Income Questions for Healthcare Application

[sheehs1]

22140 AGI, Doesn't that put you into Medicaid land?

I was thinking the same thing. In the same WSJ article already reference in the thread, it said that they were probably going to have to call people back and tell them they were not eligible for a health plan meaning they would be routed to Medicaid. So double check your income levels with your state for anyone that doesn't want that happen.

 

[sheehs1]

Medicaid and CHIP Eligibility Levels | Medicaid.gov

The links in this link break down Medicaid income levels by state.

Not sure I understand the "Other Adult" column for some states. Where the state did not expand their Medicaid roles the income is "0". Don't know what that means.

 

[homestead]

I was thinking the same thing. In the same WSJ article already reference in the thread, it said that they were probably going to have to call people back and tell them they were not eligible for a health plan meaning they would be routed to Medicaid. So double check your income levels with your state for anyone that doesn't want that happen.

Wonder what happens if you estimate a little high on your income and after all is said and done at tax time you run short and are under the limit, especially after a year of being in a non-medicaid plan.

 

[tinlizzy]

Not sure I understand the "Other Adult" column for some states. Where the state did not expand their Medicaid roles the income is "0". Don't know what that means.

Other adults still won't qualify for Medicaid in those states - unless they are disabled and on SSDI. I think being disabled was the only reason an adult under 65 could qualify before states were asked to expand the program.

 

[sheehs1]

I know/knew very little about Medicaid. Good question homestead as that can happen for all sorts of reasons including loss of job, death of a family member. I'm sure they will make allowances or have some sort of in depth reconciliation process.

Thank you tinlizzy. I looked it up hoping to learn a bit more about it. If I am reading this right, looks like individuals or individual childless couples can be covered in states that expanded their medicaid roles, if their income is low enough. Prior to this, the Supreme Court struck down the medicaid mandate, allowing states to decide on expansion themselves. Some did, some didn't. I think we all knew that. Depends on where you live.

Don't know how current this link is:

ObamaCare Medicaid Expansion

 

[NW-Reader]

Thank you for that link, tinlizzy. It explains why, if I put our income for next year at 140% FPL (will be Roth conversions for us, too) WA state says we qualify for subsidies but our son, 16, will get a separate Medicaid plan. We would rather have him on our policy, so I'm not sure how to figure this one out...

 

[TromboneAl]

What would the advantages/disadvantages be for medicaid versus a subsidized regular health insurance plan?

 

[NW-Reader]

As regards our son, just the more limited availability of providers. His current doc is not accepting new Medicaid patients. However, he's a pretty healthy kid, so we might just go with Medicaid and he will age out in two years, at 18. We can add him to our plan then.

 

[MichaelB]

What would the advantages/disadvantages be for medicaid versus a subsidized regular health insurance plan?

With standards in place for minimum essential health benefits and how cost sharing is implemented, another thing to look for when comparing plans is network size and scope. There may be important differences among the networks when comparing Medi-Cal, the exchange silver plan with cost sharing, and other exchange plans. Lower cost plans often have more restricted networks.

 

[davemartin88]

What would the advantages/disadvantages be for medicaid versus a subsidized regular health insurance plan?

Maybe a good topic for a new thread? I finally was able to enter my information in to the Federal exchange site (WV uses that site) and given our low income only from investments, I was told I qualified for Medicaid and would be sent more information via regular mail.

We have current health coverage that we pay for ourselves so will be interested to see how this will compare to what we purchase already. Basically, we participate in the group coverage provided by my wife's former employer but don't receive anything towards the cost. For purposes of the ACA, I've assumed that we don't have coverage from an employer since we are both retired and not receiving any payments for health care?

 

[sheehs1]

Maybe a good topic for a new thread? I finally was able to enter my information in to the Federal exchange site (WV uses that site) and given our low income only from investments, I was told I qualified for Medicaid and would be sent more information via regular mail.

