How to financially assist DD to help continue her Obamacare

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SaveAShilling
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How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 10:28 am

30-something DD can no longer work in her chosen profession due to back problems. (She has had surgery. The doctor told her not to continue in that profession.) She is trying to find another job. She has psychological issues (crowd anxiety and depression) which complicate finding a new job. She hopes to work from home and is willing to take courses and retrain. She has lived with DH and me since graduation with her MFA when she worked and then through the surgery.

She has $119,000 in a taxable account. She has $80,000 in a Roth and $56,000 in a Roth 401K. All are at Vanguard in VTSMS and VTIAX.

She has health insurance through Obamacare. She pays no copays and no deductibles as she is a voting member of a federally recognized Native American tribe. Keeping her health insurance is very important. She made no money last year as she was working her way through the system with periodic steroid shots before the insurance would consider surgery. I think she needs to make the minimum amount of $12,071 in order to keep Obamacare by staying above Medicaid threshold. (It’s a little confusing. She may just need to say she thinks she will make the minimum.)

Right now she has $30,000 in capital gains in her taxable account. She could sell some of her funds now to earn the amount she needs and some later if needed, rebuying immediately.

DH and I are considering gifting her money to invest so she can have a source for money from dividends. I am 68 and retired. He is 67 and continually considering retirement. (I keep telling him we have enough money for him to retire, but the good parts of his well-paying job continue to be stronger than the bad parts.) We can continue our present lifestyle on his pension and social security. We have 1.5 million in investments to live on until SS at age 70. Our house is paid for. Long term care will be paid for this year in the last of ten-year payment plan. DD is our only heir.

I am looking for suggestions for suggestions for ways to help her financially in order to help her keep her health insurance. Please don’t suggest Tough Love. Thank you for your help.

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simplesimon
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Re: How to financially assist DD to help continue her Obamacare

Post by simplesimon » Thu Dec 28, 2017 10:48 am

Can't you just pay for her healthcare premiums?

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 10:58 am

She has to make a minimum amount to stay on Obamacare. Insurance outside of Obamacare will not cover preexisting conditions, which include depression and now her back issues. So it is not the cost of the premiums so much as being able to stay on Obamacare.

Not Law
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Re: How to financially assist DD to help continue her Obamacare

Post by Not Law » Thu Dec 28, 2017 11:00 am

She can tax gain harvest up to the 138% of poverty level required to qualify for the ACA. When she files her taxes, this amount will be included in her MAGI even though the tax rate on the funds is 0%. I did this in 2012 and 2013 to make sure after the ACA that a sale would not push me over the cliff.

Shallowpockets
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Re: How to financially assist DD to help continue her Obamacare

Post by Shallowpockets » Thu Dec 28, 2017 12:03 pm

The federal gift tax exemption is 14k. Don't know if you could do 14k each, but that is a paltry amount to expect any significant dividends to live on even if you can do 28k. Unless you are willing to go higher and incur the taxes.
Your retirements are close, if you are planning on 70. I would certainly start to entertain the possibility of retiring for three people.

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dm200
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Re: How to financially assist DD to help continue her Obamacare

Post by dm200 » Thu Dec 28, 2017 12:06 pm

SaveAShilling wrote:
Thu Dec 28, 2017 10:58 am
She has to make a minimum amount to stay on Obamacare. Insurance outside of Obamacare will not cover preexisting conditions, which include depression and now her back issues. So it is not the cost of the premiums so much as being able to stay on Obamacare.
I think you are misunderstanding. Almost all individual policies, whether obtained through an exchange or not, or whether a credit/subsidy is received - may not exclude pre-existing conditions. If you/she pay full premiums on her current policy, there should be no problems with this.

delamer
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Re: How to financially assist DD to help continue her Obamacare

Post by delamer » Thu Dec 28, 2017 12:50 pm

Shallowpockets wrote:
Thu Dec 28, 2017 12:03 pm
The federal gift tax exemption is 14k. Don't know if you could do 14k each, but that is a paltry amount to expect any significant dividends to live on even if you can do 28k. Unless you are willing to go higher and incur the taxes.
Your retirements are close, if you are planning on 70. I would certainly start to entertain the possibility of retiring for three people.
OP wouldn’t incur taxes if she and her husband gave their daughter more than $28K; they’d just have to file with the IRS (taxes would only come into play, which is unlikely, upon their deaths).

