I am 80 years old and widowed in December. I have no health insurance and due to a decision to take my money out of PERA, I do not qualify for Medicare. What should I do?


If you are over 65, and do not qualify for Medicare, you can buy Marketplace insurance and get cost assistance.

Since this is true, the easiest next step is to call healthcare.gov. There are many details to consider, so it can help to get someone on the phone to walk you through it. With that said, below are the basics.

If you are over 65 and do not qualify for Medicare you may be eligible for cost assistance based on your household size and income during open enrollment (or if you otherwise loose coverage and qualify for special enrollment).

Since you recently experienced the death of a close family member, you may also qualify for a hardship exemption (although you won't need it if you sign up before Feb 15).

Here is How ObamaCare Works if You are Over 65, But Don't Qualify For Medicare

You’re over 65 but not eligible for Medicare. You are eligible to get coverage on HealthCare.gov (the ObamaCare marketplace). If you meet the qualifications based on income and family size, you are eligible for cost-saving subsidies, too.

You have retiree health benefits. You’re considered covered under Obamacare and won't owe the fee. You can replace that coverage with coverage from HealthCare.gov. However, if your retirement coverage is considered affordable and meets certain minimum standards, or if you are eligible for Medicare but have chosen not to enroll, you won’t qualify for Obamacare’s cost-saving subsidies.

You don’t have any health coverage. If you are over 65 the fee for not having coverage still applies to you. Whether you get a Marketplace plan, get Medicare, or keep a retiree plan from a previous employer you are covered.

IMPORTANT: If you do have access to Medicare, it's actually illegal for someone to sell you a non-Medicare health plan and you won't be able to shop on the Marketplace.

Learn more from LegalConsumer

Find Medicare Plans Find and compare Medicare Advantage and Drug plans at MedicarePolicyHelper.com.

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jayendra patel on

I am 72 year old,working part time job and getting approximate $160000.

I am not eligible for medicaid nor medicare.

Who can i get obamahelthcare insurance?

I need rate and plan., sorry i have 16 quarters only


ObamaCareFacts.com on

You won’t qualify for Medicare yet, but you can get ObamaCare. You’ll shop during open enrollment and qualify for cost assistance based on household income claimed on your tax return.

Learn more about Medicare rules here: http://www.insubuy.com/medicare-for-new-immigrants-green-card-holders/

Learn more about ObamaCare coverage at HealthCare.Gov

ps. In some states you may have Medicaid options if your income is below 138% of the poverty level.

brian medhurst on

i am 69 years old. i do not have medicare, and oregon does not have medicaid exp., i receive approx. $13000 per year in pensions. and do not earn enough for obamacare tax breaks…help!!!

Gary N. Smith on

I turn 65 on June 14th and am not eligible for Social Security. My Obamacare started in 2014 but ends on June 30th. Have been unable to RE-NEW my benefits so I need an alternative. I live on a trust…receive from an executor approximately $400 a month. It is finite and running out…$9,000 left. Need healthcare. Undocumented health issues prevent me from working.

tripurari prasad singh on

I am 69 years old. I want to medicare insurance. Please help.

Heather on

My mother is 66. She was on medicaid, until she was denied due to age in April.. She didn’t know she had to apply for Medicare at 65. She thought she could wait until 70, to receive full benefits… As soon as she got the denial from Medicaid she applied for Medicare, but was too late. She has part A, which only covers part of hospitalizations. She has non Hodgkin’s lymphoma. Without insurance, she is not getting the care she needs… I’ve been filling out papers after papers, to no avail… The bills are piling, her body is ill, and I am sickened that our country treats out elderly the way they do…

Roderico Matta on

Every time I entered my information, to see plans, costs, or agents a page came uo with words saying I should look for medicare plans, but I am a legal permanent resident without any social security benefits. Where can I get health insurance??

ObamaCareFacts.com on

If you are Medicare age a great place to start your journey is Medicare.Gov, if not then Healthcare.gov is best. It isn’t that these are your only options, it is that this is a good place to start when you are confused. Enrolling in Medicare is a little complex and must be done during open enrollment periods. See here https://obamacarefacts.com/medicare/medicare-enrollment/

Tanya on

My mother is 71 and has mcr, part D, and a supplement that add up to almost 400 a month, her income is 1150. She has a house payment and bill, food etc.. she can’t afford this insurance. Is there any other options.

