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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.


Enroll 80-Yr-Old in Covered California?

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Question: My mother came in May 2013. Up to today, she has lived in the U.S. for 1.5 years. She just got her green card couple weeks ago. Can she qualify for Medicare as she never works in US or lives in US for 5 years? If she can't qualify for Medicare, can she get any healthcare plan with good medical coverage (> $1million)

Answer: Yes. You can enroll your 80-year-old mother in health insurance through Covered California even though she never worked in the US as long as she has legal residency in California. In fact, the only way to get her covered right now is through Covered Ca. She may be eligible for premium assistance otherwise the monthly cost will be pretty high as she will pay the monthly rate of a 64-year-old, the highest rate. Mom will be eligible for Medicare in 3.5 years, so she can use the Covered California coverage in the meantime. Longer term, she should apply for Medicare as soon as possible. Start at medicare.gov. She will have to pay for Medicare and cancel her Covered california coverage at that time.

9 Comments

In addition, I had a lengthy Live Chat with a second associate who assured me that seniors who had not accrued enough work credits to receive Medicare benefits automatically at age 65 (and, therefore, would have to pay the $400-plus for Part A if they enrolled in Medicare) could enroll in Covered California, instead, and receive Covered CA subsidies—within the same income parameters of other Covered CA enrollees. This second associate directed me to the page I quoted from (fifth and sixth paragraphs):

http://www.coveredca.com/individuals-and-families/special-circumstances/individuals-on-medicare/

Another source on the same topic is California Health Advocates::

Frequently Asked Questions About Medicare and Covered California (the section entitled “If You Are Required to Pay the Premium for Medicare Part A”)

http://cahealthadvocates.org/news/reform/2013/faq-about-medicare-and-covered-california.html

I hope this adds to the discussion, rather than obfuscates. It’s just general info, not specific to the individual’s original question!

Re-reading your original post, I missed the part about your mother only being in the US for 1.5 years. She will not be eligible for Medicare for another 3.5 years, and will have to pay premiums at that time (she could get married to someone who is eligible for premium-free Medicare, and subsequently gain eligibility after she has been married to that person for at least 12 months).

So, between now and 3.5 years from now, it might be possible for her to obtain health insurance through CoveredCA with APTCs … if she qualifies. There are several “hoops” through which she must jump. And she’ll have to wait for open enrollment, which means her coverage can’t begin until January 1 … if she’s even eligible.

How will she be filing her income tax returns? As your dependent or as an individual? What is her taxable income?

In order to receive APTCs. an individual/household must have income between 100% and 400% of the Federal Poverty Line. If your mother does not work and does not have income, she will not qualify for CoveredCA and APTCs … that’s a pretty simple fact. If she is your dependent, claimed on your tax return, then she is part of your household and your premium tax credits are also determined by total household size and income. How are you receiving your health insurance — through an employer-sponsored plan or through CoveredCA?

In California, however, any individual/household with income of less than 138% of the Federal Poverty Line will be eligible for Medi-Cal, and cannot enroll in a CoveredCA plan and receive APTCs.

So which circumstance is most closely related to your mother’s situation? I’m guessing little or no income and/or as your dependent. And if so, that means Medi-Cal for her.

Here’s the hard part of that “solution.” EVERY (repeat, EVERY) $ of medical expense — in or out of the hospital, drug costs, supplies and durable medical equipment, home health care, you name it — paid by Medi-Cal for persons over age 55 and for persons of any age being cared for in an “institutional” setting (skilled or lower standard of care, other than home care) will be tracked and totaled and is subject to mandatory asset recovery following his/her death. In the case of a dependent parent receiving Medi-Cal assistance, asset recovery can attach to the individual providing financial support or to other heirs in addition to, or in place of, the deceased recipient’s “recoverable” estate. This is a requirement under federal law.

As for what you were told by CoveredCA … CoveredCA customer service representatives frequently dispense wrong information because they are not truly experienced in insurance. They have limited training.

The IRS has clarified the conditions under which a person eligible for Medicare “may” be eligible for APTCs. But it requires the individual to DISENROLL completely from Medicare, which means that if the person later wants to re-enroll in Medicare, he/she will be subject to the premium penalties I previously mentioned.

Thank you for your prompt reply! I just talked to an associate at Covered California, and she confirmed that someone aged 65 in the position of having to pay for Part A of Medicare (for not having accrued enough work credits) could enroll in a Covered California plan instead and receive premium assistance. If she was in the wrong, could you please point me to the change in law? Many thanks!

