I’m 64, resident of Al. Currently have coverage thru husband’s employer. My husband will retire in May and be on Medicare. I need coverage May-Sept when I get Medicare. Will I qualify for subsidy based on MY current year income of $9600. Or will it be based on our JOINT income this year of $140,000 even tho husband will NOT be applying since he will have Medicare?

How can I find out what my premium would be for me alone and whether I would get subsidy WITHOUT going through entire application? I’m trying to see whether Obamacare or Cobra would be less expensive


Answer

Marketplace subsidies are based on household income, even if one spouse qualifies for non-Marketplace coverage like Medicare. That being said, subsidies are based on projected household income for the next year, although they typically use last years income to estimate next years. Since your husband will retire this could drop your actual household income and thus qualify you for cost assistance. You'll be able to take advantage of special enrollment, starting at least 30 days before you lose your current coverage, to enroll in a plan that starts when you lose your current coverage.

In your case COBRA will be more expensive if you get subsidies, if you don't then it's a toss up depending upon what COBRA offers and the plans in your region. Typically holding a policy for a limited time isn't good for much beyond catastrophic coverage, benefits covered by copays, and avoiding the fee.

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Carolyn Foster on

I am on medicare and my husband’s income is 20, 000 a year. Combined we have 90,000 annually with my pension. He works and his jobs insurance is far too high. Can he qualify for marketplace Obamacare?

ObamaCareFacts.com on

Your combined household MAGI is most likely too high to get cost assistance through ObamaCare, despite the cost of the employer coverage it is most likely your best option. Having access to employer coverage also prevents you from cost assistance, so this reinforces that. You can still apply to the marketplace during open enrollment and see what your options are, anyone can get a plan, but only certainly people are eligible for cost assistance.

Aaron Michel on


Answer Rating:

The question isn’t fully answered. For example, I am 58, my wife is 67 and on medicare. When I go through the questions about coverage on my BCBS online renewal application it indicates that because our family receives medicare then I do not qualify for a subsidy even though our family income for 2015 will be around 40,000. This doesn’t make sense, but then regulations and tax law never do so I am asking if this is correct, that I can’t qualify under any circumstances for a subsidy because my wife is on medicare.

ObamaCareFacts.com on

Any family member who doesn’t qualify for Medicare can get a family plan and qualify for a subsidy based on income for that coverage.

As long as the person on Medicare isn’t on the plan it shouldn’t matter.

This can be backed up by looking directly at page 9 of the instructions of form 8962 (https://www.irs.gov/pub/irs-pdf/i8962.pdf). The instructions walk through an example where a family member qualifies for Medicare mid year and the family retains the tax credits for the family member who stayed on a subsidy eligible plan.

You may want to have BCBS clarify what they meant. Make sure you are buying a tax credit eligible plans sold on the Health Insurance Marketplace.

Jen Z on

This is very interesting as I also lost the premium tax credit when my husband became eligible for Medicare in March 2015 due to disability. The requirement is to be married filing jointly which we still do. I feel I was penalized because he is disabled. How fair and affordable is that? It is frustrating arguing with Marketplace Customer service when they contradict what the guidelines state.

ObamaCareFacts.com on

Well I know you have to file the allocation part, but it shouldn’t affect household income, MAGI, or family size (so it shouldn’t affect the credit)… although now that you say this i’m going to re-read the 8962 instructions to see if i’m missing something.

Taking example 2 on page 12 at face value (https://www.irs.gov/pub/irs-pdf/i8962.pdf) it instructs to adjust for coverage family and complete the allocation, but it doesn’t specifically insinuate that you should get less credits… if anything I would assume you would get more as that is one less from the coverage family, but no change to the tax family or household income compared to the poverty level.

With that said, we can see how simplifying this process should be on the table. The ACA and IRS in general is so insanely fair it creates a lot of paperwork and rules, i’m not sure this is the most elegant longterm solution… but back to the topic, i’ll be looking into this one. Anyone else feel free to post with details below.

