Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

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Carefreeap
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Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Carefreeap »

Just hung up from Kaiser phone h*ll and am frustrated. Could use the wisdom of the group's experience.

DH turns 65 next month and transitions to Medicare. I just turned 62.

We are on the ACA with about $74k in annual income and are in CA.

As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.

I don't want to lose coverage. What happens when DH is no longer covered by the ACA?

Thanks as always for your help!
Carefreeap
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Taylor Larimore
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Taylor Larimore »

carefreeap:

I don't know the answer but this 124 page Medicare handbook may be helpful:

https://www.medicare.gov/publications/1 ... nd-You.pdf

I've been on Medicare for many years, and like most others, I cannot understand its mind-blowing complexity.

Best wishes.
Taylor
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HomeStretch
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by HomeStretch »

I don’t think you have to worry about losing ACA coverage as long as you remain eligible. But the amount of subsidy you receive or if you are even eligible for a subsidy after 2025 will likely change. Also my understanding is that you have to timely cancel spouse’s ACA coverage as of the date Medicare coverage starts otherwise your ACA insurer will expect you to pay the premium (without subsidy). If spouse is primary on the ACA policy, be very clear that you continue to need and be eligible for ACA coverage so they don’t cancel your coverage inadvertently.

I am not in CA. In my state, when my spouse transitions to Medicare in the future (one year earlier than me) I am still eligible for ACA coverage. When we enrolled for the first time this year, I made myself primary on the ACA policy. From an older forum thread, a poster advised this as it was easy to drop the older dependent spouse and have coverage remain in force for me.
Last edited by HomeStretch on Mon Oct 02, 2023 12:55 pm, edited 3 times in total.
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MP123
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by MP123 »

Carefreeap wrote: Mon Oct 02, 2023 12:25 pm As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.
If your spouse is no longer eligible (on Medicare) then your PTC will be reduced because it will only apply towards your health insurance, not both of yours. But his income will still be included in your household income for purposes of figuring the PTC.

There's no reason why you should lose coverage.
nalor511
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by nalor511 »

MP123 wrote: Mon Oct 02, 2023 12:53 pm
Carefreeap wrote: Mon Oct 02, 2023 12:25 pm As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.
If your spouse is no longer eligible (on Medicare) then your PTC will be reduced because it will only apply towards your health insurance, not both of yours. But his income will still be included in your household income for purposes of figuring the PTC.

There's no reason why you should lose coverage.
This is the answer. The ACA-remaining-spouse will (can) remain on ACA but their MAGI will be calculated using both spouse' incomes even though only one of you is on ACA.
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Carefreeap
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Carefreeap »

MP123 wrote: Mon Oct 02, 2023 12:53 pm
Carefreeap wrote: Mon Oct 02, 2023 12:25 pm As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.
If your spouse is no longer eligible (on Medicare) then your PTC will be reduced because it will only apply towards your health insurance, not both of yours. But his income will still be included in your household income for purposes of figuring the PTC.

There's no reason why you should lose coverage.
Thank you for your first comment but could you please explain PTC?
Every day I can hike is a good day.
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quantAndHold
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by quantAndHold »

nalor511 wrote: Mon Oct 02, 2023 12:54 pm
MP123 wrote: Mon Oct 02, 2023 12:53 pm
Carefreeap wrote: Mon Oct 02, 2023 12:25 pm As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.
If your spouse is no longer eligible (on Medicare) then your PTC will be reduced because it will only apply towards your health insurance, not both of yours. But his income will still be included in your household income for purposes of figuring the PTC.

There's no reason why you should lose coverage.
This is the answer. The ACA-remaining-spouse will (can) remain on ACA but their MAGI will be calculated using both spouse' incomes even though only one of you is on ACA.
Exactly. If your tax filing is MFJ, then it will still use both of your incomes. The insurance premium and subsidy, though, will only be for one person, so both will be half as much as they were before.

