Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

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Rdytoretire
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Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

My understanding is that the Initial Enrollment Period for Medicare Part A and B lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. I decided I would sign up in the final month of this period.

I recently signed up for Medicare on the SS website and visited my local SS office. SS has now informed me that my Medicare Part A started in April and my part B will start in August.

It appears that I was automatically signed up for Part A even though I am not collecting Social Security benefits. I was not informed in any manner that I had Part A coverage until now.

I expected both Part A and B to start after my recent sign up. The fact that I was signed up for Part A and also had ACA coverage plus subsidy the past 3 months will mean I will have to pay back the subsidy.

Is enrollment in Part A in this case automatic or did SS make an error? Does anyone else have experience with this situation?
Last edited by Rdytoretire on Sat Jul 29, 2023 8:23 am, edited 2 times in total.
livesoft
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Re: Automatic Enrollment in Medicare Part A at 65? ACA Subsidy issues.

Post by livesoft »

Enrollment is NOT the same as starting Medicare. This is a common misconception. That is, one can be late starting enrolling in Medicare and it will be started retroactively for you. The enrollment period is helpful to those who are not paying attention.
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Rdytoretire
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Re: Automatic Enrollment in Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

The retroactive start of Part A is a problem because I was receiving ACA subsidies and will have to pay them back. That is an expensive problem. If it starts automatically the month one turns 65 I would at least expect some notice so I could have acted accordingly.

I had thoroughly reviewed documentation on the Social Security, Medicare and ACA websites and nowhere was the automatic start of Medicare Part A the month one turns 65 mentioned.

I would imagine more than a few using ACA have run into this issue.
curmudgeon
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by curmudgeon »

My interpretation of ACA subsidies (not based on reading the law, but various other descriptions) is that you lose the subsidy as soon as you are eligible for Medicare, regardless of when you sign up. At one point I though I might try to slide a few months of extra ACA coverage by signing up for Medicare late (to handle some oddities in medicare timing for my wife and I), but I decided it wasn't a clear enough situation to gamble on. I hadn't even considered that the "retroactive Part A coverage" would make it even less possible. I think you can only decline the Part A if you had employer coverage.

ACA does have more than a few gray areas and "gotchas" to trip up the unwary. I think you'll have to chalk this one up to an expensive lesson learned. You'll have saved the medicare B premium, though, so that offsets part of the ACA cost.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

curmudgeon wrote: Thu Jul 27, 2023 12:27 pm My interpretation of ACA subsidies (not based on reading the law, but various other descriptions) is that you lose the subsidy as soon as you are eligible for Medicare, regardless of when you sign up. At one point I though I might try to slide a few months of extra ACA coverage by signing up for Medicare late (to handle some oddities in medicare timing for my wife and I), but I decided it wasn't a clear enough situation to gamble on. I hadn't even considered that the "retroactive Part A coverage" would make it even less possible. I think you can only decline the Part A if you had employer coverage.

ACA does have more than a few gray areas and "gotchas" to trip up the unwary. I think you'll have to chalk this one up to an expensive lesson learned. You'll have saved the medicare B premium, though, so that offsets part of the ACA cost.
Thanks, you are probably right. That is pretty disappointing. No where could I find anything that states Medicare Part A automatically starts the month you turn 65. And if it does I would expect to at least be informed of that fact in a timely manner.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

I googled when does Medicare Part A start. This is the result I got. Guess this is my answer :| The expectation of a notice from Medicare and maybe a Medicare account number or card. Nothing was provided.

https://www.medicare.gov/basics/get-sta ... rage-start

When your coverage starts
The date your coverage starts depends on which month you sign up during your Initial Enrollment Period. Coverage always starts on the first of the month.

