Health coverage options for retirees

Retired persons may be able to get an affordable health insurance plan through the insurance marketplace. Connected to marketplace, you can now find out if your retired clients qualify for private plans and low-cost ACA plan coverage.

Plans for retirees under age 65

If your client retires before age 65 and loses a job-based health plan, you can use Inshura to quote and enroll the retired client in an affordable health plan.

Losing health coverage qualifies the retiree for a Special Enrollment Period. This means you can enroll in a health plan even if it’s outside the annual open enrollment period.

When you fill out an application for the client, you’ll find out if they qualify for a private plan with premium tax credits and lower out-of-pocket costs. This will depend on income and household size.

Retirees with health benefits

If the client has retiree coverage and wants to buy a marketplace plan instead, they can, but:

  • The client would not qualify for premium tax credits and other savings based on income. This is true only if they are actually enrolled in retiree coverage. If eligible for retiree coverage but not enrolled, the client may still qualify for premium tax credits and lower out-of-pocket costs based on household size and income.
  • If retiree coverage is voluntarily dropped, the client will not qualify for a Special Enrollment Period.

To find plans for which the retiree qualifies, submit an application in minutes via the Inshura app.


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More answers to retiree questions from Inshura

What if the retiree turns 65 in the middle of the year? Can they get coverage to carry them over until eligible for Medicare?

You, the retiree can get a marketplace plan to cover them before Medicare begins. The retiree can cancel the Marketplace plan once Medicare coverage starts.

What if the retiree is 65 or older but not eligible for Medicare?

The client may qualify for a Marketplace plan and get lower costs on monthly premiums and out-of-pocket costs based on your household size and income. Find out in the Inshura app.

Do IRA or 401k withdrawals count as income?

Generally, yes. Learn more about reporting income from retirement savings funds from the IRS 1040 Instructions on pages 24 and 25.

Can the retiree drop COBRA and get marketplace coverage instead and still qualify for lower costs based on income?

It depends.

  • If the COBRA coverage runs out outside Open Enrollment, the client qualifies for a Special Enrollment Period. This means you can enroll them in a Marketplace plan outside the annual Open Enrollment Period.
  • But they can’t choose to drop COBRA coverage outside Open Enrollment and enroll in a Marketplace plan instead. The Special Enrollment Period applies only if COBRA coverage runs out.
  • During the annual Open Enrollment Period, they retiree can drop COBRA coverage even if it’s not running out and replace it with a Marketplace plan.

After you finish a client application in the Inshura app, you’ll see plans for which the client qualifies.

About Inshura

Inshura is a FREE online ACA insurance tool, perfect for agents and agencies! Agents can boost their ACA and other enrollments using this easy-to-use solution for quoting, enrolling, automating renewals, and managing clients!

And inshura is CMS EDE PHASE III certified, so it automatically exchanges data directly from the Marketplace.

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