A Few ACA Insurance Questions

[DINKFIRE]

I am reading upon the ACA insurance options and rules and have a few things I can't figure out, maybe people on this forum has answers from their experience:

1. It appears that most policies offered on ACA doesn't cover out-of-state medicals except for an emergency. And if out-of-state emergency is covered, the individual may still be subject to balance billing. Only some PPO plans may cover out-of-state medicals. Is this true?

2. It appears that most of early retirees want to keep they income above the level for Medicaid, and the reason is subpar services under Medicaid, is that true?

3. The policy language for deductible on family plan appears to indicate that each individual must meet the individual deductible and total deductible of all family members must exceed family deductible before the insurance coverage would apply (except for some preventative cares). Does this mean if total family members' incurred deductible exceeds family deductible total, but one member did not exceed individual deductible, then the individual still won't receive insurance coverage until this specific individual's deductible is met? For example, if individual deductible is $5K, and family deductible is $10K. If one member incurred $12K and another member incurred $4K (total $16K, assuming zero co-insurance, the insurance would only cover $2K instead of $6K. Is this correct?

 

[Aerides]

1 - Yes, but ymmv by plan provider. A lot. The blue cross network is a notable (good) exception.

2 - I can't speak to Medicaid services, but I think that the reasons are more nuanced. Many states still don't expand Medicaid - you can be in a "gap" with no access to coverage (too rich for medicaid, too poor for ACA plans). There many be other coverage issues.

3 - DH and I have our own deductible and then a family one. If he blows past his, I'm still paying full freight, until we get to the family cap.
Either way, pre deductible, we're both still getting coverage. We're paying provider rates vs. retail (huge). We go for a blood test that Quest bills as $900 but we pay the BCBS rate of $85.

 

[Dtail]

Agree on @Aerides' points 1 and 2. We have FLA BCBS.
If you are in a state which doesn't have expanded medicaid coverage, it could be quite an issue if your income falls into that range. FLA doesn't have it, but since I effectively control my MAGI, it doesn't affect me.

 

[PaunchyPirate]

Aerides has accurately responded to your 3 questions.

The comment about Blue Cross being a notable exception to the geographic limitation of coverage... That too will vary by plan provider. Where I live in NW Pennsylvania, our Blue Cross affiliate does not offer any plans that cover non-emergency claims for out-of-state/out-of-network on the ACA exchange. Meaning if you want an ACA tax subsidy, you can't get that feature from them. If you're willing to pay full price and purchase OFF the ACA exchange, they sell plans that have that feature.

It really sucks. If I want a plan from the ACA exchange, I do not have an insurance option that fully covers me out of my local network, which isn't even state wide.

This is one of these US healthcare issues that often people don't think about until it impacts themselves.

 

[DINKFIRE]

1 - Yes, but ymmv by plan provider. A lot. The blue cross network is a notable (good) exception.

2 - I can't speak to Medicaid services, but I think that the reasons are more nuanced. Many states still don't expand Medicaid - you can be in a "gap" with no access to coverage (too rich for medicaid, too poor for ACA plans). There many be other coverage issues.

3 - DH and I have our own deductible and then a family one. If he blows past his, I'm still paying full freight, until we get to the family cap.
Either way, pre deductible, we're both still getting coverage. We're paying provider rates vs. retail (huge). We go for a blood test that Quest bills as $900 but we pay the BCBS rate of $85.

Thank you for the response, Aerides!

I have one more question about ACA income limit. Per my reading it is based on MAGI, which is AGI plus tax exempted income. It seems to me that rental income is only included if it is positive (after depreciation and NOL). We have rental properties that are cash flow positive, but there's no taxable rental income after deducting depreciation. Do you know if my understanding is correct?

 

[cathy63]

Thank you for the response, Aerides!

I have one more question about ACA income limit. Per my reading it is based on MAGI, which is AGI plus tax exempted income. It seems to me that rental income is only included if it is positive (after depreciation and NOL). We have rental properties that are cash flow positive, but there's no taxable rental income after deducting depreciation. Do you know if my understanding is correct?

Yes, that's correct. You take your total income or loss from Schedule E and add it (or subtract if negative) from your additional income on Schedule 1. The total from Sched 1 goes on line 8 of your 1040 and gets included in your AGI. You do not do anything else with rental income in order to calculate your ACA MAGI after that.