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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Over 65 - No Medicare

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Question: I’m a US citizen and just brought my foreign citizen mother to the US to live with me (by sponsoring her to become a permanent resident) after my father passed away. She is well over 65 and I’m paying $1600 per month for her health insurance alone with a one year waiting period for many treatments. Can she qualify for the exchange plans if she is well over 65? She does not qualify for Medicare.

Answer: Your mother will be eligible for Covered California coverage once she is a permanent resident. Though she is over 65, she will be eligible because she does not have access to any public coverage - Medicare or Medi-Cal.


At age 65 I went in to apply for Medicare, only to be told that with only 20 quarters of Social Security credits, I would have to pay a huge amount for Medicare Part A until I achieved 40 quarters. So it seemed like the best idea to stay with the newly instituted Covered California. However, I was offered Part B, which at first I accepted. But upon reflection, I realized that you can’t break up Covered California payments, so I would be double paying for doctor coverage, so I immediately disenrolled in Part B. Now, several years later, I will soon accrue my 40 quarters of Social Security credit. When I reapply for Medicare, am I going to have to pay more for my Part B coverage? Isn’t this a Catch-22 situation I am being put in, since the advent of Covered California?

Walter, I recommend international travel insurance with International Medical Group. Here’s a link http://www.imglobal.com/insurance_plans.cfm?imgac=18145&frames=0

I want my mother to visit me who is currently outside of the USA & not a citizen. She is 67 years old and in good health. Is there any good plan for visitors?

I would like to bring my parents to come to USA to take care of them. age 67 and 60. we are single income family by my husband. Can my parent apply affordable health care insurance if we have higher income? since I am not quite understand how to calculate the plan.

Marta: You can enroll an applicant over age 65 through Covered California in individual coverage without subsidy. I don’t know Medi-Cal eligibility rules for 65+.

I have a couple, Mr is 65, Mrs is 63, Mrs has OHC thru IHSS, Mr needs Medi cal, earnings, SA benefits (2), with all the deductions, put Mr over the Limit for A&D program. My was inform that he needs to apply for Covered California. As Medicare/Aged recipient, I do not think he is eligible for Covered California, Am I right?

Can a German couple, ages 79 and 77, who have been in US for 17 years and not worked or have earned credits, get Covered CA?, and with unearned income at $75K get any subsidies?

I think some of LBlewett’s question having to do with “age 65” was inadvertently cut off.

The language of the ACA ends with persons age 64 who cannot be charged more than three time the premium that a 21 year old is charged. The assumption in the ACA is that persons age 65 and older are supposed to enroll in Medicare, whether they are “fully insured” or not.

New in 2014, there will now be the same sort of 10% per 12-full months lifetime premium penalty for failure to enroll “when first eligible” (i.e., age 65). The law makes no distinction between premium-free and premium-required Part A enrollment, so all persons age 65 and older are supposed to enroll in Medicare.

Those with less than the requisite 40 credits for fully insured status must pay the premium for Part A. In 2013, persons with 30-39 credits pay $243 per month, and those with less than 30 credits pay $441. Part B premiums are a minimum of $104.90 per month (and can be up to $358.70 for persons with 2011 income of $213,000 or more). 2014 premiums will be posted on Medicare.gov sometime in the middle of October, and are expected to be about 2% to 3% higher than the 2013 premiums.

At a total of $545.90 per month, this is about half the premium for a Silver or Gold plan for someone age 64. So why would someone age 65 want to seek insurance through the Exchange, other than to enroll in Medi-Cal? The IRS regulations do not mention the availability of premium tax credits for persons after age 64 either, because one cannot obtain premium tax credits for Medicare.

A person age 65 or older may continue working and earning credits to reduce or eliminate the premium for Part A. But failure to enroll will be a big mistake.

Those who are still covered by an employer-sponsored plan may opt out of Part B, but depending on the size of the employer (less than 50 employees or 50 or more employees), Medicare is forced to be either primary or secondary coverage to the employer-sponsored plan. Medicare is always secondary to Workers’ Comp medical expenses.

