Need Health Insurance but Aren’t Eligible for Medicare Yet?
If you're under 65 and don't have health insurance through an employer, Medicare usually isn't an option yet.
That doesn't mean you have to go without coverage.
Health insurance available through the Affordable Care Act, commonly called ACA coverage or Marketplace insurance, can help provide comprehensive medical coverage until you become eligible for Medicare.
ACA coverage can be especially important if you:
At Senior Savings Network, we can help you understand your coverage options, available plans, and whether you may qualify for financial assistance.
COMPARE ACA HEALTH PLANS
The Affordable Care Act created a Health Insurance Marketplace where individuals and families can shop for private health insurance.
You may also hear these plans called:
The plans themselves are offered by private insurance companies.
The Marketplace provides a way to compare those plans and determine whether you qualify for financial assistance that can reduce what you pay for coverage.
For most states, the federal Marketplace is HealthCare.gov. Some states operate their own Marketplace.
ACA coverage can be a good option for people who need their own health insurance and aren't currently covered through Medicare.
That includes many people who are:
Retiring Before 65?
Most people don't become eligible for Medicare until age 65.
There are exceptions. Certain people under 65 may qualify for Medicare because of a disability, End-Stage Renal Disease, ALS, or other qualifying circumstances.
But for millions of people under 65, individual health insurance through the ACA Marketplace is one of the primary ways to get comprehensive medical coverage.
This is one of the most common reasons people need ACA coverage.
Maybe you're ready to retire at 60, 62, or 64.
There's just one problem:
Medicare hasn't started yet.
If retiring means losing your employer health insurance, an ACA Marketplace plan can potentially cover the gap between your employer coverage ending and Medicare beginning.
Losing job-based health insurance can also qualify you for a Special Enrollment Period, which may allow you to enroll in Marketplace coverage without waiting for the annual Open Enrollment Period.
HELP ME FIND COVERAGE BEFORE MEDICARE
ACA Marketplace plans are comprehensive major medical health insurance.
Marketplace plans must cover the ACA's 10 essential health benefits, which include categories such as:
Marketplace plans also include certain preventive services at no additional cost when you receive them according to the plan's requirements.
This is one of the most important protections provided by the Affordable Care Act.
An ACA Marketplace insurer can't deny you coverage because you have a medical condition.
Your health history also can't be used to charge you a higher premium simply because you're sick or have had medical problems in the past.
Once your Marketplace coverage begins, the plan can't refuse to cover treatment for a pre-existing condition simply because you had that condition before enrolling.
That can be especially important for someone retiring before Medicare who already has ongoing healthcare needs.
There isn't one standard ACA premium.
The price depends on several factors, including:
Your medical history and health conditions can't be used to determine your Marketplace premium.
But the full monthly premium isn't necessarily what you'll actually pay.
You may qualify for financial assistance.
Possibly.
Many people who purchase coverage through the Health Insurance Marketplace qualify for a premium tax credit.
A premium tax credit can reduce the amount you pay each month for your health insurance premium.
The amount of assistance you qualify for is based on factors including:
For 2026, the additional enhanced Marketplace subsidies that were available during the pandemic-era expansion ended on December 31, 2025. Under current 2026 rules, premium tax credits generally apply to eligible households with income between 100% and 400% of the Federal Poverty Level, subject to the other Marketplace eligibility requirements.
Don't assume you make too much—or too little—to qualify.
The best way to know is to complete a Marketplace application using an accurate estimate of your household income.
Marketplace financial assistance is based largely on your expected household income for the coverage year.
That's especially important for retirees.
Your income after retirement may look very different from your income while you were working.
Marketplace income can include various sources such as:
For example, withdrawals from traditional retirement accounts can affect the income used to determine your Marketplace financial assistance.
That means retirement income planning and health insurance costs can sometimes affect each other.
If your income changes during the year, it's important to update your Marketplace application so your financial assistance remains as accurate as possible.
If you qualify, you can generally choose to use some or all of your premium tax credit in advance.
The credit is sent toward your health insurance premium, reducing the amount you pay each month.
For example:
If a plan's full premium were $900 per month and you qualified for a $600 monthly premium tax credit, your portion of the premium would be:
$300 per month
That's only an example. Your actual premium and tax credit depend on your circumstances and the plans available where you live.
There's also an important tax consideration.