PTC is the subsidy.
billaster
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by billaster »

quantAndHold wrote: Mon Oct 02, 2023 1:01 pm Exactly. If your tax filing is MFJ, then it will still use both of your incomes. The insurance premium and subsidy, though, will only be for one person, so both will be half as much as they were before.
Your new subsidy will likely be less than half and your after-subsidy premium cost higher. This is because your household income remains the same so the percentage of income your household must pay for an ACA plan remains the same. But only your ACA premiums count toward the percentage of income your household must pay. Your spouse's Medicare premiums are no longer counted, so your share of required payments goes up. It's a quirk of the system that has been commented on before.
HomeStretch
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by HomeStretch »

The ACA cliff is scheduled to be reinstated in 2026. Will OP’s cliff be based on 400% of FPL for a household of 1 ($58,320 for 2023 for the 48 contiguous states) or a household of 2 ($78,880 for 2023)?
billaster
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by billaster »

HomeStretch wrote: Mon Oct 02, 2023 1:27 pm The ACA cliff is scheduled to be reinstated in 2026. Will OP’s cliff be based on 400% of FPL for a household of 1 ($58,320 for 2023 for the 48 contiguous states) or a household of 2 ($78,880 for 2023)?
The number in household, two, does not change.
LotsaGray
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by LotsaGray »

Carefreeap wrote: Mon Oct 02, 2023 1:00 pm
MP123 wrote: Mon Oct 02, 2023 12:53 pm
Carefreeap wrote: Mon Oct 02, 2023 12:25 pm As I understand it even though I can remain on Covered CA my subsidy will change because they will count our income for as if I were single.
If your spouse is no longer eligible (on Medicare) then your PTC will be reduced because it will only apply towards your health insurance, not both of yours. But his income will still be included in your household income for purposes of figuring the PTC.

There's no reason why you should lose coverage.
Thank you for your first comment but could you please explain PTC?
Premium Tax Credit (PTC) i.e. the subsidy.
nhs76
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by nhs76 »

HomeStretch wrote: Mon Oct 02, 2023 1:27 pm The ACA cliff is scheduled to be reinstated in 2026. Will OP’s cliff be based on 400% of FPL for a household of 1 ($58,320 for 2023 for the 48 contiguous states) or a household of 2 ($78,880 for 2023)?
For a household of 2 is my understanding, at least under current law.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

Taylor Larimore wrote: Mon Oct 02, 2023 12:40 pm carefreeap:

I don't know the answer but this 124 page Medicare handbook may be helpful:

https://www.medicare.gov/publications/1 ... nd-You.pdf

I've been on Medicare for many years, and like most others, I cannot understand its mind-blowing complexity.

Best wishes.
Taylor
Despite 124 pages of info, it probably does not cover the aspects of ACA relevant to the transition.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

nhs76 wrote: Mon Oct 02, 2023 1:45 pm
HomeStretch wrote: Mon Oct 02, 2023 1:27 pm The ACA cliff is scheduled to be reinstated in 2026. Will OP’s cliff be based on 400% of FPL for a household of 1 ($58,320 for 2023 for the 48 contiguous states) or a household of 2 ($78,880 for 2023)?
For a household of 2 is my understanding, at least under current law.
All household income counts whether or not all who earn household income are covered by an ACA-exchange plan.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

My understanding:

Be sure to call the exchange on the last day of ACA coverage before medicare starts to cancel. Probably want to start medicare on the first day of the month DH turns 65. Kaiser Medicare insurance brokers will not (and should not) advise you about ACA.
Conch55
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Conch55 »

We went through this a few years ago and the responses provided are good. I transitioned to Medicare and spouse stayed on the federal exchange for about 6 months. Spouses premium increased as mentioned but our income was already within the ACA guidelines for subsidy assistance so that did not change. I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
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Carefreeap
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Carefreeap »

Conch55 wrote: Mon Oct 02, 2023 2:00 pm We went through this a few years ago and the responses provided are good. I transitioned to Medicare and spouse stayed on the federal exchange for about 6 months. Spouses premium increased as mentioned but our income was already within the ACA guidelines for subsidy assistance so that did not change. I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
Thanks. We're going to do a joint call with Kaiser the day DH gets his medicare # which is expected to be in two weeks. Hopefully continuous coverage once he's dropped and I'm primary.

