ACA vs Medicaid

M

mmurphy111

Confused about dryer sheets
Joined
Mar 20, 2019
Messages
7
Location
WADSWORTH
We are going to be entering FIRE in a few months. We will have less than $40k in earnings as we will be living off of our brokerage savings for awhile. We have 1 child and could qualify for Medicaid or also could take some taxable withdraws to get above the Medicaid line. Anyone have experience between the ACA plans and Medicaid? Thoughts on 1 vs the other?
 
Last edited:
It depends in part on your location and how good the local Medicaid system is. Generally speaking, fewer providers and facilities accept Medicaid and wait times are longer for care. If you have a choice, I would choose an ACA plan.
 
With Medicaid, besides having more limited provider network, you often have to wait for long approval lead time for procedures. You should try to stay away from Medicaid.
 
Available ACA policies and Medicaid vary from area to area. Find out what is available to you where you are. Then compare the best (for you) ACA policy to Medicaid coverage.
 
I have experience with it. Check the Managed Care plans in your area and the Provider networks. All my docs from work are in the plans in my county so I see no difference and the coverage is better than I had at work. Best part is you can't be billed beyond super minimal co-pays. The max OOP a year is $200.
 
Last edited:
I will caution you that it's essentially impossible to compare networks. The provider network list is out of date as soon as it's published. When I was in family practice we frequently struggled with finding specialists for our patients. The Medicaid plan website would say Dr. XYZ was in network, so we'd refer the patient there, only to have them call us later saying that doctor no longer accepted the plan. We'd have to work our way through the list that we got straight from the plan to find someone who was actually accepting it and taking new patients.



The other problem, which I alluded to earlier, is wait times can be much longer because the few providers who do accept the Medicaid plans get swamped. I even knew of some Medicaid doctors who didn't take appointments. They only saw patients on a first come, first served basis. That meant basically lining up early in the morning to potentially wait hours and possibly not getting seen that day and having to do it all again the next day.
 
OK. I'll be the first to say it.

Medicaid is intended as medical care for people that cannot afford any other care. Not for millionaires who want to retire early.

If you need Medicaid in order to afford to retire early, then you are not FI.

If you are FI, then use the ACA for your health care, managing your income for maximum benefit. I still think that flies in the face of the intention of ACA, but at least you are paying something towards your healthcare.
 
disneysteve said:
I will caution you that it's essentially impossible to compare networks. The provider network list is out of date as soon as it's published. When I was in family practice we frequently struggled with finding specialists for our patients. The Medicaid plan website would say Dr. XYZ was in network, so we'd refer the patient there, only to have them call us later saying that doctor no longer accepted the plan. We'd have to work our way through the list that we got straight from the plan to find someone who was actually accepting it and taking new patients.



The other problem, which I alluded to earlier, is wait times can be much longer because the few providers who do accept the Medicaid plans get swamped. I even knew of some Medicaid doctors who didn't take appointments. They only saw patients on a first come, first served basis. That meant basically lining up early in the morning to potentially wait hours and possibly not getting seen that day and having to do it all again the next day.
Click to expand...
YMMV I guess. I never had wait times or busted appointments. NY has an up to date Provider lookup tool to check what plans they take.
 
CardsFan said:
OK. I'll be the first to say it.

Medicaid is intended as medical care for people that cannot afford any other care. Not for millionaires who want to retire early.

If you need Medicaid in order to afford to retire early, then you are not FI.

If you are FI, then use the ACA for your health care, managing your income for maximum benefit. I still think that flies in the face of the intention of ACA, but at least you are paying something towards your healthcare.
Click to expand...
So no ACA subsidies as well? ACA subsidies can cost way more then Medicaid.

Warning Porky alert!
 
Let’s please stick to the thread topic, folks.
 
For me DW and I did not qualify for Medicaid but they wanted DD to go on CHIPS... the forms were a big book asking so much that I went back in and upped my income so DD could get ACA plan..


I am surprised that you would qualify.. here there is an asset qualification in addition to income... I was surprised that CHIPS did not have an asset test...
 
Texas Proud said:
I am surprised that you would qualify.. here there is an asset qualification in addition to income... I was surprised that CHIPS did not have an asset test...
Click to expand...
Expansion Medicaid and CHIP are based solely on income.
 
We retired last year about five months before my wife started her pension. We lived on our personal savings during that time, which put our income level well below the ACA threshold and were forced to go on Medicaid. I wanted ACA but the state did not give us any option, so Medicaid it was.