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65. (If your birthday is on the first of the month, coverage starts the month before you turn 65.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

The other thing that irks me is that having Medicare Part A, Hospital insurance, is not the same as having health insurance. Oh wel, it's all water under the bridge.
Gubshu
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Gubshu »

This document from Medicare makes it clear that once you are eligible for Medicare Part A, you are no longer eligible for assistance to pay for a marketplace plan: https://www.medicare.gov/Pubs/pdf/11694 ... tplace.pdf.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by marcopolo »

Rdytoretire wrote: Thu Jul 27, 2023 12:34 pm
curmudgeon wrote: Thu Jul 27, 2023 12:27 pm My interpretation of ACA subsidies (not based on reading the law, but various other descriptions) is that you lose the subsidy as soon as you are eligible for Medicare, regardless of when you sign up. At one point I though I might try to slide a few months of extra ACA coverage by signing up for Medicare late (to handle some oddities in medicare timing for my wife and I), but I decided it wasn't a clear enough situation to gamble on. I hadn't even considered that the "retroactive Part A coverage" would make it even less possible. I think you can only decline the Part A if you had employer coverage.

ACA does have more than a few gray areas and "gotchas" to trip up the unwary. I think you'll have to chalk this one up to an expensive lesson learned. You'll have saved the medicare B premium, though, so that offsets part of the ACA cost.
Thanks, you are probably right. That is pretty disappointing. No where could I find anything that states Medicare Part A automatically starts the month you turn 65. And if it does I would expect to at least be informed of that fact in a timely manner.
It seems your real concern is loss of ACA tax credits.

If so, it is not clear why you are so hung up on the start date and retroactive nature of Medicare Part A.
It makes no difference when you sigh up for or start Medicare with respect to ACA tax credits.

The rules are quite clear. You are no longer eligible for ACA tax credits once become eligible for Medicare. It does not when you actually start it.
Once in a while you get shown the light, in the strangest of places if you look at it right.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

Yes of course the tax credits are the issue. I have to pay ACA for 4 months of subsidies. The rules are clear to me now. But it all seemed pretty muddled.

I still believe the expectation of a notice from Medicare and a Medicare account number or card in a timely manner is not too much to expect. Nothing was provided.
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Eagle33
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Eagle33 »

Rdytoretire wrote: Thu Jul 27, 2023 1:30 pm still believe the expectation of a notice from Medicare and a Medicare account number or card in a timely manner is not too much to expect. Nothing was provided.
How does Medicare know when you are applying for Medicare? Medicare A was retroactive once you applied for Medicare, not before. How could they send you a notice until you applied? Does your Medicare card have the separate start dates for Part A and Part B? The card is your notice. What I don't understand is why ACA insurance allowed you to pay for ACA insurance the month you turn 65! You should try to get a refund of your ACA premiums.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

Eagle33 wrote: Fri Jul 28, 2023 11:29 am
Rdytoretire wrote: Thu Jul 27, 2023 1:30 pm still believe the expectation of a notice from Medicare and a Medicare account number or card in a timely manner is not too much to expect. Nothing was provided.
How does Medicare know when you are applying for Medicare? Medicare A was retroactive once you applied for Medicare, not before. How could they send you a notice until you applied? Does your Medicare card have the separate start dates for Part A and Part B? The card is your notice. What I don't understand is why ACA insurance allowed you to pay for ACA insurance the month you turn 65! You should try to get a refund of your ACA premiums.
If you do not apply for Medicare until after the month you turn 65 Part A starts retroactively the month you turned 65. I applied in July. I have been informed by SS that my Part A started effective April and Part B will start effective August.

Wishful thinking. Not only will I not get my premiums refunded but I will have to pay back the subsidies I received the past 4 months. Ouch! I thought I did my research on the subject but still screwed up. Part of the reason I am posting on Bogleheads is so others don't make the same mistake. I doubt I am the first.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by SuzBanyan »

Rdytoretire wrote: Fri Jul 28, 2023 2:29 pm
Eagle33 wrote: Fri Jul 28, 2023 11:29 am
Rdytoretire wrote: Thu Jul 27, 2023 1:30 pm still believe the expectation of a notice from Medicare and a Medicare account number or card in a timely manner is not too much to expect. Nothing was provided.
How does Medicare know when you are applying for Medicare? Medicare A was retroactive once you applied for Medicare, not before. How could they send you a notice until you applied? Does your Medicare card have the separate start dates for Part A and Part B? The card is your notice. What I don't understand is why ACA insurance allowed you to pay for ACA insurance the month you turn 65! You should try to get a refund of your ACA premiums.
If you do not apply for Medicare until after the month you turn 65 Part A starts retroactively the month you turned 65. I applied in July. I have been informed by SS that my Part A started effective April and Part B will start effective August.

