I have been diagnosed with ESRD and will need a transplant.
I haven’t yet applied for Medicare.

Can I get a Covered CA – QHP- Qualified Health Plan – ObamaCare instead?

According to federal guidance, people with ESRD who have not applied for Medicare are eligible for premium tax credits if their income is between 100% and 400% of the federal poverty limit (FPL). This group can buy a Qualified Health Plan (QHP) Covered CA, instead of enrolling in Medicare. This federal guidance does not address the issue of someone with ESRD whose income is above 400% of the FPL and is ineligible for a premium tax credit and whether they can buy a QHP instead of Medicare. It also does not address the issue of whether a person in this situation whose income is between 100% and 250% of the FPL is eligible for any cost-sharing subsidy.

If you are considering a QHP instead of Medicare you should carefully compare all the costs and benefits associated with both a QHP and Medicare before making your decision. Please read the answer to #5 and 6. You should also know that if you do not enroll in Medicare Part A before you have a transplant, you will not be eligible for Medicare’s immunosuppressive medication benefit under Part B, even if you decide to enroll in Medicare later. In addition, you might be charged a late enrollment penalty and have a delay before benefits begin if you apply for Medicare in the future. For more help with this difficult decision, contact your local HICAP for assistance or ask your question in the  FAQs / Ask Us a Question below. You don’t have to put in your name.  Copied from ca health advocates.org/

 

You cannot buy additional coverage through Covered California if you have premium-free Part A. Policies sold through Covered California are intended to be primary coverage. Medicare is your primary coverage, and it is illegal for anyone to sell you coverage that duplicates your Medicare benefits.

NOTE: This information also applies to people younger than 65 whose benefits begin the first month they receive disability benefits because they have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s Disease, and to people younger than 65 who have Medicare because of a disability and are receiving Social Security Disability Insurance.

Obamacare PROHIBITS discrimination or different rates based on health!   ‘‘§2701 Page 37  HR 3590 FAIR HEALTH INSURANCE PREMIUMS.

Medicare Publication # 11694 Medicare & Covered CA

Click here for Individual ACA, Covered CA,
Obamacare Quotes for California
 

Obamacare PROHIBITS discrimination or different rates based on health!   ‘‘§2701 Page 37  HR 3590 FAIR HEALTH INSURANCE PREMIUMS.  * 

SNP Benefits 
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Chronic Condition Special Needs Plans  C SNP

Scan Foundation Summary on Chronic Care Act 

Forbes  * Commonwealth Fund - Social Services

home-delivered meals, transportation for nonmedical needs, pest control, indoor air quality equipment (e.g., air conditioner for someone with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs).    Listening

telehealth is  the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.  Learn More Health IT.gov  *  Telehealth  *  Modern Health Care  *

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Medicare & You - Online

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions

Enroll in Blue Cross

Enroll in Blue Shield 


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4 comments on “under 65 End Stage Renal can I buy an policy – ObamaCare, Covered CA, Health Care.gov – direct from Insurance Company?

    • I have End-Stage Renal Disease (ESRD), but I haven’t signed up for Medicare. Can I get a Marketplace plan?

      Yes. People with ESRD aren’t required to sign up for Medicare. If you have ESRD and don’t have either Part A or Part B, you can get a Marketplace plan. You may also be eligible for tax credits and reduced cost-sharing through the Marketplace. However, once you enroll in Part A and your coverage starts, any tax credits and reduced cost-sharing you get through the Marketplace will stop.

      I have Medicare coverage due to ESRD. Can I drop my Medicare coverage and choose a Marketplace plan?

      Generally, no. Once you apply for Medicare, your Medicare coverage will end one year after you stop getting regular dialysis or 36 months after a successful kidney transplant. However, you may withdraw your original Medicare application. You would have to repay all costs covered by Medicare, pay any outstanding balances, and refund any benefits you got from Social Security or the Railroad Retirement Board. Once you’ve made all of the repayments, the withdrawal will be processed as though you never had Medicare at all.

      What if I become eligible for Medicare after I join a Marketplace plan?

      If you have coverage through an individual Marketplace plan (not through an employer), you should end your
      Marketplace coverage and enroll in Medicare during your Initial Enrollment Period to avoid a delay in future
      Medicare coverage and the possibility of a Medicare late enrollment penalty.

      Once you’re considered eligible for or enrolled in Part A, you won’t qualify for help paying your Marketplace Covered CA plan premiums or other medical costs. If you continue to get help paying your Marketplace plan premium after you have Medicare, you might have to pay back the help subsidies you got when you file your taxes https://www.medicare.gov/Pubs/pdf/11694-Medicare-and-Marketplace.pdf

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