Another ACA to Medicare question

[pirsquared]

DH starts Medicare on June 1. He is already signed up for Medicare A and B and we are in the process of choosing Medigap and Part D policies. We are currently on an ACA plan as a family and I am primary. I understand that I need to call the Marketplace to remove him at some point. After reading through old threads on this topic, it sounds like I should wait to call until June 1. However, I keep getting emails and we got a letter saying that we may need to contact them earlier to avoid overlap. Any further advice? I would rather have an overlap than a lapse in coverage but we really can't afford to have either one.

Thanks!

 

[Sarah S]

I think it is probably different depending on which exchange you are working with. My situation was less complicated because I was just stopping my individual plan but my exchange ( Massachusetts) said clearly in several places that I needed to cancel in advance or I would owe for the next month ( to cancel June it had to be terminated by a certain date - I think May 23). This is very different than what others have said which is why I think it must vary. My concern about having insurance stop on the day I canceled did not happen. Ymmv

 

[MichaelB]

They do make this difficult, don’t they? The challenge here isn’t just the end date for your DH, it’s also changing your policy so your coverage continues.

You being primary for the current policy is helpful. Based on this post (here) which you probably have read, you should call on the last day on this month, which is your intended end date. I would call, rather than try to do this online, just to confirm everything is correctly setup before hitting the go button.

There’s no harm in calling now and asking if the end date and your new policy can be scheduled now or later this month but before the 31st. That will also give you an opportunity to see how difficult it will be to do this over the phone.

 

[xlf11]

Did your DH or you get Medicare/ACA by himself/yourself? If going through a Medicare/ACA agent, they know in and out of both government systems and it costs you nothing (insurance pays them). We got through this process twice through our local agent and it went smoothly. Check healthcare.org for your local agent list if you don't have one...

 

[Rianne]

OP, glad you brought this up. I'm the primary on our ACA plan. I start Medicare in Sept., but he doesn't start until December. He'll have to get his own ACA plan. I have to figure out how to do that.

 

[wmc1000]

OP, glad you brought this up. I'm the primary on our ACA plan. I start Medicare in Sept., but he doesn't start until December. He'll have to get his own ACA plan. I have to figure out how to do that.

Once you cancel your ACA participation, DH will remain on the plan separately but the premium won't necessarily change much at least that was our case.

 

[Beldar]

I went thru this myself just last week.

When I called a week prior to the date (May 1) to take myself off the ACA plan and leave DW on it, the agent told me to call on the date my Medicare coverage would start. They would not pre-schedule any adjustments.

On May 1st I called the marketplace again, and it was smooth sailing in just a few minutes. They told me DW's new premium, and a few days later the insurance company confirmed via letter.

Easy peasy. HTH

_B

 

[pirsquared]

I went thru this myself just last week.

When I called a week prior to the date (May 1) to take myself off the ACA plan and leave DW on it, the agent told me to call on the date my Medicare coverage would start. They would not pre-schedule any adjustments.

On May 1st I called the marketplace again, and it was smooth sailing in just a few minutes. They told me DW's new premium, and a few days later the insurance company confirmed via letter.

Easy peasy. HTH

_B

Was this the federal marketplace or one of the state-run exchanges?

 

[PaunchyPirate]

I went thru this myself just last week.

When I called a week prior to the date (May 1) to take myself off the ACA plan and leave DW on it, the agent told me to call on the date my Medicare coverage would start. They would not pre-schedule any adjustments.

On May 1st I called the marketplace again, and it was smooth sailing in just a few minutes. They told me DW's new premium, and a few days later the insurance company confirmed via letter.

Easy peasy. HTH

_B

And for the benefit of others (I’m only 59, but curious and learning)… did you still pay the May premium to your ACA insurer? My bill is auto-paid 5 days prior to the start of the month. I’m assuming you stopped any auto-payments done in late April.

 

[Beldar]

And for the benefit of others (I’m only 59, but curious and learning)… did you still pay the May premium to your ACA insurer? My bill is auto-paid 5 days prior to the start of the month. I’m assuming you stopped any auto-payments done in late April.

This was thru the Federal marketplace.

And yes, I did pay the May premium for both of us. My portion will be credited to DW's account. We haven't used any auto-pay features though, just old school checks.

_B

 

[pirsquared]

This was thru the Federal marketplace.

And yes, I did pay the May premium for both of us. My portion will be credited to DW's account. We haven't used any auto-pay features though, just old school checks.

_B

Thanks! Ours is through the Federal Marketplace also so I will call them 7-10 days ahead and see what they recommend. We do plan to pay our full June premium on time and let them sort it out later. I expect the cost will be about the same as we will lose both the premium and subsidy attributable to DH.

 

[Rianne]

Once you cancel your ACA participation, DH will remain on the plan separately but the premium won't necessarily change much at least that was our case.

Could you explain further? On Sept. 1 I call ACA and tell them I am now on Medicare. They will continue DH as usual until he goes on Medicare in December? Same plan, same subsidy. Just my thought, but wouldn't he have to pay a single person's premium?

