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When One Applicant is Over 65?

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Question: I looked at rates for a 2 person household- age 67 and 63. Plan quotes seem to reflect both being covered although the 67 year old , while part of the household for premium subsidy amount, has Medicare and not eligible! Perhaps it would be settled out in application process but meanwhile quite shocking to see the huge rate for 1 person.

Answer: I will assume that you are referring to the "Shop and Compare" tool at the Coveredca.com site. I'll also assume that your 67 year-old spouse is on Medicare. In that case, he or she is not enrolling in Covered California. The online tool has a checkbox that should be left unchecked for the 67 year-old. The silver plan rate for a 63 year old should be about $700/mo unsubsidized. If the older spouse is ineligible for Medical and must enroll in Covered California coverage also, then the premium for the 2 of you will be about $1500/mo unsubsidized.


Agent …

Unless your client is disabled due to ESRD, I would recommend Medicare Advantage over Medicare Supplement. MAPD is $0 premium in most parts of CA from nearly all insurance companies, and most with $0 deductibles and $0 copays for physician visits, plus more benefits than Medicare A&B + Medicare Supplement combined.

Medicare Supplement will cost your client thousands of dollars in premiums per year. She is disabled. Why would you want her to have to pay for something?

My client is disabled and on Medicare at age 56. She has Part A & B without a supplemental plan. Can she get a supplemental plan do open enrollment or what options does she have?

“If the older spouse is ineligible for Medical and must enroll in Covered California coverage also, then the premium for the 2 of you will be about $1500/mo unsubsidized.” While the premium numbers may be close in some areas (they are much higher in northern CA than this for persons age 60+), some of the rest of the answer is not entirely accurate.

Persons over age 65 are NOT ELIGIBLE for premium tax credits, and as recommended, most should NOT apply for health insurance through CoveredCA at all. Persons age 65 and older are now required to apply for Medicare Parts A, B & D. The only exceptions are for those who are legal residents who have not been in the US at least five years at or after age 65.

Most Americans and legal residents obtain Medicare Part A (Hospital insurance) premium-free because they have 40 Social Security “credits” (about 10 years of work history). Those who do not have 40 credits and are not eligible based on a spouse’s work record, must pay a monthly premium for Part A based on the number of credits they have: 30-39 = $234 and <30 = $426.

Failure to enroll in Part A when “first eligible” now carries a premium penalty of 10% for each 12 months of non-enrollment for twice the length of time a person should have been enrolled. Failure to enroll in Part B (Medical Insurance) carries the same 10% penalty for each 12 month period of non-enrollment, but it is a LIFETIME penalty. And failure to enroll in a Part D plan carries a 1% per month lifetime penalty for every month of non-enrollment. (Part B monthly premium is a minimum of $104.90, but can be as high as $355.70 based on MAGI two years ago.)

The individual who is age 67 could enroll in a Medicare Advantage plan (with $0 premium in most parts of California), but must still be enrolled in and pay any premiums for Medicare Parts A and B.

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