Whoops, Prospect Didn't Drop ACA Plan at T65, Part A Sign Up

yorkriver1

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Virginia
My question is, does the prospect have any appeal, such as low income, for the clawback of his subsidy that should occur from the time he T65/became eligible for Medicare A? (p. 31, Medicare and You 2015, subsidy/CSR end when eligible for Medicare Part A) I know there is an exception to penalty/clawback if household income falls below poverty level, but for this mistake, not so sure.

He kept the ACA plan and declined Medicare B, thinking he liked the current ACA plan at $25/mo & very low CSR better than Medicare B at $104.90/mo.

The clock has ticked by each month on several hundred dollars subsidy. I helped him do online app for Low Income Subsidy for Medicare D, and the app will roll to Social Services for further help on Medicare B premium. Income level looks to qualify for LIS and QI level on Medicare Savings Program, pays for Part B. Can't enroll in a Medicare Advantage plan until Part B set up.
Most importantly, LIS gives a free pass on late enrollment penalties for Medicare part B and D, and a SEP to enroll in Part B/D.
 
Very good question.

Keep us posted here as to the outcome.

I would imagine that with everything being so new and the confusion they would waive any potential clawback penalty for medicare beneficiaries. However the law states no subsidy if medicare eligible. They might waive it this year but I doubt they would next year.
 
My gut says he'll be subject to a clawback of subsidies for the months he received them and was ineligible, limited by his current FPL level. I doubt they'll waive all penalties for a year, and highly doubt they'd waive one class of penalized Americans.

Ultimately, the marketplace agreement your client signed states that he would be responsible for notifying the exchange about any change in eligibility. He didn't, and the motivation for doing so is irrelevant.
 
did you advise the client when notified of the t65 situation? if so you did your job... I assume you have recorded all calls to back up your advice...

I don't worry about recording my own calls....I'll just ask the NSA for a copy if I need one.
 
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