QUESTION

I have retiree coverage from my former employer, but the premiums are too expensive and I have to pay a lot out-of-pocket. Can I drop my retiree plan and get financial help in the health insurance marketplace?

Individuals with coverage | Retiree Coverage
ANSWER

Yes, as long as you drop your retiree health plan, you may be eligible for coverage in a health insurance marketplace, and depending on your income, for premium tax credits. There are a few important considerations to keep in mind:

  • You must apply for coverage during the annual open enrollment period. If you drop your plan expecting to enroll at another time, you will have to wait.
  • In order to avoid a gap in coverage, be sure to coordinate the date your retiree coverage will end with the date your health insurance marketplace coverage will begin.
  • If you are eligible for premium tax credits, you will be able to shop for coverage and see the premiums you would pay, taking into account the tax credit.
  • If you want to compare benefits and cost-sharing under your retiree plan to those you would get in a plan in a health insurance marketplace, keep in mind that plans that cover only retirees (and not active workers as well) don’t have to comply with the same consumer protections as plans in a health insurance marketplace. (26 U.S.C. § 36B; 45 C.F.R. § 155.420; HealthCare.gov, Health Coverage for Retirees Without Medicare).
Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues