Transitioning to Retirement - Healthcare Hurdles

[mountainsoft]

Past months have no bearing on current month income for Medicaid.

We made clear on the initial application that my wife was retiring and would have no income. They still wanted verification of her income the previous 2-3 months, which disqualified us.

They also disqualified us because we already had insurance through her work, even though we told them it was ending in April.

I thought we finally had it all sorted out, only to have to start over again. I have explained it numerous times and sent multiple documents detailing exactly what is happening, but somehow it keeps getting messed up. It's not rocket science, I don't know why it's such a problem.

We were trying to avoid having a lapse in coverage, but planning ahead was obviously a mistake. It probably would have gone smoother if we had just waited till she quit and existing health coverage ended. Knowing our luck, we would have had a health emergency before the new coverage started.

 

[jim584672]

We were trying to avoid having a lapse in coverage, but planning ahead was obviously a mistake. It probably would have gone smoother if we had just waited till she quit and existing health coverage ended. Knowing our luck, we would have had a health emergency before the new coverage started.

COBRA has a grace period to cover in case something happens. Also Medicaid can be retroactive up to 3 months, so next time let the coverage end before applying. I know that doesn't help things and as you stated is probably the source of most of your problems, combined with poorly trained workers handling the application.

 

[target2019]

Same policy. I just checked both of our health accounts at Kaiser. They both say "cancelled", but still show "active status" on the member info page. My wife had a dentist appointment yesterday with no issues, so who knows. Maybe the pharmacy is just being picky since the official refill date is May 2nd, despite me requesting a refill a few days earlier before our insurance expires. No biggy, just odd. I have enough pills to last a few weeks so I can sort this out next month.

With a pharmacy and others you may be finding that one set of systems is out of sync with another. IOW, when a date is pulled, it could be something cached in CVS data, and not fully accurate.

One piece of advice I found here was to complete procedures and refills well in advance of insurance switchover.

In our case the hospital pharmacy promised me that there's be no billing delay with an expensive Rx, and it would be billed to the old insurance, no problem.

Months later I noticed on new insurance that they had gotten the claim. It was cleared up on its own, without me, and a credit was issued to my account. So it must have been that the charge went to New Ins., but eventually had to be accepted as a claim to Old Ins.

 

[RetiredHappy]

... no expert here but when I went on ACA for one year (only), I projected our entire year income. Should you not have included the upcoming pension in September + 4 months of pay for your annual income in your submission? I bet that would not put you into Medicaid, and likely make it a faster process. They will still need a letter from you to explain how you come up with the numbers.

 

[Aerides]

When we first went on, the cap for subsidies was 63.9 i think? I didn't know what our income would be, but I figured estimate 60k and we'd be fine, knowing we'd be probably under in reality (best to estimate high and come in less vs the opposite).

So we went 30k each, /12, and put in 2500 projected monthly income each for us both. Done, no questions, despite that being very much lower than prior years, as it was our first full RE year.

Had we gone on the ACA mid-year, we'd have just entered the real numbers for the past months, and then the same 2500 or lower for the remaining ones. It was very easy and simple, no challenges. But some states might have different things involved? Our state did not take the Medicaid expansion but we weren't estimating anywhere close anyway.

 

[ncbill]

And so the fun continues... Even though we had already been approved, and we already received our medical cards, I received another request for income verification. So, I followed the instructions on the request exactly and sent them the verification they requested. No response, no further reminders, so I assumed all was good.

Then a few days ago I received a new message saying our coverage had been terminated because I didn't send the requested verification. Huh? I sent them weeks ago, and have a copy of the email to prove it.

So, I spent about 30 minutes on a chat, and resubmitted everything. Not feeling very confident, I got on another chat to make absolutely sure this time. Seemed to be okay, though I noticed the updated submission now said "not requesting coverage". Huh? Why would I even apply otherwise. Dumb.

So, more chatting, and digging through some unrelated screens to find the items I needed to toggle back where they were. And now I wait again for the documents to be reviewed.

Of course, the change in my wife's income mid-year has really caused a hassle. First we didn't qualify because she made too much. Then they said to take the four months income and average it over the year (It's on their web site instructions, word for word). Now they say we can't do that without some kind of special letter. After yet another chat, he said just to enter zero for her income since she is retiring.

The whole thing is a mess and I really don't feel confident about any of it. First we're covered, then we're not. Now I have to wait to see if we're covered again.

