Implications of ACA for low-budget ER

[kevink]

Like many here my wife and I have been following the ongoing saga of the Affordable Care Act AKA Obamacare with much interest. Reading these forums I feel like we're part of a small minority not only in not having group health insurance from a megacorp but also in living on considerably less than many seem to spend on health insurance premiums alone.

We've been very fortunate in having no major medical stuff so far and have gotten by with ultra high-deductible (10K per person) plans costing us ~$220-300 total per month (I'm 55, DW is 49). Since we live off of assets only and are frugal our taxable income each year is way below federal poverty guidelines, making us elibigible for Medicaid coverage in 2014 according to ACA.

So as things stand now (realizing the upcoming elections could change everything) this is the way I read things: we pay the premiums for our current bare bones/catastrohpic coverage through 2013, are then able to use Medicaid as our catastrophic coverarage starting in 2014, but once we hit age 65 we need to budget for Medicare and Medigap premiums as "normal" Medicaid has means/asset tests which we'd clearly fail. This all sounds too crazy and complicated to be true, but based on a careful reading of the info put out by Kaiser Foundation and others this is what I'm thinking is the case. Comments?

 

[MichaelB]

kevink, the medicaid expansion is by state and is voluntary. So far not every state has committed to it and some have indicated they will not participate. This depends on your state and how it determines eligibility. See here for a KFF overview of the medicaid expansion.

Edit: here's a link from the PPACA thread to a USA Today story that summarizes the implementation efforts by state http://www.usatoday.com/news/nation/story/2012-06-28/health-care-states/55889922/1

 

[donheff]

I think you should read the whole thread that was recently made a sticky thread on this topic. It should address your concerns and, if not, you should ask there so your expansion will be added to the sticky.

 

[FUEGO]

I have the same question about medicare for those age 65 and over and how it is impacted by the Obamacare. I am helping my father in law get set up with an appropriate medicare plan since he is turning 65 soon. They are very low income and have no assets outside of a couple thousand in bank account, a few old vehicles, and limited personal property. It seems like my MIL who will still be under age 65 in 2014 will get heavily subsidized health insurance from the exchanges or free medicaid, but upon turning 65 she will have to deal with medicare, medigap, and Part D coverage or a medicare advantage plan? Looks like premiums for those options are 4-5x what they might pay for the subsidized exchange HI at age 64, but I am not certain that incongruous treatment is what will actually happen.

 

[John Galt III]

kevink, I will be 59 when 1/1/2014 rolls around. From what I have read, I will be able to then enroll in Medicaid (for free, I think), under the ACA. I have assets, but will have income below $10,000 per year then, if I quit my job. I live in Pa. We are participating in the exchanges, and if I want non-medicaid coverage (supposedly better) from the exchange, I will need to get a part time job to increase my income above whatever the threshold is. The non-medicaid coverage would be heavily subsidized. I would only pay about $50 a month.

 

[MichaelB]

Here's a link (not verified) dated 7/5 that summarizes each state's current status just on the Medicaid expansion. Where each state stands on ACA's Medicaid expansion - The Advisory Board Daily Briefing

It shows:

Participating California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Vermont, Washington

Will not participateFlorida, Louisiana, Mississippi, South Carolina,Texas

Leaning toward not participatingIowa, Missouri, Nebraska, Nevada, New Jersey

Leaning toward participating Arkansas, Oregon, Rhode Island


The rest are undecided.

 

[kevink]

Thanks all for the feedback. I have been keeping up with the ongoing story of the individual State's decisions, and have found the Kaiser Foundation site to be the single most useful resource on this topic and on ACA in general:

http://healthreform.kff.org/the-states.aspx


We wouldn't consider living anyplace that didn't participate in the program. New Mexico is our most likely long-term destination and they already have more doctors and clinics that accept Medicaid than any other place we've lived (large % of the population living on very little and a dyed-in-the-wool "blue" state their current Republican governor notwithstanding.

Clearly one is rolling the dice to some extent no matter what as the health care system and costs will remain in crisis regardless.

donheff I don't see a sticky on this topic but have read as much as I can find on it in this forum. Would welcome any more info.

 

[teejayevans]

kevink, I will be 59 when 1/1/2014 rolls around. From what I have read, I will be able to then enroll in Medicaid (for free, I think), under the ACA. I have assets, but will have income below $10,000 per year then, if I quit my job. I live in Pa. We are participating in the exchanges, and if I want non-medicaid coverage (supposedly better) from the exchange, I will need to get a part time job to increase my income above whatever the threshold is. The non-medicaid coverage would be heavily subsidized. I would only pay about $50 a month.

I believe the medicaid/exchanges are only for those who can't get coverage through their employer (or COBRA), so if you quit your job, you'll be on COBRA for 18 months, then if your insurance company doesn't offer to convert the policy to an individual policy, only then does the ACA affect you.
TJ

 

[kevink]

We've been ER'd for some time and never had COBRA, so in our case the exchanges would be a viable option. Where I see this as a game-changer is for people like ourselves needing to make it on the kind of modest incomes that would otherwise necessitate either going without coverage and risking ruin or moving to a place like Mexico or Thailand with affordable out-of-pocket costs until reaching age 65. Given what's happened with employment, retirement account balances post-crash and housing values I would think the number of boomers in this boat, though small, is probably growing.

 

[John Galt III]

I believe the medicaid/exchanges are only for those who can't get coverage through their employer (or COBRA), so if you quit your job, you'll be on COBRA for 18 months, then if your insurance company doesn't offer to convert the policy to an individual policy, only then does the ACA affect you.
TJ

In my particular case, if I were to quit, I would probably go on COBRA since it would only be $385 a month. However, I could refuse COBRA, as far as I know, go without health ins, or buy my own individual policy, until 1/1/2014, then sign up for medicaid / subsidized exchange.I don't think you are forced too keep your existing health ins if you want to go onto ACA 1/1/2014.

 

[MichaelB]

donheff I don't see a sticky on this topic but have read as much as I can find on it in this forum. Would welcome any more info.

We recently had a long discussion which was moved to the FAQ section. You can read it here: http://www.early-retirement.org/forums/f47/patient-protection-and-affordable-care-act-61961.html

 

[teejayevans]

In my particular case, if I were to quit, I would probably go on COBRA since it would only be $385 a month. However, I could refuse COBRA, as far as I know, go without health ins, or buy my own individual policy, until 1/1/2014, then sign up for medicaid / subsidized exchange.I don't think you are forced too keep your existing health ins if you want to go onto ACA 1/1/2014.

If you refused COBRA, you will also lose out on eligibility for HIPAA insurance (insurance for those who can't get insurance because of pre-existing conditions, kicks in after COBRA). I would only refuse COBRA if I had already applied and been accepted for individual insurance.
Also remember that the individual policy you will have will not be the same as the policy you will get in the exchanges (so called Silver plans), you may want to stay with your plan because of better coverage or better network of doctors, etc
TJ