Can someone over 65 ineligible for Medicare – as they have not lived in the USA five years so they can buy in to coverage  get the advance premium tax credit?

What if they have to pay for Part A?

 We believe they can, after weighing the research below:


Q  I entered the U.S. lawfully and I’m over 65, but I don’t qualify for Medicare. Can I apply for coverage and subsidies in the Marketplace?

Yes, you can purchase Marketplace coverage and qualify for subsidies based on your incomeKFF

Individuals must also not have an offer of affordable health insurance from an employer or from the government.

  • For Premium Assistance, you must be otherwise eligible and your annual household income must be between 138%* and 400% of the federal poverty level (FPL).
  • For Cost-Sharing Subsidies, you must be eligible for Premium Assistance and your annual household income must be between 138%* and 250% of the FPL. You may only receive cost-sharing subsidies if you enroll in a Silver-level plan.   Covered CA FAQ 102
  • Aetna 5.2016 Letter that when you get Part A you don’t get subsidies

Medicare Part A has a premium: However, if someone qualifies for Medicare but has to pay a premium for Part A and does not enroll in Medicare Part A, they may be eligible for a Covered California health plan. Depending on a consumer’s income, they may be eligible for premium assistance and cost-sharing subsidies for the Covered California health plan.  Covered CA – Medicare Info 

To be eligible for tax credits, an individual must:

  1. Be a U.S. citizen, U.S. national, or lawfully present immigrant who has purchased coverage through Covered California.
  2. Have an annual household income between 138%* and 400% of the FPL.
  3. Not be eligible for other public health coverage—including full-scope Medi-Cal, premium-free Medicare Part A, or military coverage—and must not have access to health insurance through an employer. …

Q. I’m over 65 but I don’t qualify for Medicare. Can I buy a plan on the exchange?

A: Individuals who are 65 years of age and over can purchase plans through Washington Health plan finder even if they are Medicare eligible. But they are only eligible for the tax credits if they are not Medicare eligible.

If a person is over 65, not Medicare eligible, and meets the other eligibility criteria, he or she could purchase a health plan and receive tax credits, too. Seattle Times

Who can buy health insurance through Covered California?

Legal California residents , except for currently incarcerated individuals and legal minors, are eligible to buy insurance through Covered California. Covered  Agent training Page 15 4.1.1

You’re over 65 but not eligible for Medicare. You are welcome to purchase a health plan from, the health insurance marketplace for Alaska. If you meet the qualifications based on income and family size, you are eligible for cost-saving subsidies, too.  Legal Consumer

Kaiser Foundation Subsidy Calculator Explanation

Code of Federal Regulations 1.36B-2 Eligibility for Premium Tax Credit Is not eligible for minimum essential coverage [Can’t get Medicare!]

26 USC §36B Refundable Credit for Coverage under a QHP Qualified Health Plan


If an applicant is eligible (exception to general rule)  for any of the following MECs but is NOT enrolled in the program at the same time he or she enrolls in a Covered California plan (i.e., no dual coverage), the applicant will be eligible for financial assistance, if otherwise eligible.  The MECs that fall under this exception include:

1.Medicare part A coverage requiring payment of premiums. Coverage offered under Medicare for which the individual must pay a premium for Medicare part A  coverage. LISI FAQ’s page 5
Over 65 and do qualify?  You will be getting a letter from Covered CA about that.
Learn More==>
Insure Me
Covered CA & Medicare dual enrollees may have to pay back subsidies Insure Me

FAQ’s Medicare & Covered CA

IRC §5000 A

Covered CA shows them eligible.  Click on images at right to enlarge

So does my quote engine for which I pay $200/month

Covered CA Calculation

Covered CA – Calculation
Covered CA

Kaiser Foundation Calculation
Kaiser Foundation Calculation

VIDEO  Medicare & the Market Place

Moulder Law – Flow Chart
Moulder Law - Flow Chart

FPL & Subsidy Calculation

Quote Engine – Input

2 Zip Code – Date of Birth  

6 comments on “Age 65 – Tax Credits?

  1. Hello – I am looking for medical insurance alternatives for my 78 year old aunt. She currently has Covered CA but I am interested to learn more. Thank you!

  2. I’m getting the tax subsidy, but now I’m thinking that I’m paying too much.

    How do I apply for Medicare and what are the cost and coverage differences?

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