ACA premium anomaly.....thanks

[nun]

This will be my first full year of ER, so no earned income, SS or pension yet. Thus my income will be very low...,.. Below the Federal poverty level in fact. I just applied to my state health exchange and was told I qualify for Medicaid program and can get health insurance and pay no premium, the value of my savings and investments doesn't matter. I support the ACA, but this is an anomoly as I can afford to pay something and there are people out there that really need this benefit

 

[MichaelB]

Any tax deferred IRA accounts you can convert to generate taxable income to get you over the minimum?

 

[Fermion]

Any tax deferred IRA accounts you can convert to generate taxable income to get you over the minimum?

+1

IRA to Roth conversions count toward your MAGI and thus your ACA qualifying income. You don't need earned income.

If you are ok with the level of medical services on Medicaid though, I don't know why you should feel guilty. You paid for it while you were working.

 

[nun]

Any tax deferred IRA accounts you can convert to generate taxable income to get you over the minimum?

Yes, I could do that to soothe my guilt or just continue with the plan I currently have. The decision space is complex from a purely mathematical perspective.......and guilt and it becomes almost impossible :

 

[nun]

Yes I agree, but I'm a pinko bleeding heart liberal and prone to guilt. I will probably end up using the 15% tax bracket to do IRA to ROTH conversions.

 

[Fermion]

I used to feel guilty about things like that before I got spanked on the bottom while held upside down. Now I just go with the flow.

 

[RonBoyd]

and there are people out there that really need this benefit

And why aren't we attacking whatever it is preventing them from participating? (Assuming, of course, these folks really "need this benefit.")

 

[travelover]

.........I will probably end up using the 15% tax bracket to do IRA to ROTH conversions.

I think I'd rather have subsidized regular health insurance than Medicaid, just for the quality of care.

 

[RockyMtn]

my gf who retired last year and had no health insurance after her cobra ran out was freaked about going on the Medicaid rolls. She's a former nurse. We converted roth ira to get her income up to $16500 more or less so that she could go into the exchange. Happy GF means happy BF.

 

[nun]

I think I'd rather have subsidized regular health insurance than Medicaid, just for the quality of care.

Well it insurance through a commercial insurer on the exchange, I just don't pay any premiums. I have the same PCP as I have now

 

[travelover]

Well it insurance through a commercial insurer on the exchange, I just don't pay any premiums. I have the same PCP as I have now

Cool. I don't think that would be the case in all states.

 

[pb4uski]

I think I'd rather have subsidized regular health insurance than Medicaid, just for the quality of care.

+1 also, won't many providers not take Medicaid patients?

 

[John Galt III]

I had to bump up my 2015 income, by doing a Roth conversion, to get to the $16,xxx minimum to avoid Medicaid. The ACA website was was acting like it felt sorry for me to have "not qualified" for Medicaid, and told me how to appeal. My PCP does take Medicaid, but very few specialists around here take Medicaid. I tried to find some concrete examples of how Medicaid coverage is inferior to "regular" insurance, but all I ever got was the basic answer "everyone knows Medicaid is no good". The only definite shortcoming I have found so far is the dearth of specialists who accept it.

 

[John Galt III]

..............................
If you are ok with the level of medical services on Medicaid though, I don't know why you should feel guilty. You paid for it while you were working.

How exactly is the "level of service" different on Medicaid? This question has intrigued me. I do believe it is substandard, but some insurance brokers have assured me it is just as good as regular insurance, except for finding a doctor who accepts it. Oh well, I suppose a lack of doctors who accept it could be reason enough to avoid it.

 

[NW-Bound]

I have read that Medicare payments to doctors are lower than from private insurers. It sounds like Medicaid payment is even lower. However, I have not seen some numerical examples.

Maybe it's just another case of getting what one pays for. Doctors want to be better paid for their service, not any differently than any of us.

 

[iac1003]

Medicaid pays poorly but with the ACA there was a significant increase in Medicaid to doctors. However that increase ends this year. Here's one article:

http://www.latimes.com/local/california/la-me-doctor-pay-20150101-story.html

I think it will hard to find a good doctor once these cuts are felt by the MD's practices.

When I was in private practice in Manhattan in NYC pre-ACA the Medicaid fee for an office visit with me as a psychiatrist was $17. No way to pay my office rent at those fees. I couldn't take Medicaid patients into my practice. Some of the Medicaid managed care plans paid better.


