Families and individuals with ACA plans and receiving a subsidy are often overlooking or not being adequately notified that their subsidy will end or change when the individual turns 65 and becomes eligible for Medicare. This can have a major economic impact on the individual or family. The situation I ran into was with a family of three that was on a plan that cost in the neighborhood of $1,300 before their subsidy. With the subsidy, they were paying a little over $300. The problem was that five days before August 1 I had to get the husband to enroll in Medicare Part B and a Medicare Advantage plan, dis-enroll him from the ACA plan and have his spouse and son re-enroll in the marketplace based on a different subsidy level. The family claimed the marketplace or carrier never gave them any notification that they had to do anything. The family did not believe it at first, but after asking other sources they realized I was correct.
Going forward, they will be paying higher family premiums for their medical insurance. Since the subsidy calculator would be looking at two people versus three with the same household income, their subsidy will be reduced. This will cause their individual premiums for the spouse and child to increase. The husband will be paying $134 per month for the Part B premium. I am expecting that the $300 per month family premium will increase closer to $500 per month with the changes. It could be higher. If they did not make these changes, the marketplace could have come back and had them pay $500-$900 per month for subsidies that they were no longer eligible for. I am afraid that with brokers not receiving commissions on individual business, families and individuals, that consumers are not getting good advice on how to deal with this transition.
NAHU has advocated for communications sent to consumers via email, postal mail, or through the HealthCare.gov message center to also be sent to the broker of record, or, in the alternative, for the broker of record to be notified that a message has been sent to their client concerning their HealthCare.gov plan. This would better enable agents to act on behalf of their clients and prevent consumers from possibly overlooking important notifications regarding their coverage, such as notifications that they are aging into Medicare. This is still under consideration by the Department of Health and Human Services, and NAHU will continue to advocate for this added benefit to both agents and consumers in the marketplace.