Wishful thinking. Not only will I not get my premiums refunded but I will have to pay back the subsidies I received the past 4 months. Ouch! I thought I did my research on the subject but still screwed up. Part of the reason I am posting on Bogleheads is so others don't make the same mistake. I doubt I am the first.
Sorry that you had to be the case study from whom others will learn. I think others have previously posted about the need to work carefully with ACA to make sure one is not paying double once one turns 65. I had a telephone conversation several months ago with a representative for my state’s ACA coverage and she did remind me that I needed to terminate effective as of the month I turn 65, even though that was not the purpose of that particular call. I haven’t spoken with a SHIP counselor yet, but may get a reminder from that source as well.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

Thanks. One of my mistakes was probably trying to figure things out on my own and not getting help from SHIP or some other source.

IF ONE IS RECEIVING SS BENEFITS AND ON ACA YOU MUST TERMINATE THE MONTH BEFORE THE MONTH YOU TURN 65. If you turn 65 in April, 3/31 should be the last day for ACA coverage. If you turn 65 on the 1st of the month, April 1, you need to terminate ACA on the last day of February.
Last edited by Rdytoretire on Sat Jul 29, 2023 1:50 am, edited 4 times in total.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by tallguy3891 »

Rdytoretire wrote: Fri Jul 28, 2023 2:46 pm Thanks. One of my mistakes was probably trying to figure things out on my own and not getting help from SHIP or some other source.

YES, IF ONE IS ON ACA YOU MUST TERMINATE THE MONTH YOU TURN 65.

So, to be precise for everyones' information, as of this time, the month a person turns 65, even late in the month, their Medicare Part A is effective the first day of that month, i.e., birthday on April 28th, Medicare effective first day of April?

So then, ACA should be scheduled to stop 3/31, not "the month you turn 65"?

Also, is it true if one's birthday is on April 1st, for example (or the first of any month), then Medicare is effective the first of the month before (in this instance Mar.), so ACA would end the last day of Feb?

This is very important to know exactly. I personally would read the Medicare.gov and ACA sites very carefully to make sure.
Last edited by tallguy3891 on Fri Jul 28, 2023 4:28 pm, edited 1 time in total.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

tallguy3891 wrote: Fri Jul 28, 2023 4:23 pm
Rdytoretire wrote: Fri Jul 28, 2023 2:46 pm Thanks. One of my mistakes was probably trying to figure things out on my own and not getting help from SHIP or some other source.

YES, IF ONE IS ON ACA YOU MUST TERMINATE THE MONTH YOU TURN 65.

So, to be precise for everyone's information, as of this time, the month a person turns 65, even late in the month, their Medicare is effective the first day of that month, i.e., birthday on April 28th, Medicare effective first day of April?

So then, ACA should be scheduled to stop 3/31, not "the month you turn 65"?

Also, is it true if one's birthday is on April 1st, for example (or the first of any month), then Medicare is effective the first of the month before (in this instance Mar.), so ACA would end the last day of Feb?

This is very important to know exactly. I personally would read the Medicare.gov and ACA sites very carefully to make sure.
Yes I believe you are correct on both counts. I have updated my post.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by quantAndHold »

Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
I believe this is generally not true. Certainly was not for me.

I was under the impression that it would not really matter when I enrolled as long as I did it within Medicares 7 month window.

If you are collecting SS you will be automatically enrolled in Medicare, I am not yet collecting SS. That means I was not automatically enrolled but Medicare Part A started the month I turned 65 even without my being enrolled.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

GOOD NEWS! I believe my initial understanding was correct. I will not have to repay any ACA subsidies. The key appears to be whether one is already receiving SS benefits or not. I am not yet receiving benefits.

This article sums things up pretty well and references the IRS regulations.
https://www.medicareresources.org/medic ... -medicare/

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 the last day of the month prior to the month you turn 65.

If you’re not already receiving retirement benefits, you’ll need to enroll in Medicare.

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.

