Answer: Be advised that Pennie can also be referred to as the Affordable Care Act (ACA) or Obamacare. Unfortunately, those who are turning 65, or become eligible for Medicare prior due to being awarded Disability, no longer qualify for subsidies on Pennie plans. This rule can’t be avoided by not enrolling in Medicare Part B or simply continuing to utilize subsidies after becoming eligible for Medicare. Those who attempt either will find themselves in a bad situation once the IRS inevitably catches up with them.

Financial implications of continuing on a Pennie plan after age 65

In Sue’s case, she’s receiving $840 per month in Federal subsidies on her Pennie plan. Once 65, she’s eligible for zero. If she were to continue on her plan for just six months before the IRS discovered she shouldn’t have been getting subsidies, she’d owe back $5,040! Failure to pay in a timely manner can result in interest and penalties like late taxes. 

Times are hard for those on a fixed income like Sue, who is living on Social Security and a very small pension, so I understand her concerns. But there’s good news for those in this situation.  

Many qualify for other helpful programs when turning 65

I have an appointment with Sue in a couple of weeks. She definitely qualifies for at least one program that will ease some of her financial concerns, PACENET, a Pennsylvania program funded with the state’s lottery proceeds that helps those 65 and older with the costs of prescription drugs. The most Sue will pay for any brand name medication, once on PACENET, will be just $15. Generics will cost just $0, $5, or $8. She may also qualify to get her Part B paid for by the state. I will be analyzing that when we meet and apply for any and all programs she’s eligible for. 

Better coverage with Medicare can offset higher premiums

And even if Sue doesn’t qualify to get relief from the Part B premium, the good news is that she’s going to have significantly better insurance. Medicare and a Supplement virtually eliminate all medical bills. Often, people on fixed incomes can’t afford the $72 to $90 monthly premiums for a Supplement so they choose a low-cost Advantage Plan. The most popular HMOs and PPOs among our clients range from $0 to $20 per month, have no deductible, and come with valuable ancillary benefits, “extras’, that I guarantee Sue either needs or is spending a good amount of money on already. 

With no deductible compared to the $1,000 Sue has now, lower co-pays for medical services and prescriptions, and all the “extras,” there’s actually a very good chance she won’t be out of pocket any more money than she is with her Pennie plan. She may even come out ahead with all the no costs goods and services ancillary benefits can provide and how much medical care and prescriptions she needs. I will personally make sure she’s utilizing every dime of “extras” and will turn over every stone to find other areas where she can save money. 

There’s almost always a solution

The Health Insurance Store has been open since 2008. We’ve run into almost every tough situation imaginable. There’s almost no scenario that we can’t find a solution for, including Sue’s. Helping people like her is the best part of our job! 

I will walk Sue through what she needs to do to sign up for Medicare; disenroll her from the Pennie plan; apply for any state and federal programs she’s eligible for; explain the differences, pros and cons of Supplements and Advantage Plans; and help guide her to the direction that fits her health care needs and budget.

And once she’s enrolled, the staff and I will always advocate for her; ensuring she never pays erroneous bills, gets the care she needs and is entitled to in a timely manner, and support her if there are ever any issues or questions even remotely related to her policy. 

These services and more are always provided by The Health Insurance Store at no cost. If you would like to make an appointment or have any questions regarding this topic or any other related to Medicare, Supplements, Advantage Plans, individual or group health insurance plans, give us a call or reach out to me personally, Aaron@GetYourBestPlan.com.