My husband and I are currently purchasing a plan through the Individual Marketplace. My husband turns 65 next month, and I turn 61 next month. Will I be able to keep our current plan with subsidies while my husband enrolls in Medicare? What are our options?
Sofia in California
When your husband enrolls in Medicare, you will need to go to Covered California and report a “life change”. In your case, your life change is your husband qualifying for Medicare. He will drop out of your plan that you are currently buying. Your coverage will not change. You have the opportunity, when you have a life change, to choose a different health plan. Changing plans might make sense if you and your husband have different health needs, such as one of you has a chronic illness and the other does not. You also have the chance to change plans during open enrollment, which is every November for the following January first.
You are correct that your subsidies will change, but the amount that you pay each month might stay the same. This is a little tricky, so let’s go one step at a time. The health reform law sets a percentage of income that can be spent on health insurance; it’s a sliding scale based upon what percentage of Federal Poverty your income is. For example, if your income was $21,000 for your household of two (133% of Federal Poverty), you would pay up to 3% of your income for the “benchmark” plan. You would be spending about $53 a month for the benchmark plan (which is the second lowest cost Silver plan).
The government is paying everything above the $53 per month for your coverage. When you go from covering two people to covering one person, the 3% cap does not change; you would still be paying the $53 a month and the government pays the rest. It’s just that the government would be paying less to cover one person than it did to cover two people.
The end result is that you might pay the same for one person as you paid for two, if your income and your plan choice are such that you have hit the income-percent cap set by the law. Your next step is to go report the life change, and have Covered California recalculate your premiums.