The first day of winter is this Wednesday, December 21. Winter can be a beautiful time to enjoy with loved ones. It is also a time when cold weather, snow, and ice can create dangerous situations. FEMA gives us five tips to stay warm and safe this winter:

Keep an emergency kit in your vehicle. This kit can include jumper cables, flares, an ice scraper, a car cell phone charger, blankets, map, food, water, and warm clothes.
Prepare your car for winter, by having it checked by a mechanic and avoiding your gap from falling below half a tank.
Never use a generator inside the house. It is also a good idea to install and test carbon monoxide alarms.
Keep heat in your home by closing blinds, closing off unused rooms, and stuffing towels in cracks under doors.
Keep your body warm by layering, eating regularly, and drinking warm liquids.

Dear Marci,

I know I need to enroll in Medicare soon. What is the best way to disenroll from my Marketplace plan and enroll in Medicare?

-Faye (Sedona, AZ)

Dear Faye,

It’s great that you’re planning ahead to smoothly transition from your Marketplace plan to Medicare.

For those that don’t know, the Health Insurance Marketplaces were created by the Affordable Care Act (ACA) so that people with no insurance or not enough insurance could purchase health insurance. Qualified Health Plans (QHPs) are one type of health insurance policy that you can buy through the Marketplace.

If you have a QHP, in most cases you should enroll in Medicare and disenroll from your QHP. There are, however, two exceptions:

You qualify for Medicare because you have End-Stage Renal Disease (ESRD).
You do not qualify for premium-free Medicare Part A.
If you qualify for premium-free Part A, you should not continue using the Marketplace to get health and drug coverage. You should enroll in Medicare when you are first eligible and disenroll from your QHP in a timely manner to avoid paying extra premiums. To disenroll from your QHP coverage, notify a state or federal Marketplace representative of your intent to disenroll form your plan at least 14 days before your Medicare coverage begins.
If you are enrolled in a plan through the federal Marketplace, contact the Marketplace Call Center at 800-318-2596 or visit www.healthcare.gov.
If you are enrolled in a plan through your state’s Marketplace, contact the state marketplace to learn how and when to disenroll from your plan.
Ask for disenrollment steps from a Marketplace representative if you are enrolled in a family plan.
Speak with your employer if you are enroll in a Small Business Health Options Program (SHOP) through the Marketplace.
Make sure to work with the Marketplace representative to ensure that your Marketplace plan ends the day that your Medicare begins, so that you do not have a gap in coverage.

Be aware that if you delay Medicare enrollment, you will likely experience gaps in coverage and have a late enrollment penalty. It is usually not cost-effective to have both Medicare and a Marketplace plan.

I hope this helps in your transition to Medicare!

-Marci

Dear Marci,

I have a Qualified Health Plan (QHP) from my state’s health insurance Marketplace. I’m turning 65 soon, though. Should I enroll in Medicare if I have Marketplace coverage?

-Tina (Cortland, NY)

Dear Tina,

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions:

You have End-Stage Renal Disease (ESRD).
If you have kidney disease that requires dialysis or transplant and are eligible for Medicare, you have the choice to enroll in or stay enrolled in a QHP with cost assistance (tax credits).
Be sure to consider how the QHP’s coverage and costs compare to Medicare before deciding to delay Medicare enrollment.
For counseling regarding your insurance options, contact your State Health Insurance Assistance Program (SHIP).
You do not qualify for premium-free Medicare Part A.
If you are eligible for Medicare but would have to pay a premium for Part A, you can keep your QHP with cost assistance as long as you do not enroll in any part of Medicare.
You should consider all consequences carefully before deciding to keep a QHP instead of Medicare. If you ever decide to enroll in Medicare, you may have to wait for the General Enrollment Period (GEP) to sign up. Using the GEP to enroll means you may experience gaps in coverage and incur a late enrollment penalty (LEP).
If you qualify for premium-free Part A, you should not continue using the Marketplace to get health and drug coverage. Enroll in Medicare when you are first eligible and disenroll from your QHP in a timely manner to avoid paying extra premiums.

Here are additional notes to remember when considering whether to enroll in Medicare if you have a QHP from the Marketplace:
You are ineligible for cost assistance (tax credits) to help pay for your QHP premium once you are eligible for premium-free Part A.
It is likely not cost-effective to have both Medicare and a QHP.
There is no guarantee that a QHP will pay for your care if you have or are eligible for Medicare Part B, meaning you may have little or no coverage.
You may experience gaps in coverage and late enrollment penalties when attempting to enroll in Medicare late.
I hope this helps you with your decision to enroll in Medicare or not.