We have current health coverage that we pay for ourselves so will be interested to see how this will compare to what we purchase already. Basically, we participate in the group coverage provided by my wife's former employer but don't receive anything towards the cost. For purposes of the ACA, I've assumed that we don't have coverage from an employer since we are both retired and not receiving any payments for health care?

Not sure. Maybe Michael can speak to this. I thought if you had any employer sponsored health care regardless of whether they pay any percentage it preempted you from a subsidy on the exchange. I think they were assuming an employer paid some portion. There is always the credit on your taxes if you pay more than 10% for premiums I suppose. But I don't yet know how that works either. Meaning I don't know if that is just premiums or total out of pocket for all medical expenses.

One question I have about medicaid under the ACA is I thought in order to receive medicaid a person couldn't have much in the way of assets. Or has that been changed also. Perhaps we do need another "topic" on the medicaid piece of this.

 

[MichaelB]

Everyone is free to start a new thread. This paper details how eligibility is determined for tax credits and premium assistance. http://www.healthreformgps.org/wp-content/uploads/crs-premium-credit-7-18.pdf

Generally speaking, an employee is still eligible for exchange assistance if the employer coverage is not affordable or does not meet minimum essential coverage standards.

 

[tinlizzy]

Maybe a good topic for a new thread? I finally was able to enter my information in to the Federal exchange site (WV uses that site) and given our low income only from investments, I was told I qualified for Medicaid and would be sent more information via regular mail.

We have current health coverage that we pay for ourselves so will be interested to see how this will compare to what we purchase already. Basically, we participate in the group coverage provided by my wife's former employer but don't receive anything towards the cost. For purposes of the ACA, I've assumed that we don't have coverage from an employer since we are both retired and not receiving any payments for health care?

My big question was also retiree insurance offered thru a former employer and I found this dated yesterday.
Employer-sponsored plans

Eligible employer plans that meet the minimum essential coverage requirements include the following:

Coverage offered to former employees, such as retiree coverage under a group health plan or COBRA (however, those who are eligible but not enrolled in such coverage may disregard their eligibility in determining whether they qualify for an exemption, premium tax credits or cost-sharing reductions for coverage offered through the exchanges)

IRS Final Rules: Individual Mandate and Minimum Essential Coverage - Towers Watson

 

[MRG]

Eligible employer plans that meet the minimum essential coverage requirements include the following:

Coverage offered to former employees, such as retiree coverage under a group health plan or COBRA (however, those who are eligible but not enrolled in such coverage may disregard their eligibility in determining whether they qualify for an exemption, premium tax credits or cost-sharing reductions for coverage offered through the exchanges)

IRS Final Rules: Individual Mandate and Minimum Essential Coverage - Towers Watson

I'm more confused now. Before October Megacorp had sent out forms that said their plan was ACA compliant. I have COBRA but this form suggested since I have terminated service (with Megacorp) I was not eligible. I must be misunderstanding something.

MRG

 

[tinlizzy]

I'm more confused now. Before October Megacorp had sent out forms that said their plan was ACA compliant. I have COBRA but this form suggested since I have terminated service (with Megacorp) I was not eligible. I must be misunderstanding something.

MRG

I took the above ruling to mean that those plans must meet the minimum essential coverage requirements if they are offered to former employees but if, as a former employee, you are not enrolled (even though you may be eligible), you may seek insurance/subsidies on the exchanges.

 

[MRG]

Thank you Tinlizzy. That helps.

MRG

 

[davemartin88]

I took the above ruling to mean that those plans must meet the minimum essential coverage requirements if they are offered to former employees but if, as a former employee, you are not enrolled (even though you may be eligible), you may seek insurance/subsidies on the exchanges.

We were given notice that we would have to make a positive choice this year to stay in the program. Seems like I can choose to not re-enroll in the employer program and use the new ACA process. Not sure I want to move on to Medicaid though so will see what information shows up in the mail!

