Medicare Blog

will i lose aca subsidy when spouse goes on medicare

by Hermann Hackett III Published 2 years ago Updated 1 year ago

No, as long as the coverage qualifies as “affordable” under the Affordable Care Act. Your spouse and dependents must get individual coverage, but they aren't eligible for the tax subsidy.

What happens to the ACA subsidy when one person goes on Medicare?

You can keep your individual market plan, but premium subsidies will terminate when you become eligible for premium-free Medicare Part A (there is some flexibility here, and the date the subsidy terminates will depend on when you enroll).Oct 5, 2021

What happens when my husband goes on Medicare?

Although your husband now qualifies for Medicare, you will not qualify for Medicare until you turn age 65. If you do not have health insurance now, you can consider signing up for health insurance coverage through a Marketplace plan.

Can you have Obamacare and Medicare at the same time?

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 you a Marketplace plan. This is true even if you have only Part A (Hospital Insurance) or only Part B (Medical Insurance).

What is the family glitch in Obamacare?

What is the 'family glitch'? The family glitch has to do with who can buy subsidized plans on the ACA marketplaces. Most people can only buy health insurance on the ACA marketplace if they do not have access to a health plan through their employer.Apr 5, 2022

Is my spouse covered under my Medicare plan?

But when a person asks “Can my non-working spouse get Medicare?” they really are asking “Can my spouse be on my Medicare plan?” The answer is no. Medicare is individual insurance, so spouses cannot be on the same Medicare plan together.

Does Medigap cover spouse?

No Medicare Supplement insurance plans provide spouse coverage. This means that a married couple who both want Medicare Supplement insurance coverage must purchase two separate policies.

Is Medicare more expensive than Obamacare?

The average Medicare Supplement Insurance plan premium in 2019 was $125.93 per month. The average Obamacare benchmark premium in 2021 is $452 per month.Dec 6, 2021

Why do doctors not like Medicare Advantage plans?

If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because the private insurance companies make it difficult for them to get paid for the services they provide.

How does the ACA marketplace work?

The Marketplace facilitates competition among private insurers in a central location where people who do not have access to employer-sponsored insurance can find a suitable plan. Individuals can compare and apply for plans via the Marketplace during the open enrollment period.

Will family glitch get fixed?

On April 5, 2022, the Internal Revenue Service (IRS) issued a proposed rule to revise its current interpretation on eligibility for premium tax credits for families.Apr 6, 2022

What is the ACA affordability threshold?

For the 2022 tax year, the ACA affordability threshold will decrease to 9.61%. According to IRS Revenue Procedure 2021-36 all health plans offered by employers beginning January 1, 2022, will need to be no more than 9.61% of an employee's household income for employer-sponsored self-only coverage to be ACA affordable.Oct 5, 2021

Is the Affordable Care Act based on income?

Under the Affordable Care Act, eligibility for income-based Medicaid and subsidized health insurance through the Marketplaces is calculated using a household's Modified Adjusted Gross Income (MAGI).

How long do you have to pick a new insurance plan after losing your spouse's insurance?

Losing the coverage you had under your spouse's plan will make you eligible for a time-limited special enrollment period in the individual insurance market, on- or off-exchange (note that in this case, you have 60 days before the loss of coverage, and 60 days after the loss of coverage, during which you can pick a new plan).

How long does it take to get Medicare if you don't have Cobra?

If you’re not going to be eligible for Medicare yourself within 18 months (or up to 36 months, depending on the circumstances), you’ll have to come up with another plan for coverage when your COBRA continuation coverage runs out.

Is Medicaid a separate program from Medicare?

It’s easy to confuse Medicaid and Medicare, but they're separate programs with different benefits and different eligibility criteria. In many states, low-income people making up to 138% of federal poverty level are eligible for Medicaid.

Can I get medicaid if my income is low?

If your income is low enough, you may be eligible for government-provided health insurance through Medicaid. In some states, the Medicaid program goes by another name like SoonerCare in Oklahoma or Medi-Cal in California. It’s easy to confuse Medicaid and Medicare, but they're separate programs with different benefits and different eligibility criteria.