If you enroll during the month you turn 65, your Part B coverage will take effect the first of the following month. Part A will be backdated to the month you turned 65, assuming you’re eligible for premium-free Medicare. But according to CMS guidance and the retroactive government coverage rule in IRS Publication 974, your premium subsidy will continue through the month you enroll (which means you’ll get a premium subsidy for the month you turned 65, even though you also ended up with retroactive Medicare Part A for that month). You won’t get a subsidy starting the following month, but both parts of Medicare will be in effect by that point.

If you enroll in Medicare during the three months following the month you turn 65, your effective date for Part B will be the first of the month following your enrollment (note that prior to 2023, there was a longer delay between enrollment and the Part B effective date). Assuming you’re eligible for premium-free Part A based on work history, your Part A coverage will be backdated to the month you turned 65. Based on the CMS guidance and the retroactive government coverage rule in IRS Publication 974, you should expect your premium subsidy to continue through the month that you enroll. Now that the rules for effective dates have changed, this helps to ensure seamless coverage, with a premium subsidy continuing through the month you enroll and Medicare Part B starting the following month.
Last edited by Rdytoretire on Sat Jul 29, 2023 9:05 am, edited 2 times in total.
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quantAndHold
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by quantAndHold »

Rdytoretire wrote: Fri Jul 28, 2023 4:38 pm
quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
I believe this is generally not true. Certainly was not for me.
It was absolutely true for my wife and everyone else I know going from ACA to Medicare, and will be true for me.The premiums on her Medicare Advantage plan are a fraction of what I pay, her Medicare plan doesn’t have the $7000 deductible that I have, etc. She has zero deductible, zero copays, and gets free dental insurance, a free gym membership and more OTC stuff from CVS than we can use. All in, my medical expenses are like 10x what hers are, and I’m on a heavily subsidized plan.

Don’t get me wrong, I’m very happy to have insurance. But going on Medicare will save me pots of money.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by typical.investor »

Rdytoretire wrote: Fri Jul 28, 2023 2:29 pm
Eagle33 wrote: Fri Jul 28, 2023 11:29 am
Rdytoretire wrote: Thu Jul 27, 2023 1:30 pm still believe the expectation of a notice from Medicare and a Medicare account number or card in a timely manner is not too much to expect. Nothing was provided.
How does Medicare know when you are applying for Medicare? Medicare A was retroactive once you applied for Medicare, not before. How could they send you a notice until you applied? Does your Medicare card have the separate start dates for Part A and Part B? The card is your notice. What I don't understand is why ACA insurance allowed you to pay for ACA insurance the month you turn 65! You should try to get a refund of your ACA premiums.
If you do not apply for Medicare until after the month you turn 65 Part A starts retroactively the month you turned 65. I applied in July. I have been informed by SS that my Part A started effective April and Part B will start effective August.

Wishful thinking. Not only will I not get my premiums refunded but I will have to pay back the subsidies I received the past 4 months. Ouch! I thought I did my research on the subject but still screwed up. Part of the reason I am posting on Bogleheads is so others don't make the same mistake. I doubt I am the first.
Thanks for posting. I learned about this from you!
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

You are welcome. I just updated this thread with some good news for me and additional information. I also changed the thread title to better reflect the subject matter.
Last edited by Rdytoretire on Sat Jul 29, 2023 8:25 am, edited 1 time in total.
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Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

quantAndHold wrote: Sat Jul 29, 2023 1:51 am
Rdytoretire wrote: Fri Jul 28, 2023 4:38 pm
quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
I believe this is generally not true. Certainly was not for me.
It was absolutely true for my wife and everyone else I know going from ACA to Medicare, and will be true for me.The premiums on her Medicare Advantage plan are a fraction of what I pay, her Medicare plan doesn’t have the $7000 deductible that I have, etc. She has zero deductible, zero copays, and gets free dental insurance, a free gym membership and more OTC stuff from CVS than we can use. All in, my medical expenses are like 10x what hers are, and I’m on a heavily subsidized plan.

