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How to find health insurance for immigrant seniors

Medicare is not an option, but they can buy other coverage

Published: November 21, 2014 03:00 PM

Q. My 71-year-old mother-in-law recently immigrated to the U.S. to live with our family here in Michigan. Health insurance from my job takes care of me, my wife, and our two kids, but won’t cover her even though we will be supporting her financially. I looked on HealthCare.gov for insurance but it seems they only sell to people under 65, and she also can’t get Medicare right now. What can we do to find health insurance for immigrant seniors?

A. Actually, she can get insurance through HealthCare.gov (or any Health Insurance Marketplace), although until quite recently it looked like she couldn’t. When you went window shopping for insurance on HealthCare.gov a few weeks ago, you had to select the applicant’s age from a drop-down menu that topped out at age 64. That was highly, highly misleading because anyone who’s not on Medicare can buy insurance through the Marketplace at any age and always has been able to.

(If you’re curious, the reason it topped out at 64 was because that’s the age at which premiums, which rise steadily with age, max out. In other words, the premium for a 71-year-old is the same as for a 64-year-old. Still, that’s no excuse for a user interface that led many people, including you, to a wrong conclusion.)

The updated window-shopping tool corrects that problem. I just obtained a premium quote in Michigan for a 71-year-old with no problem whatsoever.

Here’s the deal for people who move to the U.S. when they are over 65. Like all “lawfully present” residents, they must have health insurance or face a fine—not to mention that at that age, they’re running a terrible financial risk by going uninsured.

But they aren’t eligible for Medicare until they’ve lived in the U.S. for at least five years. So in the meantime they can purchase Marketplace health insurance just like anybody else.

After the five years are up, they can join Medicare. But having never paid payroll taxes during their working years, they’re going to have to pay a premium for Part A, which is normally free. And it’s a substantial one: $407 a month in 2015, on top of the $105 a month that everyone pays for Part B.

At this juncture, they have a choice. They can either drop their Marketplace plan and enroll in Medicare. Or they can keep their Marketplace plan indefinitely. When your mother-in-law reaches that point, you’ll have to run the numbers to see which option is more affordable.

Now, a word about her Marketplace application. Because you’re supporting her, you’re going to be declaring her as a dependent on your 2015 tax return. That means that when she applies, she should tell the Marketplace she lives in a household of five people, but check the boxes that say that everyone but her gets coverage through an employer. The Marketplace will then calculate her individual premium tax credit, if any, based on your whole household’s income, and show her a list of available plans that she can enroll in.

Premium tax credits are available for someone in a five-person household if its Modified Adjusted Gross Income will be less than $111,640 in 2015. (Here’s more information about how all of this works.)

P.S. Prior to health reform, it was essentially impossible for a person over 65 to buy non-Medicare-related health insurance on the private market at any price.

—Nancy Metcalf

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