When does Medicare subsidy end?

If you enroll in Medicare during the final three months of your initial enrollment period, your premium subsidy will likely end before your Part B coverage begins, although your Part A coverage should be backdated to the month you turned 65.

What happens if you don't sign up for Medicare?

And if you keep your individual market exchange plan and don’t sign up for Medicare when you first become eligible, you’ll have to pay higher Medicare Part B premiums for the rest of your life, once you do enroll in Medicare, due to the late enrollment penalty.

How long does it take to get Medicare if you are not receiving Social Security?

If you’re not yet receiving Social Security or Railroad Retirement benefits, you’ll have a seven-month window during which you can enroll in Medicare, which you’ll do through the Social Security Administration. Your Medicare card will be sent to you after you enroll. Your enrollment window starts three months before the month you turn 65, ...

When does Medicare coverage take effect?

If you complete the enrollment process during the three months prior to your 65th birthday, your Medicare coverage takes effect the first of the month you turn 65 ( unless your birthday is the first of the month ). Your premium subsidy eligibility continues through the last day of the month prior to the month you turn 65.

When will Medicare be enrolled in Social Security?

Here are the details: If you’re already receiving retirement benefits from Social Security or the Railroad Retirement Board, you’ll automatically be enrolled in Medicare with an effective date of the first of the month that you turn 65. As is the case for people who enroll prior to the month they turn 65, premium subsidy eligibility ends on ...

When will Medicare be sent to you?

Your Medicare card will be sent to you after you enroll. Your enrollment window starts three months before the month you turn 65, includes the month you turn 65, and then continues for another three months. (Note that you’ll need to enroll during the months prior to your birth month in order to have coverage that takes effect the month you turn 65.

When will Medicare be sent out to my 65 year old?

If you’re already receiving Social Security or Railroad Retirement benefits, the government will automatically enroll you in Medicare Part A the month you turn 65, with your Medicare card arriving in the mail about three months before you turn 65. If you’re not yet receiving Social Security or Railroad Retirement benefits, ...

How long do you have to work to qualify for Medicare?

First, it is important to know how eligibility for Medicare works. Most Medicare beneficiaries have worked and paid Medicare payroll taxes for at least 10 years to qualify for premium-free Medicare Part A as well as Part B coverage. If you have not worked for 10 years but your spouse has, you are allowed to claim benefits on their record. Medicare benefits cannot start earlier than when you turn 65, unless you are disabled, have ALS, or have end-stage renal disease. Medicare will only cover you, not your spouse or children if they are not eligible on their own.

How long does a spouse have to be on Cobra?

If a company has more than 20 employees, it is required to offer COBRA benefits. COBRA allows coverage for 18 months, sometimes longer, so if the working spouse can wait to retire until 18 months before the younger spouses 65th birthday, this would work out nicely.

Can a non-working spouse get Social Security?

If the non-working spouse is older than the working spouse, the non-working spouse can qualify on on the working spouses work record if they are at least 62, since that is when qualification for Social Security begins. In this case, if the working spouse is still working, the non-working spouse should stay on the work health insurance ...

Can a spouse get health insurance after 65?

The other option would be for the younger spouse to find a job that offers health insurance until they turn 65. While this is a long-shot, some companies will provide coverage for the younger spouse even after the working spouse retires.

Can a non-working spouse claim Medicare?

If the working spouse is no longer employed, the non-working spouse should go ahead and apply for coverage fully from Medicare. If the working spouse is younger than 62, the non-working spouse will not be able to claim on the record.

Does Medicare cover spouse?

Medicare will only cover you, not your spouse or children if they are not eligible on their own. This is where problems begin, especially when a working spouse is older than a non-working spouse. Say the working spouse turns 65, retires, and claims Medicare. The other spouse is only 61.

Can a spouse with a low income get medicaid?

Medicaid is a joint Federal and State program designed to help people with low incomes cover healthcare costs. If, by retiring, your income falls under a certain level, the younger spouse may be eligible for Medicaid coverage. Be aware, as a family, you have to have a very low income and very little assets, so many people will not qualify.