-Marci

Dear Marci,

I am recently retired from the military and am turning 65 soon. I believe I must enroll in Medicare, even though I have TRICARE benefits. How does TRICARE for Life work with Medicare?

-Jaime (Salt Lake City, UT)

Dear Jaime,

TRICARE is a health insurance program provided by the federal government to active duty and retired military personnel and their family members. There are many different TRICARE programs. TRICARE for Life (TFL) is a program for Medicare-eligible military retirees and their dependents.

TFL acts as a supplement to Medicare. This means that TFL typically covers your Medicare cost-sharing (deductibles, coinsurances, and copayments). TFL may also pay when services are not covered by Medicare or when you have used up your Medicare benefits.

If you are eligible for premium-free Part A, you should sign up for Medicare and enroll in Medicare Part B to continue receiving TRICARE benefits when you are no longer an active duty service member or covered by an active duty service member. After enrolling in Medicare, you should automatically receive your TRICARE benefits through TRICARE for Life. If you delay Part B enrollment, you may face late enrollment penalties and gaps in coverage.

TFL also offers a pharmacy program that provides creditable drug coverage. You may choose to delay Part D enrollment without penalty and continue using TFL’s pharmacy program.

Remember, there are many different TRICARE programs. If you are an active duty service member (ADSM) or active duty family member (ADFM), you may receive your health benefits through a different TRICARE insurance program (such as TRICARE Standard or Prime). You typically can delay Part B enrollment if you are an ADSM or ADFM and enroll in Medicare when you are no longer active duty using the Part B Special Enrollment Period (SEP).

If you need assistance with TRICARE for Life or a different TRICARE program, visit TRICARE’s website for more information and contact information.

Thank you for your service, and congratulations on retirement.

-Marci

Dear Marci,

I have Veterans Affairs (VA) health coverage and am turning 65 in late March of this next year. Do I need to enroll in Medicare?

-Chris (Springfield, OH)

Dear Chris,

For our other readers, let’s start with a quick review of Veterans Affairs benefits, also called VA benefits. VA benefits are administered by the federal government for veterans—people who served on active duty in the U.S. Armed Forces for a required period of time and received an honorable discharge or release. VA benefits include pensions, educational stipends, and health care, among other benefits.

It is important to know that VA benefits do not work with Medicare, though you can be enrolled in both.


In order for your VA coverage to pay for your care, you must generally receive health care services at a VA facility.
In order for Medicare to pay for your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
VA benefits will not pay for Medicare cost-sharing like deductibles, copayments, or coinsurances.

This means that if you choose not to enroll in Medicare and to keep only your VA coverage, you will not have health insurance for facilities outside the VA system. Enrolling in Medicare gives you more flexibility in what doctors and facilities you go to, while also having VA benefits to cover things not covered by Medicare, such as hearing aids and dental care.

Some people choose to enroll in Medicare Part A for added hospital insurance because it’s often premium-free, but they turn down Part B because of the monthly premiums. In this scenario, though, you would likely face a premium penalty and coverage gap if you decided to enroll in Part B in the future.

VA benefits do offer creditable drug coverage. This means that if you are enrolled in VA drug coverage, you can delay Medicare Part D enrollment without having a late enrollment penalty. Be sure to compare the costs and benefits of Part D and your VA drug coverage to decide which best suits your needs. Typically, VA drug coverage has no premiums and no or limited copayments for prescriptions—but you must use VA pharmacies and facilities. You may want Part D coverage if you:
Live far from a VA pharmacy or facility, or do not want to use a VA provider to get prescriptions.
Want the flexibility of filling prescriptions at retail pharmacies or find the VA formulary too restrictive.
Reside in a non-VA nursing home and want to get prescriptions from the long-term care pharmacy that works with your nursing home.
Qualify for full Extra Help, which has lower copays than VA coverage.

If you decide to enroll in Medicare Part B and Part D, you should do so during your Initial Enrollment Period (IEP). Your IEP is the three months before your 65th birthday month, the month of your 65th birthday, and the three months after. Because you are turning 65 in March, your Initial Enrollment Period is from December through June.

-Marci