That said, you are right that they’d need to give her a lot more to generate enough income to get above the threshold.

Any chance of OP’s husband adding daughter to his work policy? She probably would then be able to get COBRA once he retires.

c1over8
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Re: How to financially assist DD to help continue her Obamacare

Post by c1over8 » Thu Dec 28, 2017 12:55 pm

Shallowpockets wrote:
Thu Dec 28, 2017 12:03 pm
The federal gift tax exemption is 14k. Don't know if you could do 14k each, but that is a paltry amount to expect any significant dividends to live on even if you can do 28k. Unless you are willing to go higher and incur the taxes.
[emphasis added]

From the facts given it is unlikely the parents have already each used up their unified tax credit (5.49 million each this year and 11.2 million each in 2018) so even if they give more than 28k this year (30k in 2018), they won't owe any gift taxes, they will just need to report the gift on a gift tax return and their remaining unified tax credit will be reduced.

The parents can give her 28k today (have her cash the check immediately) and 30k on January 1 and then they've given her 58k and don't need to file a gift tax return (assuming they made no other gifts in 2017 and make no additional gifts in 2018 to the daughter). Or better yet gift her those amounts in appreciated stock so she can trigger the gains as needed and the parents avoid the gains entirely.

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simplesimon
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Re: How to financially assist DD to help continue her Obamacare

Post by simplesimon » Thu Dec 28, 2017 1:14 pm

Could you claim her as a dependent?

I don't quite understand the dilemma. She'll get Medicaid if she qualifies and can afford health plans on Obamacare if she doesn't. Am I missing something?

lightning
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Re: How to financially assist DD to help continue her Obamacare

Post by lightning » Thu Dec 28, 2017 2:21 pm

I take your question to be how can she have income in 2017 to meet the requirement for insurance she already has.

Here are some ideas to consider:
1) Harvest capital gains in taxable accounts to generate sufficient MAGI to meet 100% or 138% FPL (depending on if you are in a Medicaid expansion state). This is the easiest way to generate income for 2017, but that would have to be done today!
2) For 2018, you could hire her as "Household Help" for cleaning, yard work, etc. You will need to pay employment taxes on the income if over $2000 paid as a W-2 employee. See IRS documentation on how the nanny tax works.
3) Read the instructions for form 8962 under Household income below 100% of the Federal Poverty Level.
4) I don't think gifting is the answer. I don't see it generating 2017 income.
Last edited by lightning on Thu Dec 28, 2017 3:36 pm, edited 1 time in total.

RudyS
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Re: How to financially assist DD to help continue her Obamacare

Post by RudyS » Thu Dec 28, 2017 2:55 pm

simplesimon wrote:
Thu Dec 28, 2017 1:14 pm
...
I don't quite understand the dilemma. She'll get Medicaid if she qualifies and can afford health plans on Obamacare if she doesn't. Am I missing something?
There are many threads on this topic, but one issue is that it may be (much?) more difficult to find a doctor who accepts medicaid patients than to find one who accepts commercial insurance.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 3:26 pm

Thank you for all of your responses.
I think you are misunderstanding. Almost all individual policies, whether obtained through an exchange or not, or whether a credit/subsidy is received - may not exclude pre-existing conditions. If you/she pay full premiums on her current policy, there should be no problems with this.
I had forgotten this fact. The last time she bought insurance on the open market, she had several problems excluded, including depression.

The premiums would not be an issue, but she pays no co-pays or deductibles through Obamacare because of the Native American heritage. Not paying for her expensive drugs makes much more of a difference than a change in premium would make.
I don't quite understand the dilemma. She'll get Medicaid if she qualifies and can afford health plans on Obamacare if she doesn't. Am I missing something?
I don't think she would qualify for Medicaid. The information I found at identity.gov says that in addition to low income, "You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, under age 21 and in foster care, adoption assistance or a nursing facility, blind, disabled, or be 65 years of age or older." Although she cannot do what she trained for, she is not completely disabled.