Helen Thompson on

The problem is in the Monthly Contribution Amount as it relates to the SLCSP. If one spouse is not eligible for PTC or is enrolled in a MEC plan, (as far as I can tell) the calculations do nothing to reduce the Monthly Contributions Amount by the amount that your Tax Family has to pay for premiums for the MEC. As a result, the family ends up paying more for medical insurance premiums than the calculated Contribution Percentage that is based on Tax Family size and MAGI. Basically, the PTC doesn’t work for your family if you have to pay premiums for both a Marketplace plan (say to cover spouse and or children) and another plan such as employer or state/federal provided insurance. Your Tax Family Monthly Contribution can easily exceed your SLCSP for your Coverage Family if you are a Tax Family of 2 and a Coverage Family of 1. Please tell me if I am missing something!! BTW, I think that Medicare Part A is considered MEC, but most of us still have to pay for Part B and Part D or pay for an Advantage plan.

Jerry on

These Penalty’s and requiring the total household income when one part goes on medicare is Unfair and Unconstitional .
The Government People who Wrote the Bill Do not live by the rules they Assign
to the PEOPLE Of the USA. They are Exempt from OBAMACARE (NOCARE)

Try Answer the Question Straight without deviations OK

ObamaCareFacts.com on

Actually you are simply only seeing one side of this. It is fair, because if person on Medicare is the only breadwinner then the family wouldn’t have insurance options without that income being counted. Of course, when the situation is not this it feels very unfair. I get that. It would be nice if the family could choose, or in states where Medicaid was expanded, if Medicaid didn’t count that income.

Jennifer Blue on

Yes, our overall medical premiums increased $65/ month when my husband went on Medicare. However, we are still paying almost a third of what we had to pay per month before Obamacare. As self employed people, our insurance premiums were financially crushing us. Also, before Obamacare, BCBS routinely denied coverage of care clearly covered by the policy, and was consistantly miserable to deal with. Obamacare is far from ideal, but the system pre Obamacare was leaving far too many uninsured and causing medical bankruptcies. I think my husband’s income should still count when he switched to Medicare becuase it is still family income! Hopefully, Obamacare will improve, but I greatly prefer the level of “screwing” I get from Obamacare over the absolute insanity and massive “screwing” of the previous system.

c on

This is so true!!! I will be going on Medicare in April and my family will be penalized because they will no longer get the subsidy attributed to me (although they love to include my income). Bottom line, I will be paying MORE for my entire family once I go on Medicare. Thank God I’m not retired yet!!!

Erin on

This is a very lame technical problem with the Affordable Care Act. Please consider writing to your legislators and letting them know that you are having this problem. Legislators (and possibly the Social Security Administration) are the ones who can make the change necessary to the law.

bob gramkowski on

the answer is correct but is so un-fair. Why should the cost of ACA be based on both incomes when only only spouse need ACA ??? This is out right discrimination of most of the senior house wholes in the USA. Most house whole one spouse is to young to get medicare and needs ACA while the other spouse is old enough to receive medicare. talk about age discrimination

Dayna Allen on

My question is similar but in my case I’m 59 and my husband is 65 and going on medicare. Based on the household income of 48000 our coverage costs $4/month but when he goes on medicare and we start paying for medicare at approx. $120/month then the younger one has to pay $140 or so. So now we’ll be paying $260/month. I don’t think the younger persons subsidy should have changed so drastically.

ObamaCareFacts.com on

Well you still count family income and family size for the ACA, even if someone has Medicare in the family. Only stipulation is that they can’t get coverage. I agree though, your experience seems odd. Maybe something else has happened? You may want to clarify with the marketplace, the upfront tax credits are advancements (it is possible to over-or-under-take credits).

John Burton on

I have just got off the phone with a representative at the Marketplace.gov as I had to report a life change, and I feel I’m being well and truly screwed.
My wife and I had a family plan through the Market place, she goes on Medicare in a few days as she is disabled at the age of 57.
Her Medicare premium is going to be around $130 my new Market place premium is now $190, we had been paying $168 for the family plan.
I expected like many, for my portion of the market place family plan to be less not more. Income hasn’t change just the fact my wife no longer has coverage through the market place. This can’t be right.

kathy d. on

As I understand it, the premium should stay the same when one spouse goes on Medicare, presuming the income stays the same, but you also have to then pay the Medicare premium. You come out behind because of that and also because the Medicare participant’s expenses won’t count toward the same out of pocket limit the rest of the family has on the Marketplace plan. When things get tough, the plans get tougher.