Thanks to everyone who responded. As usual you all have been helpful!
Every day I can hike is a good day.
OnTrack2020
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by OnTrack2020 »

We will go through this same process, but early next year. I have been reading over the following posts and have it bookmarked.

https://bogleheads.org/forum/viewtopic.php?f=2&t=350116
nalor511
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by nalor511 »

Carefreeap wrote: Mon Oct 02, 2023 3:27 pm
Conch55 wrote: Mon Oct 02, 2023 2:00 pm We went through this a few years ago and the responses provided are good. I transitioned to Medicare and spouse stayed on the federal exchange for about 6 months. Spouses premium increased as mentioned but our income was already within the ACA guidelines for subsidy assistance so that did not change. I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
Thanks. We're going to do a joint call with Kaiser the day DH gets his medicare # which is expected to be in two weeks. Hopefully continuous coverage once he's dropped and I'm primary.

Thanks to everyone who responded. As usual you all have been helpful!
You don't cancel with Kaiser(at least I didn't), you do it with covered CA
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

Carefreeap wrote: Mon Oct 02, 2023 3:27 pm
Conch55 wrote: Mon Oct 02, 2023 2:00 pm We went through this a few years ago and the responses provided are good. I transitioned to Medicare and spouse stayed on the federal exchange for about 6 months. Spouses premium increased as mentioned but our income was already within the ACA guidelines for subsidy assistance so that did not change. I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
Thanks. We're going to do a joint call with Kaiser the day DH gets his medicare # which is expected to be in two weeks. Hopefully continuous coverage once he's dropped and I'm primary.

Thanks to everyone who responded. As usual you all have been helpful!
I believe you need to call the ACA exchange the day before medicare coverage starts to cancel coverage effective at midnight when medicare coverage starts. This of course assumes that you have confirmed the medicare enrollment was successful.
Conch55
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Conch55 »

Northern Flicker wrote: Mon Oct 02, 2023 11:55 pm
Carefreeap wrote: Mon Oct 02, 2023 3:27 pm
Conch55 wrote: Mon Oct 02, 2023 2:00 pm We went through this a few years ago and the responses provided are good. I transitioned to Medicare and spouse stayed on the federal exchange for about 6 months. Spouses premium increased as mentioned but our income was already within the ACA guidelines for subsidy assistance so that did not change. I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
Thanks. We're going to do a joint call with Kaiser the day DH gets his medicare # which is expected to be in two weeks. Hopefully continuous coverage once he's dropped and I'm primary.

Thanks to everyone who responded. As usual you all have been helpful!
I believe you need to call the ACA exchange the day before medicare coverage starts to cancel coverage effective at midnight when medicare coverage starts. This of course assumes that you have confirmed the medicare enrollment was successful.
Thanks for jogging my memory on this. I started Medicare on 1 September and cancelled my ACA plan by calling the federal exchange on 1 September. I do not live in CA but assume the process is the same. I did not call the insurance company.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

Were you charged a premium for the ACA plan for Sept? The usual advice would be to call the exchange on Aug 31 if Medicare starts Sept 1.
billaster
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by billaster »

Northern Flicker wrote: Tue Oct 03, 2023 5:36 pm Were you charged a premium for the ACA plan for Sept? The usual advice would be to call the exchange on Aug 31 if Medicare starts Sept 1.
Don't know if it matters whether they send you a bill or not. You never have to pay it. If you don't pay, they eventually cancel your coverage, retroactive to your last paid month.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

billaster wrote: Tue Oct 03, 2023 8:15 pm
Northern Flicker wrote: Tue Oct 03, 2023 5:36 pm Were you charged a premium for the ACA plan for Sept? The usual advice would be to call the exchange on Aug 31 if Medicare starts Sept 1.
Don't know if it matters whether they send you a bill or not. You never have to pay it. If you don't pay, they eventually cancel your coverage, retroactive to your last paid month.
It matters for a married couple needing to continue paying for one and for whom cancellation would be undesirable.
Conch55
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Conch55 »

Northern Flicker wrote: Tue Oct 03, 2023 5:36 pm Were you charged a premium for the ACA plan for Sept? The usual advice would be to call the exchange on Aug 31 if Medicare starts Sept 1.
I looked back my through records (was 3 years ago) and I am not sure it I paid some/all of the September premium. Spouses rate went up once I dropped off the policy but partial subsidy continued. At the time I was more concerned with continuity of coverage for spouse which is why I cancelled on 1 September.
GettingComfortable
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by GettingComfortable »

