anybody been on Medicaid?

[garyt]

Just retired in May, my wife is likely to follow next May. Live in Michigan which has expanded Medicaid. We will have very low income and could manage it to get below138% FPL and qualify for Medicaid for a couple of years. Is this smart?
What does Medicaid pay for?
Do many Dr.s take it?
What about surgeons etc , if God forbid we needed something done?
Would we be better to just get a max subsidy and get on the exchange with the high deductibles and high max OOP?
Thanks

 

[Mykle57]

It's called something different in MA. And it'll matter what state your in. There are several plans under the program. Called my PCP and asked which plan he accepted. I'm pretty healthy and haven't needed anything more than an office visit and a prescription refill (statin). Works for me.

Overall, I keep my expenses low, pull most distributions from my tax-paid account, and just a bit from the tax-deferred account.

 

[Sarah S]

I think it will vary by region. In Massachusetts my experience as a doctor was my Masshealth ( medicaid) patients had a lot of trouble finding specialists to take them. In fact my group ( internal medicine) only accepted Masshealth for our existing patients who had an insurance change.

You may not find the lowest cost exchange plan has much better access to a wide range of doctors. Or maybe you will. This again seems to be location specific. Massachusetts has a decent choice of exchange plans - maybe 7 or 8? At all the metal levels. Only three take both my pcp and my one specialist.

I would talk to your current doctor who will probably have a sense of medicaid there and then start looking for doctors that you know you would want for surgery etc and see if they are on the exchange plans.

It is a lot of work I know but this is important and too late if you get sick and have a restrictive plan

 

[MichaelB]

Medicaid is a federal program that is managed by each state, often at the county level, so experience with Medicaid in Alabama or California may have little relevance for Michigan. Many states subcontract insurance companies to administer the program, so you might look first to see how it is managed in your area.

It’s pretty safe to say that in some areas Medicaid is a comprehensive health care option for low income beneficiaries, and in other areas it is a health care plan that suffers from budget limitations and narrow, overloaded networks.

 

[Jerry1]

Doesn’t Medicaid have a total asset test? As in, you have to be really poor, not just lacking in reported income, to qualify?

 

[LRDave]

Doesn’t Medicaid have a total asset test? As in, you have to be really poor, not just lacking in reported income, to qualify?

Single data point: In Colorado in Larimer County, there is no means testing. DS is on Medicaid this year dues to missing about a half-year of work last year due to an auto accident.

As MichaelB pointed out, it certainly varies state by state and even county by county.

 

[MRG]

Doesn’t Medicaid have a total asset test? As in, you have to be really poor, not just lacking in reported income, to qualify?

I don't think the expanded Medicaid has an asset test.

 

[kevink]

Yes, no asset test under ACA.

We've had a few years when we were on Medicaid but have mostly managed our MAGI to hit the subsidy sweet spot (around 23K for married filing jointly this year). As others have said, it is very state and local specific in terms of what doctors you'll have access to.

Also very much worth being aware of are individual state rules about work requirements and claw backs (ability to come after your estate to get repaid for any Medicaid benefits you took).

As examples, in small-town Colorado we had access to slightly fewer doctors under Medicaid than ACA but also had access to subsidized dental care under Medicaid that ACA doesn't offer. Meanwhile in Arizona where we are now they are always pushing for a 20 hour a week work requirement and have also asked for a 5 year cap on Medicaid benefits regardless of age. So choose your state and city carefully - and stay on top of the news as the battle to gut ACA and Medicaid is still very much alive.

 

[MBSC]

Would we be better to just get a max subsidy and get on the exchange with the high deductibles and high max OOP?

If you qualify for max premium subsidy, you also get Cost Sharing Reductions (CSR) which reduce deductibles and MOOP on Silver plans. There are 4 levels of Silver plan CSR.

Over 250% FPL: No cost sharing reductions
200%-250% FPL: Small CSR
150%-200% FPL: Medium CSR
Below 150% FPL: Largest CSR (lowest deductible/MOOP)

 

[Jerry1]

Okay. To OP original question. Not sure about the physicians, but I’m sure that every hospital in Michigan accepts Medicaid. Now if it’s a third party Medicaid HMO, that’s a completely different animal, but if it’s the State Medicaid program, all hospitals. So be careful what you sign up for.

