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HI for DS in California
Old 03-24-2021, 09:50 AM   #1
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HI for DS in California

DS is approaching 26 years old this October. He is a fulltime college student and is currently under my work insurance plan, but HR has confirmed that his coverage will end at the end of his birth month. We are in California, so I guess our options would be:
1- Medicaid for him (His income is low)
2- Get college student HI
3- I am planning to fire later this year or next, so there could be the option of adding him to DW and my ACA plan once I fire (cost seems to be lower for 3 vs 2 even for max income below the cliff)
My question is: is there some difference in service provided between Medicaid vs ACA (he hardly sees his doctor in the past 5 years under my MC HI plan, so there is no preferred doctor etc.)? We plan to move to the Sacramento area once I stop working.
Another question is: while I am still working, is there a way for me to bring DS income higher to get him qualified for ACA (through family gift etc.)?
We are leaning toward filing tax for him as an independent in 2021. Does that impact his future HI plan in anyway?
Thanks in advance for educating us in this matter.
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Old 03-24-2021, 10:49 AM   #2
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I may be wrong, but Medicaid is for the disabled is he ?

26 years old, he should be working and paying his own way through college, this includes insurance and school

Time for these kids to support themselves, like most of us had to do ...... I was removed from my parents insurance at 18
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Old 03-24-2021, 10:52 AM   #3
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when our son hit 26 and was finishing grad school, he purchased the schools health insurance, so he had something after he was off ours. ACA was not available then.
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Old 03-24-2021, 10:59 AM   #4
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Getting insurance through the University may be surprisingly affordable. We are doing this with our daughter - cost is ~$2500 for the full year of coverage including the summer session. Not super cheap, but cheaper than adding her to my ACA coverage. Since we are supporting her education, we consider it just part of her cost to attend college.

Check your assumption that he can be added to your ACA coverage. IF he is not your dependent and reported as such on your income taxes, I believe that he would need to get his own policy.

Finally, consider the networks and accessibility where he is at school. If your ACA coverage is with a company that has limited services in his area, that might not be such a good choice.

Lots of variables!
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Old 03-24-2021, 11:00 AM   #5
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I may be wrong, but Medicaid is for the disabled is he ?

26 years old, he should be working and paying his own way through college, this includes insurance and school

Time for these kids to support themselves, like most of us had to do ...... I was removed from my parents insurance at 18
Not all students follow a conventional path. OP was not, I believe, looking for an editorial comment on his son's path.
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Old 03-24-2021, 11:39 AM   #6
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Check your assumption that he can be added to your ACA coverage. IF he is not your dependent and reported as such on your income taxes, I believe that he would need to get his own policy.

Finally, consider the networks and accessibility where he is at school. If your ACA coverage is with a company that has limited services in his area, that might not be such a good choice.

Lots of variables!
We have the option to claim him as a dependent for 2021, or not. Since his income is currently low, adding him to our ACA (once I fire) actually lower our premium, I believe. What you have mentioned is something I need to think about (the dependency status). Thanks.
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Old 03-24-2021, 11:40 AM   #7
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I may be wrong, but Medicaid is for the disabled is he ?
Medicaid expansion was what I meant
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Old 03-24-2021, 11:54 AM   #8
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He isn't sickly with special requirements Medicaid should be fine. Not in Cali so can't comment on how they run things there, but my guess is it is ok, since it is a blue area.

Medicaid is excellent coverage, very comprehensive.

Gift are not income.
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Old 03-24-2021, 12:04 PM   #9
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I don't think you can put your over-26 year old on your own ACA plan. The extension to 26 applied to all plans, but only up until the day they turn 26 for employers, and end of year in which they turn 26 on Marketplace plans.

Once 26 he will need to have his own coverage, either Medicaid, student, employer, or his own ACA plan, even if he is still a dependent.
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Old 03-24-2021, 12:45 PM   #10
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Don't you mean MediCal for low income health insurance
Qualifications: An individual earning under $17,237 a year(2020) Apply through CoveredCa.com to get this years limits
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Old 03-24-2021, 02:24 PM   #11
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I don't think you can put your over-26 year old on your own ACA plan. The extension to 26 applied to all plans, but only up until the day they turn 26 for employers, and end of year in which they turn 26 on Marketplace plans.

Once 26 he will need to have his own coverage, either Medicaid, student, employer, or his own ACA plan, even if he is still a dependent.
Thanks for the info Aerides. I was not aware of that.
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Old 03-24-2021, 02:28 PM   #12
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Don't you mean MediCal for low income health insurance
Qualifications: An individual earning under $17,237 a year(2020) Apply through CoveredCa.com to get this years limits
Yes. It looks like I was using the wrong term. Thanks.
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Old 03-24-2021, 02:37 PM   #13
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No you can't add him to your ACA plan. He needs to get his own HI plan with ACA if that is the route he wants to go.
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Old 03-24-2021, 06:07 PM   #14
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He isn't sickly with special requirements Medicaid should be fine. Not in Cali so can't comment on how they run things there, but my guess is it is ok, since it is a blue area.