We only saw a doctor once or twice while on Medicaid and had no issues with the plan. No premium, no copays, and we had the same Kaiser doctors and coverage we had through my wife's employer. We even qualified for extra benefits like the Affordable Connectivity Program (ACP - now discontinued). There's a certain stigma that comes with Medicaid, but the doctors don't handle billing so we saw no change in care or attitude.

Once my wife's pension started, we signed up with an ACA plan. Still no premium with low income subsidies, but we do have copays. We switched to a different insurance plan and had to find new doctors and medical facilities. No issues since then.

We're in Washington state and while the signup processes were confusing and frustrating, the actual coverages have been fine.
 
jim584672 said:
Expansion Medicaid and CHIP are based solely on income.
Click to expand...
Exactly, it's intended for millionaires (in assets) just as someone with no assets. Expanded Medicaid is actually part of the ACA, not an alternative.

I don't qualify for Medicaid and am using an ACA marketplace plan. Out of pocket costs can be very high if you actually need to use healthcare services.
 
Last edited:
GenXguy said:
Exactly, it's intended for millionaires (in assets) just as someone with no assets. Expanded Medicaid is actually part of the ACA, not an alternative.

I don't qualify for Medicaid and am using an ACA marketplace plan. Out of pocket costs can be very high if you actually need to use healthcare services.
Click to expand...
Still time for BRK.B, LOL.
 
Both our son and daughter have, at times, qualified for our state medicaid and CHIPS for kids. They have both found medicaid/CHIPS easy to use, good quality care, and their current providers have been in network so they seamlessly went from ACA to Medicaid back to ACA.
 
In our area, as a provider of care for newborns as a pediatric hospitalist, it drove me nuts that almost no pediatricians accepted Medicaid. Check with your pediatrician. Family docs more frequently accept Medicaid in our area.

If you qualify for cost sharing on an ACA silver plan, that can greatly reduce your OOP expenses.
 
Instead of pulling funds from taxable accounts to manage your income to get on an ACA plan, it may be better to convert IRA to Roth instead. Just an idea in case you haven't thought about that.

And experiences with Medicaid are dependent by state.
 
Thanks

Thanks everyone for the feedback. I am in Ohio and don’t think I can choose an ACA plan if my income is not above the Medicaid level. I’ll do more research but tough to get good answers on providers and costs.

In response to Medicaid not being intended for “millionaires” - I’m pretty certain the ACA subsidies were also not intended for them as well.
 
mmurphy111 said:
In response to Medicaid not being intended for “millionaires” - I’m pretty certain the ACA subsidies were also not intended for them as well.
Click to expand...

Yeah, that "two wrongs make a right" logic gets used frequently in these discussions.
 
mmurphy111 said:
Thanks everyone for the feedback. I am in Ohio and don’t think I can choose an ACA plan if my income is not above the Medicaid level. I’ll do more research but tough to get good answers on providers and costs.
Click to expand...
You need over $20,782 to get over the Medicaid line. You can always buy an ACA policy for full price at any time.
 
As others have suggested, do ROTH conversion or simply withdraw from IRA if you don't have enough taxable funds to pay taxes for ROTH conversion.

If you are healthy, Medicaid is fine. But no one can plan for medical issues. For any sort of somewhat moderate procedures, Medicaid has got to approve and it can be a long process.
 
mmurphy111 said:
Actually, it is $34k for a family of 3.
Click to expand...
I'm a family of one. With $34K, I can't even get cost sharing reductions on a silver plan. And I'm not doing any conversions, distributions, or taking any capital gains.
mmurphy111 said:
In response to Medicaid not being intended for “millionaires” - I’m pretty certain the ACA subsidies were also not intended for them as well.
Click to expand...
The law looks pretty clear on that intention. They didn't include an asset test for ACA PCT or ACA Expanded Medicaid.
 
Last edited:
You must log in or register to reply here.

Similar threads

M
How are ACA premiums tax deducted?
Replies
11
Views
1K
SecondCor521
SecondCor521
erkevin
Advice on Inherited Qualified Annuity and Taxes
Replies
11
Views
574
all4j
A
S
Please check my understanding of ACA subsidies.
Replies
6
Views
588
SecondAttempt
S
J
ACA and End of Year LTCGs
Replies
15
Views
1K
pirsquared
P
Gumby
  • Sticky
Some important "trigger" income levels for 2024
Replies
15
Views
8K
Gumby
Gumby

Latest posts

Back
Top Bottom