 

[garyt]

Thanks for the replies. I think we'll likely just plan to get a max subsidy and get a silver plan, but man those deductibles and max OOP are high. We're pretty healthy right now,so it may not cost us a ton.

 

[gauss]

Not sure if you can get an ACA subsidy or plan if your income is too low.

I believe all expansion Medicaid plans in Michigan (aka Healthy Michigan) are administered by private companies.

I would ask providers if they accept Healthy Michigan rather than Medicaid.

Gauss

 

[jim584672]

Just retired in May, my wife is likely to follow next May. Live in Michigan which has expanded Medicaid. We will have very low income and could manage it to get below138% FPL and qualify for Medicaid for a couple of years. Is this smart?
What does Medicaid pay for?
Do many Dr.s take it?
What about surgeons etc , if God forbid we needed something done?
Would we be better to just get a max subsidy and get on the exchange with the high deductibles and high max OOP?
Thanks

Most states have Medicaid Managed Care plans. They are like a Medicare Advantage plan with their own provider networks. I was on these plans in NY for the last 5 years, and no problems with specialists. Luckily they have the same doctors as my work plan used to. Max OOP per year $200, $1-$3 Rx. Dental is VERY limited, basic cleaning and fillings. Look at Medicaid Managed Care plans in your state, they will have their own web sites so you can look the networks and formularies.

 

[CardsFan]

I don't know OP's finances, but there is no way in Hades I would default to Medicaid, if I could easily afford the alternates. Even if they might hurt for a few years. Yes, they can be expensive. Frankly, it needs to part of the ER plan. Everyone is perfectly healthy, until they aren't.

 

[jim584672]

I don't know OP's finances, but there is no way in Hades I would default to Medicaid, if I could easily afford the alternates. Even if they might hurt for a few years. Yes, they can be expensive. Frankly, it needs to part of the ER plan. Everyone is perfectly healthy, until they aren't.

The MMC networks in my area are basically the same as the networks for the ACA metal plans, so even paying more isn't going to get you any better quality, just a bigger bill. Do you speak from personal experience or just from what you have heard others say?

 

[Bamaman]

In our state, Medicaid is essentially for pregnant low income women and children. Approximately 40% of the state's children on the plan. My daughter is chronically unemployed and she's ineligible for Medicaid since she was turned down for Social Security Disability.

Those on SSI disability are also eligible for Medicaid--usually the disabled young and those that have never worked 40 quarters. You have to jump through the same hoops as Social Security Disability, and few people are approved without horrendous injuries/illnesses.

Few of our quality physicians accept Medicaid, as the payments are ridiculously low. Those doctors accepting Medicaid are very often foreign born (for a lack of a better term.) Come to think of it, but our very best doctors (and some hospitals) won't even accept Medicaid Advantage programs.

 

[jim584672]

In our state, Medicaid is essentially for pregnant low income women and children. Approximately 40% of the state's children on the plan. My daughter is chronically unemployed and she's ineligible for Medicaid since she was turned down for Social Security Disability.

Those on SSI disability are also eligible for Medicaid--usually the disabled young and those that have never worked 40 quarters. You have to jump through the same hoops as Social Security Disability, and few people are approved without horrendous injuries/illnesses.

Few of our quality physicians accept Medicaid, as the payments are ridiculously low. Those doctors accepting Medicaid are very often foreign born (for a lack of a better term.) Come to think of it, but our very best doctors (and some hospitals) won't even accept Medicaid Advantage programs.

Non Medicaid expansion states make it impossible for able bodied childless adults from even qualifying, they are categorically denied.

 

[swakyaby]

Our local hospital, part of a larger chain of hospitals covering a wide area of Northern California, has opted out of accepting Medicaid patients for non-emergency care. The consequence of that financial decision is that any emergency care cannot be denied and will not be reimbursed to the hospital by the state. Apparently, the bean-counters at the hospital looked at Medicaid payments and decided reimbursements were too low to bother. The only other hospital in our town is Kaiser Permanente, but I’m not sure what their policy is regarding Medicaid. It would seem to me that obtaining care could be more limiting and require more travel, depending on your location.

 

[jim584672]

Our local hospital, part of a larger chain of hospitals covering a wide area of Northern California, has opted out of accepting Medicaid patients for non-emergency care. The consequence of that financial decision is that any emergency care cannot be denied and will not be reimbursed to the hospital by the state. Apparently, the bean-counters at the hospital looked at Medicaid payments and decided reimbursements were too low to bother. The only other hospital in our town is Kaiser Permanente, but I’m not sure what their policy is regarding Medicaid. It would seem to me that obtaining care could be more limiting and require more travel, depending on your location.

