Transition from ACA to MediCare?

[Murf2]

Hi all. I tried searching but came up empty. I’m not too good with this site, I guess.

I will be turning 65 on Sept 16 2022. I am the primary on the Marketplace with my younger wife as our group.

What is the simplest/ cleanest way for us to handle the change next year? I read on Healthcare.gov. that if the primary needs to get off the ACA coverage you have to call & have it done. They make it sound like the secondary person getting off can be done online.

Can she just sign up as the primary & me be secondary on her’s? Do we need to put me in a different “group “ than her?

Any help would be very welcome. My biggest concern is not having any lapses in coverage. I use a fair amount healthcare.

Thanks
Murf

 

[toddm]

We are not there yet, but my wife and I are in separate ACA groups, with our own individual policies. When the time comes for me to transition to Medicare, I just have to cancel my coverage, and hers will continue with no interruption.

 

[T-Minus]

Hey Murf - thanks for asking this. While I don’t have an answer for you, I am in almost exactly the same boat minus 1 year, so will have to deal with the same issue next year. I’ll be watching the responses you get carefully.

 

[Go Bolts]

In our case, I called our agent and she did it during our call. It didn’t seem this was something you could easily do by yourself online without possibly messing something up in the process. If you don’t have an agent, my suggestion is to call the Marketplace and let them handle the switchover.

 

[Murf2]

In our case, I called our agent and she did it during our call. It didn’t seem this was something you could easily do by yourself online without possibly messing something up in the process. If you don’t have an agent, my suggestion is to call the Marketplace and let them handle the switchover.

Yes, that’s what they tell you to do on the Marketplace site. I guess I just always assume something will go wrong when dealing with them on the phone. We aren’t using an agent.

I thought maybe changing how we enroll, making her the contact. I’d like to hear from anyone who has done this to see how it went. I wonder what would happen if I need nothing on the Marketplace and just let it run until the end of the year. It would cost some money but probably not much more than insuring just her for 3/4 months.

I know I’m overthinking it but I’m really concerned that it goes smoothly with no lapse of coverage for me.

Go Bolts, thanks for your reply!

Murf

 

[pirsquared]

Also following this discussion. DH will start Medicare in summer 2022 and DD will probably start a job with her own insurance in fall 2022. I am already primary on the policy so that makes things a little easier. I would prefer to all be one group for 2022 because I think that it is more advantageous for us to share deductibles, but I could be wrong. I would be interested in hearing more about the pros/cons of separate groups.

I have a solid understanding of how/when DH signs up for Medicare, it is just the ACA options that I am still a little unsure of. I did hear multiple places online that canceling ACA for the Medicare-starting spouse should happen by phone and not until the day of starting Medicare.

 

[pb4uski]

We are not there yet, but my wife and I are in separate ACA groups, with our own individual policies. When the time comes for me to transition to Medicare, I just have to cancel my coverage, and hers will continue with no interruption.

+1 except we have both gone through the process... DW in March 2020 and me in November. DW and I had separate ACA policies so when we went on Medicare at different times it was simply sgning up for Medicare and cancelling the ACA policy.

I would call the Marketplace and ask about the best way to handle it. I would lean towards establishing two separate ACA policies to begin 2022 to make the transition easier.

 

[pb4uski]

.... I would prefer to all be one group for 2022 because I think that it is more advantageous for us to share deductibles, but I could be wrong. I would be interested in hearing more about the pros/cons of separate groups. ...

Actually, the reason that we ended up with separate policies was because the couple policies at the time only had aggregate deductibles. Say the deductible is $6k for one or $12k for 2 and the deductible is an aggregate deductible. We are both pretty healthy and had negligible claims in the normal course.

With separate policies, if one of you has a health event that costs $20k, the insurer picks up $14k and you pick up the $6k deductible. If youhave a $12k aggregate deductible, then the insurer pays $8k and you're on the hook for $12k.

