Eligibility for an aca plan?

Dec 1, 2018

  1. Devin01
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    Devin01 Guru

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    Client is 57 years old has Part A no Part B went on Cobra and missed opportunity for Part B. Now has to wait until GEP and coverage delayed until July. From my understanding she can not qualify for an aca plan because she has Part A. No short term medical approved n NJ. Anybody confirm her eligibility for an aca plan? Any ideas?
     
    Devin01, Dec 1, 2018
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  2. Northeast Agent
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    Northeast Agent Guru

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    Check out Petersen's plan below. I think once enrolled in Medicare A or B, you're not supposed to have ACA as you could face financial penalties.

    Note: this product is underwritten.

    Bridge Major Medical Insurance Plan

    Medicare Restriction #3: Some people, for various reasons, have only Part A or Part B. They may be able to get the additional part through Medicare, but at a later date.

    Petersen’s Solution #3: The Bridge Plan may be sold with both Part A and Part B, just Part A, or just Part B.
     
  3. Chazm
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    Chazm Guru

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    Not trained in ACA but I’m pretty sure she’s eligible for an ACA plan but not eligible for a subsidy.
     
    Chazm, Dec 1, 2018
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  4. russelltw
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    russelltw Guru

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    Correct, she can pay the full amount, just not eligible for a subsidy.

    Changing from Marketplace Health Insurance to Medicare

    "Once your Medicare Part A coverage starts, you won’t be eligible for a premium tax credit or other savings for a Marketplace plan. If you kept your Marketplace plan, you’d have to pay full price."
     
  5. LostDollar
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    LostDollar Guru

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    Your quote is talking about keeping a plan already in place. I think it would be appropriate to specifically check into whether that also applies when someone wants to buy a new aca plan after they have medicare in place.

    edit:
    see bottom two paragraphs on page 1 as a source for raising the question:
    https://www.ncdoi.com/SHIIP/Documents/Medicare Marketplace FAQs.pdf
     
  6. Yagents
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    Yagents Guru

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    I'm a health agent, and I'm stumped. I'm hoping a consumer can come on the forum, and tell me the correct answer. No license necessary, just Google and someone who cant read.
     
    Yagents, Dec 1, 2018
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  7. yorkriver1
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    yorkriver1 Guru

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    On healthcare.gov/medicare:
    Can I choose Marketplace coverage instead of Medicare?
    Can I get a Marketplace plan in addition to Medicare?
    No. It’s against the law for someone who knows that you have Medicare to sell or issue you a Marketplace policy. This is true even if you have only Medicare Part A or only Part B.
     
  8. Devin01
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    Devin01 Guru

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    Thanks for sharing this, she has a pre-existing condition. With that said can this be written in New Jersey? ave you placed any business in NJ w/Bridge Major Medical Insurance Plan>
     
    Devin01, Dec 3, 2018
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  9. somarco
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    somarco That Medicare Guy

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    Yagents, I am a consumer, but I also have a license. So I am conflicted.

    Is there a question on Obamacare apps that ask if you have Medicare? How is it worded? If you don't apply for a subsidy how does a carrier know if you have Medicare or not?
     
    somarco, Dec 3, 2018
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  10. bill3173
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    bill3173 Guru

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    Yes, other coverage is a question, and if you have Part A, you're ineligible. You could possibly get a plan off exchange if you have B only, since B alone isn't considered creditable coverage.
     
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