Looks like it went up for 2024 to $35,631, Medicaid updates right away, ACA is a year back.
ACA vs Medicaid
- Thread starter mmurphy111
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Texas Proud
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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Texas Proud
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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And what would prevent you from getting over $34K of income?
It was easy for me to show income if I wanted... it was much harder keeping it low to try and get the cost reduction silver plan.. I would bounce back and forth on one...
tenant13
Full time employment: Posting here.
I was on Medicaid for 3 years and loved it. In my state there’s estate recovery so whatever subsidies I was receiving, will be fully repaid from my estate when I’m dead. In that sense it was not “free” health insurance (or a free ride for a millionaire) but a loan that covered the services.
My ACA experience is awful. High co-pays, 6k deductible, worse network than what was available to me on Medicaid. I actually avoid using it like a plague and after my recent 3k charge at ER for a small problem I would rather get on the flight and go anywhere else in the world than sink any money in the US system. I must have a plan (NJ imposes penalties for being uninsured) but consider it a racket.
My ACA experience is awful. High co-pays, 6k deductible, worse network than what was available to me on Medicaid. I actually avoid using it like a plague and after my recent 3k charge at ER for a small problem I would rather get on the flight and go anywhere else in the world than sink any money in the US system. I must have a plan (NJ imposes penalties for being uninsured) but consider it a racket.
In our state, if you can have a certain level of income that's too high for everyone to be on Medicaid (type of program) which directs you toward the ACA.
If you have too little income above that threshold, the child won't qualify for ACA and thus the parents go on ACA plans and the child goes on the state's Medicaid (like) program. So there's a Goldilocks window. That's how we've played it.
Our state doesn't look at assets such as IRAs so our Roth conversions don't count as income (because you're trading one IRA for another IRA) for basing the kid's portion (but get ready to do some explaining as it's not a normal situation that these guys deal with), only our investment income. All income is counted when factoring in any ACA credits.
I believe we also reduce our income (for sure with ACA and likely with the state program) by our HSA contributions as they want to see your AGI line item.
So it's a bit of a multi-factor scenario for both the kid side and the adult side. I certainly didn't write the rules but since they're there, I'm using the programs as listed.
If you have too little income above that threshold, the child won't qualify for ACA and thus the parents go on ACA plans and the child goes on the state's Medicaid (like) program. So there's a Goldilocks window. That's how we've played it.
Our state doesn't look at assets such as IRAs so our Roth conversions don't count as income (because you're trading one IRA for another IRA) for basing the kid's portion (but get ready to do some explaining as it's not a normal situation that these guys deal with), only our investment income. All income is counted when factoring in any ACA credits.
I believe we also reduce our income (for sure with ACA and likely with the state program) by our HSA contributions as they want to see your AGI line item.
So it's a bit of a multi-factor scenario for both the kid side and the adult side. I certainly didn't write the rules but since they're there, I'm using the programs as listed.
As others have mentioned - it varies widely by state.
I live in CA and I ran into the situation where my kids were put on medicaid until I straightened it out... Three times. (Took me the third time to figure out how to avoid it.)
California has a special program that is well intentioned... wants to make sure no kid goes without health coverage. Our income was towards the top of the ACA subsidy bracket (before CA expanded it)... but they still wanted to put the kids on medicaid - just to be safe. I learned to "overestimate" my planned IRA withdrawals to put me above the subsidy level altogether... I paid more per month, but at tax time, any ACA tax credits were given to me as a refund.
My issue was the kids and I were on Kaiser and Kaiser SoCal has limited spots... so there was no guarantee they would remain on Kaiser if they were put on Medicaid.
Kaiser doesn't care if a patient is medicaid, employer insurance, retired teacher... Only the billing office cares. And since it's closed network, there's no 'finding a doc that accepts MediCAL". But, as I said, there was a big risk the kids would be pushed off Kaiser... so I upped our 'estimated income'.
Now that the kids are adults, (but still dependents as they're in college) I no longer have to overestimate my IRA withdrawals.
I have friends who's kids were on medicaid - no issues... One friend's son got lyme disease that landed him in the hospital for close to a month...Rady's Children Hospital - best in the area... paid in full. (As were all the specialists that were involved.)
But... it's very geographically dependent.
I live in CA and I ran into the situation where my kids were put on medicaid until I straightened it out... Three times. (Took me the third time to figure out how to avoid it.)
