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Obamacare and +-65
Old 02-19-2013, 10:37 AM   #1
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Obamacare and +-65

Is anyone out there in a situation like ours; married couple, one eligible for Medicare the other not? And you are trying to determine what your health care premium under Obamacare "might" be?

Using the calculator commonly referenced on this forum, National Health Care Calculator , I'm not sure what the calculator is telling me.

Assuming: number of famiiy members 2, MAGI $40k, age of youngest 62 -- premium cost to family $276 monthly.

DW's Medicare premium is currently approx say $100. Does the calculator projection of $276 include the $100 Medicare premium or would our monthly healthcare premiums total $376?
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Old 02-19-2013, 12:35 PM   #2
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We're not in the same situation but similar. DH (58) will have insurance through his pension plan. I (58) am currently covered but his pension plan is eliminating coverage for spouses so I will be needing coverage through Obamacare.

All the calculators seemed designed for singles or families where everyone in the household needs the coverage. I have been unable to get an answer to the question of - Can 1 person of a married couple get coverage and how much will it cost me?

Please let us know if you find any info. There are a few folks here in similar situations.
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Old 02-19-2013, 12:56 PM   #3
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I posted on this in another thread. Basically the current calculators are all based upon either a single or a family in limited situations because that is all there has been info provided on.

I am 58, DH is 65 and on medicare. We are more complicated because we still have children on our plan. Currently kids and I are insured through DH's retiree plan. Obviously a concern I have is that this will go away at some point and so we will have to deal with the exchanges.

I know that if you look at Massachusetts, I could for example buy a plan that would be just for me and the kids and wouldn't insure DH at all. He would continue getting his insurance through Medicare. I suspect that there will be a similar option for Obamacare. But at this point no one really knows.

I think that for married couples where one is on Medicare and there are no kids that the spouse without Medicare will end up buying a policy for a single person. I think the one on medicare will keep paying for medicare and supplement as they are now. The one not on medicare will pay the cost for a single person policy through the exchange.

The real question to me is that for subsidy purposes will the household be treated as a 2 person household or will it be treated as a 1 person household? If the latter then the subsidy will be quite different for many (or non-existent). I don't know how that shakes out.

I do think that people shouldn't base much on the calculators at this point. For example, right now the calculators say it is more expensive for me to have a family policy than it would be for me and 2 adolescents to each have individual policies. That doesn't seem right. There is also no way to tell the calculator that one person in our family is on Medicare. Also the cost for a family policy on the calculator for me was more than double, almost triple, the cost for a policy using the Massachusetts calculator. I would think that since the Massachusetts one is for real policies that it would likely be closer to accurate.
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Old 02-19-2013, 01:37 PM   #4
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Originally Posted by Katsmeow View Post
The real question to me is that for subsidy purposes will the household be treated as a 2 person household or will it be treated as a 1 person household? If the latter then the subsidy will be quite different for many (or non-existent). I don't know how that shakes out.
Since the subsidy is determined by your income tax return, I would think the number of people in the household would be determined by the filing status. It's possible that you might have to choose married, filing separately to get the subsidy, assuming one spouse had a low enough income to qualify. Of course, in that case the other spouse would probably end up paying more regular income tax than the subsidy by not filing jointly.
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Old 02-19-2013, 03:13 PM   #5
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I'm curious about the OP's issue too. My MIL and FIL are in the same situation - one is on medicare and paying the $100/mo Part B premium, the other is uninsured now but may qualify for Obamacare Jan 1 2014 and has 4 more years until medicare eligibility.

