Find a plan.
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.

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.

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?

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.

Related articles

For refugees and people who have been granted asylum in the United States, there are fairly robust health coverage benefits available.
Planning a trip abroad? Or just to another state? Here's what you need to know about staying covered while you're trotting the globe.
In most cases, you need to be living in a state in order to apply for insurance in that state (although it's possible to obtain coverage even if you don't ...
Let’s take a look at the health insurance options for immigrants, and how they’ve changed – or haven’t changed – under the Affordable Care Act.
Becoming a U.S. citizen, U.S. national, or lawfully present resident is a qualifying event that triggers a 60-day special enrollment period in the exchanges.
The Trump administration’s 'public charge rule' and favored Medicaid work requirements have been stayed by federal courts. Will those rulings hold?
0 0 votes
Article Rating
Subscribe
Notify of
guest
14 Comments
Oldest
Newest Most Voted
Inline Feedbacks
View all comments
Paul
Paul
5 months 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
5 months 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
4 months 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
4 months 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 months 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
4 months 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/

Susan P.
Susan P.
4 months ago

I have recently returned to the USA after many years in Europe. I have Part A Medicare. Is there some insurance alternative to the huge penalty I would have to pay to join Part B since I didn’t sign up at 65 when retired in 2006 . I lived and worked in Europe until retirement and I had German national health insurance for retirees.

Louise Norris
Editor
4 months ago
Reply to  Susan P.

We advise you to contact the Social Security Administration to see if it’s possible that your coverage in Germany might exempt you from the Part B late enrollment penalty. According to the Medicare Rights Center, working in a country with a national health system can make it possible to get a Part B special enrollment period (without a penalty) as long as you enroll within 8 months of losing your health coverage in the foreign country: https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/medicare-and-living-abroad/medicare-coverage-for-those-who-live-abroad-but-plan-to-move-back-to-the-united-states-or-travel-back-frequently
It’s widely understood that having employer-sponsored coverage as an active employee (not retiree coverage or COBRA) will allow a person to delay Part B, regardless of whether they’re living in the U.S. https://www.medicareresources.org/medicare-eligibility-and-enrollment/why-you-cant-afford-to-get-medicare-part-b-wrong/ But that Medicare Rights Center page indicates that this could also be an option in a situation like yours, so it’s definitely worth double-checking with the SSA.

Al Tash
Al Tash
3 months ago

I am a US resident with green card who turned 65 10 months ago. I missed the 8 month enrollment period due to covid-related delays waiting for my original birth certificate to be mailed from my birth country. I finally got it and applied, but now my Medicare Part B coverage won’t begin until 9 months from now. I am without insurance now. What can I do to get coverage sooner?

Louise Norris
Editor
3 months ago
Reply to  Al Tash

Although this won’t be helpful for your situation, Medicare will have the opportunity to grant special enrollment periods for exceptional circumstances starting next year: https://www.medicarerights.org/medicare-watch/2021/01/07/key-benes-act-provisions-signed-into-law

If you’re also waiting for Part A (ie, you’re not eligible for premium-free Part A and also have a delay before it takes effect), you would be able to enroll in a plan through the marketplace in your state until your Medicare takes effect. But unfortunately, enrollment in those plans is limited to the fall open enrollment period (with coverage effective January 1) or special enrollment periods triggered by qualifying life events. Here’s an overview of special enrollment periods, in case you might qualify for one: https://www.healthinsurance.org/special-enrollment-guide/why-you-need-this-book/

Otherwise, your best bet might be a non-ACA-compliant plan such as short-term coverage, or a fixed indemnity plan, possibly combined with a direct primary care membership. None of these options are ideal, but you might find that they’re better than nothing while you’re waiting for Medicare to take effect.

Mercedes
Mercedes
3 months ago

This a great site.
My Mom (67 years old) is planning to live in US. What alternatives she have to be enrolled in a health plan? She needs diabetes treatment. She will be based on California oand/or Nebraska. Do the state makes any difference?
Thanks so much for your help

Louise Norris
Editor
3 months ago
Reply to  Mercedes

Assuming she won’t be eligible for premium-free Medicare Part A (meaning she or her spouse does not have 10 years of work history in the US), she will be able to enroll in a health plan through the marketplace. And premium subsidies (premium tax credits) may be available, depending on her income.

California runs its own marketplace (Covered California) while Nebraska uses the federally-run marketplace at HealthCare.gov. So the specific plans available to her will be different depending on which state she chooses. But eligibility for coverage and premium tax credits will be the same in both states.

Franklin P
Franklin P
2 months ago

Hi Louise,

If my parents, legal permanent residents > 5 years, move to the US and do not work because of their ages. Is my understanding correct that they may be eligible for Medicaid (Medi-Cal in CA)?

Also, I am even less familiar with Medicaid than I am with ACA, but I have heard that in-patient service for Medicaid patients is not as good (from room and doctors perspectives) as if you come in with an insurance, is that true? Do you know where I’d be able to find information on this for Medi-Cal?

Thank you very much.

Louise Norris
Editor
2 months ago
Reply to  Franklin P

Hi Franklin,

California has recently expanded Medicaid coverage for older adults, regardless of immigration status: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/OlderAdultExpansion.aspx So I believe the five-year wait is no longer necessary in California, if they qualify for Medi-Cal based on income.

If they want to purchase a private plan in the marketplace (Covered California), that’s an option as well. They could potentially qualify for premium subsidies, since they wouldn’t be eligible for premium-free Medicare Part A (I assume they don’t have a work history in the US? If that’s the case, they aren’t eligible for premium-free Medicare Part A). But premium subsidy eligibility is based on income, and subsidies are not available to people who are eligible for Medicaid. So if your parents end up being eligible for Medi-Cal, they would not be eligible for subsidies in the marketplace. They could still purchase a marketplace plan instead, but would have to pay full price.

Depending on where they are in California, Medi-Cal may enroll them in a managed care plan, or in a County-Organized Health System. Here’s more about that: https://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/OAE/Older-Adult-Expansion-FAQ.pdf I would recommend checking with the local Medi-Cal office to see what their network of hospitals and doctors would be, so that you can get an idea of the coverage they would have if they enrolled in Medi-Cal, assuming they’re eligible.

14
0
Would love your thoughts, please comment.x
()
x