Neal on

I am unschooled in these matters, but given what Kathy has said, I don’t understand why someone with a spouse and an affordable ACA plan would ever choose to go on Medicare. Perhaps sometimes the choice is forced? And recognizing the situation after the fact, is it not possible to change one’s mind, drop Medicare and go back to the ACA plan?

ObamaCareFacts.com on

Medicare has very specific rules. Once you are eligible for Medicare you can no longer get a private non-Medicare plan. So that may be the answer.

ken blake on

Approaching my 65th birthday and attended a local seminar,,,Medicare is required coverage at age 65 and it is “illegal” for me to keep Obamacare once eligible for Medicare. My Medicare Part A & Part B information and card arrived in the mail last week, with the option to keep or discard Part B, and the option to get other available plans like Medicare advantage which combines Part A, B,C,D etc. My spouse is age 58 and will have to keep current Obamacare, regardless of cost, for the rest of the year and shop for coverage for 2017.

ObamaCareFacts.com on

Yes, this is all correct. The one plus is that your spouse will still use household income to determine subsidies. Thus, at some incomes this works out to a great deal (in my opinion better than Medicare cost-wise), but only at some incomes.

Harry on

I am preparing to retire. My spouse is 58. I have been checking locally for the ACA policies available. Without any assistance from the ACA I would pay a monthly premium of 890 dollars for a silver plan. With the deductible my out of pocket for my spouse will be 14000 dollars a year. Now to qualify for a ACA subsidy you need to have a family income between 100% and 400% of the poverty income level. When qualifying it asks the family size. Would my spouse family size be 1 or 2 when qualifying?
In real numbers it means the following,
Family size of 1 : 11880 – 47520.
Family size of 2 : 16020 – 64080.
Does my spouse family income fall between a family size of 1 or 2?
In my state for 2016 they were allowed by the Insurance commission a 25% increase in premiums.
In my state for 2017 they are already allowed by the Insurance commission a 35% increase in premiums
I have nothing good to say about ACA.

Don on

I think I have a unique situation or at least it seems so. I am 64(laid off of work) and my wife of 44 years is 71 years old. She did not acquire enough work credits to qualify for social security or medicare even though she had 20 work credits. I am paying medicare 532.00 dollars per month for her Medicare and 60.00 dollars per month for her Medi-gap plan. Her monthly co-payments for prescriptions average approximately 150.00 per month. I am on ACA and I pay 300.00 per month. I live on a pension of 20.000 dollars per year and I pay approximately 1150 per month for medical expenses only which leaves less than 500 dollars to live on. When I started on ACA my premiums started at 20.00 dollars per month, then jumped to 160 dollars per month and are now 300 per month, but yet my income remained the same. Is there any advice you can give me towards my dilemma.

ObamaCareFacts.com on

If your MAGI income is right around the 100% poverty level you might be dipping below the subsidy cliff and thus losing credits. Likewise, if your income is over 400% you might be dipping over the cliff on that side. I can’t exactly tell which would be happening, but it seems like you may be going under 100%. So this would be one thing to consider.

My general advice is make sure you are using the exchange, and make sure you are getting the credits you should be as explained on form 8962 and 8965.

I know that isn’t a simple answer, but it includes all the elements you need. My guess is that its either confusion over Medicare or the poverty level that is leaving you not getting the credits you should be.

https://obamacarefacts.com/form-8965-health-coverage-exemptions/

https://obamacarefacts.com/premium-tax-credit-form-8962/

https://obamacarefacts.com/federal-poverty-level/

Briann on

I will go on medicare this year but my wife is 8 years younger than me and will be on Obamacare. We are both retired/housewife. Since our joint household income is about 50K from dividends and interest, we get premium aid. But from now on, since only one is on obamacare, our aid is reduced plus I have to pay the premium for medicare. So our personal costs go up from 100 to 500 per month. Is there any way I can reduce it? Why are we getting penalized because one of us crossed the magical age of 65?