Your premium tax credit is ultimately based on your actual household income for the year.
If your income ends up being different from what you estimated, the amount of your credit may need to be reconciled when you file your federal tax return.
Some people qualify for another form of ACA financial assistance called a:
Cost-Sharing Reduction
Cost-sharing reductions can lower expenses such as:
But there's an important rule:
You generally must choose a Silver Marketplace plan to receive these additional cost-sharing reductions.
Someone who qualifies for this additional assistance could find that a Silver plan provides significantly better coverage than simply choosing the plan with the lowest monthly premium.
ACA Marketplace plans are divided into categories commonly called metal levels.
These categories don't represent the quality of the insurance company or the quality of the doctors.
They primarily describe how you and the insurance company share healthcare expenses.
Bronze plans generally have:
Lower monthly premiums
but
Higher costs when you use healthcare
They can be attractive to someone who wants to keep monthly premiums down and is comfortable taking on a larger deductible or more out-of-pocket expense.
Silver plans generally fall in the middle.
You may have:
Silver plans are particularly important if you qualify for cost-sharing reductions, because those additional savings are generally only available when you enroll in a Silver plan.
Gold plans generally have:
Higher monthly premiums
but
Lower costs when you receive medical care
Someone who expects to use healthcare more frequently may want to compare whether paying a higher monthly premium could reduce their overall medical expenses.
Where available, Platinum plans generally have the highest monthly premiums but lower cost sharing when you use healthcare.
Plan availability varies significantly by area.
Catastrophic plans are another category available to certain individuals.
They're generally designed to have lower premiums and higher out-of-pocket costs.
Eligibility is limited. They may be available to people under age 30 and certain people age 30 or older who meet applicable requirements.
Catastrophic plans also don't qualify for premium tax credits.
A low monthly premium can look great.
But it doesn't tell you what the plan may cost when you actually need healthcare.
Before choosing a plan, look at:
The cheapest premium isn't always the cheapest plan overall.
You need to consider how you're likely to use your coverage.
The deductible is the amount you may have to pay for certain covered healthcare services before your insurance begins paying according to the plan's benefits.
For example, a plan might have a:
$5,000 deductible
That doesn't necessarily mean every medical service requires you to pay the full deductible first.
Some plans offer services such as primary care visits or prescriptions for a copayment before the full deductible has been met.
Every plan is different.
That's why it's important to look beyond one number.
A copayment is generally a fixed dollar amount you pay for a covered service.
For example:
$30 for a primary care visit
Coinsurance is usually a percentage of the covered cost.
For example:
You pay 20%, and the insurance company pays 80%
The exact amounts depend on your plan.
Unlike Original Medicare by itself, ACA-compliant health plans have an annual limit on how much you're required to pay for covered in-network essential health benefits through deductibles, copayments, and coinsurance.
For 2026, the maximum annual out-of-pocket limit for a Marketplace plan can be as high as:
$10,600 for individual coverage
$21,200 for family coverage
Many plans have lower limits.
Your monthly insurance premiums generally do not count toward the out-of-pocket maximum. Costs for non-covered services and certain out-of-network care may not count either.
ACA health plans usually have provider networks.
Before enrolling, check whether your:
are included in the plan's network.
This is especially important if you're currently receiving treatment or have doctors you don't want to change.
Don't assume that because your doctor accepts one plan from an insurance company, they accept every plan that company offers.
Check the specific plan network.
Prescription drug coverage is an essential health benefit under ACA Marketplace plans.
However, every plan can have its own:
If you take prescriptions regularly, checking the plan's drug coverage should be part of your comparison.
A plan with a lower premium could end up costing you more if your medications aren't covered favorably.
For the federally facilitated Marketplace, the annual Open Enrollment Period generally runs:
November 1 through January 15
Under the current federal Marketplace schedule:
Some states operate their own Marketplaces and may use different enrollment deadlines.
You may qualify for a Special Enrollment Period.
Certain life events can allow you to enroll in ACA Marketplace coverage outside the normal annual enrollment window.
Examples can include:
Special Enrollment Period rules vary by situation, but many qualifying events provide a limited window—often around 60 days—to enroll.
Don't wait several months after losing coverage to start looking.
Your enrollment window may be limited.
If you're under 65 and lose employer-sponsored health insurance, you may have several options.
Those could include:
Losing qualifying job-based coverage can trigger a Special Enrollment Period.