Don’t get me wrong, I’m very happy to have insurance. But going on Medicare will save me pots of money.
I was only referring to the ACA premiums with subsidy and not the total cost of medical care. If one is relatively healthy the premiums are often the only expense.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by valleyrock »

quantAndHold wrote: Sat Jul 29, 2023 1:51 am
Rdytoretire wrote: Fri Jul 28, 2023 4:38 pm
quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
I believe this is generally not true. Certainly was not for me.
It was absolutely true for my wife and everyone else I know going from ACA to Medicare, and will be true for me.The premiums on her Medicare Advantage plan are a fraction of what I pay, her Medicare plan doesn’t have the $7000 deductible that I have, etc. She has zero deductible, zero copays, and gets free dental insurance, a free gym membership and more OTC stuff from CVS than we can use. All in, my medical expenses are like 10x what hers are, and I’m on a heavily subsidized plan.

Don’t get me wrong, I’m very happy to have insurance. But going on Medicare will save me pots of money.
This gets into the need to learn about the options for insurance to cover what Part B does not, either Medigap ("traditional" Medicare) or a Medicare Advantage plan, the latter being advertised ad nauseum on TV . There are Bogleheads threads on this topic.
Last edited by valleyrock on Sat Jul 29, 2023 2:46 pm, edited 1 time in total.
SuzBanyan
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by SuzBanyan »

Rdytoretire wrote: Sat Jul 29, 2023 2:13 am
quantAndHold wrote: Sat Jul 29, 2023 1:51 am
Rdytoretire wrote: Fri Jul 28, 2023 4:38 pm
quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
I believe this is generally not true. Certainly was not for me.
It was absolutely true for my wife and everyone else I know going from ACA to Medicare, and will be true for me.The premiums on her Medicare Advantage plan are a fraction of what I pay, her Medicare plan doesn’t have the $7000 deductible that I have, etc. She has zero deductible, zero copays, and gets free dental insurance, a free gym membership and more OTC stuff from CVS than we can use. All in, my medical expenses are like 10x what hers are, and I’m on a heavily subsidized plan.

Don’t get me wrong, I’m very happy to have insurance. But going on Medicare will save me pots of money.
I was only referring to the ACA premiums with subsidy and not the total cost of medical care. If one is relatively healthy the premiums are often the only expense.
I think with most things, it will depend on personal circumstances and choices. But people should be aware that it is not a given that medical insurance expenses will go down when you reach Medicare age.

My husband was on traditional Medicare + F supplement plan + Cheapest Part D plan and his cost was over $400/month. My ACA plan with subsidy was cheaper (although I was both younger and had a high deductible).

When I go on Medicare this year, traditional Medicare + G supplement plan + cheapest Part D will be very close to my current ACA with subsidy. I expect to lower those monthly costs by choosing a G high deductible plan. However, because I am now a widow, I will soon be firmly in IRMAA territory and I don’t believe that even G - HD will save me from paying more than I currently pay.
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Jack FFR1846 »

quantAndHold wrote: Fri Jul 28, 2023 4:31 pm Medicare is like a bajillion times cheaper than an ACA plan, even with the subsidies. I don’t understand why someone would try to delay switching.
This depends on prior income. I just started Medicare at the beginning of the month. DW and I analyzed ACA for her and taking Cobra was cheaper and had better coverage (deductible already paid and out of pocket max eaten into). Between the 2 of us, our cost is 5 times what it was with my work coverage. This is all in flux as I have put in my form for re-calculation of my premiums as my income from 2 years ago (what they use to determine your cost) put me 2 clicks into IRMMA. I did file my form and the SS agent let me know that it could not be officially filed until I actually started Medicare. I'm still waiting to hear the outcome of that while I pay double the cost for part B and what seems like an order of magnitude higher for the drug plan.
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Rdytoretire
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

I would appreciate if others would limit their posts in this thread to discussion of the actual move from Obamacare to Medicare and not discuss the numerous other issues, such as cost, related to Medicare.
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Eagle33
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Eagle33 »

Rdytoretire wrote: Sat Jul 29, 2023 9:15 am I would appreciate if others would limit their posts in this thread to discussion of the actual move from Obamacare to Medicare and not discuss the numerous other issues, such as cost, related to Medicare.
I believe your earlier post clearly spells out the timing issues about the ACA/Medicare transition. What more needs to be discussed?
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by dillrob »