They have almost no income and regrettably (for my in laws) our state has decided not to extend medicaid eligibility to those under 133% of the poverty level. So she may have to figure out a way to get their AGI up enough to qualify for the subsidies for her, if that is how the subsidies work.
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Old 02-19-2013, 04:08 PM   #6
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If I didn't have workplace insurance I'd be in the same situation. My husband is on Medicare and I am 64. But I'm in a bigger place of stupid than anyone else, I guess. I went to that calculator and started playing. I don't understand results like these. Maybe it doesn't work if it turns out the person is not eligible or something. The only change in input in the two runs is $1,000 of additional income but look at the cost and subsidy lines:
1. $62,000 income
Quote:
Calculator
Number of family members (1-8) 2
Annual family income $62,000
Age of the youngest adult in the family (ages 19-64 only) 64
Federal poverty level 400%
Monthly Premium
Total Premium, No Subsidy $1,723
Maximum % of Income Towards Premium 9.5%
Premium Cost to Family $491
Federal Premium Subsidy $1,232
Annual Out-of-PocketLimit on Deductibles, Co-Pays and Other Cost Sharing $12,800
2. $63,000 income:
Quote:
Calculator
Number of family members (1-8) 2
Annual family income $63,000
Age of the youngest adult in the family (ages 19-64 only) 64
Federal poverty level 406%
Monthly Premium
Total Premium, No Subsidy $1,723
Maximum % of Income Towards Premium N/A
Premium Cost to Family $1,723
Federal Premium Subsidy $0
Annual Out-of-PocketLimit on Deductibles, Co-Pays and Other Cost Sharing $12,800
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Old 02-19-2013, 04:15 PM   #7
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But I'm in a bigger place of stupid than anyone else, I guess
Nope. You've just illustrated the infamous "Obamacare cliff" that was discussed extensively in another thread.
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Old 02-19-2013, 05:04 PM   #8
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I'm curious about the OP's issue too. My MIL and FIL are in the same situation - one is on medicare and paying the $100/mo Part B premium, the other is uninsured now but may qualify for Obamacare Jan 1 2014 and has 4 more years until medicare eligibility.

They have almost no income and regrettably (for my in laws) our state has decided not to extend medicaid eligibility to those under 133% of the poverty level. So she may have to figure out a way to get their AGI up enough to qualify for the subsidies for her, if that is how the subsidies work.
Yes, they need to spike their AGI, or move. Spiking AGI can be done by triggering capital gains, very high dividend funds/vehicles, roth conversions...or working part-time if they have no assets and/or only very low pension/annuity income. If they can spike their income into the 100%+ range, the subsidies they will get in return will more than make up for any tax liability, to a massive degree. It sounds like they are probably in the income range where any SS they get would not count towards their AGI, since none of it would be taxable.
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Old 02-19-2013, 09:44 PM   #9
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Yes, they need to spike their AGI, or move. Spiking AGI can be done by triggering capital gains, very high dividend funds/vehicles, roth conversions...or working part-time if they have no assets and/or only very low pension/annuity income. If they can spike their income into the 100%+ range, the subsidies they will get in return will more than make up for any tax liability, to a massive degree. It sounds like they are probably in the income range where any SS they get would not count towards their AGI, since none of it would be taxable.
The parents in law are basically destitute, especially on paper. No savings, no investments, no real assets. SS for 1 of them of $1000/month, other is too young to draw (2 more years). They get a little taxable income from carpentry work and childcare (both 1099 work). They could probably spike their income by not counting business expenses and DW and I could always dump more money on them for the childcare they provide (and we would probably benefit tax wise as well). $16000 or so in income would cost $2400 in self employment taxes, but probably worth it to get the subsidized HI.

Or maybe a better choice is to not sign up until it is needed for some major illness. The current health care plan is to just not pay the hospital bills if something bad happens. At least one good local (state supported) hospital waives 100% of hospital fees if you fall below a generous income threshold. So if MIL gets anything more severe than a splinter in her finger, it's off to the emergency room! Cheaper than paying $100-200 to a family doc or urgent care! The state will end up funding health care for low income people one way or the other (using state dollars or federal dollars).

There is also a possibility that they will make it easy to qualify for the 100% of poverty level in order to qualify for the subsidy since it sounds like many states will not be participating in the federally funded medicaid expansion. In a roundabout way, this may encourage more people to pay SS and medicare taxes by spiking their income to qualify for obamacare subsidies.
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