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.
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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

Q & A from Medicare Page


If one is 65 plus, can they get subsidies in Covered CA?

If you don’t qualify for Premium Free Part A, yes you can qualify for Covered CA subsidies.  See our webpage for more detail.  



. My father and mother have had Covered CA Silver 94 PPO plan, with APTC – Advanced Premium Tax Credit since ACA – ObamaCare  went into effect. Their income is below FPL – Federal Poverty Level but through two years of consecutive appeals hearing, the Judge had ordered Covered CA that they are eligible for APTC since they are not eligible for non-MAGI Medi-Cal (since both my dad and mom are above 65, and have assets more than Medi-Cal limits, and they cannot spend down).

***But does the IRS agree with that when they file 1040 and 8962 Premium Tax Credit

I would like to see that order.

Both my dad and mom have been legal permanent residents (green card) at the time of the appeals in 2016 and in 2015. They are eligible for Medicare but are not eligible for premium-free Medicare, and Covered CA did send them a letter stating that people who are not eligible for premium-free Medicare and who dont enroll in Medicare could be eligible for APTC. Just like last two years, again for 2017, Covered CA has told them that we are not eligible for APTC for 2017 coverage. My dad became a US citizen late 2016. But they continue to be ineligible for Medi-Cal, or premium-free Medicare. And without APTC,

***What if they just take the credit when they file their taxes at the end of the year?

they cannot afford to get an affordable minimum qualified health plan – minimum essential coverage.

They have filed for an appeal, but if you can point us to any sections of the ACA, or Federal Code of Regulations

***CFR  §1.37-1   General rules for the credit for the elderly.   *   §1.37-2   Credit for individuals age 65 or over.

or California regulations, or special rules/clarifications, or IRS notes that we can represent to the judge during our hearing, it would be really helpful.

It is strange that while they would be eligible for APTC as non-citizen aliens (as decided by the Judge last 2 years), their becoming a citizen makes it worse for them.

***How so?

I think Covered CA is getting too expensive. I’m thinking of enrolling and paying for Part A, then Part B like everyone else, then enrolling in Medi Gap and Part D. What are the costs? Pros & Cons?

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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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