ACA and Retro Medicare Approval with SSDI

Forum|Forum|2 months ago
May 23, 2026
1 reply
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I am currently filing SSDI and the date of disability is most likely to be in 2022 or 2023 - this would have me medicare eligible in 2024 or 2025. By the time this gets approved, it could be 2027 or 2028. I might not be on ACA next year due to getting on my significant other's insurance but if not, I'll be on ACA yet. Since Medicare eligibility makes one ineligible for ACA, even though I was hoping to not file for SSDI and to get better and put off filing - how does this work with ACA/Medicare overlap? Do I owe all the ACA stipends for this entire time period in full? I would cancel Marketplace as soon as approved. Or would, I only owe in the year awarded if the ACA amounts pushed my income over threshold? Or if I allocated the amounts to the various years, would I owe partial amounts back? I'm concerned about potentially owing back years and years of retro stipends back - if it comes to 4 years that would be about 48,000. And if I got back pay for just the 1 year, that wouldn't even cover the ACA amounts. I have called Medicare, Social Security, The Marketplace, and SHIP and got so many different answers on how this would work. At this time it is hypothetical, as I am in the process of filing but due to not working since mid 2021 minus a recent work attempt of 5 months that was pretty unique in nature and was temporary, I am very confused. I don't know if I can put my disability date as after my last job which would make this easier but am pretty certain the earlier gap might be the date they will go by. I have extreme anxiety and really want to know what I am looking at by doing this - I am nervous about how this all works and if I'm opening a can of worms by applying. So, apologies for getting off topic some - my question is if Medicare is showing as retroactive as of 2022 and I've been on ACA since 2023, do I owe all these stipends back? Or just the year it is filed with the lump sum if it goes over? Sorry, my head is spinning as I've researched all day with no answer. Each agency tells me to call the other.

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Best answer by AmeliesUncle

Expert Reviewed

Assuming you are receiving Advance credits, retroactive coverage of Medicare or Medicaid will NOT require any repayments of the Premium Tax Credit.

As you said, if a person is eligible for government-sponsored insurance such as Medicare or Medicaid, that disqualifies the credit. However, here is the pertinent excerpt in the Regulation that says that retroactive coverage should not affect you:

(iv) Retroactive effect of eligibility determination. If an individual receiving advance credit payments is determined to be eligible for government-sponsored minimum essential coverage that is effective retroactively (such as Medicaid), the individual is treated as eligible for minimum essential coverage under that program no earlier than the first day of the first calendar month beginning after the approval.

https://www.law.cornell.edu/cfr/text/26/1.36B-2