Decent income but put on Medicaid!

[BobTomas]

Hi, love this forum.....so useful! Just wondering if anyone else has had this experience as it seems wrong to me. We retired in our early 50's 18 months ago and COBRA has just run out. We signed up for the ACA with a taxable income of >$100K and they put us on Medicaid due to the COVID pandemic! Everything free including dental. We called and said something was wrong but they said we had been "selected" to get Medicaid due to the pandemic, and they confirmed to us that our income was recorded as >$100K (married, no kids). We live in a medical hub so I am not *too* worried about the level of care, but still, feels wrong!

I'd rather not say which state

[OldShooter]

Quote:

Originally Posted by BobTomas ... We live in a medical hub so I am not *too* worried about the level of care ...

In our state, Medicaid reimbursements are very low and, hence, many providers refuse Medicaid patients. I have been told that almost no dentists will serve Medicaid patients, for example, leaving only the local university's dental clinic as a provider.

So availability of providers might be something to check out before you need help.

[Major Tom]

That does sound odd Bob. Not sure what to say about that. As for Old Shooter's point about dental care, you can always purchase a separate plan. There is no free lunch with dental plans. You either pay a lot for actual insurance, or very little for a plan that might be called insurance, but is really a discount plan. I signed up with DeltaCare USA, which is a discount plan. I get a few cleanings a year, x-rays etc, and maybe a few fillings. More involved procedures are provided at a discount.

There's no cheap way to get dental, though with your income, it doesn't sound as if the cost will be a problem. Medicaid-provided dental care is worth avoiding, IMO. I tried it for a year or two some years ago, and it was pretty grim.

[BobTomas]

Yes finding a dentist is challenging so prob just pay private for that if anything major needed. Our health plan uses all the major hospitals that we had/wanted access to and we could keep most of the doctors that we had previously....but I do worry a bit about whether you get less care.....

[RetiredAndLovingIt]

I wonder if something in here applies to you, they do mention moving from Cobra to Medicaid.

https://www.dol.gov/sites/dolgov/fil...-under-arp.pdf

[disneysteve]

That sounds really odd, and I'd be pretty pissed if it happened to me. Medicaid is NOT good coverage. Many doctors don't accept it. Access to care can be extremely challenging. If you earn over 100K, you should be able to get yourself regular non-Medicaid coverage.

[RetiredAndLovingIt]

I agree, they tried to that to me on my first year with the ACA. In my case my taxable income was to low. After a lot of discussion with Covered California, we agree that I could resolve the issue with a Roth Conversion which I did immediately. Once they had that paperwork, problem solved. It was worrisome though because in California, if you qualify for and refuse Medicare then they won't let you get an ACA plan, I was freaking out.
The OP's situation is completely different though and I would be very concerned about them going after his estate for repayment at a later time. Better to try and figure it out now, hopefully his state will help him do that.
I have a feeling that the recent changes to the law are responsible and they may be treating him as someone who became unemployed due to Covid.

[Aerides]

I'm not sure who the "they" are in this case, as it sounds like something very specific to your state, and not the experience of most folks here. Places like PA, CA, MA have expansions/additions/add-ons to the ACA but I've never heard of anyone being denied an ACA plan and given no option except Medicaid...unless they clearly met the FPL requirements.

Who are you speaking to? It might be a good time to look up an insurance broker in your state for guidance.

[EastWest Gal]

You might want to try calling back again, or use an insurance broker. At that income, you are not eligible for Medicaid. It sounds like a mistake was made. It definitely needs to be straightened out. You don't want to be on Medicaid. Dental Medicaid is laughable-only a few overburdened health centers offer dental care to Medicaid patients.

[BobTomas]

Thanks for all of the replies guys. Some thoughts (a bit long sorry!):

1. Regarding the help with COBRA payments scheme- we should not qualify for that because we quit voluntarily.

2. We are in Boston MA, so signed up for ACA through the official government portal (Mass connector) by web and then completed by telephone (that who "they" is). Part of the application process involves uploading income verification documents (tax returns etc).

After some time we logged in to the official state ACA website to browse plans and saw that we were eligible for $703/mo credit towards a plan and our income was listed correctly and the site stated we were at 714.28% FPL. Silver-Plat plans seemed to range from $1300-3000/mo after the $703 credit (but would be less because of the new 8.5% max premium for standard level plan). Not cheap!

We browsed a bit but did not select a plan. The next day we logged in to continue browsing and now saw we had been assigned to MassHealth, which is Mass version of medicaid and now had no access to browse ACA plans. We were still listed at 714.28% FPL and our income in $ was correctly stated.

Sensing this can't be correct but also "free healthcare! - great! (I am from UK) we called up the official portal and explained the situation. The lady said we know your income is above what normally is the limit for MassHealth but you have been "selected" for it due to the pandemic, and when the emergency is over you will be off it (maybe end of year). I asked her to recite what they thought our income was and they correctly stated all income (rental income, dividends etc).

I asked whether we could still look at ACA plans and she said the only way is to completely cancel your application and re-start a new application. As mentioned, In some states you cannot get ACA plans if you are eligible and refuse medicaid - not sure about Mass.

