💬 Client Q&A Database
Real questions from real clients with Faith's answers. Search by keyword or filter by topic.
Yes — if your letter says you are "entitled to monthly disability benefits beginning February 2025," then your Medicare eligibility begins February 2027 — exactly 24 months after your first disability payment.
The 24-month waiting period starts from the first month you're entitled to SSDI benefits, not the date you applied or were approved.
Yes — the reconciliation amount is paid directly to the IRS, combined with whatever other taxes you owe. You do not pay it to a separate agency.
When you file your taxes, you'll submit your 1095-A form (which you'll receive from the Marketplace). The IRS reconciles the amount of subsidy you received versus what you were eligible for, and the difference either increases what you owe or gives you a credit.
As for estimated tax payments — if you know you received more subsidy than you're entitled to, making estimated quarterly payments to the IRS throughout the year can help you avoid a large bill at tax time. However, there's no separate penalty just for the reconciliation amount itself — it's just added to your regular tax balance.
You won't get in trouble, and you won't pay any extra penalties for leaving it as-is. The only consequence is that you'll owe back the portion of the subsidy you weren't eligible for when you file your taxes at the end of the year.
The IRS reconciles this annually through your 1095-A — it's just added to your tax balance, not treated as a separate offense or penalized beyond the standard tax interest if you underpay.
Your ACA policy will typically auto-renew at the end of the year — it won't just expire and leave you uninsured. So going without coverage between year-end and your Medicare start date is generally not necessary.
Also, if you have a spouse on the policy, we'll need to update her coverage too. If you're no longer receiving a subsidy, your wife may actually be a good candidate for a non-Marketplace (off-exchange) plan, which can sometimes offer better pricing when a subsidy isn't involved — especially if she's relatively healthy.
Let's review both situations before the renewal period to make sure you're both covered in the most cost-effective way.
Mostly yes. Under-65 Medicare beneficiaries CAN enroll in Medicare Advantage. However, most Medigap/Supplement insurers are not required to sell them a plan until they turn 65 — so Medigap is typically unavailable or very limited for this group. A few states (NY, CT, MA, ME) mandate it, but most don't.
When they turn 65 they receive a Guaranteed Issue right for Medigap — insurers must sell them a plan regardless of health conditions. That's the trigger to reach back out and move them from MA to Medigap if appropriate.
If still working at 65 with employer coverage, Medicare is secondary and they can delay Part B without penalty. When employment and coverage end, the timeline depends on whether they already enrolled in Part B:
If already enrolled in Parts A & B:
• 63-day Guaranteed Issue window for Medigap
• 63-day SEP for Medicare Advantage and Part D
If they delayed Part B:
• 7 months from when the job AND employer coverage ended to enroll in Part B
• Once Part B starts: 3 months to enroll in an MAPD or Part D drug plan
• 6 months from their Part B effective date to pick a Medigap plan — this acts as a brand new Initial Enrollment Period with full Guaranteed Issue rights, just like when Medicare first starts
⚠️ Important: COBRA does NOT count as creditable coverage for avoiding a Part B late enrollment penalty. They cannot use COBRA to extend this window.
All Medigap plans are standardized by the federal government — every Plan G from any carrier covers the exact same benefits. The only difference between carriers is price, so always shop on price alone for the same plan letter.
Plan G (most popular) — covers everything except the annual Part B deductible (~$240/yr). Best overall value for most clients.
Plan N — lower monthly premium, but small copays for office visits ($20) and ER ($50). Good for healthy clients who rarely use care.
Plan F — no longer available to anyone who turned 65 after January 1, 2020.
We write Aetna Plan G. Note: we do NOT write Aetna Silverscript drug plans — Medigap and drug plans are separate products.
Medigap requires a separate Part D drug plan (PDP). Underwriting (health questions) applies outside of Guaranteed Issue periods.
OTC allowances are listed in plan brochures (ANOC/EOC) and visible on SunFire when quoting. Amounts vary widely — typically $25–$200+ per quarter depending on the plan. They're loaded onto a prepaid card monthly or quarterly and cover items like vitamins, OTC medications, bandages, and personal care items.
Food/grocery cards are primarily available on D-SNP plans (dual Medicare/Medicaid eligible members). Some standard MA plans offer a limited "healthy food" benefit, but the more generous food allowances are tied to D-SNP plans.
Always verify current OTC amounts on SunFire before quoting — they change annually at plan renewal.
PDPs are not all the same — they vary significantly in monthly premium, annual deductible (up to ~$590 in 2025, some $0), drug formulary tiers, and preferred pharmacy networks.
Cheapest premium doesn't mean cheapest overall. A $0/month plan with high drug costs can easily cost more than a $30/month plan with lower tier copays. Always run the client's actual drug list on SunFire or Medicare.gov Plan Finder to compare true out-of-pocket costs.
PDPs must be re-shopped every AEP (Oct 15–Dec 7) — formularies and pricing change annually, and a plan that was best last year may not be best this year. We use SunFire or MyHealthPlan to compare.
Medicare and Social Security are completely separate programs — you can take one without the other.
If they're not collecting Social Security, Medicare enrollment is NOT automatic at 65. They must actively sign up during their Initial Enrollment Period (IEP): the 7-month window starting 3 months before their birthday month through 3 months after.
They enroll through SSA.gov or by calling Social Security (1-800-772-1213) — even though they're not claiming benefits, Social Security still administers Medicare enrollment.
Part A is usually premium-free. Part B is approximately $185/month in 2025, billed quarterly since there's no SS check to deduct it from.
If they miss their IEP without having other creditable coverage, they'll face a 10% Part B late enrollment penalty for every 12-month period they delayed — and it's permanent.