For nearly everyone, that is not worth it.
How to Switch from the Marketplace to Medicare Without a Gap
- Mark your Initial Enrollment Period. It runs 3 months before through 3 months after your birthday month. If you sign up before the month you turn 65, coverage starts the first day of your birthday month. If you sign up later in the window, it starts the next month. See our Initial Enrollment Period guide.
- Sign up for Medicare. If you are not getting Social Security yet, apply at ssa.gov/medicare, by phone at 1-800-772-1213, or at a local Social Security office.
- Get your Medicare start date in writing. It is on your Medicare card and your approval letter.
- Report it to the Marketplace. Log in to HealthCare.gov or your state Marketplace and update your application. You can report the date up to 3 months ahead. HealthCare.gov's example: if Medicare starts May 1, you can update as early as February 1, and Marketplace coverage ends April 30.
- End coverage only for the person starting Medicare. A younger spouse or dependents stay on the plan, and their premium tax credit may change because the household changed. Re-check their savings when you update.
- Choose drug coverage. Join a Part D plan or a Medicare Advantage plan with drug coverage during your Initial Enrollment Period so the Part D penalty clock never starts.
- Watch your tax return. You will get Form 1095-A for the months you had Marketplace coverage. Make sure no advance credit was paid for months after Medicare began.
Why This Comes Up in November
From November 1, 2026 to January 15, 2027, Marketplace open enrollment for 2027 coverage overlaps Medicare's fall open enrollment, which runs October 15 to December 7. Someone turning 65 in early 2027 may get a Marketplace renewal notice and Medicare mail in the same week. Medicare open enrollment is for people already on Medicare who want to change plans. If you are new to Medicare, your Initial Enrollment Period, not the fall dates, controls when you sign up. Renewing your Marketplace plan for 2027 is fine, but plan to end it the day before Medicare starts, and expect the credit to stop once you are eligible for premium-free Part A.
Frequently Asked Questions
Do I have to take Medicare at 65?
No law forces you to enroll. But if you are eligible for premium-free Part A, you lose the Marketplace premium tax credit whether you sign up or not, and if you skip Part B without job-based coverage from current work, you risk a permanent penalty. For most people, enrolling at 65 is the safer choice.
Can I keep Obamacare instead of Medicare?
You can keep a Marketplace plan you already have, but at full price once you are eligible for premium-free Part A. You cannot buy a new Marketplace plan once you have Medicare.
Does Marketplace coverage count for a Part B Special Enrollment Period?
No. Medicare.gov specifically lists having or losing Marketplace coverage as a situation that doesn't qualify. The main exception is SHOP coverage through a current employer.
When exactly does my premium tax credit stop?
It stops for months when you are eligible for premium-free Part A, or for months when your Part A or Medicare Advantage coverage has started. Report your Medicare start date to the Marketplace so the advance credit stops on time. Starting with 2026 coverage, any excess advance credit has to be paid back in full.
What if I can't afford Medicare premiums?
Look at Medicare Savings Programs, which can pay your Part B premium, and Extra Help, which lowers drug costs. Your state's Medicaid office handles Medicare Savings Program applications, and you can apply for Extra Help through Social Security.
My spouse is younger. Do they lose the Marketplace plan when I go on Medicare?
No. End coverage only for the person starting Medicare. Your spouse keeps the plan, and their premium tax credit is recalculated based on the new household situation.
I don't have 40 work quarters. Should I pick the Marketplace?
It can make sense, because you would have to pay for Part A, and you can get the premium tax credit if you don't enroll in Medicare and otherwise qualify. Weigh that against Part B late penalties if you need Medicare later. A free counselor from your State Health Insurance Assistance Program (SHIP) can work through your numbers.
This article is general information, not legal, tax or insurance advice. Rules and figures change; confirm your situation with Medicare (1-800-633-4227), Social Security, or HealthCare.gov. 2027 Medicare Part A and Part B premiums had not been published when this was written.