Cynthia Sisson on

My husband is on Medicare, I can’t afford health insurance.How can I get health insurance.

Doug lingusky on

Both of us on obama care until august when my wife goes on medicare. I will be on medicare jan 2018. Will I get charged more for obama care since my wife be on medicare for the last 5 month of 2017?

ObamaCareFacts.com on

No, Medicare is minimum essential coverage, thus having Medicare means not owing the fee.

Philip and Deborah Ansbaugh on

Thank you I am presently having problems with your health Idaho they canceled my wifes insurance policy with out contacting us about any problems I just went on medicare and was concerned about this same income issue.

George Morris on

Obamacare discriminates against the disabled and retired My wife releases medical records for a hospital. Her position was outsourced and she just recently was offered a worthless Minimum Essential Coverage which cover nothing! our joint income{not that much} reduce her subsidy to hardly nothing! She pays united Healthcare $450 per month for limited coverage with a $12,000 deductible She even has to pay federal income taxes on most of the premium amount! If this is not a scam then tell me what is?? She was discriminated more than once!! And on top of that the Social Security dual entitlement clause cheats her again!!

Victoria on

I have dental insurance through Obamacare. My husband is on Medicare. Can I get him on my dental plan?

ObamaCareFacts.com on

If you have a standalone plan then you should be able to (I would ask the insurer directly). However, if you don’t have a standalone dental plan then the answer is no. You can however still call the insurer to ask about options.

MARK H REINACHER on

How is the potential for cost assistance calculated for the remaining spouce on the marketplace using household income? Can you provide an example of the calculation assuming less than 300 percent of FPL?

Thanks

ObamaCareFacts.com on

The spouse gets assistance based on family size and MAGI (AGI adjusted) income regardless of who else in the tax family qualifies.

Doing the math is a little heady, it means knowing family size compared to the federal poverty level, cost of second lowest cost silver plan in your state, and the amount credits are adjusted by on form 8962. Instead of trying to brave that, try out KFF’s handy calculator.

http://www.kff.org/interactive/subsidy-calculator/

sharon mckay on

My husband and I have health care subsidy – we make less than 63,000 annually. He will be elgible for medicare on august 19, 2018. How will this change my insurance coverage and will I have to change my government health care and find an individual coverage. Kaiser says 3 month notice before cancellation – our annually wage stays the same – just me who needs coverage and looks like if I change the subsidy to one person would be like $650 per month for me??

L. Henggeler on

Does a dependent disabled adult who makes only about $1400 a year who has a Blue Cross short-term plan or a Philadelphia American Non traditional plan need to pay a penalty?

ObamaCareFacts.com on

The mandate was removed in the tax bill, so moving forward you won’t owe the penalty.

However this would have been more questionable in the past due to you being just above the poverty level in terms of income.

https://obamacarefacts.com/federal-poverty-level/

That said, even then, you should have been able to get an exemption due to being in the range that would qualify you for Medicaid expansion (if your state didn’t expand and you applied and can’t get it, then you are exempt from the fee).

I would call the marketplace and discuss this with them though.

kevin on

I will start medicare as of Nov.1 2018 , we file a joint return we bith are currently on ACA[obama] we qualify for a subsidy when i start my medicare and my spouse is on ACA will our healthcare providers current fee be reduced because there will only be my spouse on that paln ??

ObamaCareFacts.com on

When you switch to Medicare in a two person family, the other person is technically supposed to switch to an individual plan. Then the tax credits are accounted for on form 8962.

Honestly it isn’t the simplest transition, I would start by calling heatlhcare.gov and getting advice from them.

Also, if you used a private broker for Medicare, ask for their help.

With all this said, if you can start your Medicare on January 1st (Due to where you are in initial enrollment) I think it might make your life easier. Again though, this is a little more complex than one might think and you’d want to get advise direct from healthare.gov or a broker to make sure your transition is smooth and you fully understand your options.

Karl on

If a spouse goes on disability/Medicare, the other spouse shouldn’t be penalized and should be able to stay on healthcare.gov based on their MAGI since the disability will be a lesser amount.

ObamaCareFacts.com on

True