Conch55 wrote: Mon Oct 02, 2023 2:00 pm ...I cancelled my policy on the phone and the only glitch I recall was a new policy was issued for spouse for the remainder of the calendar year which reset the annual deductible to zero. I thought I was explaining to the rep that I wanted to be removed from the existing policy for two but that was lost in the translation. The original policies were under my account so maybe that's why they cancelled the joint account.
An excellent piece of advice from on this site, that I used last year, is to signup for the ACA policy in the younger person's name. That way the older just gets dropped from the policy during the year s/he moves to Medicare.
Northern Flicker
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Northern Flicker »

+1 Aside from being easier to cancel the new medicare recipient, it apparently also avoids a reset of deductible and OOP max for the remaining insured family members.
Big Dog
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by Big Dog »

Northern Flicker wrote: Tue Oct 03, 2023 5:36 pm Were you charged a premium for the ACA plan for Sept? The usual advice would be to call the exchange on Aug 31 if Medicare starts Sept 1.
That is correct. Hubby needs to call Covered California (which acts as the ACA broker) to cancel the day before Medicare starts. (you can also cancel online) If you wait until the 1st or 2nd of the month, Covered Cal will be a PIA bcos thier computer systems will not allow them to change it. At least, that's what happened to us. We had Covered Cal with Blue Shield and also went with Blue Shield for teh Supplement. I called Blue Shield and ask, how come I have two plans with you? They said call Covered Cal, who gave me the run-around, 'call Blue Sheild'. Uh, no. A short e-mail complaint to the state dept of Insurance got all of their attention. Received a phone call from a higher up at Blue Shield two days later who said, no problem, your ACA plan with Covered Cal has been cancelled retroactive to the las day of last month.'
startwithtruth
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by startwithtruth »

My husband switched from our ACA policy to Medicare earlier this year; despite me being the primary person on the ACA account, and following the ACA’s directions about when to notify them about the change, they somehow managed to remove me from the ACA policy as well. I didn’t discover the error until several days later when a provider told me I was coming up as uninsured. On the 1st of the month when your husband moves to Medicare, I’d recommend double checking with the ACA that your insurance is still intact.
tman9999
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by tman9999 »

quantAndHold wrote: Mon Oct 02, 2023 1:01 pm
nalor511 wrote: Mon Oct 02, 2023 12:54 pm
This is the answer. The ACA-remaining-spouse will (can) remain on ACA but their MAGI will be calculated using both spouse' incomes even though only one of you is on ACA.
Exactly. If your tax filing is MFJ, then it will still use both of your incomes. The insurance premium and subsidy, though, will only be for one person, so both will be half as much as they were before.

PTC is the subsidy.
I’m in CA turning 65 this fall (October), and it looks like the ACA premium for my wife only will nearly double. Would there be any cost advantage for me to wait 2 or even 3 months after October to enroll in Medicare in order to delay when her higher premium starts?
EricGold
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by EricGold »

I went through this ACA -> Medicare transition in Dec 2023, the month I turned 65

One mistake I made was to apply for Medicare in Oct 2023. I didn't realize that the early application caused Medicare to begin the 1st of December. If I had applied later (Nov, I think), Medicare would have started Jan 1st. Due to the above mentioned way that family income will increase the remaining spouse's out of pocket contribution to her ACA, my premature paperwork pushing added to my tax return work and increased my wife's premium for a month.
Last edited by EricGold on Wed Apr 03, 2024 3:28 am, edited 1 time in total.
marcopolo
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Re: Please Help Me Understand What Happens When One Spouse Transitions to Medicare when Using the ACA

Post by marcopolo »

EricGold wrote: Tue Apr 02, 2024 7:00 pm I went through this transition in Dec 2023

One mistake I made was to apply for Medicare in Oct 2023. I didn't realize that the early application caused Medicare to begin the 1st of December. If I had applied later (Nov, I think), Medicare would have started Jan 1st. Due to the above mentioned way that family income will increase the remaining spouse's out of pocket contribution, my premature paperwork pushing added to my tax return work and increased my wife's premium for a month.
When did you become eligible for Medicare?
I don't think it matters when you actually start Medicare.
You lose eligibility for ACA tax credits when you become eligible for Medicare. That does not change even if you decide to delay starting Medicare.
Once in a while you get shown the light, in the strangest of places if you look at it right.
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