What I find confusing is how the PTC is calculated for a medicare transition year such as this. For example, I will start Medicare in March 2025 and my wife in October 2025. So, for 2 months there will be 2 of us with ACA coverage, 7 months just one spouse with coverage and 3 months with none of us having ACA coverage. Is the PTC based on our household income as compared to the federal poverty level for a family of 2 even though for the majority of the year only one of will have coverage?
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Rdytoretire
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

Eagle33 wrote: Sat Jul 29, 2023 1:27 pm
Rdytoretire wrote: Sat Jul 29, 2023 9:15 am I would appreciate if others would limit their posts in this thread to discussion of the actual move from Obamacare to Medicare and not discuss the numerous other issues, such as cost, related to Medicare.
I believe your earlier post clearly spells out the timing issues about the ACA/Medicare transition. What more needs to be discussed?
Maybe nothing more needs to be discussed. I only asked that people don't stray from the topic at hand. Since you appear to have nothing useful to add please do not post in this thread.
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by valleyrock »

Rdytoretire wrote: Sat Jul 29, 2023 9:15 am I would appreciate if others would limit their posts in this thread to discussion of the actual move from Obamacare to Medicare and not discuss the numerous other issues, such as cost, related to Medicare.
Moving to Medicare from ACA coverage (aka Obamacare) includes the important issues pertaining to Part B (medical other than hospitalization) and whether and how to cover what Part B does not. This is done either via "traditional medicare" (i.e. Medigap; see https://www.medicare.gov/health-drug-pl ... n-benefits) or through a Medicare Advantage plan. The pros and cons of these two approaches should be looked at carefully. And then there is Part D to figure out: https://www.medicare.gov/drug-coverage-part-d. A move to Medicare includes making decisions about these other things, as well.
erp
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by erp »

Rdytoretire wrote: Sat Jul 29, 2023 1:46 am GOOD NEWS! I believe my initial understanding was correct. I will not have to repay any ACA subsidies. The key appears to be whether one is already receiving SS benefits or not. I am not yet receiving benefits.
I wish they would design the rules so that people are incentivized to optimize more. The way this works, with almost free double-coverage for a couple of months which has no real benefit, the money is just going to the insurance companies. If people were on the hook, they would be much more careful with spending (eg I pay full-freight obamacare and will definitely be avoiding any overlap if I can).

CBS just had a report saying that premiums are expected to jump 15% next year - but don't worry the subsidies will cover it! (since those are tied to income) I'm not sure exactly how the govt is affording this. Does NIIT really cover it, plus the people like me who do pay full-freight? It's been a windfall for insurance companies for sure, with their stock prices jumping 10x since 2013.
SuzBanyan
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by SuzBanyan »

I hope the OP is correct and the relevant date when you lose subsidies under the ACA is when you start Part B, but I just received a letter from Covered CA which provides ACA coverage in my state. It says:

“If you qualify for free Medicare Part A:
you do not qualify for financial help, such as premium tax credit for your covered California health plan. If you keep your covered California plan, you may have to pay back some or all of the premium tax credit you got during the year.”

The purpose of the letter was to remind me to cancel my ACA plan at least 14 days prior to the start of Medicare Part A.
Topic Author
Rdytoretire
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

I received a similar letter at the beginning of the year. After reading this article by someone who specializes in this subject matter. And also the CMS and IRS guidance which included examples I feel confident that the information provided is accurate.

https://www.medicareresources.org/medic ... -medicare/
CloseEnough
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by CloseEnough »

Rdytoretire wrote: Sat Jul 29, 2023 1:46 am GOOD NEWS! I believe my initial understanding was correct. I will not have to repay any ACA subsidies. The key appears to be whether one is already receiving SS benefits or not. I am not yet receiving benefits.

This article sums things up pretty well and references the IRS regulations.
https://www.medicareresources.org/medic ... -medicare/

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 the last day of the month prior to the month you turn 65.

If you’re not already receiving retirement benefits, you’ll need to enroll in Medicare.

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.

