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Old 10-14-2010, 09:07 AM   #21
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Originally Posted by shotgunner View Post
My understanding is Medicaid eligibility is based on both income and assets, at least it is in my state. The subsidies for health insurance available to those who have qualified insurance plans (HDHP w/HSA would not be qualified) appear to be income based. Many of us may have to settle for ESR rather than ER so we earn enough to stay above a Medicaid income threshold but not earn so much so as to lose out on getting any subsidy for medical insurance.
I thought the 2014 changes will include medicaid eligibility being tied to income (AGI on the 1040 more specifically). I could be wrong because I have a very imperfect understanding of the health care reform legislation (and many of the regs to implement it are not written yet).

I'm sure I could "find" income to get me to $31,200 a year, even if I had to start a company that paid me w-2 income. Although I'm sure I could find cap gains to get me to that level without having to get any craftier (unless the Great Depression III kicks in ).

Edited to add:

It looks like assets will not be a criteria of eligibility for the broad new medicaid program mandated for 2014. Apparently states can voluntarily start covering "low income" people now if they wanted:

PPACA establishes a new Medicaid coverage group defined as individuals with incomes below 133 percent of the poverty line who are under the age of 65, not pregnant, not enrolled in Medicare, and not eligible under any other mandatory Medicaid coverage group (such as the coverage groups for people receiving SSI benefits and very low-income parents). An individual’s assets are not considered in determining eligibility for this coverage group. States can start covering some or all of the individuals in this new group as early as April 1, 2010, even though their coverage is not required until January 2014.

I know it is a fluid situation for the next couple years, but I wonder how big the gap in quality of coverage will be between the medicaid coverage and the regular subsidized health insurance policies. If medicaid reimbursement rates are inadequate, I could see more doctors walking away from accepting medicaid patients. Presumably the top tier docs will opt out of medicaid and take the privately or publicly subsidized insured patients?? Maybe there is a provision in the health care reform that somehow requires or entices docs to accept medicaid patients if they accept other insureds? In any event, if there ended up being a significant difference in quality or flexibility of coverage between medicaid and the highly subsidized $1000 a year health insurance, I might make sure my income just pushed me out of the medicaid eligibility.

Retired in 2013 at age 33. Keeping busy reading, blogging, relaxing, gaming, and enjoying the outdoors with my wife and 3 kids (4, 10, and 11).
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Old 10-14-2010, 09:30 AM   #22
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No matter what happens, the contributions are a nice (if limited) tax shelter and the expenses they can be used to pay for will have to get paid one way or another. I'm gonna keep on contributing for the few more years I am eligible.

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ESR'd March 2010. FIRE'd January 2011.

As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 10-14-2010, 12:37 PM   #23
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Originally Posted by stephenandrew View Post
I am in an HDHP with an HSA. My employer provides several options for health insurance including the HDHP as well as standard/traditional policy, and an HMO. We are allowed to change policies annually--to the best of my knowledge I have not heard that anyone who is not currently in the HDHP can no longer join. Is what you are saying only true for the individual market?
Anyone, up through the end of 2013, can apply to join a higher deductible policy (although I have not studied in detail the other changes coming before 2014). My point is that pre-2010 policies are "stale". And in 2014, all previously sold health insurance policies will become "stale", even low deductible policies.

Yes, group insurance can be different. That is because, if the group is large enough, it is its own risk pool. That is why someone in a large group, unlike an individual, can change their policy each year. It is also why the insurance company can do the same -- essentially, the entire thing is often renegotiated annually.

However, many smaller groups are experiencing this dilemma (along with virtually all individual plans). There has been a great deal of debate about what it means to be grandfathered and the debate is still happening, the people writing and interpreting the regulations are in control of this.

Sometimes I think that many folks don't realize the magnitude of the change coming. Or they falsely believe that there is a high probability that they will be able to keep their existing policy a long time. In my opinion, these people are in for a big shock to their pocketbooks and their freedom to manage their health care.

Understanding this is important to someone with an already large HSA, because what they should do is different if they think they will be able to keep their high deductible policy for many years, versus being forced into a high cost low deductible policy.


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