Sent from my iPhone using Early Retirement Forum

 

[NW-Bound]

Thanks for the link.

California has one of the lowest Medicaid payment rates in the country. According to data compiled by the California Medical Assn., in April 2014 Medicare paid $45.69 for a basic office visit for a returning patient — more than twice the standard Medi-Cal rate at the time of $18.10.​

$18.10! Whoa!

Many people do not know what their health care service costs. But as we have had a $10K deductible policy, we have to pay every penny until we exceed that, so we know what everything costs. Per negotiated rate with our insurer, we pay something like $90 per regular visit with our family physician. Recently, I had a fungal+bacterial ear infection, and an otolaryngologist charged me $120 for the exam. Earlier, I went to a Walgreen Walk-in Clinic, and the nurse there charged $80 (her antibiotic cured the bacterial infection, but not the fungal one). The ear specialist gave me the right thing, and the infection cleared up in a few days.

If I were a doctor, I'd love to have patients with private insurance like myself.

 

[nun]

On the Medicaid program I get the same PCP as I have now. A state Medicaid person checked in the provider network and I double checked with the Doctor that he takes the state's Medicaid patients. My closest hospital is in network as well as some other great hospitals. I only get emergency coverage out of state and no coverage out of the US. So if I stay in state I don't see how my standard of care will be any less than anyone with regular insurance.

 

[pb4uski]

Sounds like your situation is the exception.

 

[tuixiu]

Maybe you paid a larger share of the tax burden than most Americans during your earning years? Then can rationalize a lifetime aggregate producer/parasite ratio that comes out more in your favor.

 

[donheff]

Nun - are you getting Medicare under traditional rules or under the Obamacare expansion? If the former make sure your state has accepted the expansion before artificially raising your earnings with Roth conversions. If not careful you could fall into the gap where you earn too much to qualify for Medicaid and don't earn enough to qualify for an ACA supplement.

 

[jim584672]

ACA verses Medicaid depends on your state.

In NY most counties have Medicaid which is managed by "Medicaid Managed Care" companies. These are mostly the same insurance companies as the Exchange. The network in the Medicaid plans actually seems bigger than the Exchange plans. The difference being you would need to pay for a "Platinum" plan to even get close to the Medicaid plan.

 

[John Galt III]

But.. but.... but...I'll be the nattering nabob of negativity here. Let's say you were admitted yo the in-network hospital. Would the doctors who treated you have to be in-network? Are most or all of the staff there in network? If they bring in an out-of-network doctor? And then there's always the "He's only giving us a lousy Medicaid reimbursement, so let's not spend much time on this guy" worry. Maybe the poster whose gf was a nurse who feared Medicaid could give us some examples. I think one good thing for sure about Medicaid is that neither the Medicaid insurance carrier nor the providers are allowed to charge the patient anything at all, not even those hated "uncovered services" that often crop up in the bill while using regular insurance. If you choose the Medicaid route, please keep us apprised of your experiences, good or bad. Oh, almost forgot, there's that gray area of "Medicaid asset recovery" : a law that allows govt to recoup your Medicaid expenses from your estate. The best I can come up with for this is that in my state, Pa, they do have the law but do not enforce it, and do not plan on enforcing it in future, but that could change! I chose to increase my income to avoid Medicaid, and will have to spend an extra $520 in federal taxes, so I am desperately looking for evidence that Medicaid in Pa is awful and I have made the right decision!

 

[pb4uski]

....I chose to increase my income to avoid Medicaid, and will have to spend an extra $520 in federal taxes, so I am desperately looking for evidence that Medicaid in Pa is awful and I have made the right decision!

Perhaps you can find comfort in that since the taxes are the result of a Roth conversion you are not necessarily spending an extra $520 in taxes, you are just paying the $520 of taxes earlier than you (or your heirs) would have needed to since you would have had taxes on that income once RMDs start (plus you're getting tax-free growth in the Roth as a bonus).

 

[ExFlyBoy5]

Wow...how can ANY medical practice run when the reimbursement for Medicaid is SO LOW? I thought that the Tricare reimbursements were really low, but I think I was wrong. I always feel a little guilty when the Doc spends more than 10 minutes with me, because I know his business isn't making much of anything for my services.