When she signed up for ACA this year, she was informed that she had to meet an anticipated minimum income requirement next year to qualify. Even if she qualified for Medicaid, she would not get the added benefit given Native Americans on ACA. When the person at ACA asked if she was Native American and explained this part of the program, I thought it was too good to be true. But it is true. She pays no co-pays and no deductibles. Healthcare.gov says "If you buy a Marketplace plan and your income is between 100% and 300% of the federal poverty level, you can enroll in a “zero cost sharing” plan. This means you won’t have to pay any out-of-pocket costs -- like deductibles, copayments, and coinsurance -- when you get care."
Any chance of OP’s husband adding daughter to his work policy? She probably would then be able to get COBRA once he retires
We are both on Medicare, with Tricare For Life as our supplement. We cannot add her. I believe she is too old (over 26) to add to a basic policy.

Not Law said
She can tax gain harvest up to the 138% of poverty level required to qualify for the ACA. When she files her taxes, this amount will be included in her MAGI even though the tax rate on the funds is 0%. I did this in 2012 and 2013 to make sure after the ACA that a sale would not push me over the cliff.
This tax gain harvesting is what I planned for her to do for 2018 and maybe the next year if needed. But she has been investing a bit at a time for over ten years to get to this point of capital gains.

I guess I want Boglehead advice on whether or not gifting to her now would give her enough time to grow the capital gains needed. I could have been clearer.

I also wanted to make sure my understanding of the minimum income requirements for ACA was correct.

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simplesimon
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Re: How to financially assist DD to help continue her Obamacare

Post by simplesimon » Thu Dec 28, 2017 3:44 pm

SaveAShilling wrote:
Thu Dec 28, 2017 3:26 pm
I also wanted to make sure my understanding of the minimum income requirements for ACA was correct.
Maybe my own understanding is incorrect, but from the Google searching that I did on the subject I don't see anywhere that says there is a minimum amount of income to qualify for ObamaCare...just that there is a minimum to qualify for subsidies. Can you or she verify this? Maybe she won't get subsidies, but it's hard for me to imagine that if she can afford to pay the premiums she can't simply apply for insurance.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 3:46 pm

I take your question to be how can she have income in 2017 to meet the requirement for insurance she already has.

Here are some ideas to consider:
1) Harvest capital gains in taxable accounts to generate sufficient MAGI to meet 100% or 138% FPL (depending on if you are in a Medicare expansion state). This is the easiest way to generate income for 2017, but that would have to be done today!
2) For 2018, you could hire her as "Household Help" for cleaning, yard work, etc. You will need to pay employment taxes on the income if over $2000 paid as a W-2 employee. See IRS documentation on how the nanny tax works.
3) Read the instructions for form 8962 under Household income below 100% of the Federal Poverty Level.
4) I don't think gifting is the answer. I don't see it generating 2017 income.
I am trying to plan for her to be able to generate income in the future if she is still training for new work at that time. She can generate enough in 2018 and probably 2019 if the stock market stays up. It took time for her to generate the income she can raise through selling. But I fear even three years is not enough to generate the needed income.
From the facts given it is unlikely the parents have already each used up their unified tax credit (5.49 million each this year and 11.2 million each in 2018) so even if they give more than 28k this year (30k in 2018), they won't owe any gift taxes, they will just need to report the gift on a gift tax return and their remaining unified tax credit will be reduced.

The parents can give her 28k today (have her cash the check immediately) and 30k on January 1 and then they've given her 58k and don't need to file a gift tax return (assuming they made no other gifts in 2017 and make no additional gifts in 2018 to the daughter). Or better yet gift her those amounts in appreciated stock so she can trigger the gains as needed and the parents avoid the gains entirely.
Yes, indeed. We are comfortable in retirement Bogleheads but not rich Bogleheads. We can gift her every year.

I didn't know about gifting appreciated stock. From my quick look-up, that's what we need! She needs the capital gains and we do not. We also have an mutual fund with capital gains which I would like to leave without taking the capital gains. Thank you, c1over8! Thank you Bogleheads for considering my issue and continuing to educate me.

maria00200
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Re: How to financially assist DD to help continue her Obamacare

Post by maria00200 » Thu Dec 28, 2017 3:50 pm

1.) I’m pretty confident there is no minimum amount of income to qualify for Obamacare. In other words, you can make $1 and still get Medicaid.
2.) Pre-existing conditions are covered by every insurance company in the U.S. now, Obamacare or not.
Someone correct me if I’m wrong.