 

[pirsquared]

Could you explain further? On Sept. 1 I call ACA and tell them I am now on Medicare. They will continue DH as usual until he goes on Medicare in December? Same plan, same subsidy. Just my thought, but wouldn't he have to pay a single person's premium?

He will pay a lower premium (for just one person) but the total subsidy will also be lower (for just one person). Generally, people have found the new monthly ACA cost to be similar after one spouse starts Medicare. But you will also be paying for your Medicare so your overall expenses will go up

 

[anethum]

A word of warning: The ACA cancellation rules vary by state. In Maryland, which runs its own exchange, you'll be billed for an entire month if you cancel an ACA policy on the 1st of the month or later. In DC, you'll be billed a prorated amount based on which day of the month you cancel. Also, you cease being eligible for an ACA subsidy the moment you're eligible for Medicare. I believe that's the case in the entire country.

My first day on Medicare began on a weekend, which didn't help. I got my cancellation date retroactively moved back thanks to a helpful person in the state Attorney General's office. I got repeated bills from my ACA insurer, Blue Cross, until I got the cancellation date sorted out.

 

[pirsquared]

A word of warning: The ACA cancellation rules vary by state. In Maryland, which runs its own exchange, you'll be billed for an entire month if you cancel an ACA policy on the 1st of the month or later. In DC, you'll be billed a prorated amount based on which day of the month you cancel. Also, you cease being eligible for an ACA subsidy the moment you're eligible for Medicare. I believe that's the case in the entire country.

My first day on Medicare began on a weekend, which didn't help. I got my cancellation date retroactively moved back thanks to a helpful person in the state Attorney General's office. I got repeated bills from my ACA insurer, Blue Cross, until I got the cancellation date sorted out.

Thanks! We use the federal marketplace and we will call a couple of weeks ahead and ask how they want us to do it to make sure we get it right. I will update on the other side...

 

[Sue J]

When we went through this in 2020 I called the marketplace on Feb 1 to cancel my policy because that's the day my Medicare started. DH was still on the Marketplace plan for 2 more months.

Because our income stayed the same but only one of us needed insurance our subsidy dropped quite a bit, making DH's cost much higher. In our case it was just for 2 months so not a big deal. I do remember paying his Marketplace premium for the month that his Medicare started and then it was refunded. He called and cancelled his plan on the first day that his Medicare was active, April 1st.

BTW, we are very pleased with Medicare compared to our years on Marketplace plans. Everything has been going smoothly in terms of claims. The best part is the deductible is $233/year compared to the $6,000+/year that we had with our Marketplace plans.

 

[pirsquared]

Thanks! Ours is through the Federal Marketplace also so I will call them 7-10 days ahead and see what they recommend. We do plan to pay our full June premium on time and let them sort it out later. I expect the cost will be about the same as we will lose both the premium and subsidy attributable to DH.

Small update: I called the federal Marketplace today and asked when I should remove my DH from our plan as he starts Medicare on June 1. They said to call back on May 31 or June 1. i have already paid for June so any adjustments will happen later. This is the federal Marketplace so state plans may have different rules.

 

[Beldar]

I should also mention that if you have any dental plan purchased thru the marketplace you will loose that also.

Prior to the switch (for me) I attended a seminar with the local SHIP office. Even if you don't take any prescription drugs don't forget to pick the cheapest part D plan. If you don't, the monthly penalty will kick in and it could get rather expensive say 10 years down the line. They gave a few examples of folks who needed pricey drugs in their mid 70s and the monthly premium to start part D at that age was rather pricey.

_B

 

[pirsquared]

I should also mention that if you have any dental plan purchased thru the marketplace you will loose that also.

Prior to the switch (for me) I attended a seminar with the local SHIP office. Even if you don't take any prescription drugs don't forget to pick the cheapest part D plan. If you don't, the monthly penalty will kick in and it could get rather expensive say 10 years down the line. They gave a few examples of folks who needed pricey drugs in their mid 70s and the monthly premium to start part D at that age was rather pricey.

_B

Thanks for the reminder about dental. Yes, DH will lose that as well. We are looking into a separate dental plan but we're not sure it's worth it.

He is signed up for Medicare A, B, D, and Medigap. So we should be all set once we get him successfully off our ACA plan.

 

[Rianne]

I called ACA and had the agent walk me through the process in detail. She was sharp and had all our personal medical information, our premium, our plan, our income, and our status. I was impressed. She was specific about the wording you use when you switch to medicare. I said, "Ok, on August 31 I call and say I want to cancel my ACA plan." Nooo!
Say "Take me off our plan and leave DH on the plan." Zipcode matters. In our zip code, his premium will stay similar, maybe a few $ differences.

 

[pirsquared]

I called ACA and had the agent walk me through the process in detail. She was sharp and had all our personal medical information, our premium, our plan, our income, and our status. I was impressed. She was specific about the wording you use when you switch to medicare. I said, "Ok, on August 31 I call and say I want to cancel my ACA plan." Nooo!
Say "Take me off our plan and leave DH on the plan." Zipcode matters. In our zip code, his premium will stay similar, maybe a few $ differences.