The funny thing is my online account shows all the income documents I have uploaded already. What else are they expecting to receive?

So no brokers in your area?

That's what I'd use did I need to switch to an ACA plan.

 

[mountainsoft]

One piece of advice I found here was to complete procedures and refills well in advance of insurance switchover.

We both tried to get pending things taken care of before insurance ran out. I tried to renew my meds ahead of time, but doc said it was too soon and to try again a couple weeks before insurance ran out. But when I tried the pharmacy said coverage had already ended.

Anyway, I think I have the medical end straightened out, at least till the end of May. I think the pharmacy part is working too, but will have to see if my order goes through successfully or not.

Beyond that, our income review is scheduled for mid-May. So I guess we just wait to hear what happens with that.

 

[CaliKid]

Our medical insurance system in this country is so broken. I do not think it could be more complicated or more cumbersome than it is. So sad!

 

[Poopycat]

This thread is terrifying to me. When I retire, I will be living off savings, with no income other than what my investments may make. I don’t want to be placed on Medicaid. I’m worried I won’t be able to qualify for ACA coverage now. I don’t know why everything has to be so complicated.

 

[jim584672]

This thread is terrifying to me. When I retire, I will be living off savings, with no income other than what my investments may make. I don’t want to be placed on Medicaid. I’m worried I won’t be able to qualify for ACA coverage now. I don’t know why everything has to be so complicated.

Medicaid is the best coverage you can get. All my docs from work are in the Managed Care plans in my area so I didn't see any difference in care. It also gives complete protection from Providers billing you. Due to the pandemic I got locked in for the last three years. I'm going to miss it when it goes away this year.

 

[TheWizard]

Medicaid is the best coverage you can get. All my docs from work are in the Managed Care plans in my area so I didn't see any difference in care. It also gives complete protection from Providers billing you. Due to the pandemic I got locked in for the last three years. I'm going to miss it when it goes away this year.

Medicaid is for destitute people.
You know that, don't you?

 

[jim584672]

Medicaid is for destitute people.
You know that, don't you?

Being destitute is not a requirement of ACA Medicaid or the ACA.

 

[mrstop]

I'm self employed and somewhat semi-retired, with the exception of 1 year, have been on the ACA for the last 6+ years. I have avoided Medicaid by always estimating above the threshold so I didn't have to deal with anymore red tape and possibly limit my healthcare options. There has been no income verification (Ohio) for me.



My guess is that you are getting asked for income verification because you enrolled in Medicaid. If you can't change it for this year, just bump up your estimated income for the year beyond the Medicaid threshold. You'll end up paying upfront, but you'll get it back on the following years' tax return.

 

[EastWest Gal]

Something that may have created this nightmare for you was the ending of the pandemic rules this spring. Apparently everyone on Medicaid was required to reapply. That probably gummed up the works.

I’ve been on insurance through the ACA for the past 2-1/2 years. Our income is lumpy because we’re living off of investments, a taxable account. I’m selling equities every couple of months, and our needs have been lumpy. Our state has an attestation form that we can use to estimate our income. That has been a big help.

 

[KarenF]

[/QUOTE] I tried to be vague enough to keep us above the minimum ACA level, but they required income verification (pay stubs, tax returns, pension estimates, etc.). So there was really no way to work around their messy system.[/QUOTE]

That is interesting that they required income verification. Maybe because it was a low amount? I retired, used COBRA for 18 months, and then transitioned to ACA. I did put in an estimate of our earnings and did not make it exact. There was no income verification required. When I picked an ACA plan I asked my doctors what insurance they took, and picked an ACA High Deductible plan with that insurance company. The only painful part for me is that I could not get a PPO plan through the ACA, and have an HMO. Luckily my doctor is great and happy to write me referrals for everything I need.

 

[KarenF]

This thread is terrifying to me. When I retire, I will be living off savings, with no income other than what my investments may make. I don’t want to be placed on Medicaid. I’m worried I won’t be able to qualify for ACA coverage now. I don’t know why everything has to be so complicated.

Everybody qualifies for ACA. My husband got a sweet private insurance plan, but I did not pass underwriting (hypothyroid) so ACA it was. We are living off our investments as well. I did not have to prove my income and it was not complicated to set up ACA.

 

[qwerty3656]

Everybody qualifies for ACA

No, If you make too little money, you have to go on medicaid.