That's the way it worked back in 2014 or so. I recall presenting that exact scenario with a BCBS CSR and she comfirmed my understanding and I said so we are best off to have separate policies and she conceded it was yes.

I have a faint recollection that they later changed it so a $12k deductible for a couple was a stacked deductible.... operated the same as two $6k deductibles so it wouldn't matter, but at that point we had individual policies and there was no reason to change it.

https://vehi.org/client_media/files/Stacked-vs-Aggregate-Deductible.01.17.2018.pdf

 

[kevink]

I'm going through this process myself, as I turn 65 in December and DW is 58.

I spoke to the healthcare.gov folks and was told to call back around December 1st and remove myself from ACA coverage, making my wife the only covered person in our household. They said it wasn't possible to make her the "primary" now as any changes would result in, effectively, a special enrollment in which our current rates and/or subsidies could change.

Not mentioned by the OP but surely important to many, as it is to us, is looking at the effect this change has on ACA subsidy eligibility as well as total household premium costs. In our case we've managed our MAGI carefully for years in order to be keep within the most favorable subsidy range. That'll have to continue for 7 more years until DW is of Medicare age. The good news, such as it is, is that I'll now have much lower co-pays and have coverage when traveling out of state, as well as having a larger choice of doctors, since I've chosen traditional Medicare plus a high-deductible Part G Medigap supplement and cheap Part D plan. The bad news is that with my Parts B, G and D premiums plus hers for a highly-subsidized Silver ACA plan our combined monthly premiums will go from $34 (!) to around $300. Admittedly that's an extreme case as I'm sure few couples here manage their MAGI to keep it in a 25-35K a year range.

 

[xlf11]

I did it throught an agent with the exact situation

Here is what needs to be done:
-Sign up for Medicare first for yourself
-After receive approval and agent will help your choose MA or MG plans
-Agent will cancel your ACA on the 1st of the month you start Medicare
-ACA will change to your wife only with new plan and credit but you are still primary ( only one person in ACA instead of two)

-Your previous plan will be changed to her own plan starting on the 1st of the month as well (most likely the credit will be lower than 1/2 of the previous plan). This is a new plan with different #, even though everything stays the same.
-You will receive two tax receipts after the end of the year.

 

[SecondCor521]

Actually, the reason that we ended up with separate policies was because the couple policies at the time only had aggregate deductibles. Say the deductible is $6k for one or $12k for 2 and the deductible is an aggregate deductible. We are both pretty healthy and had negligible claims in the normal course.

With separate policies, if one of you has a health event that costs $20k, the insurer picks up $14k and you pick up the $6k deductible. If youhave a $12k aggregate deductible, then the insurer pays $8k and you're on the hook for $12k.

That's the way it worked back in 2014 or so. I recall presenting that exact scenario with a BCBS CSR and she comfirmed my understanding and I said so we are best off to have separate policies and she conceded it was yes.

I have a faint recollection that they later changed it so a $12k deductible for a couple was a stacked deductible.... operated the same as two $6k deductibles so it wouldn't matter, but at that point we had individual policies and there was no reason to change it.

https://vehi.org/client_media/files/Stacked-vs-Aggregate-Deductible.01.17.2018.pdf

Interesting. I wonder if it varies by insurance company or by state.

In my situation, when I had family coverage (either me+wife+kids or me+kids), it was the exact opposite of your description: the policy had a family deductible, and any toward-deductible costs were applied to it, and as soon as we collectively met that deductible, then the better coverage kicked in for everyone.

So if it was a $3K individual / $6K family deductible, and kid A incurred $2.5K, kid B incurred $2.5K, and kid C incurred $2.5K, then the last $1.5K of kid C had the better coverage because the family deducible had been met collectively.

 

[sengsational]

DW turns 65 in 1Q2022. My plan is 2 groups on the HC.gov, as the chance of filling the high deductible in Q1 is miniscule, and separate groups is simple.


