ACA vs Apple Health/Medicaid in WA State

[lawman3966]

This question is directed principally to WA state residents, but may apply in other states that have expanded Medicaid.

For calendar year 2016, I used a health insurance broker to assist with my health exchange application. Though my income seemed to straddle the threshold between Medicaid (Apple health in WA state), and several possible ACA exchange plans, the broker advised me to avoid Medicaid as my options for doctors and various associated medical services would be very limited under Medicaid. I ended up on Silver plan from Grouphealth.

I have since met one person on Apple Health who is quite pleased with it. Since this somewhat conflicts with the my broker's advice, I'm writing to see what other people's experiences have been on Apple Health or on comparable Medicaid plans in states that have Medicaid expansion.

 

[jim584672]

In my state Medicaid is handled by managed care companies. I am in the UHC Community Plan, aka Medicaid. So far so good. All my old doctors from the work plan are in this plan and I see no difference in care. The dental portion is very lame with only a few dentists in my whole county.

 

[MichaelB]

Is the broker compensated if you choose the Medicaid plan or only if you use the Silver plan?

 

[pb4uski]

Also, are you in good health? If you don't use much in medical services and health insurance is simply a backstop against an adverse health event then perhaps you can live with Medicaid rather than pay HI premiums.

 

[frank]

my grandaughter is in the same boat in Iowa, they are changing to managed care and have three companies to choose from but how to know which one is best is a problem. I told her to call the doctor's and pharmacist she now uses and find out which they prefer or work with.

 

[jim584672]

I looked up Washington state which does have managed care plans. Go to the plans websites and look at the doctor networks in your area. Go with the best one.

 

[John Galt III]

I'm in the same boat. My income is low enough to get medicaid. I'm in Pa with expanded medicaid. But I have chosen to bump up my income via Roth conversions, so that I qualify for a silver ACA plan with large subsidy. The Roth conversion is a good thing, since I only pay 10 percent tax on it now, avoiding paying more than 10% when I am forced to take MRD's later on. I'm afraid to go on Medicaid anyway, since I don't know anyone here in Pa who is on it and can't get an evaluation of it. I just hear the horror stories in general about Medicaid. But I have heard a few people online saying they have it and like it. I checked around with my local doctors, and some simply do not accept medicaid patients.

 

[jim584672]

Most states now have managed care vs. fee for service. I can understand why fee for service has a bad reputation, since the reimbursement rates are very low. But managed care plans are different. So I would not go by what you hear which may not be true in your state.

 

[AllDone]

I'm a retired primary care physician. I used to work for a very large primary care group and we had a contract with Medi-Cal just like most of the other big insurance providers. Medi-Cal, Medicare and commercial patients all received the same treatment. A few of the doctors had political views that caused them to dislike Medi-Cal patients, but that was limited.

Referrals to certain specialists, but not all, could be slow for Medi-Cal patients, but super-specialist referrals went to the big name medical school and were not a problem.

It was a normal level of medical care, but I worked in a large metropolitan area. The biggest problem was usually people going on and off Medi-Cal as their income level changed. That resulted in a lot of doctor switching. I would avoid that, if possible.

 

[lawman3966]

Is the broker compensated if you choose the Medicaid plan or only if you use the Silver plan?

I should have thought to ask at the time, but didn't. I have so far been unable to answer the question using internet searches. However, even assuming that the broker is not paid if I choose to covered under Medicaid, the main question in the top post is still valid, since knowing that would not, by itself, indicate how good or bad Apple Health would be for me.

Also, are you in good health? If you don't use much in medical services and health insurance is simply a backstop against an adverse health event then perhaps you can live with Medicaid rather than pay HI premiums.

I have a few chronic conditions that require ongoing attention, so I would not benefit from having a catastrophic care type policy.

Based on what I've read here, I guess I'll just continue to ask around, and do further online searching to see if Apple Health would work for me next year. Thanks to all for the input.

 

[jim584672]

You can always report a drop of income and go in mid-year. I did that last year.

