Frequently Asked Questions about the Affordable Care Act (ACA)

Click on any of the frequently asked questions about the Affordable Care Act below to see an answer from HealthKY.com.

Retirees

What if I’m retired but not eligible for Medicare?

If you’re retired without coverage, you may use the Health Insurance Marketplace to buy health insurance. If you don’t have coverage you may have to pay a fee.

I’m a retired Veteran collecting VA pension and benefits. Are those benefits counted in determining my eligibility for subsidies in the Marketplace?

Yes, VA pension benefits, like Social Security benefits, are counted as income in determining eligibility.

I’m 62 and already collecting Social Security. Are my Social Security benefits counted in determining my eligibility for subsidies in the Marketplace?

Yes, Social Security benefits are counted as income in determining eligibility for premium tax credits in the Marketplace.

I’m 63 and enrolled in a retiree health plan from my former employer. Can I look for better coverage and subsidies in the Marketplace?

Yes, as long as you do so during the Open Enrollment period.

People with employer-provided retiree health benefits should know that most early retiree health plans are considered qualified health plans, and thus meet an individual’s requirement for coverage.

If you are enrolled in such coverage, you can also look at coverage options through the Marketplace, and if your income is between 100% and 400% of the Federal Poverty Level, you may qualify for premium tax credits. However, there’s one exception. Some employers may provide retired employees with access to an account, called a health reimbursement arrangement or HRA, that the retiree may use to reimburse medical expenses, including an individual policy through a Marketplace or in the non-group market. A retiree that signs up for an HRA offered by a former employer is considered to have minimum essential coverage from an employer and would therefore would not be eligible to claim a premium tax credit if he or she enrolled in a Marketplace plan.

Remember that outside of Open Enrollment, you cannot voluntarily drop your retiree coverage and replace it with other coverage.

I’m 63 and about to retire. I’ll be offered a retiree health plan. Can I look for better coverage and subsidies in the Marketplace instead?

Yes. Most early retiree health plans are considered qualified health plans, and thus meet an individual’s requirement for coverage. However, if you want to obtain coverage through the Marketplace, you may do so, and if your income is at or below 400% of the Federal Poverty Level, you are eligible for premium tax credits. Eligibility for retiree coverage will not affect your eligibility for Marketplace coverage and subsidies.

My spouse is an early retiree with affordable retiree health benefits from his former employer, but I’m not eligible to be on his plan. Can I apply for coverage and subsidies in the Marketplace?

Yes, assuming you meet the other requirements, you can apply for health plans and premium tax credits in the Marketplace. Your spouse’s eligibility for early retiree coverage will not affect your ability to seek coverage and financial help in the Marketplace.

I’m 63 and my husband is 65 and on Medicare. Our income is less than 400% of FPL so I need help affording the premium in the Marketplace. Can we count what my husband has to pay for his Medicare premiums and supplemental and Part D premiums against what I will be required to contribute toward coverage in the Marketplace?

No. Your eligibility for premium tax credit subsidies and the amount of your premium tax credit will be based on your family income. The amount your husband pays for his Medicare, Part D, and supplemental insurance premium costs will not be taken into account.