3. Being British I am a big advocate of free healthcare, but this being the USA I was initially worried that it might not be as good as private...since "poor" people can be discriminated against, not get all tests etc. That plan we chose is an ACO with the best hospitals in Boston - the Brigham and Womens ACO, which includes Brigham and Womens, Mass general and Dana Farber, and there are loads of doctors in it, including the important ones that my wife used in our previous COBRA plan. But I can't help but wonder if they treat you different because the reimbursements are less? So, we are not in the middle of nowhere where the medicaid facilities are the B-teams, but should we be worried? I don't want to get in a situation where a serious health issue arises and we get sub-par treatment, as I would NEVER trade health for money, but if its the same facilities/doctors as private (mostly) in Boston it is better than paying a big premium/deductible/out of pocket - while it lasts (even though they can reclaim some costs after you die)!

aaggghhh!!!

[Major Tom]

Quote:

Originally Posted by disneysteve That sounds really odd, and I'd be pretty pissed if it happened to me. Medicaid is NOT good coverage. Many doctors don't accept it. Access to care can be extremely challenging.

Broadly speaking, you're probably right. I've been on Medi-Cal (the California version of Medicaid) courtesy of the expansion under the ACA, since 2014, and have been happy with my coverage. I'm a member of a local clinic system, with a new and very pleasant facility in Berkeley. Have never had trouble making appointments, and have always had my needs catered to. Recently, I had a total knee replacement. Total cost to me was zero. Not even a co-pay. The only downside, was that had I carried different insurance, I might have been able to have had the procedure performed at one of several hospitals that are within half a mile of my place. As it was, I had to go to a hospital 16 miles away. Considering the non-existent out of pocket cost to me, I can live with that.

My point, is that while most folk will find that their options are limited under Medicaid, some people may find that there are perfectly acceptable choices available to them.

[MichaelB]

Just to point out two things. One, Medicaid is implemented and managed by the state, and each state is different, so Medicaid may be (and probably is) substantially different between Cal and NY. Few states have Medicaid programs like California’s version, which has broad access and coverage.

Second, Medicaid eligibility is pretty clearly defined and states have clawback power, so even if the state is at fault by incorrectly assigning to Medicaid instead of ACA there might be clawback exposure down the road.

[Major Tom]

Regarding clawback, just as the quality of Medicaid coverage varies from state to state, so do the estate recovery powers, as MichaelB alluded to.

This will not be helpful to the OP, as we are not in the same states. However, in CA, for people who die after 2017 (which will be everyone in CA currently reading this!), Medi-Cal estate recovery is limited to repayment of long term care services, and procedures related to that. That is the brief version but basically, as long as you're not an inpatient in a care facility, repayment will not have to be made from your estate. Also, repayment (if any) is only sought from estate assets that are subject to probate.

YMWACV*, depending on what state you are in.

(*Your Mileage Will Almost Certainly Vary)

[Mykle57]

Bob, on MassHealth as well. The online signup is horrible. It mostly collects info, but doesn't provide much if any back to you.
Providers under MassHealth aren't great, and vary by region. Had Tufts first year, didn't like any of the doctors. Saw my longtime doctor (he lives two houses up the street) asked what plans he takes and got that one. All good for me. But, if I'm out of my area I'm assuming I've got no coverage.

[BobTomas]

Might have lucked out! Mass is ranked #1 for best medicaid coverage for spending and quality!

https://wallethub.com/edu/states-wit...coverage/71573

https://www.beckershospitalreview.co...d-quality.html

[Sarah S]

I am in Boston too. I was never in your situation. I think you could indeed do another application without putting in for subsidies and then get refunded at tax time. I never bothered to put my income in because I didn’t qualify. There was no point where it screened for medicare when I didn’t ask for a subsidy.

If you have a plan that really gives access to all the doctors you need ( call and ask) you might just go with it. The covid cobra thing isn’t going to last forever and unless you are in the middle of expensive treatment or are very unlucky they are unlikely to clawback for a comparatively small amount and as you said you won’t be here to worry
you wouldn’t get different care as long as the doctors accept the insurance I used to have trouble finding specialists for my MassHealth patients but maybe things are better now.

Re the recommendation for an insurance broker when I checked a few years ago it was impossible to buy individual insurance except from Mahealthconnector

[BobTomas]

Mykle57 - you can get emergency care coverage out of state/area with MassHealth.

[BobTomas]

Thanks Sarah - good info. We can get the important docs so far it seems but we are calling them directly to confirm. Good to know we will get the same care...a good doctor should do that but you wonder when the business aspect of it overtakes the medical ethics aspect! We won't be on MassHealth forever I don't think!

[RetiredAndLovingIt]

Regarding clawback, there was a previous discussion on MassHealth Estate Recovery earlier this year.

https://www.early-retirement.org/for...ml#post2609967

To be honest I just don't see this ending well for you, something is very wrong here. I wonder if they did come after you, even if its their mistake, would they take into consideration and give you credit for the subsidy that you would have been eligible for if you'd picked and applied for an ACA plan.
No judgement here, I just would not want the hassle. I've had previous experience with an incompetent branch of the government who simply didn't didn't care that they made the mistake.

[BobTomas]

RetiredAndLovingIt - noted! The agent said they have made a note in our file that we have queried it and I have screenshotted our MassHealth account showing our *verified* income as $123K, us at 714% FPL, but still getting Masshealth. But yes, I am not fully confident in the people running it and who will hold the bag if it all come crashing down!