Is this Lady Screwed? (ACA/Medicare Issue)

Sep 18, 2015

Tags:
  1. PamTurner
    Offline

    PamTurner New Member

    Posts:
    17
    Likes Received:
    0
    Just got a call, a referral from an existing client. She turned 65 back in April and is still on her Obamacare plan. She is self-employed and can barely afford the $90 per month payment.

    She thought that after turning 65 she had to wait until the open enrollment period (to us known as AEP) to get on Medicare.

    With all the attention T65 people get, I can't understand how she could fall through the cracks and not have talked to someone!

    Now she is beyond her initial enrollment period for Medicare. To make matters worse, I just read
    "When you’re considered eligible for Medicare Part A, you won’t
    qualify for Marketplace tax credits to help pay your premiums
    or reductions in cost‑sharing that may be available through the
    Marketplace."
    She will likely owe months worth of premiums back, because she has continued to pay the subsidized rate.

    Is there anything she can do? Has anyone ever heard of someone contacting medicare and requesting an exception claiming they didn't know what to do?

    I'm assuming she'd also have to wait until January to enroll in Medicare. Is that right?
     
  2. somarco
    Offline

    somarco GA Medicare Expert

    Posts:
    29,803
    Likes Received:
    3,781
    State:
    Georgia
    Enrolls during the General Election Period. Coverage effective 7/1/16. Pays Late Enrollment Penalty.
     
    somarco, Sep 18, 2015
    #2
  3. PamTurner
    Offline

    PamTurner New Member

    Posts:
    17
    Likes Received:
    0
    Thanks somarco!
     
  4. G.Gordon
    Offline

    G.Gordon Guru

    Posts:
    3,182
    Likes Received:
    4
    State:
    Missouri
    Get clarification if she is taking Social Security. If so, she has Medicare, they auto enroll if taking retirement benefits. If she is self employed and not making much (less than $15,700ish) then she can take SS and not get the 2:1 reduction of benefit.

    She is out of her OEP and IEP/ICEP so she will have to get a creditable coverage letter from her individual on-exchange plan deeming the prescription coverage as good as or better than part D to avoid the part D LEP.

    If she does not have Medicare at all, she is SOL until the GEP.
     
    G.Gordon, Sep 18, 2015
    #4
  5. j10
    Offline

    j10 Expert

    Posts:
    64
    Likes Received:
    0
    State:
    New Jersey
    I thought exchange plans auto-disenrolled when their records indicated the enrollee was turning 65. Good to know.
     
    j10, Sep 18, 2015
    #5
  6. yorkriver1
    Offline

    yorkriver1 Guru

    Posts:
    1,252
    Likes Received:
    45
    At least one carrier is now writing letters to those T65, telling them to make the change. I can't recall exactly, maybe Aetna.

    The Marketplace now has a longer set of paragraphs they read to callers, newly including the info about needing to drop the coverage when eligible for Medicare.

    As you probably noticed, it seemed to me anyway to be new, the AHIP slides now mention that Marketplace plans are not autmatically cancelled, in addition to Med/Supp to MA.

    Not that it helps that person if past OEP. Some may avoid penalty if LIS, but still have to wait to the following July. I know of one. Fortunately, there are some good free clinics in the area, and a teaching hospital with financial support up to 100%.
     
    Last edited: Sep 21, 2015
  7. tesflex
    Offline

    tesflex Super Genius

    Posts:
    129
    Likes Received:
    0
    State:
    Hawaii
    If she was getting SS before April, she may already have Part B, would may have started on 4/1. If yes, she is still in her 6 month OEP, but only for 10 more days.
     
    tesflex, Sep 21, 2015
    #7
Loading...