California has a special program that is well intentioned... wants to make sure no kid goes without health coverage. Our income was towards the top of the ACA subsidy bracket (before CA expanded it)... but they still wanted to put the kids on medicaid - just to be safe. I learned to "overestimate" my planned IRA withdrawals to put me above the subsidy level altogether... I paid more per month, but at tax time, any ACA tax credits were given to me as a refund.
My issue was the kids and I were on Kaiser and Kaiser SoCal has limited spots... so there was no guarantee they would remain on Kaiser if they were put on Medicaid.
Kaiser doesn't care if a patient is medicaid, employer insurance, retired teacher... Only the billing office cares. And since it's closed network, there's no 'finding a doc that accepts MediCAL". But, as I said, there was a big risk the kids would be pushed off Kaiser... so I upped our 'estimated income'.
Now that the kids are adults, (but still dependents as they're in college) I no longer have to overestimate my IRA withdrawals.
I have friends who's kids were on medicaid - no issues... One friend's son got lyme disease that landed him in the hospital for close to a month...Rady's Children Hospital - best in the area... paid in full. (As were all the specialists that were involved.)
But... it's very geographically dependent.
+1 for Medicaid
When I filled out the ACA I entered my honest monthly income and was forced onto Medicaid, which actually turned out great. No costs, ever, for anything here in MO anyway. But, there is a clause that after you and your wife die, they can come after your estate for whatever costs you and your family incurred while alive, but without interest charges. I'm not sure how often they actually do that, I think it's mostly used for folks who end up in nursing homes for a long time.
After a few months on Medicaid my son got a job and we no longer officially qualified. I updated our status, but being Covid policy was still in place they wouldn't kick us off for another 6 months. I called several times letting them know we don't qualify until one of the operators finally told me about the Covid policy, so I just let it ride.
When I filled out the ACA I entered my honest monthly income and was forced onto Medicaid, which actually turned out great. No costs, ever, for anything here in MO anyway. But, there is a clause that after you and your wife die, they can come after your estate for whatever costs you and your family incurred while alive, but without interest charges. I'm not sure how often they actually do that, I think it's mostly used for folks who end up in nursing homes for a long time.
After a few months on Medicaid my son got a job and we no longer officially qualified. I updated our status, but being Covid policy was still in place they wouldn't kick us off for another 6 months. I called several times letting them know we don't qualify until one of the operators finally told me about the Covid policy, so I just let it ride.
The COVID lock in was great, I could make any amount and not lose coverage for 3 years from March 2020. Only a few states do Estate Recovery for ACA Medicaid, like NJ does.
WorkIsOverrated
Confused about dryer sheets
I triggered Medicaid when I retired while I was living off my severance package. Basically because of the severance I received at the beginning of the year, I had no income the rest of the year. I paid for ACA coverage for the first year. It was slightly less than COBRA. Then during re-enrollment, I triggered Medicaid. It was not my intent. I did so much research for retirement, and believed I had thought of everything. But missed this one thing.
When I got the screen on the ACA that I qualified for Medicaid, I called my state Medicaid office (Indiana) and told them it was a mistake. That while I currently had no income, I was planning on w/ding from my 401k eventually. They said it didn't matter...since I qualified for Medicaid I could not get coverage through ACA. I tried re-enrollment a couple times, same result. Like "Mountainsoft", I had no option.
It has been a year and a half. My experience with Medicaid has been OK. I did have to change my primary care physician, which didn't bother me or my husband. I do have to call around some to find specialists. Currently trying to find a physical therapist that takes my insurance. Overall the experience has been fine. No premiums, no copays, no pharmacy costs.
I suspect I will be denied Medicaid this fall during open enrollment given that I have now w/d from 401k/IRA. We shall see.
Good luck mmurphy111! Enjoy retirement!
When I got the screen on the ACA that I qualified for Medicaid, I called my state Medicaid office (Indiana) and told them it was a mistake. That while I currently had no income, I was planning on w/ding from my 401k eventually. They said it didn't matter...since I qualified for Medicaid I could not get coverage through ACA. I tried re-enrollment a couple times, same result. Like "Mountainsoft", I had no option.
It has been a year and a half. My experience with Medicaid has been OK. I did have to change my primary care physician, which didn't bother me or my husband. I do have to call around some to find specialists. Currently trying to find a physical therapist that takes my insurance. Overall the experience has been fine. No premiums, no copays, no pharmacy costs.