“but health insurance is out of her reach. We thought she could get insurance, but that is way to much $ for her 12000/year income.”

If her income is $12,000 in 2014, then your mother-in-law, who has been in the US more than 5 years should be eligible for Medi-Cal, because $12,000 is well below the 138% FPL limit 0f about $15,856.

Can you tell me where in the ACA it says that legal immigrant eligibility to purchase coverage on the exchange (with < five years) is restricted to under age 65?

Of course there was a plan. She works full time hours at 3 different jobs, but her employers offer no benefits. One even pays her as a “contractor” so they dont have to pay FICA taxes for her. She has been working for 4 of the 7 years she has lived here. She has only 16 credits (yes, i know all about those). She needs about 6 more years of work to get part A free. Maybe her health will allow that, maybe not. She lives on her own and takes care of herself, but health insurance is out of her reach. We thought she could get insurance, but that is way to much $ for her 12000/year income.

Her entire family immigrated here legally…So what was she supposed to do? Stay in her home country and die alone? And if we as a nation cannot help care for her, then what…she dies here for lack of care?

She does not want “free” healthcare. She just wants it to be affordable. Like the rest of us.

Question for you… Do you realize that when someone immigrates to the country based on a family relationship, that they have to prove that they will not be a financial drain on the government? Throw that in with the 5 year waiting period, limited familial green card availability, and the super high costs of immigration applications, and I doubt you will have to worry about “every immigrant bringing in their elderly parents.”

phemfrog, A little editorial here.

I don’t understand. Your mother-in-law came here over 5 years ago. I don’t know what age that was. Perhaps age 60 or earlier.

Was there no plan? My own mother was born and raised here and because my father was a teacher, never paying into Soc. Sec., my mother was not covered for Medicare Part A. Though a lifelong citizen, she had to pay Parts A+B until she died at age 97

Now I am uncomfortable that one might expect essentially free coverage after coming to this country late in life, at the very time medical costs increase rapidly, age 66 through 90 and beyond.

The $545 doesn’t begin to cover the true costs. True costs for someone age 80 or so would be over $2,000 per month. Your family, your wife, should be extremely happy that their mother can get covered for $545 a month, a true bargain.

I have to wonder, what was she doing for medical care from age 55 or 60 to age 66 ? I’ve been pay over $500 a month all those years out of my own pocket and savings. I won’t be able to retire until I am 75+.

Has your mother in law not worked in the past 5+ years? Perhaps she is close to having her 40 quarters. It takes very little work to gain 4 quarters. Often you can work just 3 months and you can get credit for all 4 quarters of that year.

Of course I don’t know all the facts. Perhaps she is disabled and can’t work.

The nation will simply go broke if every immigrant brings in their elderly parents at the very time the medical costs begin to ramp up. Even if they pay the $545 that only covers a small portion of the true costs.

(*In the year 2013, you must earn $1,160 in covered earnings to get one Social Security or Medicare work credit and $4,640 to get the maximum four credits for the year.)

Medicaid “expansion” means only one thing: A person qualifies for Medicaid if his/her income is 138% of FPL or less and he/she is under age 65 on January 1, 2014. Otherwise, as in Texas, qualifying income remains at 133% of FPL or less. The 5% bump is mostly meaningless for single persons — it has much greater importance for households with 4-14+ related residents.

And as for affordability of the premiums for Medicare Parts A, B, and D, like the affordability of dependent coverage under employer-sponsored plans, Congress gave no real consideration to affordability issues — mostly just lip-service.

We were all told, by Obama, Pelosi, and several hundred others, “Your premiums will be lower” and some things “Will be free … your insurance company will pay for it.” That is not same as “You will be able to afford them.” Sadly, none of those statements is true for most people in America. (Nothing related to insurance is ever “free” — we’ll all pay for it with higher premiums.)

According to my understanding of the tax credits, a person must be under age 65 to obtain them. Over age 65, a person is assumed to be qualified for Medicare, and the law states that persons “eligible” for a government-sponsored minimum essential benefit health plan (such as Medicare and Medicaid, and certain veterans’ plans, including Tricare) are NOT eligible for tax credits.