Medicaid is excellent coverage, very comprehensive.

Gift are not income.
In our state, the only people on Medicaid are 1. Low income children (40% of the children in the state) 2. Pregnant single mothers and 3. People that are on SSI which means disabled people that never worked 40 quarters (10 years.) That's it.

Those disabled that worked 40 quarters get Medicare 2 years after they became disabled.

Those on Medicaid will find it difficult to find a top tier physician that will even accept our State's Medicaid payouts. They don't want to lose money on any patient. Most of those accepting Medicaid are physicians that graduated from foreign medical schools.
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Old 03-24-2021, 06:12 PM   #15
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In our state, the only people on Medicaid are 1. Low income children (40% of the children in the state) 2. Pregnant single mothers and 3. People that are on SSI which means disabled people that never worked 40 quarters (10 years.) That's it.

Those disabled that worked 40 quarters get Medicare 2 years after they became disabled.

Those on Medicaid will find it difficult to find a top tier physician that will even accept our State's Medicaid payouts. They don't want to lose money on any patient. Most of those accepting Medicaid are physicians that graduated from foreign medical schools.
It depends on the state you live in. In Massachusetts and California this is not the case. If you are very low income you can go on Medicaid. Also, people on Medicaid receive excellent care and have access to the same doctors as other folks that are better off financially.
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Old 03-24-2021, 10:14 PM   #16
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He needs to apply for insurance through covered California.
From there the system will determine if he is eligible to Medi-Cal. Medi-Cal expansion is based on income only. If the system determines MC eligibility it will not let him apply for any of the ACA insurance plans.
His application for MC will be transferred to his county of residence.

The biggest issue with MC is finding a doctor who will accept it.
These days it isnít as difficult with federally qualified health centers (FQHC)etc. These days FQHCs often have urgent care facilities.
Dental coverage is so so for adults but the medical coverage should be fine particularly for someone his age.
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Old 03-24-2021, 10:17 PM   #17
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In our state, the only people on Medicaid are 1. Low income children (40% of the children in the state) 2. Pregnant single mothers and 3. People that are on SSI which means disabled people that never worked 40 quarters (10 years.) That's it.

Those disabled that worked 40 quarters get Medicare 2 years after they became disabled.

Those on Medicaid will find it difficult to find a top tier physician that will even accept our State's Medicaid payouts. They don't want to lose money on any patient. Most of those accepting Medicaid are physicians that graduated from foreign medical schools.

Your state probably opted out of the Medicaid expansion that was implemented with ACA.
Itís quite a disservice to the residents in those states in my opinion.
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Old 03-25-2021, 01:01 AM   #18
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It depends on the state you live in. In Massachusetts and California this is not the case. If you are very low income you can go on Medicaid. Also, people on Medicaid receive excellent care and have access to the same doctors as other folks that are better off financially.
I'm a physician in California and disagree strongly with this. The medicaid program in California (Medi-cal) requires almost all participants to be in a managed Medi-cal plan. The quality of providers will vary by location but in general is poor. This is a result of the fact that reimbursement to physicians by Medi-cal is shockingly abysmal, indeed a disgrace. I do not know a single physician that I would consider going to myself that participates as an outpatient provider.

You might see some well qualified physicians if you are hospitalized, but as an outpatient you will have an extremely limited choice of providers. There will be a gatekeeper before being allowed to see a specialist, and there are many specialties where you will find it almost impossible to see anyone.

The authorization process to obtain procedures and advanced imaging is notoriously difficult, and it results in substandard care.

For a young healthy patient who needs very little medical care, you might get by without a bad outcome but I would recommend accepting Medi-cal only as a last resort, if you cannot afford any other type of coverage.
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Old 03-25-2021, 04:17 AM   #19
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My Megacorp doctors are in several Medicaid Managed Care plans in my area, so the only difference I saw was lower costs. YMMV
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Old 03-25-2021, 04:30 AM   #20
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I'm a physician in California and disagree strongly with this. The medicaid program in California (Medi-cal) requires almost all participants to be in a managed Medi-cal plan. The quality of providers will vary by location but in general is poor. This is a result of the fact that reimbursement to physicians by Medi-cal is shockingly abysmal, indeed a disgrace. I do not know a single physician that I would consider going to myself that participates as an outpatient provider.

You might see some well qualified physicians if you are hospitalized, but as an outpatient you will have an extremely limited choice of providers. There will be a gatekeeper before being allowed to see a specialist, and there are many specialties where you will find it almost impossible to see anyone.

The authorization process to obtain procedures and advanced imaging is notoriously difficult, and it results in substandard care.

For a young healthy patient who needs very little medical care, you might get by without a bad outcome but I would recommend accepting Medi-cal only as a last resort, if you cannot afford any other type of coverage.
^^^^^^ This. I have never been on Medical , however know several people who are, and it is the last resort for medical insurance.

The only thing that was worse was the California assigned risk plan for un-insurable , that was pre A.C.A.

Health insurance thru a college is usually good , and at an affordable price.
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