Timing my Medicare application

[Focus]

The best laid plans often go awry...My 65th birthday is in October, so I was going to apply on Dec. 1 to start receiving Medicare on Jan. 1, 2026, allowing me to stay under the ACA for all of 2025. My premiums are essentially entirely covered by the ACA, thanks to the Inflation Reduction Act's enhanced tax credits that expire this year. But now, with all the workforce cuts and turmoil, I'm wondering if my Medicare application will be processed in time. Should I nix this optimal plan and apply earlier?

 

[SevenUp]

Have you looked at Changing from the Marketplace to Medicare | HealthCare.gov?

 

[FIREchief]

The best laid plans often go awry...My 65th birthday is in October, so I was going to apply on Dec. 1 to start receiving Medicare on Jan. 1, 2026, allowing me to stay under the ACA for all of 2025. My premiums are essentially entirely covered by the ACA, thanks to the Inflation Reduction Act's enhanced tax credits that expire this year. But now, with all the workforce cuts and turmoil, I'm wondering if my Medicare application will be processed in time. Should I nix this optimal plan and apply earlier?

I believe that your premium subsidies will end the month before you become eligible for Medicare. If you don't report that to the exchange, you will owe them back when you file your 2025 tax return.

 

[MichaelB]

You are no longer eligible for premium tax credit or any other premium assistance once you turn 65 and become eligible for Medicare. Medicare B plus a supplement must be substantially less expensive than an individual policy at full price. See here

You may be allowed a Premium Tax Credit if:​

• You or a tax family member enrolled in health insurance coverage through the Marketplace for at least one month of a calendar year in which the enrolled individual was not eligible for affordable coverage through an eligible employer-sponsored plan that provides minimum value or eligible to enroll in government health coverage – like Medicare, Medicaid, or TRICARE.

 

[Focus]

Hmmm. My understanding (supported by a Medicare advisor) was that my tax credits would end once my Medicare A coverage started -- not necessarily upon turning 65. But as you say, that IRS language seems to indicate that once I'm eligible for Medicare at 65 the tax credits go away. Looks like my original plan would not have worked anyway and I should apply for Medicare three months before my birthday.

 

[engineernerd]

The best laid plans often go awry...My 65th birthday is in October, so I was going to apply on Dec. 1 to start receiving Medicare on Jan. 1, 2026, allowing me to stay under the ACA for all of 2025. My premiums are essentially entirely covered by the ACA, thanks to the Inflation Reduction Act's enhanced tax credits that expire this year. But now, with all the workforce cuts and turmoil, I'm wondering if my Medicare application will be processed in time. Should I nix this optimal plan and apply earlier?

If you are eligible for premium-free Medicare Part A, as most people are, you can only get ACA subsidies through the month before you turn 65. Full stop. Unless your birthday is the 1st of the month (Oct 1), then they transition you one month earlier, meaning your Part A starts Sept 1 and your ACA subsidy ends Aug 31.

 

[engineernerd]

Hmmm. My understanding (supported by a Medicare advisor) was that my tax credits would end once my Medicare A coverage started -- not necessarily upon turning 65.

They make your Part A coverage retroactive, up to 6 months (but not earlier than Oct 1 or Sept 1 as discussed above). If you miss your one-time 7-month application window then you'll pay more for the rest of your life.

 

[FIREchief]

Hmmm. My understanding (supported by a Medicare advisor) was that my tax credits would end once my Medicare A coverage started -- not necessarily upon turning 65. But as you say, that IRS language seems to indicate that once I'm eligible for Medicare at 65 the tax credits go away. Looks like my original plan would not have worked anyway and I should apply for Medicare three months before my birthday.

Probably best not to get tax advice from a Medicare advisor. The IRS instructions are very clear.

 

[MBSC]

Hmmm. My understanding (supported by a Medicare advisor) was that my tax credits would end once my Medicare A coverage started -- not necessarily upon turning 65.

You need a new Medicare advisor if they don't know Part A is retroactive after age 65 and 0 months.

Part A coverage begins the month the individual turns age 65, provided he or she files an application for Part A (or for Social Security or RRB benefits) within 6 months of the month in which he or she becomes age 65. If the application is filed more than 6 months after turning age 65, Part A coverage will be retroactive for 6 months.

Original Medicare (Part A and B) Eligibility and Enrollment | CMS

This page contains information on Medicare Part A and Medicare Part B eligibility and enrollment. For more information about Medicare for people who are still working, go to our Employer page or I’m 65 and Still Working page.

www.cms.gov

 

[Flieger]

This is very timely as I just posted elsewhere that I would try to game ACA for a Sept Bday to keep ACA until the end of the year.