Your mother-in-law is “eligible” for Medicare. Her ability to afford the cost is not a consideration. On the other hand, anyone can pay that premium for her — like you, your spouse, or your spouse’s siblings. You might even be able to enroll her in an employer-sponsored plan as a dependent if she lives with you.

There is, apparently, no definitive answer about the availability of enrolling through the exchange after age 65.

But the ONLY reason to enroll through the Exchange is to obtain the tax credit. If it’s not available, why bother? The same plans will be available outside the Exchange at the same price. Just find a local licensed agent and see what, if anything, is available.

okay, so we are in this exact situation.

my mother in law is 66, and didn’t sign up for Medicare because she does not have 40 credits, and the premium is too expensive for her.

She has lived here as a legal permanent resident (Green Card) for more than 5 years, so she is not limited by this. But i cant get a clear answer on how she can afford the $545 premium for Medicare. and if not, can she use the exchange? or does PPACA explicitly prohibit over 65?

this is also confounded by the fact that we live in Texas, where Medicaid is not expanding.

any ideas?

My mistake. Both Medicaid and Medicare impose a five year restriction.


“The “5-year Rule” only applies to Medicaid (Medi-Cal in California), not to Medicare. Any legal resident age 65 or older is eligible to apply for Medicare at their first eligibility”

I’m sorry Max, but I read everywhere that since 1996, the “5-year Rule” applies to Medicare.

Multiple updated sites indicate just that.

So today I called Medicare, talked to a agent and then to the supervisor. Each of them repeated the fact that a legal permanent resident, non-citizen, must wait 5 years to be eligible for Medicare. Then they must pay for parts A and B.

I don’t know where you get your information. Perhaps from a pre 1996 site. Perhaps you are mixing up Medicaid with Medicare

The “5-year Rule” only applies to Medicaid (Medi-Cal in California), not to Medicare. Any legal resident age 65 or older is eligible to apply for Medicare at their first eligibility. In fact, there is a Part-A premium penalty of 10% (just like the premium penalty for Part-B) if a person fails to enroll in Medicare within three months of their first eligibility.

Example: A person lawfully immigrates to the US on his 63rd birthday and obtains permanent resident status at that time. He begins working and paying into Social Security and Medicare. At age 65, he may apply for Medicare benefits (three months prior to their birth month and up to three months after). Because he is not “fully insured” under Social Security, he must pay the premium for Medicare Part-A in addition to that for Part-B.

At age 67, having enrolled in Medicare, the beneficiary suffers a stroke and will be confined to an assisted-living facility for the remainder of his lifetime. He is ineligible for Medicaid assistance in this year because he has not been a resident of the US for five years. When he turns age 68, having been in the US lawfully for a minimum of five years, he will then be eligible to apply for Medicaid assistance.

To be eligible for enrollment in a Qualified Health Plan through the Exchange, a person must be under age 65, a US Citizen, naturalized citizen, or legal resident. It does not matter whether they are eligible for Medicaid or not. Persons who are not legal immigrants cannot apply for health insurance through the Exchange, and may not receive tax credits or other premium subsidies. There is no 5-year residency requirement for this.

For more information, you may consult the Congressional Research Service document: “Treatment of Noncitizens Under the Patient Protection and Affordable Care Act” by Alison Siskin, Specialist in Immigration Policy, dated March 22, 2011. Nothing has changed concerning this issue in the last two years.

Two quotes regarding aged non-citizens, and non-elderly and length of time in country.

” The ACA will greatly expand access to free or subsidized health insurance coverage for the millions of naturalized citizens and for documented non-citizens who have been in the country for more than five years.

“Access to subsidized coverage will also expand under the ACA for non-elderly lawfully residing immigrants with incomes below 400 percent of the Federal Poverty Level who have been in the country five years or less.”