If you enroll during the month you turn 65, your Part B coverage will take effect the first of the following month. Part A will be backdated to the month you turned 65, assuming you’re eligible for premium-free Medicare. But according to CMS guidance and the retroactive government coverage rule in IRS Publication 974, your premium subsidy will continue through the month you enroll (which means you’ll get a premium subsidy for the month you turned 65, even though you also ended up with retroactive Medicare Part A for that month). You won’t get a subsidy starting the following month, but both parts of Medicare will be in effect by that point.

If you enroll in Medicare during the three months following the month you turn 65, your effective date for Part B will be the first of the month following your enrollment (note that prior to 2023, there was a longer delay between enrollment and the Part B effective date). Assuming you’re eligible for premium-free Part A based on work history, your Part A coverage will be backdated to the month you turned 65. Based on the CMS guidance and the retroactive government coverage rule in IRS Publication 974, you should expect your premium subsidy to continue through the month that you enroll. Now that the rules for effective dates have changed, this helps to ensure seamless coverage, with a premium subsidy continuing through the month you enroll and Medicare Part B starting the following month.
Well it sounds like with this "good news" new understanding, if you are transitioning from ACA to Medicare and ACA is less expensive (it can be, putting aside other opinions, and also putting aside which is actual better health insurance coverage) then you are better off delaying the enrollment in Medicare to sometime during the three months after you turn 65, and just staying on the ACA with subsidies for as long as possible. Is this correct?
Topic Author
Rdytoretire
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by Rdytoretire »

[quote=

Well it sounds like with this "good news" new understanding, if you are transitioning from ACA to Medicare and ACA is less expensive (it can be, putting aside other opinions, and also putting aside which is actual better health insurance coverage) then you are better off delaying the enrollment in Medicare to sometime during the three months after you turn 65, and just staying on the ACA with subsidies for as long as possible. Is this correct?
[/quote]


Yes, in my situation it made sense to stay on ACA, with subsidies, as long as possible. Delaying is only possible if you are not yet receiving SS benefits.  If you are already receiving benefits you’ll automatically be enrolled in Medicare with an effective date of the first of the month that you turn 65. 
This may be the reason for the confusing/conflicting information. 
SuzBanyan
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Re: Automatic Start of Medicare Part A at 65? ACA Subsidy issues.

Post by SuzBanyan »

Rdytoretire wrote: Mon Jul 31, 2023 8:46 pm
[Quoting CloseEnough: Well it sounds like with this "good news" new understanding, if you are transitioning from ACA to Medicare and ACA is less expensive (it can be, putting aside other opinions, and also putting aside which is actual better health insurance coverage) then you are better off delaying the enrollment in Medicare to sometime during the three months after you turn 65, and just staying on the ACA with subsidies for as long as possible. Is this correct?]

Yes, in my situation it made sense to stay on ACA, with subsidies, as long as possible. Delaying is only possible if you are not yet receiving SS benefits.  If you are already receiving benefits you’ll automatically be enrolled in Medicare with an effective date of the first of the month that you turn 65. 
This may be the reason for the confusing/conflicting information. 
Based on the information you linked, it looks like the letter that I received from Covered CA was correct for 2022 but is no longer correct for 2023. My insurance premiums in 2023 will be lower on Medicare than on ACA, so this change would not have changed my decision. Also, it looks like eligibility to contribute to an HSA is still based on enrollment in Part A, not Part B. So that is a potential benefit of the ACA (with an appropriate plan) that goes away on the first day of the birth month (or the month before with first of the month birthday), even if still receiving ACA coverage and subsidies for several more months.
Topic Author
Rdytoretire
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

If I had it to do over again I would have enrolled in Medicare the month I turned 65. This issue should be cut and dried but there appears to be much conflicting information being provided.
goaties
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by goaties »

I'm bringing back this thread from last year because I would like to hear from the OP. Did he/she have to pay back the PTC for the three months after they turned 65?
Topic Author
Rdytoretire
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Re: Making the move from Obamacare to Medicare. When to stop ACA coverage and subsidies

Post by Rdytoretire »

I filed my taxes on my own using H&R Block software as I have done for years. I E-filed in late March. I had to repay About $1,000 of the PTC but I believe that was due to the level of my income and not related the ACA to Medicare switch. H&R Block did not indicate that I had to pay back any of the tax credits I received for the 3 months after I turned 65 and I have not heard anything from the IRS.
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