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Old 01-09-2015, 02:47 PM   #41
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Originally Posted by nun View Post
When I started looking at state exchange programs it was really just out of curiosity. My ex-employer's plan that costs me $450 a month is good insurance.....a bit expensive, but the premium will go down to $100/month in 18 months time when I reach retirement age, so I kept it thought last year for convenience, continuity and to avoid all the teething troubles in ACA's first year. So when open enrollment came around I wanted to see what was on offer. I entered my MAGI estimates.....about $35k for 2014 as I worked for a couple of months and $10k for 2015 as I only have investment and rental income and some large deductions and I didn't include potential rollovers to ROTHs. Well that shunted me into Medicaid and the whole process has a momentum all of it's own. I got a card, got placed with a health insurer after I called to ask about the benefits but specifically told the nice lady on the phone I already had insurance and would call back if I decided to go ahead. Now they have asked for income verification and I sent back the information almost out of curiosity to see what happens. One of the income categories was "Inheritances and gifts". I actually did get a small inheritance in 2014, and I wrote back to say that as assets aren't a determining factor for the Medicaid plan I am one and inheritances don't contribute to MAGI I would not tell them the value of the inheritance, but had estimated the income it would contribute towards my MAGI.

I also have a claim for state premium assistance for my existing insurance that I was encouraged to submit by one representative. So it looks like there will be one of 4 outcomes

1) just stick with my existing ex-employer insurance.....and do rollovers to ROTH
2) get Medicaid plan and pay nothing for premiums, cancel existing insurance and keep my income below the 133% FPL.
3) get some assistance from the state to pay my ex-employers insurance premiums......ironically the state was my ex-employer
4) Do some rollovers to bump my income up above the 133% FPL, tell the state about this, get off Medicaid and apply for an exchange health plan and get the subsidy.

It's complex, but I'm grateful to have access to good coverage and have the choices.
Since Medicaid is monthly based, even if an inheritance was countable, which it isn't, it would only disqualify you for the month it was received, since this is in the past, it is a moot point.
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Old 01-09-2015, 03:21 PM   #42
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Originally Posted by John Galt III View Post
Gauss, Thanks for the post. Yes, the scenario was discussed in a previous thread, but it doesn't hurt to bring it up again for current readers. I was slightly tempted to just not do the Roth conversion for 2014, to avoid the taxes, and hope my ACA would not be affected (my income would be below the $16,xxx threshold without the conversion), but after someone pointed out that I would have to pay the taxes on it eventually anyway, in same bracket, I felt better about doing the conversion. No worries about gray areas. BTW, I went to a free "ACA information" visit at H & R Block yesterday, and asked about the asset recovery laws for Medicaid (govt billing your estate for Medicaid premiums). The H and R person had never heard of it. Another gray area for anyone age 55 to 64 considering Medicaid from the ACA. I don't recall the ACA website mentioning anything about asset recovery.
From...

https://www.health.ny.gov/health_car...id/#definition
---
Will there be a lien (legal claim) placed on my estate (my assets) when I die?

If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
----

Note it makes no distinction between the new MAGI Medicaid and the old Medicaid groups, both are subject to recovery.
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Old 01-10-2015, 01:31 PM   #43
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Since Medicaid is monthly based, even if an inheritance was countable, which it isn't, it would only disqualify you for the month it was received, since this is in the past, it is a moot point.
Yes, that's my understanding too. The application had lines for various types of income that all seemed ok and I filled those out. The income verification letter I got also seemed perfectly sensible apart from the single category "inheritance and gifts". Philosophically I think that there should be some accounting for assets in the Medicare and health exchange qualification, but not to the extent thy it forces people to become destitute, maybe exclude retirement accounts and real estate.

Still my 1040 MAGI for 2015 will be around $10k so strictly speaking I'm poor. Going on my bank balance you wouldn't conclude that. I'm just grateful that I'm in a situation that I can qualify for Medicaid, but have other insurance in place if I don't.
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Old 01-10-2015, 07:50 PM   #44
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your precious.
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Old 01-10-2015, 07:56 PM   #45
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Please "feel free to tax yourself additionally to help the masses, and lower your level of HealthCare". If you think a Medicare primary payer, Medicaid secondary payer HCare office visit to a MD garners the same treatment levels other well insured patients receive, your precious. Example: Hmmmm, this patients insurance is paying me 50% of my billing, and this patients insurance is paying me 5% of my billing, but the .gov requires me to see both to practice medicine. You think theres no human emotional "adjustment" in service? R-I-G-H-T(Richard Pryor), again, your precious. Many older Dr's I know have left or are leaving the business they schooled for because of the ACA's terms. Good luck with the incoming freshmen!
It's a pity that the Hippocratic Oath means nothing anymore. I have never though that the "free market" is the right place for healthcare.
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Old 01-10-2015, 08:07 PM   #46
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No "Free market", you get what the .gov gives you. Like the RMV or DMV or so many other efficient and well run .gov services/sarcasm/.
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Old 01-10-2015, 08:13 PM   #47
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It's a pity that the Hippocratic Oath means nothing anymore. I have never though that the "free market" is the right place for healthcare.
Talk is cheap! Where you get what you pay for, right? You and I disagree, no big deal. In 1968 Congress passed the Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA) in response to the practice of emergency rooms transferring patients from one emergency room to another for care (dumping). Patients were ostensibly transferred to another facility better equipped to provide for their medical care, but in reality were selected because they lacked insurance or evidence of the ability to pay for their medical care. In many cases the receiving emergency facility was unaware of the transfer until the patient arrived.

In practical terms, EMTALA regulations require that all persons seeking treatment in a hospital emergency room should be evaluated promptly, regardless of their ability to pay. Monetary and civil penalties are incurred if individuals are not evaluated appropriately. EMTALA applies to all hospitals that receive Medicare funding and have emergency rooms. A Medical Screening Examination (MSE) must be provided to all persons requesting examination or treatment. The MSE must not be delayed or denied while inquiries about payment or insurance take place.

The purpose of the MSE (perform by a physician or qualified medical person) is to determine whether a condition is present that is deemed a medical emergency. MSE may include ancillary services and specialty consultation within the facility's ability. An emergency medical condition is any acute symptom including pain that could reasonably result is serious jeopardy to the person's health, serious dysfunction of an organ, or body parts without immediate treatment.

So EVERYONE that showed up at the ER was entitled to top shelf HCare, as they are now, with a "cold and runny nose". Its worked out stupendously!
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Old 01-10-2015, 08:33 PM   #48
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Old 01-10-2015, 09:06 PM   #49
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I think the question of what standard of care you can expect on different types of insurance....say Medicaid vs Cadillac Blue Cross......is an interesting one. Does the Hippocratic Oath mean anything in the real world of reimbursement and budgets? Are we assuming a fee for service reimbursement model with some insurers paying more than Medicaid or Medicare for the same service. MA is now mandating a global reimbursement model for all insurers rather than a fee-for service model, will that level the playing field? and do we want a level playing field?
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Old 01-11-2015, 06:45 AM   #50
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Thanks for an interesting discussion
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