I Didn't Say "Simple"
Real World Case Illustrates My Point
Sometimes A Horse-and-Carriage Won’t Do
I would describe this person as a very practically-minded woman, with experience in dealing with companies (her former employer), and health insurance carriers. After a description of her facts, just take a look at the details that were required to even begin guiding her. This is a person that has been become Medicare-eligible just prior to turning 65 due to being award SSDI benefits. This is only an example: these layers exist for those who are considering retirement as well.
WHYOHWHY WOULD I SHARE THIS WITH YOU???
Medicare, by itself, is complicated, maybe or not. What is almost certainly complicated is that any combination of facts can put you straight down a wormhole, and the number of variables that need consideration increases exponentially. This doesn’t even begin to mention any financial planning implications, this is Medicare-only.
My comparison is to that of a car. You may simply not require a 400hp engine, you drive 20mph to bingo and church on the single paved road in your zip code. My point is that you may not know if that road has a sinkhole, or that the specific paved road sits in a tornado alley.
The point here is to increase the awareness of the types of issues and questions that you should raise. The problem, one that my own mother stated, more than a decade ago, “We don’t even know where to start to ask.”
Email sent is here. No her name is not here, y’all know me better than that, her name is Miss Nunya(business) to you. She lives in Texas, we didn’t talk about the Cowboys, this situation was challenging enough.
You have been awarded Part A and Part B with different coverage dates.
1. The reason that I am adding this text is that a Medicare-eligible person can not have BOTH an ACA compliant plan and simultaneously receive the APTC (Advance Premium Tax Credit).
2. You CAN have an ACA plan but NOT WITH the APTC. The issue here is that I do not know the “date” from which this takes effect.
3. In “theory,” my thought would’ve been the first date, i.e. November 1, 2023 (which will be on your Medicare card when you receive it). This will take some work by your CPA to resolve, I am not part of the IRS and not a CPA. It can be that I am not correct here (only an accountant after some further research can confirm this, I believe).
Medigap
a. In TX, you cannot be Medicare eligible prior to 65 AND obtain a Medigap policy. Part D access is unrestricted, that is not a problem.
b. HOWEVER, due to a very specific clause, that rule will change on Jan 1, 2025, and YOU CAN access Medigap. That said, the premium will be VERY high (but likely worth it, depending on the procedures or anticipated healthcare services you may receive between Jan 1 and Apr 30, 2025.
c. On May 1, you will have access to Medigap at the lowest available premium in your zip code, Jae will find and capture this for you, we would apply separately.
Now
A. It is very unlikely that you will resolve 1-3 easily, and almost impossible prior to November 1 (this was sent today, the call was today).
B. You have the right to enroll in Medicare Advantage between Nov 1 and Dec 31 and even starting on Dec 31 for a month, and then separately from Jan 1 through April 30 (using the Medicare Annual Election Period rules, but we will not likely use this path due to my observation in point b).
C. Jae can/will find the efficient solution. One of the carriers on possible plans will be from the same insurance company you currently have an ACA-plan with, which may/may not help from a documentation standpoint (although the carrier is an enormous organization).
D. One possible approach is to delay enrollment in any Medicare Advantage plan, but the financial downside “might be” that you would have to pay back the APTC, from date XXX (to be finalized due to points 1-3).
The future
i. I will find the Medicare Advantage plans available to you, to be in effect at any point between Nov 1 and Dec 31. These need to start on the 1st of a month. Note that this will be YOUR choice, Jae follows marching orders.
ii. I will find the Part D and Medigap combination that fits you to be in effect beginning on January 1 and report to you an estimate of the cost that would begin on May 1 (Medigap will be much lower, point c).
Whew! Ask anything, Jae
Miss Nunya has earned flowers from me, for simply understanding that there were a lot of moving parts. In return, she gets my blank check; access to time and every question that I answer, along with clear lines to specify what I cannot.
Other financial matters are more complicated than this. Why? The language and rules here are known, the terminology of Medicare is federally-governed, and therefore, universally-accepted. In other financial contracts (insurance, annuity, financial markets), that is simply not the case. Either the rules are fragmented or the language is company-specific and cannot be easily compared.