Thanks! I will make sure to use that specific wording also. I asked if I was supposed to call on June 1. The rep said yes, and then he said, "Or May 31." I asked if it mattered which one, and he said either is fine. So maybe I'll call late on the 31st. Apparently they are open 24/7.

 

[Rianne]

Thanks! I will make sure to use that specific wording also. I asked if I was supposed to call on June 1. The rep said yes, and then he said, "Or May 31." I asked if it mattered which one, and he said either is fine. So maybe I'll call late on the 31st. Apparently they are open 24/7.

They are open 24/7.

 

[pirsquared]

Thanks! I will make sure to use that specific wording also. I asked if I was supposed to call on June 1. The rep said yes, and then he said, "Or May 31." I asked if it mattered which one, and he said either is fine. So maybe I'll call late on the 31st. Apparently they are open 24/7.

So I called today (5/31) and was told that if we went ahead with the change then DH's policy would be canceled immediately. I said we really needed it to go until midnight tonight and then asked if I should call back tomorrow. The rep said that would be better. So now I am confused about why the rep from two weeks ago said that May 31 was fine. I assume any time tomorrow (6/1) is fine? They can't possibly expect me to call right at midnight tonight!

 

[pirsquared]

Thanks! Ours is through the Federal Marketplace also so I will call them 7-10 days ahead and see what they recommend. We do plan to pay our full June premium on time and let them sort it out later. I expect the cost will be about the same as we will lose both the premium and subsidy attributable to DH.

Small update: I called the federal Marketplace today and asked when I should remove my DH from our plan as he starts Medicare on June 1. They said to call back on May 31 or June 1. i have already paid for June so any adjustments will happen later. This is the federal Marketplace so state plans may have different rules.

So I called today (5/31) and was told that if we went ahead with the change then DH's policy would be canceled immediately. I said we really needed it to go until midnight tonight and then asked if I should call back tomorrow. The rep said that would be better. So now I am confused about why the rep from two weeks ago said that May 31 was fine. I assume any time tomorrow (6/1) is fine? They can't possibly expect me to call right at midnight tonight!

So I called back today and went through the whole process and then the rep confirmed the new premium amount and that it would begin on July 1. I said no, it needed to begin today (6/1) as DH started Medicare and I was told to call back today. After a lot of calm insistence on my part, she found a record of my 5/31 call and the notes from that rep stating what I had called for. Then I spent lots of time on hold before a different rep (apparently a supervisor) answered and said she would be escalating the issue to get the change retroactive to today. Someone will call me back if they have more questions; otherwise I will get an email stating the change is retroactive to 6/1.

The phone call was one hour and 21 minutes total. Very, very stressful

 

[pirsquared]

I went thru this myself just last week.

When I called a week prior to the date (May 1) to take myself off the ACA plan and leave DW on it, the agent told me to call on the date my Medicare coverage would start. They would not pre-schedule any adjustments.

On May 1st I called the marketplace again, and it was smooth sailing in just a few minutes. They told me DW's new premium, and a few days later the insurance company confirmed via letter.

Easy peasy. HTH

_B

I wish it had gone this smoothly for DH...

When we went through this in 2020 I called the marketplace on Feb 1 to cancel my policy because that's the day my Medicare started. DH was still on the Marketplace plan for 2 more months.

This is what I kept hearing from many sources.

I asked if I was supposed to call on June 1. The rep said yes, and then he said, "Or May 31." I asked if it mattered which one, and he said either is fine. So maybe I'll call late on the 31st. Apparently they are open 24/7.

The above was from my 5/18 call. I also called 5/31 and was told to call back on 6/1 (see below).

So I called back today and went through the whole process and then the rep confirmed the new premium amount and that it would begin on July 1. I said no, it needed to begin today (6/1) as DH started Medicare and I was told to call back today. After a lot of calm insistence on my part, she found a record of my 5/31 call and the notes from that rep stating what I had called for. Then I spent lots of time on hold before a different rep (apparently a supervisor) answered and said she would be escalating the issue to get the change retroactive to today. Someone will call me back if they have more questions; otherwise I will get an email stating the change is retroactive to 6/1.

The phone call was one hour and 21 minutes total. Very, very stressful

While the marketplace did approve the change retroactive to 6/1, we are still dealing with the fallout from their original error. The date is now correct on healthcare.gov and also correct with our insurance company, but Medicare still thinks his old insurance is active and thus they won't cover his June 7 appointment. After spending hours on hold with Medicare, the Marketplace, and our insurance company, it sounds like it may be figured out. The insurance company is mailing us an official cancellation notice for DH that we will then need to send in to Medicare. After that, things should run smoothly. Now I just need to get the doctor's office to hold off a few weeks on payment until we get this the rest of the way sorted out. It has been quite the process