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Reply to ACA and Medicare Question     
Old 09-12-2017, 09:13 AM   #1
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ACA and Medicare Question ACA and Medicare Question
I had a 70 year gentleman call me about his options for coverage. He has always been a self pay guy....does not believe in insurance. he has Medicare Part A....and never got B. If he wants B, he has to wait until Jan to apply, and then Part B will start in July, with a penalty.

He was just diagnosed with stage 4 pancreatic cancer, and assumes he will be dead by July...so Part B will do him no good by then.

The question is, since he only has Part A, could he buy an ACA plan at full price from someone during open enrollment. I know you can get ACA at any age, but generally the question is are you eligible, or do you have Medicare. He only has part of it....and will likely benefit from Part B or ACA....else, I just feel sorry for him.

The wife, unbelievably, somehow signed up for ACA when she was 66.....and now learned that it was a mistake, so I can get her unto Medicare next year....as she will still be alive. She never applied for A or B.

Some people are just clueless when it comes to their options.

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Herman Bruns
Atlanta, GA
404-272-9249

[email protected]
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Old 09-12-2017, 10:23 AM   #2
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ACA and Medicare Question Re: ACA and Medicare Question
https://www.cms.gov/Medicare/Eligibi...8-28-14_v2.pdf

page 4

You can't sell him the ACA plan. He can't reject the Medicare without also having to repay his social security benefits to date and anything Medicare has paid on his behalf.

This guy is in trouble.
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Old 09-12-2017, 10:52 AM   #3
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ACA and Medicare Question Re: ACA and Medicare Question yankee466 is the thread starter for: ACA and Medicare Question

Originally Posted by TN_agent View Post
https://www.cms.gov/Medicare/Eligibi...8-28-14_v2.pdf

page 4

You can't sell him the ACA plan. He can't reject the Medicare without also having to repay his social security benefits to date and anything Medicare has paid on his behalf.

This guy is in trouble.
Thanks.....I assumed that was the answer. No idea if he collects social security or ever made a medical claim on part A.
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Old 09-12-2017, 05:19 PM   #4
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ACA and Medicare Question Re: ACA and Medicare Question
Originally Posted by yankee466 View Post
Thanks.....I assumed that was the answer. No idea if he collects social security or ever made a medical claim on part A.
I had similar case, when the wife made mistake and didn't do the documentation right, so her husband who was with all kind of medical issues, was left without part B. In this case they can bay through ACA and the medical from there will cover what part A doesn't plus medications. Yes, you can go this way.
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Old 09-12-2017, 05:43 PM   #5
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ACA and Medicare Question Re: ACA and Medicare Question yankee466 is the thread starter for: ACA and Medicare Question

Originally Posted by ARus View Post
I had similar case, when the wife made mistake and didn't do the documentation right, so her husband who was with all kind of medical issues, was left without part B. In this case they can bay through ACA and the medical from there will cover what part A doesn't plus medications. Yes, you can go this way.
Well now....there is a real conflicting answer from the first responder who provided documents showing it can NOT be done. Is the assumption still that he MUST drop Part A or do you think Part A alone does not count as credible coverage?

This sounds like the good old ask three people and go with the first two answers that match!!!!

Dare I call the marketplace and ask an idiot?
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Last edited by yankee466; 09-12-2017 at 05:49 PM.
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Old 09-12-2017, 06:09 PM   #6
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Dave020 on ACA and Medicare Question
 
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ACA and Medicare Question Re: ACA and Medicare Question
Can I get a Marketplace plan in addition to Medicare?
No. Its against the law for someone who knows that you have Medicare to sell or issue you a Marketplace policy. This is true even if you have only Medicare Part A or only Part B.
https://www.healthcare.gov/medicare/...e-marketplace/

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Old 09-12-2017, 06:24 PM   #7
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ACA and Medicare Question Re: ACA and Medicare Question
Yep, I saw it. But was a real case 3 years ago and was resolved exactly this way, until the client was able to obtain Part B.
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Old 09-13-2017, 02:09 PM   #8
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ACA and Medicare Question Re: ACA and Medicare Question
I don't think they had the database in place 3 years ago to check on this through the exchange. I also had one sneak through (telling me he wasn't on Medicare A when he really was), then this past year the exchange caught him and made him prove he wasn't on Medicare (which he couldn't prove of course because he was on it). That is probably how he was able to get away with it previously. But, not anymore.

Any private carrier off-ex is going to require proof that he is not enrolled in Medicare (or a legal attestation which if the OP's client answered no to being on Medicare would be committing fraud) before they will put the coverage into effect.

I would not risk selling an ACA policy to the man. He doesn't believe in insurance anyway.
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