susa wrote:
Posting as follow-up in this thread ...
If there is anyone on the forum that care to share and meets the following criteria/conditions:
(1) Has not applied for Social Security and does not plan to file in 2021
(2) Has active ACA Healthcare.gov subsidy in 2021 or had it until applying for Medicare
(3) Turned 65 but waited past their birthday month (BD +1, +2 or +3) to file for Medicare
(4) Enrolled in Medicare online only since not on Social Security
Friends and relatives keep sending messages that Insurance Agents are claiming that ACA Subsidy will "stop" or be "clawed back" if waiting past BD month to enroll in Medicare (+1, +2, +3).
I keep telling them that "As long as you are not collecting Social Security" there is no automatic enrollment and there is no loss of ACA Subsidy and no loss of insurance until Medicare kicks in on a delayed schedule
In this same thread I had posted this from an online example for a person with BD in September and considers +1,+2 or +3 month enrollment to Medicare
If you enroll in October, Medicare starts December 1. (Healthcare.gov notified 12/1/2021 - only 1 month loss of subsidy)
If you enroll in November, Medicare starts February 1, next year (no notice to Healthcare.gov, no loss for subsidy in 2021)
If you enroll in December, Medicare starts March 1, next year (no notice to Healthcare.gov, no loss for subsidy in 2021)
Posting new follow-up as we actually found a case and verified with a conference call to Healthcare.Gov with a very large helpful hands person (my description of someone who knows how this really works).
Lessons learned today during the call and from the actual case (a MFJ, neither one on Social Security, both on ACA and one ready to enroll Medicare inside Sep 2021 but not yet enrolled, receiving a subsidy on ACA which resulted in Zero monthly payments on Silver Plan):
(1) No automatic Medicare enrollment (not on Social Security)
(2) Must apply online via ssa.gov logon on the "Month -3,-2,-1 or 0 = the actual BD month"
(3) If waiting (by Medicare rules) for months past BD, +1,+2,+3 then not only is subsidy LOST but it is LOST FOR BOTH !!
(4) Medicare does not care or interact with ACA in any way, so the 7 month window is still valid and ACA does not care about Medicare in the sense that they allow "eligible to enroll" person to remain on ACA, they just remove the subsidy and now Zero monthly premiums suddenly become over $2,000.00/month bills to pay.
(5) Once Medicare enrollment is done, then ACA needs a phone call, -1 day before the eligible "Medicare Start date". They (Healthcare.Gov) will drop the one spouse off the ACA plan and the couple can then decide to keep primary as the "application contact person" for the ACA plan remaining individual OR they can completely drop that primary person and use new email credentials for the remaining spouse.
In the actual example case, if the one spouse ready to Medicare waits, then the loss/charge/clawback to both of them is over $2,000 for every month that is +1 (So it would be $2,000x3=$6,000.00 cost) or more after the BD month of the Medicare "ready" individual. Since Medicare Part B is 148.50/month, the Medicare eligible spouse signed up today with a Medicare start date (if process online works as planned) of October 1 and will call Healthcare.Gov on September 30 to make the adjustments.
So in summary, it appears the warning from 2018 was valid and what was learned from todays call was that it would have been even more catastrophic in cost to the couple if they waited to act immediately.