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?

  • By
  • healthinsurance.org contributor
  • November 3, 2015

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 US long enough. Can they get individual health insurance in the exchange?

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

During the 2015 open enrollment period, one percent of private plan enrollees in the 37 states that used Healthcare.gov were 65 or older.

Section 1882 (d)(3) of the Social Security Act states that it is unlawful to sell private health insurance to a person who is eligible for 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.

Before Obamacare, age was a limiting factor for eligibility in the individual market, just like pre-existing conditions. 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 will be charged no more than three times as much as applicants in their 20s.

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 a regularly scheduled open enrollment period. For 2016 coverage, open enrollment runs from November 1, 2015 to January 31, 2016.

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