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Imperabo
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Re: How to financially assist DD to help continue her Obamacare

Post by Imperabo » Thu Dec 28, 2017 3:52 pm

c1over8 wrote:
Thu Dec 28, 2017 12:55 pm
. Or better yet gift her those amounts in appreciated stock so she can trigger the gains as needed and the parents avoid the gains entirely.
I want to make sure this doesn't get overlooked. Unless all of your investments are in retirement accounts this is the best answer. Your family gets to clear capital gains at 0% rate, and she gets to record the income in the eyes of ACA.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 4:01 pm

simplesimon says
Maybe my own understanding is incorrect, but from the Google searching that I did on the subject I don't see anywhere that says there is a minimum amount of income to qualify for ObamaCare...just that there is a minimum to qualify for subsidies. Can you or she verify this? Maybe she won't get subsidies, but it's hard for me to imagine that if she can afford to pay the premiums she can't simply apply for insurance.
That's interesting. She spoke to someone on the phone who said she couldn't get coverage unless her projected income was at least a certain amount. So I looked up "minimum income for ACA" but I need to check some more online. If the minimum is only for the subsidy, she's OK. Two possible solutions from the Bogleheads. I'm feeling much better about the situation. Thank you.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 4:06 pm

Imperabo said
I want to make sure this doesn't get overlooked. Unless all of your investments are in retirement accounts this is the best answer. Your family gets to clear capital gains at 0% rate, and she gets to record the income in the eyes of ACA.
Thank you, Imperabo. I think you and clover8 are right. This is a great solution for us if she does indeed need the income. I'll do some more research on that.

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BL
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Re: How to financially assist DD to help continue her Obamacare

Post by BL » Thu Dec 28, 2017 4:15 pm

Imperabo wrote:
Thu Dec 28, 2017 3:52 pm
c1over8 wrote:
Thu Dec 28, 2017 12:55 pm
. Or better yet gift her those amounts in appreciated stock so she can trigger the gains as needed and the parents avoid the gains entirely.
I want to make sure this doesn't get overlooked. Unless all of your investments are in retirement accounts this is the best answer. Your family gets to clear capital gains at 0% rate, and she gets to record the income in the eyes of ACA.
+1

clip651
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Re: How to financially assist DD to help continue her Obamacare

Post by clip651 » Thu Dec 28, 2017 4:38 pm

Can you clarify, are you trying to get her 2017 income to the correct level (for her 2017 coverage that she already has, which relates to her 2017 taxes, which are filed this spring)? If so, you have very little time left to arrange things before the year ends.

If you are only concerned about 2018 and future income, then you have more time to help her make arrangements, assuming she met the deadline to register for 2018 insurance. That was December 15, unless there are different rules for the Native Americans using the program.

best wishes,
cj

mouses
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Re: How to financially assist DD to help continue her Obamacare

Post by mouses » Thu Dec 28, 2017 4:45 pm

maria00200 wrote:
Thu Dec 28, 2017 3:50 pm
2.) Pre-existing conditions are covered by every insurance company in the U.S. now, Obamacare or not.
Someone correct me if I’m wrong.
I believe this is correct. If the new tax bill had done away with that, I think it would have been widely reported. (I know this is not a tax issue, but the tax bill had a provision about Obamacare so, kitchen sink.)

delamer
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Re: How to financially assist DD to help continue her Obamacare

Post by delamer » Thu Dec 28, 2017 5:04 pm

SaveAShilling wrote:
Thu Dec 28, 2017 4:01 pm
simplesimon says
Maybe my own understanding is incorrect, but from the Google searching that I did on the subject I don't see anywhere that says there is a minimum amount of income to qualify for ObamaCare...just that there is a minimum to qualify for subsidies. Can you or she verify this? Maybe she won't get subsidies, but it's hard for me to imagine that if she can afford to pay the premiums she can't simply apply for insurance.
That's interesting. She spoke to someone on the phone who said she couldn't get coverage unless her projected income was at least a certain amount. So I looked up "minimum income for ACA" but I need to check some more online. If the minimum is only for the subsidy, she's OK. Two possible solutions from the Bogleheads. I'm feeling much better about the situation. Thank you.
I found this at https://www.healthcare.gov/medicaid-chi ... lace-plan/

“If you still want a Marketplace plan after you’re found eligible for Medicaid or CHIP, you will have to pay full price for your share of the Marketplace plan without premium tax credits or other cost savings”

Based on this and other things I’ve read, anyone can enroll in a plan through a marketplace. The only income issue is whether the enrollee gets a premium subsidy. About 85% of enrollees do.

(Sorry that I earlier missed the fact that she was too old to added to your family plan.)