ObamaCareFacts.com on

IT is very risky to not use Medicare. You can owe a bigger premium if you don’t continue it from your initial enrollment period on. Without giving you my feelings on that, I would generally say there isn’t a better option for a Medicaid eligible person… However, you can always go with just A & B (Original Medicare) then use drug savings card like this one: http://easydrugcard.com/.

Again, once off Part D you could have real problems moving forward, but A & B and a life insurance plan (for long-term care costs) can be an alternative, as can just using a savings account to have back-up money for future costs.

No perfect solution here, but hope this helps.

Nina Rathore on

Hi, my mother is a US Citizen but has lived overseas for past 10+ years. She is planning to move to US and live with me as she has no income here in US. During her prior visits we would purchase her Travelers Insurance but now most insurance are way too high for her. She has not earned enough credits to be eligible for Medicare although I am aware that she can purchase Medicare A&B at registered premiums. Does Obamacare offer any subsidized health care options for my elderly mother. We live in New York.

Erin on

New York has expanded Medicaid and your mother would qualify for Medicaid because she has no income. In addition, you may also be able to be included in your tax family as a qualifying relative and claimed as your dependent. This would allow you to apply for health insurance together and for you to claim an additional dependent exemption and filing as head of household (assuming you couldn’t already), which could potentially lower your tax burden.

mary on

Delete medicare so evrryone can purchase a healthcare plan

mar on

Yes we need keep for old people and because that can’t get any morObamacare. it is hard to get any from the government if you are just had 66/80

Frank Maye on

What is the law ie statute etc that says that if I don’t qualify for medicare that I can get private primary healthcare insurance ?

Frank Maye on

I am 65 and don’t qualify for medicare parts a or b. What is the section or statute or title or page of ACA which says I am entitled to get private insurance thru obamacare

Mavis Barnett on

I have a member that immigrated from England and has a resident green-card. They qualified for a plan on the marketplace. They received their ID cards and information but the information is referencing U65 and they are over 65? Why does it say U65? Thanks

Alma on

My mother is 66 years old and is a legal permanent resident in California. She is currently on Medical. She does not have enough work credits to qualify for social security which means she will not qualify for Medicare either. She does not want to purchase medicare because she does not have any income other than a small monthly SSI check and the monthly premiums for Medicare are too high. Will she be able to continue with Medical? or does she have Obamacare options that would be cheaper than buying Medicare? She is pretty healthy for her age, she has no chronic illnesses and does not take any medication on a regular basis, therefore if she is unable to find affordable health coverage here she would prefer to visit the doctor in Tijuana Mexico and pay 100% out of pocket which would be way cheaper than buying medicare or any other unaffordable health insurance. Will she have any problems if she does that?

ObamaCareFacts.com on

Yes, she will have problems. Namely, she can get charged higher rates for life if she doesn’t enroll. Medicare is a complex thing to navigate, and it can be expensive, but getting locked in is pretty darn useful. It is a personal choice, beyond that I’d need to offer a full theory of healthcare to give you insight into the pros and cons of forgoing Medicare and going to the doctor in Tijuana.

Angelique Eddins on

Complicated, confusing, and unhelpful

ObamaCareFacts.com on

Sorry you feel that way, we updated the article to make it clearer. Although to be fair, it was actually already offering the correct answer.

T on

An elder relative who is 65 years of age, permanent legal resident, he is qualified not qualified for medicare as he does not have enough work credits. He could not get the medicaid as it automatically kept putting him on medicare. What would be the best next step of actions for him?

Erin on

Call your states Marketplace or the Medicaid program in your state directly for help.

Dunfa on

Just reached 65 in Oregon. Got kicked out of medicaid. Not eligible for Medicare. Income is not enough to get tax credit from Obama care. Is this a loop hole? Now need to pay 700 per month for insurance premiums.

