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My parents are 68, but recently moved to the U.S., so they don’t qualify for Medicare. Can they buy insurance in the exchange?

If your parents are 65 or older, but don't qualify for Medicare because they have not lived in the U.s. long enough, they can purchase a private plan in the marketplace and can receive cost-sharing and premium subsidies if they are eligible based on income.

Q. My parents moved to the United States last year. They have been using a travel health insurance policy, but it will expire soon. They are both 68 years old, but do not qualify for Medicare because they have not lived in the U.S. long enough. Can they get individual health insurance in the exchange?

A: Yes. Since your parents are not eligible for Medicare, they can purchase a private plan in the exchange (marketplace), and can receive cost-sharing reductions and premium subsidies if they are eligible based on income.

Section 1882 (d)(3) of the Social Security Act states that it is unlawful to sell private health insurance to a person who is entitled to Medicare, but that rule is based only on Medicare eligibility, not age. And as your question demonstrates, not everyone who is 65 or older is eligible for Medicare. [For additional information, this FAQ sheet from CMS is helpful in understanding the rules regarding individual market coverage and Medicare.]

Individual-market plans no longer drop enrollees at age 65

Before the Affordable Care Act (Obamacare), age was a limiting factor for eligibility in the individual market, just like pre-existing conditions. Insurers typically only allowed people up to about 64.5 years old to enroll in coverage, and coverage was terminated for members who turned 65. But that is no longer the case. For applicants 65 or older, the exchange may require a Medicare application appeal in order to be certain that Medicare is not an option. Assuming that’s the case, the application will then be processed just as it would for a person under age 65.

The ACA limits premiums for older applicants to three times as much as premiums for younger applicants. So eligible enrollees age 65 and older are charged no more than three times as much as applicants in their 20s. And again, premium subsidies are available, depending on income, for people of any age.

Be aware that most travel insurance policies do not qualify as minimum essential coverage under the ACA. As such, their expiration is not considered a qualifying event that triggers a special open enrollment. So your parents will need to make sure that they enroll in a permanent plan during the annual open enrollment period.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Paul
Paul
1 month ago

Is there any option to enrolling in part B for me now age 67 living overseas after I missed the Jan-March enrollment period (which goes up 10% every year I don’t enroll, another ripoff), this seems so unfair. I’ve lived in Thailand over 14 years and want to move this summer all I have is Part A. Why should I have to wait until Jan of 2023 to enroll in Part B? I’m sure private insurance would be insanely expensive until I would be able to get Part B July 2023 (after I enroll in part B in Jan-March 2023) is there any options for someone in my situation, or do I just have to pay cash and take the risk I don’t have a major illness?

Louise Norris
Editor
1 month ago
Reply to  Paul

Paul,
Under the BENES Act, people who enroll during the January-March enrollment window will no longer have to wait until July to have Part B, as of 2023. Instead, it will take effect the month after enrollment. So if you sign up in January 2023, you’ll have Part B as of February 2023.
If you have been covered under an employer-sponsored health plan as an active employee (or under your spouse’s active employee plan), you would be able to enroll in Part B as soon as that coverage ends, or anytime before that, or anytime in the 8 months after that. But otherwise, yes, you will most likely have to wait until January to enroll in Part B.

Katie
Katie
18 days ago

How is income for immigrant parents calculated for the healthcare exchange purposes? Is it only for the parents, or does the income of the sponsoring child and their family get included? Essentially, are the parents considered dependents and part of the household, or their own household?

Louise Norris
Editor
13 days ago
Reply to  Katie

Subsidy eligibility is based on household income for the enrollee, as determined by the tax return they’re going to file for the year in question. The adult child’s household income would only be counted if the immigrant and the adult child file one tax return together. So if the adult child claims the parents on their tax return as a qualifying relative, then the adult child’s household income would also be counted when their subsidy eligibility is determined. But if the parents file their own tax return, only their own income would be counted. Here’s more about health insurance for immigrants over the age of 65: https://www.medicareresources.org/faqs/can-recent-immigrants-to-the-united-states-get-health-coverage-if-theyre-over-65/

rosanna
rosanna
4 hours ago

i’m an american citizen leaving in Italy and covered by the italian health care system, can I purchase a medical insurance on the Obama care act if I plan to come back to the US for couple months a year? Thanks

Louise Norris
Editor
32 minutes ago
Reply to  rosanna

To enroll in a health plan through the marketplace (exchange), you must have an address in the US, and apply through the marketplace in that state. If you have a US address, you can enroll in a health plan during open enrollment (November 1 to January 15 in most states) and keep it year-round, even if you’ll only use it during the time you’re in the U.S. (Note that in order to qualify for premium tax credits, you’d need to file a tax return in the U.S.)

If you’re trying to enroll outside of open enrollment, you need a qualifying event. Moving to the US from a foreign country is a qualifying event, but it does have to be considered a move rather than a vacation. Here’s more about that: https://www.healthinsurance.org/special-enrollment-guide/how-your-big-move-can-trigger-an-sep/

If neither of these will work, a travel insurance policy might be your best bet. Travel insurance is not regulated by the ACA (Obamacare), but the plans are available for exactly the sort of scenario you’re describing. Here’s more about how these plans work: https://www.healthinsurance.org/other-coverage/dont-forget-to-pack-travel-health-insurance/

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