Health Insurance question (get subsidy for a private insurance, not Medicaid)

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mav12
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Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by mav12 » Thu Nov 30, 2017 9:30 pm

Thank you guys for this forum and for keeping up well informed. I have somewhat of a unique situation. I have no income now, but do have an IRA account which I plant to convert a partial amount from to a Roth IRA= I plan to convert about $12,000 to a Roth and pay a small tax.

Now, I'm purchasing full cost bronze level health insurance directly from the Insurance company (provides access to NDs and easy labs), but in 2018, the rates will go up and diagnostic labs coverage (70% now) will be eliminated, and I'll have to pay the full amount up to a deductible ($2,500). I do some routine labs through an ND, now i have coverage at 70%, but will have to pay 100% up to $2,500.

I'm applying to get the Fed subsidy, but with my low income, I'm stuck with Medicaid (worst coverage), which my Doc (ND) will not accept. Would you suggest I convert $12,000 and claim as my income and hope I will not qualify for Medicaid. And Remain with my Private Insurance and hope I'll get a subsidy? Or up the conversion to $17,000? Or go with Medicaid and lose access to my ND and beg an MD to allow me to do labs, which I'm trying to avoid?

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Watty
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by Watty » Thu Nov 30, 2017 11:05 pm

I would call the 800 number for people that run your state exchange, which may be healthcare.gov or one the state set up, and ask them how much income you would need to stay above the medicaid level of income. The medicaid rules vary a lot by state.

For the ACA policies there are two subsidy levels that you need to check on.
1) A subsidy for your premium.
2) For low income people that are not getting medicare there can also be a subsidy for their deductible and co-pays.

Two other things be be aware of;
1) You only get the subsidy if you buy the policy through the exchange. If you just renew a policy you got outside the exchange you will not get the subsidy.
2) You need to check to see if the doctors are in the exchange plan even if the names sound the same since a different network may be used. When I was getting COBRA I had Blue Cross, when I switched to an ACA policy there was also a Blue Cross option but when I looked into it none of the doctors I had would have been in that network.

You should also double check your income. If you have money in non-retirement accounts it likely is paying some dividends or interest.

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mav12
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by mav12 » Fri Dec 01, 2017 4:01 am

Watty wrote:
Thu Nov 30, 2017 11:05 pm
I would call the 800 number for people that run your state exchange, which may be healthcare.gov or one the state set up, and ask them how much income you would need to stay above the medicaid level of income. The medicaid rules vary a lot by state.

For the ACA policies there are two subsidy levels that you need to check on.
1) A subsidy for your premium.
2) For low income people that are not getting medicare there can also be a subsidy for their deductible and co-pays.

Two other things be be aware of;
1) You only get the subsidy if you buy the policy through the exchange. If you just renew a policy you got outside the exchange you will not get the subsidy.
2) You need to check to see if the doctors are in the exchange plan even if the names sound the same since a different network may be used. When I was getting COBRA I had Blue Cross, when I switched to an ACA policy there was also a Blue Cross option but when I looked into it none of the doctors I had would have been in that network.
You should also double check your income. If you have money in non-retirement accounts it likely is paying some dividends or interest.
The Second Chapter
1) Yes. That one I clarified. Subsidy through the exchange.
2) Is a very good point. The Docs coverage.

In my state, this is a chart:
Below $16,643 Free or low-cost coverage through Medicaid. Next steps.
$16,643 - $30,150 A health plan with lower monthly premiums PLUS extra savings. Next steps.

I have Providence, but it seems they really begin to choke you with fees. In 2018, I'll pay $450/mo + $80 per visit for NatDoc (my ND charges about $120-$150, so Providence will pick up only $40-$80 per visit) and I'll have to pay for all the labs up to $2,500 deductible). I may see a Doc 1 or 2 times per month, I might as well save on premiums and pay cash. Am I doing this math correctly?