Cora on

My mom is 77 y/o first time in US, never work before, she has ESRD what kind of insurance she can have to get proper treatment of her kidney problem.


Anonymous on

A friend was on SSI for most of life, but family helped turn inheritance into small income, just above medicaid, but this person will never be qualified for social security or medicare hospitalization plan bcz never worked ten years. Can they enroll in ACA marketplace plan instead? Much cheaper than being forced to pay for medicare at 65.

ObamaCareFacts.com on

If you qualify for Medicare then you can’t get marketplace insurance. One can however apply for assistance via Medicare. https://www.medicare.gov/your-medicare-costs/get-help-paying-costs

Anne McDannels on

I am a senior and didn’t take part b medicare as I was still covered by Tricare Prime. My husband is retired military. I was told about 3 mo ago that I was no longer being covered. I called my local S.S. office and the person I spoke to was very rude and unhelpful He did take great delight in telling me I cannot apply again until 2022 and would be fined for every month I don’t have it. I really need healthcare .Where can I turn to for help , I will be 67 in Aug , and I am diabetic .Can you please help me to get covered My pension is 320 a month.

ObamaCareFacts.com on

I don’t think that is correct at all unless I’m missing something. If you don’t enroll when you are first eligible, what you were told is correct.

However, you losing your creditable coverage should trigger a special enrollment period for Part B (generally people would have Part B and TRICARE, but if TRICARE was considered creditable coverage for you, then it shouldn’t be the case). Losing creditable coverage should create a 7 month Special Enrollment window in which coverage would start the month after you enroll in Part B. You also have a number of other enrollment periods to consider, including General Enrollment (which to be fair doesn’t come around until 2022) even if you somehow missed your SEP.

Okay, that said. If you somehow missed the window by 7 months, you may consider appealing, as I would argue no one making you aware for 7 months straight could be seen as the fault of someone else.

Lastly, if you cannot get Part B, you CAN get a non-Medicare health plan, even if you won’t qualify for assistance. So you can contact the marketplace for example.

I hope that helps.




Ronald W Gless on

So to not pay into SSI or Medicare is a batter way to go… because if you and your spouse make under 27 thousand a year fixed INCOME … You can get healthcare and prescription plans that only cost you a few dollars a month and a great co-pay for medications… But if you just have worked and made Earned Income and just qualify for SSI and Medicare YOU GET ROYALLY SCREWED when you turn 65 and you’ll pay upwards of 6 thousand once they take out the 170 for A & B and 30 for part D and if you get a good supplement plan you’ll pay another 130 a month all with deductibles that you’ll pay at least 700 bucks before you get anything out of the Medicare and prescription plans! So there goes your SSI and MORE! It’s not fair to people over 65 on a fixed income… and only get 445 bucks from SSI… that were only paying dollars a month to be kicked out in the street just because they turned 65….A real rip off and elderly abuse… And please don’t say you can get Low income assistance…the cut off is 26, 200 a year for 2 people…

ObamaCareFacts.com on

For anyone reading who doesn’t know, there are multiple assistance options. https://medicarepolicyhelper.com/medicare-guide/medicare-cost-assistance/

However, I get that this doesn’t help depending on your overall taxable income. That said, one thing to note is that SSI is not taxable and assistance is typically based on MAGI/AGI (which excludes taxable income). In short, only taxable income counts toward assistance and that means you disclude certain types of income and tax deductions before you tally! In short, this means you would not count your SSI income.

Anyone who thinks they don’t qualify should double-check and perhaps even apply, as some income they don’t think is excluded may be, and that can lower Original Medicare and Part D costs, and then this can for example be paired with a $0 premium Part C plan. That still leaves out-of-pocket costs to contend with, but it can come a long way toward bringing down monthly costs.

jennifer on

Hi. I need help please I am 67 and haven’t worked in a long time. I have 17 out of 40 credits. I recently called social security they told me I do not qualify for anything. Can I get a marketplace plan> I filed a tax income last year. /I do not qualify for medicare or medicaid. Thanks for any help.

ObamaCareFacts.com on

You can get a marketplace plan yes. Just call your state marketplace or check out healthcare.gov