ACA and Medicare Question

Discussion in 'Health Care Reform Forum' started by yankee466, Sep 12, 2017.

  1. yankee466
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    yankee466 Guru

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    I had a 70 year gentleman call me about his options for coverage. He has always been a self pay guy....does not believe in insurance. he has Medicare Part A....and never got B. If he wants B, he has to wait until Jan to apply, and then Part B will start in July, with a penalty.

    He was just diagnosed with stage 4 pancreatic cancer, and assumes he will be dead by July...so Part B will do him no good by then.

    The question is, since he only has Part A, could he buy an ACA plan at full price from someone during open enrollment. I know you can get ACA at any age, but generally the question is are you eligible, or do you have Medicare. He only has part of it....and will likely benefit from Part B or ACA....else, I just feel sorry for him.

    The wife, unbelievably, somehow signed up for ACA when she was 66.....and now learned that it was a mistake, so I can get her unto Medicare next year....as she will still be alive. She never applied for A or B.

    Some people are just clueless when it comes to their options.
     
  2. TN_agent
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  3. yankee466
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    yankee466 Guru

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  4. ARus
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    I had similar case, when the wife made mistake and didn't do the documentation right, so her husband who was with all kind of medical issues, was left without part B. In this case they can bay through ACA and the medical from there will cover what part A doesn't plus medications. Yes, you can go this way.
     
  5. yankee466
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    Well now....there is a real conflicting answer from the first responder who provided documents showing it can NOT be done. Is the assumption still that he MUST drop Part A or do you think Part A alone does not count as credible coverage?

    This sounds like the good old ask three people and go with the first two answers that match!!!! :skeptical:

    Dare I call the marketplace and ask an idiot?
     
    Last edited: Sep 12, 2017
  6. Dave020
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  7. ARus
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  8. TN_agent
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    I don't think they had the database in place 3 years ago to check on this through the exchange. I also had one sneak through (telling me he wasn't on Medicare A when he really was), then this past year the exchange caught him and made him prove he wasn't on Medicare (which he couldn't prove of course because he was on it). That is probably how he was able to get away with it previously. But, not anymore.

    Any private carrier off-ex is going to require proof that he is not enrolled in Medicare (or a legal attestation which if the OP's client answered no to being on Medicare would be committing fraud) before they will put the coverage into effect.

    I would not risk selling an ACA policy to the man. He doesn't believe in insurance anyway.
     
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