Medicare Marketplace Insurance Explained

Medicare Marketplace insurance is not a separate program you buy through a government website. It is a way to compare and enroll in Medicare Advantage plans (Part C) and prescription drug plans (Part D) online, all in one place. The Medicare Marketplace — also called Medicare.gov — lets you see what plans are available in your area, what they cost, and what doctors and pharmacies they cover, without having to call each insurance company separately.

The plans themselves are sold by private insurance companies like UnitedHealthcare, Humana, and Aetna. Medicare pays those companies to offer the coverage. When you enroll through the Marketplace, you are buying from the insurance company, not from Medicare. The Marketplace is just the tool that shows you the options.

This is different from Original Medicare (Parts A and B), which you get directly from the federal government. With Original Medicare, you can see any doctor who accepts Medicare, and you pay a deductible and coinsurance for each service. With a Medicare Marketplace plan — usually a Medicare Advantage plan — you typically have a network of doctors, a lower monthly premium, and different out-of-pocket costs.

Key Takeaways

  • The Medicare Marketplace is a website where you compare and enroll in Medicare Advantage and prescription drug plans offered by private insurance companies.
  • Medicare Advantage plans (Part C) replace Original Medicare and usually include prescription drug coverage, dental, and vision benefits that Original Medicare does not.
  • Prescription drug plans (Part D) are only for people who stay on Original Medicare and need to cover the cost of medications.
  • You can enroll during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event like moving or losing other coverage.
  • The Marketplace shows you plan costs, deductibles, copays, and which doctors and pharmacies are in each plan's network before you enroll.

Medicare Advantage Plans Through the Marketplace

A Medicare Advantage plan is a Medicare Part C plan sold by a private insurance company. When you enroll in one through the Marketplace, you are choosing it instead of Original Medicare. The insurance company is responsible for covering your hospital care, doctor visits, and other medical services that Medicare Part A and Part B would normally cover.

Most Medicare Advantage plans include prescription drug coverage (Part D), dental, vision, and hearing benefits — things Original Medicare does not pay for. Some plans also offer fitness benefits or transportation to medical appointments. The trade-off is that you usually have to use doctors and hospitals in the plan's network, and you may pay more if you go out of network.

When you look at a plan on the Marketplace, you will see the monthly premium, the annual deductible, the copay for a doctor visit, and the copay for a specialist. You will also see a list of which doctors, hospitals, and pharmacies are in the network. Many people choose Medicare Advantage because the monthly premium is lower than Original Medicare plus a separate Medigap policy, and because the extra benefits (like dental) save money over time.

Prescription Drug Plans for Original Medicare Users

If you stay on Original Medicare (Parts A and B), you need a separate prescription drug plan (Part D) to cover the cost of medications. You can find and enroll in Part D plans through the Medicare Marketplace. These plans are also sold by private insurance companies, and each one covers a different list of drugs at different costs.

Part D plans have a monthly premium, an annual deductible, and copays or coinsurance for each prescription. The cost depends on which drugs you take — some plans are cheaper if you take common medications, and others are better if you take expensive specialty drugs. The Marketplace lets you enter your current medications and see which plans will cost you the least for that specific list.

You must enroll in a Part D plan when you first become may be able to access for Medicare, or during the annual open enrollment period. If you do not enroll when you are first may be able to access and you do not have other drug coverage, you may pay a penalty for every month you go without it.

How to Use the Medicare Marketplace to Compare Plans

Go to Medicare.gov and click "Find Care Providers and Suppliers" or "Compare Medigap Policies" — or search for "Medicare Marketplace" directly. You will land on a page where you can enter your ZIP code and see what plans are available in your area. The site will show you Medicare Advantage plans, Part D prescription drug plans, and Medigap supplemental policies side by side.

To compare Medicare Advantage plans, you enter your current doctors' names and the medications you take. The Marketplace will tell you which plans include those doctors in the network and how much each plan will cost you for your specific prescriptions. You can sort by monthly premium, deductible, or out-of-pocket maximum to find the plan that fits your budget and health needs.

For Part D plans, enter your medications and the Marketplace will calculate the total annual cost — premium plus copays — for each plan. This is the fastest way to see which plan saves you the most money. You can also call 1-800-MEDICARE to speak with someone who can walk you through the comparison, though the website is usually faster if you have your doctor and medication list ready.

When You Can Enroll in Marketplace Plans

The main enrollment window is the annual open enrollment period, which runs from October 15 to December 7 each year. Any changes you make during this window take effect on January 1. This is when most people switch plans or enroll for the first time.

You can also enroll outside the open enrollment period if you have a may have access to life event. These include turning 65 and becoming may be able to access for Medicare, moving to a new state or county, losing other health coverage (like employer coverage or Medicaid), getting married or divorced, or having a significant change in income. When you have a may have access to event, you usually have 60 days to enroll in a new plan.

If you miss the important date to enroll when you first become may be able to access for Medicare, you may have to wait until the next open enrollment period to join a plan. Some people also pay a late enrollment penalty if they do not enroll in Part D or a Medicare Advantage plan within the required timeframe.

Marketplace Plans Versus Original Medicare Plus Medigap

Original Medicare (Parts A and B) covers hospital and doctor visits, but it does not cover dental, vision, hearing, or prescription drugs. Many people on Original Medicare buy a Medigap policy (also called supplemental insurance) to cover the costs that Medicare does not pay — like deductibles and coinsurance. Medigap policies are not sold through the Medicare Marketplace; you buy them directly from insurance companies.

A Medicare Advantage plan through the Marketplace is often cheaper than Original Medicare plus Medigap plus a separate Part D plan, because the monthly premium is lower and the plan includes extra benefits. However, Medicare Advantage plans have networks, so you may not be able to see your current doctor. Original Medicare plus Medigap lets you see any doctor who accepts Medicare, but the total cost is usually higher.

The choice depends on your health, your doctors, and your budget. If you want to keep your current doctors and do not mind paying more, Original Medicare plus Medigap may be better. If you want lower monthly costs and do not mind switching doctors, a Medicare Advantage plan through the Marketplace may save you money.

Frequently Asked Questions

Can I switch from Medicare Advantage back to Original Medicare?

Yes, but only during the annual open enrollment period (October 15 to December 7) or if you have a may have access to life event. If you switch back to Original Medicare, you will need to enroll in a Part D prescription drug plan and may want to buy a Medigap policy. You can also switch from one Medicare Advantage plan to another during open enrollment.

Do I have to use the Medicare Marketplace to enroll in a plan?

No. You can enroll directly with the insurance company by phone or mail, or you can call 1-800-MEDICARE and have someone help you over the phone. The Marketplace is just one way to compare and enroll. Many people find it easier to use the website because they can see all available plans at once and compare costs side by side.

What if my doctor is not in the Medicare Advantage plan's network?

You can still see that doctor, but you will usually pay more out of pocket. Some Medicare Advantage plans allow out-of-network care for a higher copay or coinsurance. Before you enroll, check the plan's website or call the insurance company to ask whether your doctor is in the network and what you would pay if you see an out-of-network provider.

How do I know if a plan covers my medications?

Enter your medications into the Medicare Marketplace comparison tool and it will show you which plans cover each drug and what you will pay. You can also call the insurance company directly or visit the plan's website to see the full formulary (the list of covered drugs). Drug coverage can change from year to year, so check every October during open enrollment.

Is there a cost to use the Medicare Marketplace website?

No. The Medicare Marketplace is free to use. You do not pay a fee to compare plans or enroll. You only pay the monthly premium for the plan you choose, and that premium goes to the insurance company, not to Medicare or the government.