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ACA premium anomaly.....thanks
Old 01-06-2015, 03:42 PM   #1
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ACA premium anomaly.....thanks

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
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Old 01-06-2015, 03:44 PM   #2
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Any tax deferred IRA accounts you can convert to generate taxable income to get you over the minimum?
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Old 01-06-2015, 04:08 PM   #3
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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.
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Old 01-06-2015, 04:10 PM   #4
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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 :
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Old 01-06-2015, 04:14 PM   #5
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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.
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Old 01-06-2015, 04:18 PM   #6
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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.
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Old 01-06-2015, 04:45 PM   #7
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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.")
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Old 01-06-2015, 05:50 PM   #8
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.........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.
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Old 01-06-2015, 06:22 PM   #9
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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.
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Old 01-06-2015, 07:22 PM   #10
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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
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Old 01-06-2015, 07:55 PM   #11
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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.
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Old 01-06-2015, 08:01 PM   #12
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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?
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Old 01-06-2015, 08:39 PM   #13
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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.
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Old 01-06-2015, 08:57 PM   #14
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..............................
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.
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Old 01-06-2015, 09:14 PM   #15
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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.
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Old 01-06-2015, 09:28 PM   #16
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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/califor...101-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.


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Old 01-06-2015, 11:01 PM   #17
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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.
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Old 01-06-2015, 11:08 PM   #18
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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.
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Old 01-06-2015, 11:42 PM   #19
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Sounds like your situation is the exception.
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Old 01-07-2015, 06:46 AM   #20
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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.
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