Medicaid eligibility under ACA

[kevink]

I suspect we may be complete outliers on this board, but we're frugal ER types who live entirely off of investments and have never had a taxable income above 13K in recent years (thanks in part, obviously, to low long-term capital gains tax rates).

I'm 56, DW is 50 and from what I can tell in my fairly extensive reading about ACA (including the threads on this board, which have been extremely helpful) we'd be eligible for Medicaid in 2014, based on income. Access to providers should be no problem, as we'll be living in a State (New Mexico) with lots of docs and clinics who take Medicaid. Clearly we'd pay for routine care, dental, etc out-of-pocket but having what amounts to free catastrophic insurance for major stuff is huge.

What seems slightly surreal to me - and I would be grateful to be corrected about this or any other assumptions if I'm wrong - is that the way I read it under ACA we would both have this coverage as long as we keep our taxable income low enough to qualify, but then as soon as I hit age 65 the normal Medicaid provisions that include means testing (which are not part of ACA) would kick in, meaning I have between now and then to set aside a chunk of change for what I presume will be sky-high Medicare supplemental premiums by then. Kind of the opposite of the current situation for so many, who pay through the nose for individual policies in their late 50's and early 60's hoping to make it to medicare eligibility age and some measure of affordability.

Any comments welcome and appreciated.

 

[plex]

Yes, you will get kicked off Medicaid at 65 into Medicare, at least until all your assets outside of your primary residence are tapped out. Basically people who FIRE with low taxable income are an exception that the new system really isn't particularly designed around, so there is a transition that occurs at 65.

 

[gerrym51]

Yes, you will get kicked off Medicaid at 65 into Medicare, at least until all your assets outside of your primary residence are tapped out.

not necessarily. at 65 someone on medicaid is considered dual-eligible.

medicare billed first-medicaid secondary

 

[plex]

not necessarily. at 65 someone on medicaid is considered dual-eligible.

medicare billed first-medicaid secondary

That would be true if means testing didn't kick in at 65+ still for Medicaid, which it does. The new system only expands Medicaid for those under 65. Medicaid, in other words, will not kick in as a secondary payer for someone covered by Medicare until their assets are tapped out (outside of their primary residence). Specifically at 65 you become ineligible because you become eligible for Medicare, which automatically disqualifies you, until you no longer have the means for paying parts B&D, at which point Medicaid kicks in as a secondary payer.

For example, see:

http://www.hca.wa.gov/hcr/me/Pages/index.aspx

http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

 

[gerrym51]

That would be true if means testing didn't kick in at 65+ still for Medicaid, which it does. The new system only expands Medicaid for those under 65. Medicaid, in other words, will not kick in as a secondary payer for someone covered by Medicare until their assets are tapped out (outside of their primary residence). Specifically at 65 you become ineligible because you become eligible for Medicare, which automatically disqualifies you, until you no longer have the means for paying parts B&D, at which point Medicaid kicks in as a secondary payer.

For example, see:

Medicaid Expansion 2014

Eligibility | Medicaid.gov

i did say not necessarily

 

[rbmrtn]

Specifically at 65 you become ineligible because you become eligible for Medicare, which automatically disqualifies you, until you no longer have the means for paying parts B&D, at which point Medicaid kicks in as a secondary payer.

It must vary by state, I had not looked as I'm 10+ yrs away from medicare. My state has you must be eligible for PART A, and monthly income less than x, then MEDICAID will pickup MEDICARE premiums , deductibles and coinsurance. No resource test applied. This is for QMB ( Qualified Medicare Beneficiary)

 

[ERhoosier]

Medicaid eligibility for QMB varies across the states. As I understand it, more states are "resource" testing every year as funds get tighter. And access to providers is getting tougher all the time. Who knows what the situation will be in 8-10 yrs. But it's a safe bet we'll all be paying more than we do now