As to the PTC, I figured I'd do what I always do, which is to determine a Roth conversion amount in December, with calculated or estimated values in the tax software.

 

[sengsational]

Interesting. I wonder if it varies by insurance company or by state.

The first year or two of ACA, the insurance companies got away with making the insured pay the entire family deductible before kicking-in a dime. So with two groups on ACA, $6,000 deductible, one person's $10,000 medical bill would get $4,000 covered. But the default, single group, that bill would have zero covered, as it didn't exceed the "stacked deductible" of $6,000+$6,000. Then, thankfully, the law was changed to prevent that practice. I always thought it was criminal to sell a policy on the ACA site, billed as a $6,000 deductible when that only would happen if both people met their deductibles (unlikely in a healthy couple).

 

[Murf2]

Here is what needs to be done:
-Sign up for Medicare first for yourself
-After receive approval and agent will help your choose MA or MG plans
-Agent will cancel your ACA on the 1st of the month you start Medicare
-ACA will change to your wife only with new plan and credit but you are still primary ( only one person in ACA instead of two)

-Your previous plan will be changed to her own plan starting on the 1st of the month as well (most likely the credit will be lower than 1/2 of the previous plan). This is a new plan with different #, even though everything stays the same.
-You will receive two tax receipts after the end of the year.

Thanks xlf11!

Just to make sure I’ve got this. I can just renew our current plan for 2022. When I’m eligible for MediCare, I can enroll on line then when approved, call and get my MediCare plans setup and the ACA insurance cancelled at the same time over the phone?

Thanks again!
Murf

 

[xlf11]

Thanks xlf11!

Just to make sure I’ve got this. I can just renew our current plan for 2022. When I’m eligible for MediCare, I can enroll on line then when approved, call and get my MediCare plans setup and the ACA insurance cancelled at the same time over the phone?

Thanks again!
Murf

Yes you can renew ACA as usual for 2022 and sign up for Medicare in 6/22 at SSA then choose your MA or MG after receiving Medicare # before Medicare start date of 9/01/22.


I would strongly recommend to find an agent that could handle both ACA and Medicare as we learned during the last 3 years that they know much more than us in terms of pros and cons of the two systems. And it costs nothing for you just like a buyer agent. For example, our agent told us don't change anything on ACA website especially the primary as somebody got their primary switched and ended up lose ACA coverage for the spouse. Also he was very specific about when to cancel ACA so that you don't lose ACA coverage when transitioning to Medicare. I recall he did that either on the last day of ACA or the first day of Medicare (not sure website or call).

 

[Murf2]

Yes you can renew ACA as usual for 2022 and sign up for Medicare in 6/22 at SSA then choose your MA or MG after receiving Medicare # before Medicare start date of 9/01/22.


I would strongly recommend to find an agent that could handle both ACA and Medicare as we learned during the last 3 years that they know much more than us in terms of pros and cons of the two systems. And it costs nothing for you just like a buyer agent. For example, our agent told us don't change anything on ACA website especially the primary as somebody got their primary switched and ended up lose ACA coverage for the spouse. Also he was very specific about when to cancel ACA so that you don't lose ACA coverage when transitioning to Medicare. I recall he did that either on the last day of ACA or the first day of Medicare (not sure website or call).

Thanks! How would you recommend I find an agent? Are there agents / companies that specialize in this. We live in a fairly rural area and I’m not sure where to look for help.

ETA would Boomer Benefits help with this?


Thanks again.
Murf

 

[xlf11]

Thanks! How would you recommend I find an agent? Are there agents / companies that specialize in this. We live in a fairly rural area and I’m not sure where to look for help.

ETA would Boomer Benefits help with this?


Thanks again.
Murf

Just search HealthCare.gov for local broker/agent with your zipcode and you should be able to find many on ACA (most likely also Medicare as both are government programs). That was how we found ours and you may benefit from plans only applicable to your area on ACA and/or Medicare. You can also try nation wide agents with good reputation for Medicare education/service in Youtube: Keith Armbrecht, Christopher Westfall.