Flieger

 

[Sarah S]

I live in Massachusetts. I had ACA without subsidies prior to Medicare which I started as soon as I was able ( midyear/ June). I had stopped my aca effective the end of May. A few weeks into June I got a letter saying my aca was terminated because I was eligible for Medicare. Not oh well see you have medicare so stopping aca. As I said it wasn’t a matter of subsidies as I had none. Maybe Massachusetts is different. Maybe despite the wording it happened because I did have medicare.

 

[Focus]

They make your Part A coverage retroactive, up to 6 months (but not earlier than Oct 1 or Sept 1 as discussed above). If you miss your one-time 7-month application window then you'll pay more for the rest of your life.

My plan may have turned out to be totally flawed, but it did not involve missing the seven-month application window! That much I got right.

Based on what I'm reading, if you apply after your birthday the Part A coverage is retroactive for premium-free (which is what most of us have), but it starts the month after applying for the premium Part A as well as Part B.

 

[Focus]

This is very timely as I just posted elsewhere that I would try to game ACA for a Sept Bday to keep ACA until the end of the year.

Flieger

Glad it helped to find out there's no game for us to play. I'm grateful the well-informed folks of this forum set me straight, because if I had trusted the (highly recommended) Medicare broker's info, things would not have turned out well.

 

[AllDone]

I turned 65 in June 2024. A month or two before that, I got a letter from Covered California (the ACA marketplace) reminding me that my ACA coverage would terminate on the May 31.

 

[Chuckanut]

I've known several people who delayed enrolling in Medicare usually for some economic reason. Two got caught in the same trap. A sickness came out of nowhere. Then the person found out that their insurance company doesn't cover people eligible for Medicare, whether they enrolled in Medicare or not.

On person who was still working found out the employer's health plan automatically switched her to a Medicare supplement plan on the expectation she would sign up for Medicare. But, she never bothered to read the information they had sent her. OOPS!

 

[audreyh1]

I've known several people who delayed enrolling in Medicare usually for some economic reason. Two got caught in the same trap. A sickness came out of nowhere. Then the person found out that their insurance company doesn't cover people eligible for Medicare, whether they enrolled in Medicare or not.

On person who was still working found out the employer's health plan automatically switched her to a Medicare supplement plan on the expectation she would sign up for Medicare. But, she never bothered to read the information they had sent her. OOPS!

This would be my biggest concern. And you might not be able to get an accurate answer from the insurance company. I think you have to assume your ACA insurance no longer covers you once you turn 65 since ACA was specifically created for folks not yet eligible for Medicare.

 

[FIREchief]

I think you have to assume your ACA insurance no longer covers you once you turn 65 since ACA was specifically created for folks not yet eligible for Medicare.

It may cover you for the remainder of the current year, but any premium subsidies will end or need to be paid back at tax time.

 

[a60dan]

The best laid plans often go awry...My 65th birthday is in October, so I was going to apply on Dec. 1 to start receiving Medicare on Jan. 1, 2026, allowing me to stay under the ACA for all of 2025. My premiums are essentially entirely covered by the ACA, thanks to the Inflation Reduction Act's enhanced tax credits that expire this year. But now, with all the workforce cuts and turmoil, I'm wondering if my Medicare application will be processed in time. Should I nix this optimal plan and apply earlier?

My NY Essential Plan gave me 45 days notice that my plan was terminated at the END of the month I turned 65.

Had I known this, I would have tried to start my Medicare start then, not at the BEGINNING of the month I turned 65.

By the time I realized this, it was too late to delay Medicare by a month.

I then tried to cancel the NY plan sooner, but they said to “use one plan or the other, but not both”

 

[sengsational]

One minor money saving play that I did with my wife was to delay the start date of the Medicare Supplemental policy. I'm not sure of the exact dates, but she wasn't (and still isn't) going to the doctor for anything, so I dragged my feet signing her up for Medigap. Not that it made THAT much difference...a few months of Medigap premiums isn't much. I couldn't wait too long or the no underwriting provision would expire.

 

[Murph]

The best laid plans often go awry...My 65th birthday is in October, so I was going to apply on Dec. 1 to start receiving Medicare on Jan. 1, 2026, allowing me to stay under the ACA for all of 2025. My premiums are essentially entirely covered by the ACA, thanks to the Inflation Reduction Act's enhanced tax credits that expire this year. But now, with all the workforce cuts and turmoil, I'm wondering if my Medicare application will be processed in time. Should I nix this optimal plan and apply earlier?

I just went through this same scenario last year. You won't be able to do what you plan with the ACA & Medicare. I recommend you begin your Medicare application in early August, and it will be effective October 1. Near the end of September, proceed to discontinue your ACA coverage on Sept 30. Sorry. The only thing that has any wiggle room is a Medigap plan (if you are planning to get one).