 

[Which Roger]

The last 2 replies are a matter of semantics. I think what was meant by "everybody qualifies for ACA" is that you can't be denied coverage, not that everybody is eligible for an exchange plan. ACA is a big complex law, and you can't "qualify" for a law. Rather, the rules for who can get an exchange plan vs who can go on medicaid are all part of that law.

 

[Aerides]

This thread is terrifying to me. When I retire, I will be living off savings, with no income other than what my investments may make. I don’t want to be placed on Medicaid. I’m worried I won’t be able to qualify for ACA coverage now. I don’t know why everything has to be so complicated.

I think perhaps the OP's situation is complicated by some income estimates that are strange given his and his wife's situations, the pension, etc.

For most of us, as you can see in this thread, reasonable estimates in the ACA range - even if not remotely exact, and lumpy vs. monthly in reality - it works just fine.

If you are expect to earn say $50k per year post-retirement, via investments, dividends, conversions, you put in $4167 per month expected earnings, and off you go.

Oh, and if some years, you don't have much because of not selling stuff, no conversions, etc., and come in UNDER the ACA range, it's also fine. You don't get bumped to Medicaid as long as you continue each year to estimate the minimum to get an ACA plan.

 

[jim584672]

Each state can have a different methodology on how to handle lumpy monthly income because Medicaid is based on going forward monthly income. To be absolutely sure, if you want to avoid Medicaid, show consistent monthly income over the Medicaid line.

 

[MC Rider]

I stressed and fought with this for weeks. Finally made a good jump forward by going in person to the Human Services office. Talked to a caseworker, outlined what we expected for income (not much), we own our house, the income is interest income) and after some more time we were approved for Medi Cal. Apparently assets are not so important to them, just income. Our insurance person told us you will get the same Doctors etc whatever insurance you have in this rural area. Works for me. No co pay at the dentist or the pharmacy.

 

[Poopycat]

Everybody qualifies for ACA. My husband got a sweet private insurance plan, but I did not pass underwriting (hypothyroid) so ACA it was. We are living off our investments as well. I did not have to prove my income and it was not complicated to set up ACA.

I just have misunderstood because it sounds to me like people whose income is too low won’t qualify for ACA but would have to go on Medicaid instead.

 

[MC Rider]

I just have misunderstood because it sounds to me like people whose income is too low won’t qualify for ACA but would have to go on Medicaid instead.

That is my understanding. But maybe check into it, Medi Cal has been pretty good for us so far. Which is about 2 months. Maybe it is different where you are though. Medi Cal is the California version.

 

[Poopycat]

Medicaid is the best coverage you can get. All my docs from work are in the Managed Care plans in my area so I didn't see any difference in care. It also gives complete protection from Providers billing you. Due to the pandemic I got locked in for the last three years. I'm going to miss it when it goes away this year.

It sounds like Medicaid worked for you because your doctors (sounds like you may be part of Kaiser) also took Medicaid patients. I used to work for a large health insurance company that managed Medicaid for multiple states and in most situations it was extremely difficult for Medicaid patients to find doctors who would accept Medicaid because the reimbursements were so low. I can see where it would work great if you could keep your same doc or HMO but if you don’t have that type of lucky situation, trust me, you don’t want Medicaid.

I guess another factor for me, whether it’s right or not, is that I would feel uncomfortable being on Medicaid. I’m glad it’s out there for people who would otherwise have no health insurance, but I wouldn’t feel right about being on it when I know I could afford health insurance. And I guess I don’t really want the stigma of being a “Medicaid patient.” That’s just me, I know others probably don’t feel that way.

 

[jim584672]

It sounds like Medicaid worked for you because your doctors (sounds like you may be part of Kaiser) also took Medicaid patients. I used to work for a large health insurance company that managed Medicaid for multiple states and in most situations it was extremely difficult for Medicaid patients to find doctors who would accept Medicaid because the reimbursements were so low. I can see where it would work great if you could keep your same doc or HMO but if you don’t have that type of lucky situation, trust me, you don’t want Medicaid.

I guess another factor for me, whether it’s right or not, is that I would feel uncomfortable being on Medicaid. I’m glad it’s out there for people who would otherwise have no health insurance, but I wouldn’t feel right about being on it when I know I could afford health insurance. And I guess I don’t really want the stigma of being a “Medicaid patient.” That’s just me, I know others probably don’t feel that way.

I have been in many Medicaid Managed Care plans in my area over the years, and my docs are in most of them. Never been billed for scans or blood work. Best coverage available, and in my state Providers are not even allowed to send a bill to a Medicaid patient.