I can’t seem to find a place that says that elderly non-citizens can participate in Covered California, at least during the first 5 years, either subsidized or unsubsidized. The rates, if there are any, for people past the age of 65 is unknown. After 5 years, it seems that individual can apply for Medicare, though must pay Parts A and B.

Max, I just went to the Medicare website and put in the possible information for this individual’s mother.

He said he just brought his mother to the USA.

The Medicare website calculator for eligibility asks if the person has been “a legal resident for at least 5 years”

If you answer NO, then you are not allowed to get coverage. It would seem that his mother will have to wait 5 more years for coverage under Medicare.

I don’t know how Covered California will handle it, but from my call to them, they suggested you had to be a citizen or green card holder. Seemingly that might even leave out a 5 year legal resident. However, I didn’t sense a high degree of confidence in their answer.

I must say, as a political consideration, we can’t be having immigrants bringing their elderly parents in at age 75 or 85 and then just jumping on Medicare. The payments, even if you pay for part A + part B, don’t come anywhere close to paying for the actual costs. To cover the true costs, you’d have to pay $1,500 to $2,000 per month.

A few points here.

My mother who passed away 2 years ago had never worked 10 years (40 quarters).

My father was a school teacher who never paid into Social Security.

As such, my mother had to pay Medicare parts A+B for many years. On top of that she paid for Kaiser supplemental.

Now, she was a citizen, born in the USA.

I have questions about whether a person, citizen or not, can be part of Covered California after age 64. I called them about that and got a mixed response even after talking to a supervisor. My call was about a citizen in that situation.

I just called them again and got some mixed and some seemingly fixed answers from a supervisor.

I was told that a person who is a non-citizen and who does not hold a Green Card, is NOT eligible for Covered California at all. She made no exception even if that person was a “permanent resident” and totally legal.

As to the citizen over age 65 who doesn’t have 10 years (40 quarters), they said that they thought they could get Covered California but had no idea what rates would be. They indicated that they would not need to spend more than 8% of income. However upon further questioning I place no confidence in the answers I was given about a citizen who did not qualify for Medicare.

I don’t think anyone at the call center has a clue about the real rules or costs for such a person. They seem to be winging it on the cost, the subsidy if any, and the eligibility. No answers about the stated cost of the highest policy being no more than three times the lowest policy.

I do not have much confidence in the answers from the Covered California call center. Seems much of it is up in the air and they haven’t been trained on specific unusual circumstances.

I beg to differ with Phil’s reply — it’s not correct. I’ve been teaching on this subject for more than 12 years.

Anyone age 65 or older who is a citizen or legal resident can apply for Medicare. Those who have the required 40 credits for “fully insured” status under Social Security receive Part A premium-free.

In fact, on the Medicare.gov website it says this:

Part A late enrollment penalty

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.

((This is something I did not know, and must be new. It might have been buried somewhere in the PPACA, although I did not see it there, or was implemented by Social Security to help offset the cost of Medicare.))

The full premium for Part A in 2013 is $441. Anyone with less than 30 credits pays that amount. Those with 30-39 credits pay $243 per month.

Everyone pays a premium for Part B. The minimum in 2013 is $104.50 per month for persons with AGI under $85,000 ($170,000 for a married couple), but can be as high as $335.70 for persons with AGI of $214,000 ($671.40 for husband and wife with AGI of $428,000 or more.

All of this information is available at the Social Security and Medicare websites operated by the US Government.

Medicare A&B would be the preferred option, however it is not available in this case. To be eligible, she would have had to worked for at least 10 years in Medicare covered employment.

Once your mother becomes a permanent resident, she may enter the Medicare system by paying both the Part A and Part B premiums. She will probably find coverage under Medicare less costly than insurance through the Covered California Exchange, even having to pay the combined $545.50 premium (in 2013).

If you are in one of the major metropolitan regions, such as Southern California (LA, Orange, Riverside, San Bernardino counties), as a Medicare beneficiary she can then enroll in a Medicare Advantage plan at (currently) no additional cost and have better benefits than Medicare Parts A and B alone with substantially lower out-of-pocket costs. This, too, would probably exceed the benefits of an Exchange-based health care plan.

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