Can someone over 65 ineligible for Medicare – as they have not lived in the USA five years so they can buy in to coverage get the advance premium tax credit?
What if they have to pay for Medicare Part A?
If someone is over 65 and not eligible for no premium Part A Hospital Medicare there was a BIG debate when ACA/Covered CA/Obamacare started. It’s now well settled that they can. Here’s proof, the 1095 A showing the subsidy!
More info on prohibiting of having Premium Free Part A Medicare & Covered CA
Our webpage on 1095 A Proof of Health Coverage for the past year
Proofs & References
Over 65, but I don’t qualify for Medicare. You can purchase Marketplace coverage and qualify for subsidies based on your income. KFF
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. Covered CA – Medicare Info
Code of Federal Regulations 1.36B-2 Eligibility for Premium Tax Credit Is not eligible for minimum essential coverage [Can’t get Medicare!]
Broker Q & A… CAHBA.com Phil Daigle
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
Links & Resources
(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:
- Interactive Tax Assistant (ITA)
- Am I eligible to claim the Premium Tax Credit?
- IRS FAQ on Premium Tax Credit
- Learn More About Your Health Insurance Tax Documents | Covered California VIDEO
- turbo tax.com
- H & R Block
- E file.com
- Estimate the Subsidy for Health Insurance, benefits, premiums, etc.
- 8962 ONLINE Calculator
- Tax Form Calculator.com
- e tax.com
- Marriage Higher or Lower Taxes?