DG …

Thanks to Congress and Pres. Obama, persons age 65 and over are not eligible for premium tax credits to help pay the cost of health insurance premiums. This is because they are required to enroll in Medicare at age 65. Certain immigrants are ineligible for Medicare until they have been present in the US for at least five years, and persons covered by qualified group health plans (employer, retiree, or that of a spouse’s employer), are also exempt.

The Medicare law was changed as a result of the PPACA to impose a premium surcharge (AKA: penalty) on persons for late enrollment into Medicare Part A, similar to that which has long existed for Medicare Part B. The Part A penalty is 10% of the required monthly premium (there are two tiers, based on the number of Social Security/Railroad Retirement “credits” a person has accumulated: (1) < 30 credits, or (2) > 30 but < 40 credits), and the penalty will be imposed for twice the number of months a person “should have been enrolled” since their first month of eligibility.

Accordingly, a person covered by a qualifying employer/retiree (or spouse’s employer’s) group health plan who decides to leave that plan in favor of Medicare, or a person just turning age 65, would not be penalizedd for enrolling at that time, and there would be no penalty on an immigrant who enrolls in Part A as soon as they complete the 5 year residency requirement, even if they were age 65 or older.

The monthly premiums for Part A in 2015 are $426 for persons with fewer than 30 credits and $234 for persons with more than 30 but less than 40 credits. Premiums may be increasing in 2016, but the numbers have not yet been announced by Medicare.

A person age 80 who is a US citizen or legal resident, and assuming they were eligible for Medicare at age 65, would have to pay the 10% premium.penalty for Part A ($42.60 or $23.40 per month) for up to 30 years (180 months x 2). The Part B premium penalty is a cumulative 10% for each 12 month period a person was not enrolled in Part B from the time they were first required to enroll, which could mean a 150% surcharge over the minimum $104.90 in 2015, or a total of $262.25.

The total monthly cost for Medicare in this situation could be as much as $730.85 per month, and that amount would increase in the future each year as the Part A and/or Part B premiums are raised. (There has not been an increase in Medicare premiums for the past few years, but there has been talk of an increase in 2016. We just haven’t heard this officially. If true, the announcement will be coming in the next couple of weeks.)

A health plan through CoveredCA could be a little less expensive, but like the premiums for Medicare Parts A & B, the government does not provide anyone over age 65 with economic assistance. Some persons might qualify for limited coverage under Medi-Cal.

I just read this at the Covered California website (August 21, 2015):

Medicare Part A has a premium: However, if someone qualifies for Medicare but has to pay a premium for Part A and does not enroll in Medicare Part A, they may be eligible for a Covered California health plan. Depending on a consumer’s income, they may be eligible for premium assistance and cost-sharing subsidies for the Covered California health plan.

A.J.

No one age 65 and older is eligible for Premium Tax Credits, courtesy of the PPACA. Everyone 65 and older must either have enrolled in Medicare (all US Citizens and Nationals and legal residents in the US 5 years or more) or obtained Minimum Essential Coverage privately — which will be more costly than Medicare Parts A + B. Part D Prescription Drug Plans vary widely in cost and benefits, and are either standalone plans, or incorporated into Medicare Advantage plans which are a substitute for Medicare Parts A + B.

The Medicare Part A penalty was newly added in conjunction with passage of the PPACA. The Part B and Part D penalties, as you well know, have been around for years.

There is NO waiting period for Medicare as long as a person enrolls within the three month period PRIOR to eligibility — missing that window, coverage would begin on the first day of the month following enrollment if done in the month of one’s birthday or the three following months. Eligibility is automatic for persons age 65 or older, including legal resident aliens who have been in the US at least five years.

If a person misses that 7-month window of opportunity, then the General Enrollment Period is Jan 1-March 31 of every year, with coverage beginning on July 1.

However, to pay for the PPACA, there is now a PENALTY for not being enrolled in Part A at age 65 (or as soon as eligible). That penalty is 10% of the premium for twice the number of months a person has not been enrolled in Part A, in addition to any penalty for not being enrolled in Part B (the Part B penalty is lifetime and 10% for each 12 months of non-enrollment), plus a Part D lifetime penalty of 1% per month for each month of nonenrollment in a Prescription Drug Plan.

DO NOT MISS YOUR MEDICARE ENROLLMENT WINDOW

Although the premium will be high, it will not be any higher than it is for someone age 64. Three and a half years from now, once your mother has been here five years, she must enroll in Medicare, and pay the Part A and Part B premiums. She will no longer be eligible for coverage through CoveredCA.

why won’t she qualify for premium assistance?

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