COBRA may allow you to temporarily continue your employer's health plan, but you may be responsible for a much larger portion of the premium.
Losing your own coverage may allow you to join your spouse's employer health plan through a special enrollment opportunity.
Depending on your income and your state's rules, you may qualify for Medicaid.
The right choice depends on your circumstances.
If you're leaving a job before Medicare begins, you may have to choose between COBRA and an ACA Marketplace plan.
COBRA allows you to keep the employer health plan you already have for a limited period.
That can be helpful if:
But COBRA can also be expensive because you may have to pay most or all of the premium yourself.
ACA coverage gives you the opportunity to shop for a new individual plan and potentially qualify for premium tax credits based on your household income.
Compare both before making a decision.
And be careful about voluntarily canceling COBRA outside Marketplace Open Enrollment. Simply choosing to end COBRA early generally doesn't create a new Special Enrollment Period; exhausting COBRA coverage can.
You can still explore Marketplace coverage if your employer offers insurance.
However, an offer of employer coverage can affect whether you qualify for premium tax credits.
For 2026, job-based coverage is generally considered affordable under the Marketplace test if the applicable employee premium for the lowest-cost qualifying option is less than 9.96% of household income, with additional rules determining eligibility for the employee and household members.
If your employer coverage is considered affordable and meets minimum standards, you generally won't qualify for Marketplace premium tax credits for the months you're eligible for that coverage.
ACA coverage can also be an important option for:
If you don't have employees and need health insurance for yourself or your family, you can generally shop through the individual Marketplace.
Your eligibility for financial assistance will depend on your household circumstances and estimated income.
When you complete a Marketplace application, your information may also be used to determine whether you or members of your household could qualify for Medicaid or CHIP.
Medicaid eligibility varies by state.
In states that expanded Medicaid, many adults with lower household incomes may qualify based on income.
Unlike Marketplace Open Enrollment, you can generally apply for Medicaid and CHIP throughout the year.
For many people using ACA coverage before Medicare, the Marketplace plan is temporary.
It's there to help bridge the gap until Medicare begins.
As you approach age 65, you'll want to understand your Medicare enrollment timeline.
Don't assume your ACA coverage automatically turns into Medicare.
It doesn't.
Marketplace coverage also doesn't automatically end simply because your Medicare begins.
You'll need to coordinate the end of your Marketplace coverage with the beginning of Medicare so you don't create an unnecessary gap—or continue paying for coverage you no longer need.
Once Medicare begins, ACA Marketplace insurance isn't designed to supplement Medicare.
Marketplace coverage:
Once you become Medicare eligible and enroll, you'll need to understand your Medicare coverage options separately.
Health insurance should be part of your retirement planning.
Before leaving employer coverage, find out:
Don't resign or retire and then start thinking about health insurance.
Know what your next coverage will be—and when it will begin—before your current insurance ends.
There's no single ACA plan that's best for everyone.
Someone who rarely uses healthcare may prioritize a lower monthly premium.
Someone with ongoing medical conditions may place more value on a lower deductible and predictable copayments.
Someone taking expensive medications may need to focus heavily on prescription coverage.
Someone with a particular specialist may need to start with the provider network.
That's why we recommend looking at the entire plan, not just the premium.
Compare:
Premium + Benefits + Network + Prescriptions + Out-of-Pocket Exposure
If you're under 65 and need health insurance, you don't have to figure out the Marketplace by yourself.
Senior Savings Network can help you understand:
Call Senior Savings Network at 1-800-729-9590.
Or click below to request help finding health insurance.
GET HELP FINDING ACA COVERAGE
Important Information
ACA plan availability, premiums, provider networks, prescription drug coverage, financial assistance, deductibles, copayments, coinsurance, and eligibility vary by state, insurance company, plan, household, and individual circumstances.
The Marketplace rules and dollar amounts referenced on this page reflect 2026 information and may change in future years.
SeniorSavingsNetwork.org is a non-government resource. We are not connected with or endorsed by the United States government, the federal Health Insurance Marketplace, or the federal Medicare program.
Information provided on this page is educational and is not tax or legal advice. Premium tax credit eligibility and reconciliation can depend on individual tax circumstances.
You can visit the federal Health Insurance Marketplace at HealthCare.gov or your state's Marketplace for information about all Marketplace options available in your area.