Thanks for the help so far!

 

[tinlizzy]

I dug up the actual ruling for retirees http://www.gpo.gov/fdsys/pkg/FR-2013-08-30/pdf/2013-21157.pdf

Pg.53650 (B.3) of the document

 

[Jackanory]

Oh dear, I thought I had a plan, but now I'm not so sure. I just retired 1/3 (yay for me) and was planning on taking COBRA for a couple of months, then signing up under ACA before the end of the open enrollment period in March. That way I can nail down what my income will actually be for 2014.

Then I found this article claiming that if you're eligible for COBRA, then you can't get premium assistance under ACA: The COBRA Catch With Covered California Health Plans »

After scrutinizing the verbiage under B.3 suggested in the previous post I became slightly more confused.

However, the final regulations provide that, for the lack of affordable coverage exemption, an individual will not be eligible for retiree coverage
unless the individual enrolls. Therefore, an individual who is eligible for retiree
coverage but does not enroll disregards that eligibility in determining
qualification for the lack of affordable coverage exemption.

It sounds that actually enrolling in COBRA might make me ineligible for something, but I'm not quite sure what. My question is: will it make me ineligible for premium assistance?

 

[Chris M]

Oh dear, I thought I had a plan, but now I'm not so sure. I just retired 1/3 (yay for me) and was planning on taking COBRA for a couple of months, then signing up under ACA before the end of the open enrollment period in March. That way I can nail down what my income will actually be for 2014.

Then I found this article claiming that if you're eligible for COBRA, then you can't get premium assistance under ACA: The COBRA Catch With Covered California Health Plans »

After scrutinizing the verbiage under B.3 suggested in the previous post I became slightly more confused.



It sounds that actually enrolling in COBRA might make me ineligible for something, but I'm not quite sure what. My question is: will it make me ineligible for premium assistance?

Here's a clear answer from the Kaiser Family Foundation FAQs section (http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/) on the ACA:

I'm leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the marketplace instead?

Yes, leaving your job and losing eligibility for job-based health coverage will trigger a special enrollment opportunity that lasts for 60 days. You can apply for Marketplace health plans and (depending on your income) for premium tax credits and cost sharing reductions during that period. If you enroll in COBRA coverage through your former employer, however, you will need to wait to the next Marketplace open enrollment period if you want to switch to a Marketplace plan.

 

[Jackanory]

Thanks, that answers the somewhat tangential question about when I'm eligible to sign up for the ACA - but since it's open enrollment through 3/31/2014, that answer seems somewhat moot.

I'd appreciate opinions though, on whether signing up for COBRA would make me ineligible for premium assistance as discussed in the article that I quoted.

 

[rbmrtn]

I believe the article you referenced is incorrect. The FAQ on healthcare.gov answers your question

https://www.healthcare.gov/what-if-...nd-qualify-for-lower-costs-based-on-my-income

I wouldn't bother with COBRA for a few months of coverage anyway. Just use your best estimate for income and it can be adjusted during the year if changes happen.

 

[Jackanory]

Ah yes, perfect!

They do advise keeping your COBRA coverage until ACA coverage begins, so I'll be doing that.

I'll only know my income for this year after I decide whether to sell my house or not ... potential profit > single persons $250K allowance.

 

[pb4uski]

If ACA (after any subsidies) is cheaper, wouldn't you be better off to sign up for ACA coverage as soon as possible and then let your COBRA coverage lapse?

 

[Jackanory]

As an optimist, let's say I make a profit of $350 on my house (bought in '98), then my income for the year would be north of $100k, making me ineligible for any premium assistance.

Due no doubt, to my aging bones, CoveredCA is quoting me $695pm for a reasonable silver plan which is quite a lot more than the $480 or so I'd expect to pay for COBRA (estimated; haven't received paperwork yet).

So COBRA saves me over $200pm unless I decide to stay put. Ah, decisions, decisions.