What happens if you marry someone with a low income?

If you have a low income and you marry someone who has a higher income, your combined income may be over the 400% FPL cutoff. You lose the subsidy. That’s intended because we expect the higher-earning spouse to subsidize the lower-earning spouse.

What happens when you put two incomes together?

When you put two incomes together, you can fall off the cliff together. For instance suppose two of you have a MAGI of $35k each. If you don’t marry, both of you qualify for the subsidy. After you marry, neither of you will qualify for the subsidy.

What happens if you don't marry?

If you don’t marry, the subsidy is calculated from your own income. If you marry, it will be calculated from your two incomes combined, even if you are buying only one policy. The cost of the second least expensive Silver plan for one person doesn’t change.

Does an employer subsidize dependents?

Most employers offer coverage to an employee’s spouse but they don’t subsidize dependents or they subsidize dependents much less than they subsidize employees. At my employer, an employee’s cost to cover the employee plus spouse is not just 2x the cost to cover only the employee. It’s 3.2x.

Do you get a lower subsidy if you marry?

Lower Subsidy. Even if you manage to stay on the cliff, you will still receive a lower subsidy when you marry, due to the fact that the FPL for two is much less than twice the FPL for one. This chart shows the subsidies two people with the same income will receive when they marry versus when they stay as two singles.

Is COBRA a short term medical plan?

Depending on where you live, you may have several coverage options until you're eligible for Medicare, including COBRA, an ACA-compliant plan, or a short-term medical (STM) policy. | Image: WavebreakMediaMicro stock.adobe.com

Is Cobra insurance cheap?

But it won’t be cheap. You’ll have to pay the full amount of the premium, including any portion that your wife’s employer had been paying on your behalf, plus an administrative fee (up to 2 percent with COBRA, but it can be more than that with state continuation). Be careful if you select COBRA or state continuation.

Is a short term medical plan ACA compliant?

Short-term medical (STM) insurance plans are exempt from many of the requirements of the ACA, and the rules that apply to them vary widely from one state to another. But if you can’t afford an ACA-compliant plan, a short-term plan may well be the next-best thing. As a general rule, STM plans are medically underwritten.

When does Medicare pay late enrollment penalty?

If you enroll in Medicare after your Initial Enrollment Period ends, you may have to pay a Part B late enrollment penalty for as long as you have Medicare. In addition, you can enroll in Medicare Part B (and Part A if you have to pay a premium for it) only during the Medicare general enrollment period (from January 1 to March 31 each year).

When does Medicare enrollment end?

For most people, the Initial Enrollment Period starts 3 months before their 65th birthday and ends 3 months after their 65th birthday.

What is the ACA eligibility for Medicaid?

The ACA gives states the option to expand Medicaid eligibility to people with incomes of up to 138 percent of the federal poverty level ($17,236 in 2020).

How long can a mate be on Medicare?

That way your mate can continue coverage under your employer plan until he or she becomes eligible for Medicare at age 65, or, if that day is far off, for at least a few more years.

How many states will have Medicaid in 2020?

As of January 2020, 36 states and the District of Columbia had done so. Some 13 million Americans have gained health coverage as a result of the expansion, according to "What Consumers Need to Know About Medicaid," a February 2019 report by the AARP Public Policy Institute.

How many people are on medicaid?

Jointly funded by the federal and state governments, Medicaid is the nation's public health insurance program for people with limited income and financial resources, serving nearly 65 million people as of late 2019.

How long can you keep Cobra insurance?

The COBRA law allows people who have left or lost a job to continue coverage through their former employer for up to 18 months by paying the full premiums. If eligible, spouses and dependent children can receive this coverage, even if departing employees don't take it themselves.

When is open enrollment for ACA?

Open enrollment for ACA plans only runs from November 1 to December 15 in most states, but people who are losing their current health coverage may qualify for a special enrollment period. Depending on your income and the plan you choose, you may be eligible for subsidies (in the form of tax credits) to reduce your premiums.

Can a younger spouse get Medicare?

Otherwise, here are some options for a younger spouse not yet eligible for Medicare.

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