Best,

 

[Murf2]

Thanks,I’ll check it out!
Murf

 

[Z3Dreamer]

Here is a thread I started when I had the same situation. It took many months to fix. I used someone at the exchange. Luck of the draw?

https://www.early-retirement.org/fo...rage-when-spouse-goes-on-medicare-103628.html

 

[Murf2]

Thanks for the link Z3Dreamer!

That’s the kind of issue I’m concerned about.

To all, what would be the downside of my wife signing up as primary with me as a household member? Is that going to cause it’s own issues?

Thanks
Murf

 

[orchid55]

I would strongly recommend separate policies. We didn't do this last year when my husband turned 65. It was a major mess as BCBS wouldn't take my husband off the policy until the Marketplace told them to take him off which was the first day he started Medicare. Then BCBS needed about 30 days to process the change and would not accept me paying for my coverage only. They wanted the full premium for both of us and said that if I didn't pay the whole thing my coverage would be suspended. So separate policies would help avoid that problem. And yes, I was the primary on the BCBS policy.

 

[cathy63]

Thanks for the link Z3Dreamer!

That’s the kind of issue I’m concerned about.

To all, what would be the downside of my wife signing up as primary with me as a household member? Is that going to cause it’s own issues?

Thanks
Murf

I don't think there's any downside of signing up your wife as primary during open enrollment, but that may not prevent "issues" if there's a delay in processing the cancellation of your own coverage. You may end up paying the wrong premium for a month or two while the paperwork gets processed, but it should get straightened out on your tax return.

 

[Murf2]

Are there any gotcha’s for me to look out for if we would go with separate plans?

My wife would have to create an account for herself and I would need to change our current plan to just me or do we have to both have to create new accounts?

Each separate plan would use the total “household income” correct? We can’t split it in half or can we?

I did some playing around on the KFF estimator online. It doesn’t seem too expensive as we can keep our income very low.

Any thoughts on this tentative plan would be welcome.

Thanks again for all the help!
Murf

 

[SecondCor521]

Are there any gotcha’s for me to look out for if we would go with separate plans?

My wife would have to create an account for herself and I would need to change our current plan to just me or do we have to both have to create new accounts?

Each separate plan would use the total “household income” correct? We can’t split it in half or can we?

I did some playing around on the KFF estimator online. It doesn’t seem too expensive as we can keep our income very low.

Any thoughts on this tentative plan would be welcome.

Thanks again for all the help!
Murf

I'd check during open enrollment after you've set everything up and in early January to make sure they get everything done the way you expect. My exchange screwed up my enrollment last year and I didn't catch it until after my January bill came. It took months to straighten out.

Also, be aware of the deductible / OOP issue that pb4uski and I were discussing up thread.

I think you could keep your current account, drop your wife from your plan, then have her create her own account.

You would both use your total household income (well, actually total household PPACA MAGI) on your individual applications. You would not split it in half.

 

[xlf11]

Same topic, different situation

My DW will turns 65 in 2 weeks and she is on ACA now. She signed up for Medicare almost 3 months ago, but her case is still pending as of today probably due to local SSA semi-closed (and/or claim of spousal benefit of both Social and Medicare together). Here are options if we don't get Medicare approved by 10/31:
1). Cancel ACA on 10/31 and hope to have Medicare # later with Part A and B backdated to 11/1;
2). Stay with ACA (entirely paid for by the credit) until the case is approved, running the risk having to pay back the credit if Part A starts on 11/1.
3). Any others?



Any experience and/or comments of pros and cons will be appreciated. In hindsight, it's probably much safer to apply Medicare separately without Social as mostly likely you may get an early approval to pay your Part B rather than deducted from Social especially under the current SSA operation mode.


Thanks in advance for your input!