Category: What To Know

I am over age 65 and covered by Medicare, but I’m wondering if I can purchase one of the health plans offered through the Marketplace and drop my Medicare coverage? Is that an option for me or should I keep my Medicare?

If you have Medicare, you should keep it.  In fact, companies that sell Marketplace plans are prohibited from selling these plans to you if they know you are covered by Medicare.  If you do drop Medicare, and choose to re-enroll later, you can only re-enroll during the Medicare general enrollment period (from January 1 to March 31), and your coverage would not begin until July of that year.  You also may face a penalty for late enrollment.  If you don’t sign up for Part B when you’re first eligible or if you drop Part B and then sign up again later, your monthly Part B premium may go up 10% for each year that you could have had Part B, but didn’t.  You may also owe a late enrollment penalty for Part D drug coverage, which is equal to 1% of the national average premium amount for every month you didn’t have coverage as good as the standard Part D benefit.

I’m 63 and my spouse is 65 and on Medicare. Our income is less than 400% of FPL so I need help affording the premium in the Marketplace. Can we count what my spouse has to pay for his Medicare premiums and supplemental and Part D premiums against what I will be required to contribute toward coverage in the Marketplace?

No. Your eligibility for premium tax credit subsidies and the amount of your premium tax credit will be based on your family income. The amount your spouse pays for his Medicare, Part D, and supplemental insurance premium costs will not be taken into account.

My spouse is an early retiree with affordable retiree health benefits from his former employer, but I’m not eligible to be on his plan. Can I apply for coverage and subsidies in the Marketplace?

Yes, assuming you meet the other requirements, you can apply for health plans and premium tax credits in the Marketplace. Your spouse’s eligibility for early retiree coverage will not affect your ability to seek coverage and financial help in the Marketplace.

I’m 63 and about to retire. I’ll be offered a retiree health plan. Can I look for better coverage and subsidies in the Marketplace instead?

Yes. Most early retiree health plans are considered minimum essential coverage, and thus meet an individual’s requirement for coverage. However, if you want to obtain coverage through the Marketplace, you may do so, and if your income is at or below 400% of the Federal Poverty Level, you are eligible for premium tax credits. Eligibility for retiree coverage will not affect your eligibility for Marketplace coverage and subsidies.

I’m 63 and enrolled in a retiree health plan from my former employer. Can I look for better coverage and subsidies in the Marketplace?

Yes, as long as you do so during the Open Enrollment period.

People with employer-provided retiree health benefits should know that most early retiree health plans are considered minimum essential coverage, and thus meet an individual’s requirement for coverage.

If you are enrolled in such coverage, you can also look at coverage options through the Marketplace, and if your income is between 100% and 400% of the Federal Poverty Level, you may qualify for premium tax credits. However, there’s one exception. Some employers may provide retired employees with access to an account, called a health reimbursement arrangement (or HRA) that the retiree may use to reimburse medical expenses, including an individual policy through a Marketplace or in the non-group market. A retiree that signs up for an HRA offered by a former employer is considered to have minimum essential coverage from an employer and would therefore would not be eligible to claim a premium tax credit if he or she enrolled in a Marketplace plan.

Remember that outside of Open Enrollment, you cannot voluntarily drop your retiree coverage and replace it with other Marketplace coverage.

I received a Form 1095-C in the mail. What’s that?

Large employers must offer health insurance to their full time workers or pay a penalty.  These employers also must provide their employees with Form 1095-C to document that health coverage was offered.   Every employee of a large employer who was eligible for health coverage this year should receive a form 1095-C next year in January.  Even if you declined to sign up for your health plan at work, you will still receive a form 1095-C.  Information on this form will also be reported to the IRS.

Form 1095-C will indicate your name and the name of your large employer, the months during the prior calendar year when you were eligible for coverage, and the cost of the cheapest monthly premium you could have paid for coverage under your employer’s health plan. If you worked for a large employer that did not offer its full time employees health coverage, Form 1095-C will also indicate that.

Keep this form with your tax records.  You may need this form if you were offered health coverage by your employer and you did not sign up for it.  If you signed up for Marketplace coverage instead and received a premium tax credit, information on Form 1095-C will help you determine whether you were eligible for the tax credit (for example, if the cost of your employer health plan was more than 9.56% of your income in 2018.)

If you were uninsured during the year even though your employer offered you health coverage that year, you will be eligible for an exemption from the tax penalty in 2018 if you experienced a hardship that prevented you from enrolling in coverage.  You can claim the hardship exemption directly on your 2018 tax return when you file.  You will not be required to submit documentation of the hardship with your tax return, though you should retain any documentation for your own tax records.

My employer offers a plan with very limited benefits. It only covers preventive services and a few doctor visits each year. However, this plan option is free. If I sign up for it, will that satisfy the individual mandate to have coverage?

Yes, most group health plans offered by an employer are considered “minimum essential coverage.” Some limited benefit plans (for example, dental only plans) are not considered minimum essential coverage.  Your group health plan materials should indicate whether the plan is considered “minimum essential coverage.”  If it is and if you enroll in the plan, you will have met the requirement to have coverage and won’t owe a tax penalty.  However, the plan you described probably does not meet the standard for “minimum value.”  If this is the only plan your employer offers, you may be able to qualify for premium tax credits to help pay for Marketplace coverage.  The premium tax credits could help you afford coverage that would be more comprehensive.

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