I don't think emergency care can ever be denied under the Emergency Medical Treatment & Labor Act (EMTALA) of 1986. As long as the hospital is Medicare participating.

"Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented."

 

[swakyaby]

Like I said, emergency care is not denied. But the hospital cannot received any payment from the state for emergency care provided, due to opting out of Medicaid.

 

[bolt]

I don't think emergency care can ever be denied under the Emergency Medical Treatment & Labor Act (EMTALA) of 1986. As long as the hospital is Medicare participating.

"Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented."

Afaik EMTALA refers specifically to "medicare" not medicaid.
Those are two different programs.

Just sayin....
Good luck & Best wishes....

 

[CardsFan]

The MMC networks in my area are basically the same as the networks for the ACA metal plans, so even paying more isn't going to get you any better quality, just a bigger bill. Do you speak from personal experience or just from what you have heard others say?

No personal experience. While I could argue controlling income to get ACA subsidies is gaming the system, it is the way the law was written.

I don't think anyone proposing the law expected retirees with substantial savings to default to medicaid so they could retire early ( or just save a few thou). To me, this is only a small step from getting food stamps because you can technically qualify. To me, this is not gaming the system, it is stealing from folks that actually need those benefits. Really?

Additionally, I prefer to have some level of control over my providers. I can afford it.

JMHO

 

[tenant13]

I got on Medicaid (or rather so called Horizon NJ FamilyCare plan) when I stopped working this year. Not because I was trying to game the system but following ACA healthcare specialist advise. I tried to enroll in ACA but had to call with a couple of questions. Once it became clear to her that I no longer work and my monthly income is below the 138% poverty line (I live off savings, interest and dividends), she suggested applying for the expanded Medicaid. I qualified simply by truthfully answering all the questions on the application. It's all completely free - including basic dental and vision care - but it's an HMO plan and my PCP is not taking it. Temporarily - they're working on getting back on the network. It's not the end of the world, I simply went back to my previous PCP who does take it but is thus always crowded (one of the reasons I switched). I looked at the specialists network plus called the insurer and it seems it pretty much matches Horizon network so whether it's ACA or this plan it may not make the difference. I'll know when I need to visit one. My recertification date - where I guess I'll have to update my information I initially submitted - is next year so I'll be on this free plan for 12 months no questions asked. OK, I'll take it...

Interestingly once you're on Medicaid it's not that easy to lose it. In order for me to get off Medicaid now, I would have to increase my monthly income and go above 138%. They're not interested in one time cash infusions. So even if I do massive ROTH conversion or realize tons of capital gains selling stocks in one month, it won't kick me off since the following month I make nothing again. Or at least that's what they're telling me on the phone: I called a few times since it seemed really weird to me.

 

[jim584672]

In NY if your income goes up you keep on the plan until your annual recertification date. You could have a bump in income, report it within 30 days, the next month have low income and come back on it. So if you really want off it you need to generate monthly income EVERY month and report it as such.

This is how the law is written. Monthly income for Medicaid and calendar year income for ACA.

 

[mountainsoft]

When my daughter turned 27 and was no longer covered under my wife's health plan, she applied for her own plan through the ACA, the Washington Healthplan Finder. Because of her low income she chose the Apple Health plan, Washington's Medicaid based health plan. She was on that a few years, but had to change plans this year as she now makes too much to qualify.

She didn't go to the doctor very often, but seemed happy with both the medical and dental plans she received at no cost. She was limited to specific offices that accepted the plan, but other than low income folks sitting in the waiting room she acted like the minimal care she needed was fine.

I know there are different types of Medicaid. My daughter had the low income health plan under the ACA.

There's also a part of Medicaid that pays for things like food assistance. I tried applying for my mom once, she didn't qualify, but was surprised they only looked at income for that and not your assets (she received retirement income, but had over 200K in savings, which they said didn't matter).

My mother-in-law receives Medicaid food assistance, though she usually spends $20 or less per week on food. Her medications are also paid for by Medicaid.

There's another part of Medicaid for things like long term care in assisted living and whatnot. That's the one that factors in your assets, which for Washington state has to be below $2000. My mom will probably need to apply for that in six years or so when her personal savings run out.