 

[bingybear]

If you're over 55 states can establish leans against your estate to recover expenses paid for medicaid health care/insurance. This may or may not be relevant to your situation.

 

[outabout]

When I signed up for ACA in Colorado in Dec 2014, I was put into Medicaid because my income was too low (they could not count the unemployment benefit I was going to receive). I have since liked it and I continued to maintain the income level to qualify for it.

The state has a doctor lookup website, it does take persistent phone calls to identify the doctors, but I usually find what I need. But so far I have got a primary doctor, a couple dermatologist, a spinal surgeon all accepting it. A neurologist group even opened a new practice that accepts medicaid.

There was a Medicaid Parity bill that raised the doctors' pay to the level of Medicare in 2013 and 2014 by the federal government. It expired in the end of 2014, but several states, including Colorado, decided to continue on their own. This might have something to do with doctors' willingness to accept medicaid patients.

Another thing you need to pay attention is that Medicaid has estate recovery provision, although most states limit the recovery to long-term care or home-based care, which is the case of Colorado.

 

[Spokane2303]

WA state changed their law the first year of the ACA and can no longer put a lean on your estate for Apple Care after 55. They still will for care in a care facility after 65.

We have Apple Care and couldn't be more satisfied! I, the husband, also have VA coverage and use that for my ongoing cardiac care. We always retain the option of increasing our income through Roth IRA conversions to switch to an ACA subsidized plan if AppleCare doesn't give us access to good medical care.

 

[gauss]

#1) It is only a 1 year commitment so I don't think you will make a mistake either way.

#2) Can you get moved from Medicaid to an ACA policy mid-year if you call your state's Marketplace with a revised estimate of income? and perhaps appropriate documentation to support it such as a taxable IRA conversion or distribution?

#3) If you get an ACA policy be sure to consider getting a Silver one so that you will qualify for limited Cost Sharing (ie deductibles etc) with income less than 250% of FPL.

 

[Spokane2303]

In WA you can move from AppleCare (Medicaid) to a marketplace plan if your income goes up any time during the year. You are required to report increases in your income of more then a couple hundred dollars; so, assuming you can adjust your income up by making Roth IRA conversions or by just withdrawing funds from an IRA monthly, you can income out of AppleCare and switch to an ACA marketplace plan if needed or desired.

 

[lawman3966]

You can always report a drop of income and go in mid-year. I did that last year.

Thanks very much for this. I will look into this in the coming months.

 

[lawman3966]

In WA you can move from AppleCare (Medicaid) to a marketplace plan if your income goes up any time during the year. You are required to report increases in your income of more then a couple hundred dollars; so, assuming you can adjust your income up by making Roth IRA conversions or by just withdrawing funds from an IRA monthly, you can income out of AppleCare and switch to an ACA marketplace plan if needed or desired.

Thanks for this information. If anything, I would be going in the reverse direction, that is from an ACA silver plan to Apple Health. Q: Do you know if I can move from the ACA silver plan to Apple health mid year?

My income will likely drop in May 2016 as my unemployment compensation will end. In fact, barring action on my part, when I report the drop in income once my UI ends, I may be forced into Apple Health barring Roth conversions on my part to remain on a silver plan.

I have another question I haven't been able to answer online yet: Q2: does Group Health take Apple Care. I am now in the Group Health system, and would prefer to keep my current network of providers if possible.

 

[jim584672]

Thanks for this information. If anything, I would be going in the reverse direction, that is from an ACA silver plan to Apple Health. Q: Do you know if I can move from the ACA silver plan to Apple health mid year?

My income will likely drop in May 2016 as my unemployment compensation will end. In fact, barring action on my part, when I report the drop in income once my UI ends, I may be forced into Apple Health barring Roth conversions on my part to remain on a silver plan.

I have another question I haven't been able to answer online yet: Q2: does Group Health take Apple Care. I am now in the Group Health system, and would prefer to keep my current network of providers if possible.

I was in the same situation, my UI ran out and I dropped into Medicaid mid year. If you want to avoid it just don't report the drop in income.

As far as GHI I don't see them in the plans list...
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