I'm currently eligible for Medicaid, it seems I need to convert a bit over $16,650 to avoid Medicaid. From the other perspective, does anyone have or had Medicaid? Is it pretty bad as far as coverage?

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Watty
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by Watty » Fri Dec 01, 2017 8:25 am

mav12 wrote:
Fri Dec 01, 2017 4:01 am
From the other perspective, does anyone have or had Medicaid? Is it pretty bad as far as coverage?
You would get a better response to that question if you started a new thread with that question in the title.

It would be interesting to hear what people say about that.

I would suspect the level of healthcare that is needed would have a big impact on people's experiences.

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mav12
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by mav12 » Fri Dec 01, 2017 1:36 pm

Watty wrote:
Fri Dec 01, 2017 8:25 am
mav12 wrote:
Fri Dec 01, 2017 4:01 am
From the other perspective, does anyone have or had Medicaid? Is it pretty bad as far as coverage?
You would get a better response to that question if you started a new thread with that question in the title.

It would be interesting to hear what people say about that.

I would suspect the level of healthcare that is needed would have a big impact on people's experiences.
Good idea.

From the other perspective these changes with Providence Health Plans would seriously bite a wallet, No coverage for labs until you hit $2,500 out of pocket.

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dm200
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by dm200 » Fri Dec 01, 2017 1:48 pm

There is a "bizarre" (in my opinion) in some state (my state of Virginia included) where your income is not low enough to qualify for Medicaid, BUT not high enough to get anything towards the credit/subsidy of an Obamacare plan. In such state, it is not even a matter of finding a provider that accepts Medicaid - but such folks cannot qualify at all.

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dm200
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by dm200 » Fri Dec 01, 2017 1:51 pm

I'm stuck with Medicaid (worst coverage), which my Doc (ND) will not accept
Actually "no coverage" is worse than that.

Many fine (in my opinion) HMOs accept Medicaid - so I would not be so quick to dismiss it. There are usually many competent Physicians that either take Medicaid or are in HMOs that do.

Topic Author
mav12
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by mav12 » Fri Dec 01, 2017 11:20 pm

dm200 wrote:
Fri Dec 01, 2017 1:51 pm
I'm stuck with Medicaid (worst coverage), which my Doc (ND) will not accept
Actually "no coverage" is worse than that.

Many fine (in my opinion) HMOs accept Medicaid - so I would not be so quick to dismiss it. There are usually many competent Physicians that either take Medicaid or are in HMOs that do.
true, it's just a matter of finding an open minded MD. Many MDs go according to a traditional protocol, they wait for clinical trials, but who is going to fund them, Pharma companies? Maybe not. But most importantly, it is lack of interest in the new research (lack of time, they say) that affects many patients. Pubmed is my friend and /MEDLINE, most big libraries have access to full text articles and you don't have to pay.

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bhwabeck3533
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Re: Health Insurance question (get subsidy for a private insurance, not Medicaid)

Post by bhwabeck3533 » Mon Dec 04, 2017 8:33 am

I am 62 years old, my wife, age 53, and I are retired (I do some part-time consulting). Since retiring in 2014, I have purchased a bronze health care plan (outside of ACA/Obamacare) ... my annual premium has increased from $8500 in 2014 to $15,600 (2018 BCBS estimate in Alabama). I am prepared to live off cash pre-2018 IRA distributions and limited 2018 income; and have begun the application process for a subsidy (premium tax credit) via healthcare.gov. My pro-forma 1040 for 2018 includes income of $48,700 (line 22), AGI of $45,200 (line 37), and taxable income of $17,100 (line 43). On my application my income is listed as $33,380 due to the intake questions and my responses; and I qualify a premium tax credit of $22,860 for the year. I have not pulled the trigger as I have some concerns/question:
* Is this too good to be true?
* What have I overlooked or not considered?
* What does the government consider as "deductions" on their ACA intake questionnaire?
* Will the government need to see my 2017 return? (which shows much higher income because of the IRA distribution)
All advice is appreciated.

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