I suspect I will be denied Medicaid this fall during open enrollment given that I have now w/d from 401k/IRA. We shall see.
Good luck mmurphy111! Enjoy retirement!
Don't forget the difference between the ACA plans and Medicaid is one is calendar year and one is monthly based. You can always drop in mid year if your monthly is under the line. Or conversely if you want to avoid it have monthly income over the line.
Looks like Medicaid is actually "average" monthly from when I looked into this before per this previous discussion:
https://www.early-retirement.org/forums/f38/when-to-do-aca-sign-up-119090-2.html#post2980587
It doesn't. That is why the person in this thread was put in it. And I am not re-hashing again that thread. Lottery winnings over $80K have special rules for spreading out income. Lump sum income only counts in the month received. Repeating cyclic going forward income MAY be annualized in certain instances, but each state has its own methodology on this. My state does a 12 month lock in to prevent churn.
tenant13
Full time employment: Posting here.
NJ asks for the previous year’s 1040 if the stated income is irregular and not the typical recurring paycheck. That way they prevent one time ROTH conversions to fly under the radar and become assets as soon as they occur.
EastWest Gal
Thinks s/he gets paid by the post
Only if you are in a Medicaid HMO.
Medicaid is great at covering hospitalization charges. It's trying to find some specialists that accept Medicaid where there are issues. For example only certain pediatric ENT specialists and ophthalmologists in our area accepted Medicaid. Fortunately they were the specialists affiliated with the local Children's Hospital. Unfortunately, their waiting list was long. Fortunately some had walk in hours. Other times I had to personally speak with the specialist when the prolem was urgent.
Not needing to rehash it, but the Cornell site you linked to in that thread, which I quoted in that thread from that website, is located in N.Y.
That is the Federal law for ACA Medicaid, the site location is irrelevant.
https://www.law.cornell.edu/cfr/text/42/435.603
Golden Mean
Recycles dryer sheets
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This was interesting thing I ran into when researching whether to go with medicaid or do Roth conversions to get into ACA territory here in NV.
What you are referring to is Medicaid Estate Recovery and I think it's due to the grey area (state law-wise) between asset based medicaid and the income based expansion medicaid.
The link above lists which states that have passed laws to make it clear income based medicaid won't involved estate recovery and which ones that haven't.
Correct, that's the site you gave me. It was this wording that jumps out at me in regard to establishing the currently monthly income:
I'm not re-doing this topic, sorry.
Yeah, that's fine. It's just on-topic for what was discussed in this thread and directly from your own linked website. People can read that and come to their own conclusions.
I already answered this and you are ignoring context and each state has their own methodology in their state plan. Lump sums (like Roth conversions) are not "reasonably predictable" and only count in the month they happen.
"(1) An amount received as a lump sum is counted as income only in the month received."
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You’ve both made your points, so let’s all move one.
Don't forget your free cell phone if you are on Medicaid...
Unfortunately the ACP program expired but Lifeline phones live on.
-----------
Assurance Wireless is a federal Lifeline Assistance program.
If you or a member of your household participates in certain public assistance programs like Medicaid/Medi-Cal, Food Stamps/SNAP/CalFresh or SSI.
https://www.assurancewireless.com/
Unfortunately the ACP program expired but Lifeline phones live on.
-----------
Assurance Wireless is a federal Lifeline Assistance program.
If you or a member of your household participates in certain public assistance programs like Medicaid/Medi-Cal, Food Stamps/SNAP/CalFresh or SSI.
https://www.assurancewireless.com/
Agree! Definitely worth doing the ACA vs being on Medicaid!
Although a small sample size, this isn't what we experienced. My son needed a procedure on his nasal passages which were too narrow and he always had trouble breathing, especially during allergy season. Rebuilding the passages after such a procedure is done by a plastic surgeon, and insurance companies often deny covering such procedures as being cosmetic.
At the time of diagnosis we were still on Medicaid and the procedure was approved to be covered with no deductible. However before the operation we were kicked off medicaid due to covid policy ending. We then signed up for ACA in 2023 and the ACA insurance denied the procedure. We ended up having to postpone the procedure to 2024 and I picked a different insurance company since the previous one was no longer offering insurance in MO. Again, the new company denied coverage and we ended up having to spend about $5000 out of pocket.
