Covered California Subsidies for someone over 65 if ineligible for Free Medicare Part A Hospitalization 

You cannot buy additional coverage through #Covered California
if you have premium-free Medicare Part A Hospital

 

Medicare complies with Health Care Reform, so you do NOT need to get a an Individual policy or a subsidized one from Covered CA.  It fact, it's illegal for anyone to sell you a policy!  ^{Kaiser Health News * Covered CA Medicare Fact Sheet * Medicare.Gov Medicare & Market Place #11694  * CMS.Gov FAQ Medicare & Marketplace * HealthCare.Gov when - how to change from Covered CA to Medicare  * Social Security §1882  * Health Care.Gov}

NOTE: This information also applies to people younger than 65 whose benefits begin the first month they receive disability benefits because they have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s Disease, and to people younger than 65 who have Medicare because of a disability and are receiving SSDI Social Security Disability Insurance.

 

There are a lot of ands, if or buts in this complex issue.  Please refer to the source material below.  There are some exceptions, but they are very complex.  Don't even think of getting a 1/2 correct answer over the phone. If you have to pay for Part A Hospital, then are options, like subsided Covered CA Plans. Email us [email protected] or ask a question below.

Video about Covered CA – if no Premium Free Part A – jump to 2:30  Medicare & the Marketplace (Covered CA

Medicare vs Covered CA - Publication 11694

Links & Resources 

• Medicare Publication # 11694 Medicare & Covered CA
• Covered CA Medicare Fact Sheet 
• InsureMeKevin.com

Sec. 1882. [42 U.S.C. 1395ss]

(3)(A)

(i) It is unlawful for a person to sell or issue to an individual entitled [no premium] to benefits under part A or enrolled under part B of this title (including an individual electing a Medicare+Choice plan [MAPD] under section 1851)—

(I) a health insurance policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under this title or title XIX,

(II) in the case of an individual not electing a Medicare+Choice plan, [aka MAPD Medicare Advantage] a medicare supplemental policy with knowledge that the individual is entitled to benefits under another medicare supplemental policy or in the case of an individual electing a Medicare+Choice plan, a medicare supplemental policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under the Medicare+Choice plan or under another medicare supplemental policy, or

(III) a health insurance policy (other than a medicare supplemental policy) with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of State or Federal law.

(ii) Whoever violates clause (i) shall be fined under title 18, United States Code, or imprisoned not more than 5 years, or both, and, in addition to or in lieu of such a criminal penalty, is subject to a civil money penalty of not to exceed $25,000 (or $15,000 in the case of a person other than the issuer of the policy) for each such prohibited act. ^{Sec. 1882. [42 U.S.C. 1395ss]} 

 

Our webpages that touch on this Issue:

• Part B – Doctors – How to sign up – Benefit
• Part B Late Enrollment Penalt
• End Stage Renal – Kidney Failure
• Age 65 – Tax Credits?
• Part A Hospital rules for zero premium
• Employer Plans vs Medicare - over or under 20 employees?

FAQ’s

• My father and mother have had Covered CA Silver 94 PPO plan, with APTC – Advanced Premium Tax Credit since ACA – ObamaCare went into effect. Their income is below FPL – Federal Poverty Level but through two years of consecutive appeals hearing, the Judge had ordered Covered CA that they are eligible for APTC since they are not eligible for non-MAGI Medi-Cal (since both my dad and mom are above 65, and have assets more than Medi-Cal limits, and they cannot spend down).
  • ***But does the IRS agree with that when they file 1040 and 8962 Premium Tax Credit I would like to see that order.
• Both my dad and mom have been legal permanent residents (green card) at the time of the appeals in 2016 and in 2015. They are eligible for Medicare but are not eligible for premium-free Medicare, and Covered CA did send them a letter stating that people who are not eligible for premium-free Medicare and who dont enroll in Medicare could be eligible for APTC. Just like last two years, again for 2017, Covered CA has told them that we are not eligible for APTC for 2017 coverage. My dad became a US citizen late 2016. But they continue to be ineligible for Medi-Cal, or premium-free Medicare. And without APTC,
  • ***What if they just take the credit when they file their taxes at the end of the year?
• they cannot afford to get an affordable minimum qualified health plan – minimum essential coverage.
• They have filed for an appeal, but if you can point us to any sections of the ACA, or Federal Code of Regulations
  • ***CFR §1.37-1 General rules for the credit for the elderly. * §1.37-2 Credit for individuals age 65 or over.
  • or California regulations, or special rules/clarifications, or IRS notes that we can represent to the judge during our hearing, it would be really helpful.
• It is strange that while they would be eligible for APTC as non-citizen aliens (as decided by the Judge last 2 years), their becoming a citizen makes it worse for them.
  • ***How so?
• I think Covered CA is getting too expensive. I’m thinking of enrolling and paying for Part A, then Part B like everyone else, then enrolling in Medi Gap and Part D. What are the costs? Pros & Cons?
  • Please note, that you can’t get Part A till next July… and you have to enroll January through March
  • Part B Doctor Visits would run $135/month
  • We may have a Part B Late Enrollment Penalty That’s a whole separate issue. Please ask that question on that page. You don’t qualify for the Covered CA waiver…???
  • Medi Gap Plan G runs say $150/month + for someone in their 70’s
  • Part D Rx Runs $30 to $100/mth
  • So that totals $752
• Covered CA PPO in San Francisco for a 73 year old earning $35K with a household of two works out like this:
  • Get a personalized quote here.
  • Plus a Part A late enrollment penalty?