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 5:14 pm

OP here

I talked to DD again. She was told that if her projected income was zero, she would not get subsidy and would lose her Native American benefits of no copay and no deductible. All of the ACA income questions online seems to be about guessing less than one made, not more than one made; that is, making too much, not making too little.

Healthcare.gov: When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% (effectively 138%) of the federal poverty level, regardless of their age, family status, or health.
The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace.
The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states haven’t expanded their Medicaid programs.
Adults in those states with incomes below 100% of the federal poverty level, and who don’t qualify for Medicaid based on disability, age, or other factors, fall into a gap.
Their incomes are too high to qualify for Medicaid in their states.
Their incomes are below the range the law set for savings on a Marketplace insurance plan.

Yep, that's DD. She does not qualify for Medicaid because our state has not expanded Medicaid to include low income levels. Besides, it's the Native American benefit that is so helpful. And anything under 138% of the Federal Poverty Level and she can't get ACA.

I don't know if she needs this income for the past year (2018) in which she used her insurance; i.e., back surgery. If so, she needs to sell mutual funds fast.

delamer
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Re: How to financially assist DD to help continue her Obamacare

Post by delamer » Thu Dec 28, 2017 5:26 pm

SaveAShilling wrote:
Thu Dec 28, 2017 5:14 pm
OP here

I talked to DD again. She was told that if her projected income was zero, she would not get subsidy and would lose her Native American benefits of no copay and no deductible. All of the ACA income questions online seems to be about guessing less than one made, not more than one made; that is, making too much, not making too little.

Healthcare.gov: When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% (effectively 138%) of the federal poverty level, regardless of their age, family status, or health.
The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace.
The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states haven’t expanded their Medicaid programs.
Adults in those states with incomes below 100% of the federal poverty level, and who don’t qualify for Medicaid based on disability, age, or other factors, fall into a gap.
Their incomes are too high to qualify for Medicaid in their states.
Their incomes are below the range the law set for savings on a Marketplace insurance plan.

Yep, that's DD. She does not qualify for Medicaid because our state has not expanded Medicaid to include low income levels. Besides, it's the Native American benefit that is so helpful. And anything under 138% of the Federal Poverty Level and she can't get ACA.

I don't know if she needs this income for the past year (2018) in which she used her insurance; i.e., back surgery. If so, she needs to sell mutual funds fast.
Did you check my post immediately above yours? She can purchase insurance through an ACA exchange at any income level. Qualifying for Medicaid does not mean you can’t buy an exchange plan. It does mean that she won’t get a subsidy.

I can’t speak to the Native American aspect. But I thought your big concern was keeping her ACA coverage, not the cost (although I appreciate that you want to minimize the cost of course).

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Thu Dec 28, 2017 6:13 pm

Did you check my post immediately above yours? She can purchase insurance through an ACA exchange at any income level. Qualifying for Medicaid does not mean you can’t buy an exchange plan. It does mean that she won’t get a subsidy.

I can’t speak to the Native American aspect. But I thought your big concern was keeping her ACA coverage, not the cost (although I appreciate that you want to minimize the cost of course)
Sorry, typing and online research slows me down.

I see now that even though the quote I found looked like she could not have coverage, she could. My DH and I can help with the premiums. That's a relief.

But I would very much like for her to be able to keep the Native American benefits on the ACA. Her drug costs are considerable. If she needs to get a subsidy in order to get these benefits, she should be able to generate the required income for the subsidy from mutual funds, with the informational help given here.

She can repay this year's subsidy if needed. I wonder if there is a chance she will be asked to repay the copays and deductibles and drug costs from her Native American benefits. That would be far more difficult.

I appreciate everyone's advice. I'm going to break for the night and do some more research in the morning.

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Re: How to financially assist DD to help continue her Obamacare

Post by Dottie57 » Thu Dec 28, 2017 9:30 pm

simplesimon wrote:
Thu Dec 28, 2017 3:44 pm
SaveAShilling wrote:
Thu Dec 28, 2017 3:26 pm
I also wanted to make sure my understanding of the minimum income requirements for ACA was correct.
Maybe my own understanding is incorrect, but from the Google searching that I did on the subject I don't see anywhere that says there is a minimum amount of income to qualify for ObamaCare...just that there is a minimum to qualify for subsidies. Can you or she verify this? Maybe she won't get subsidies, but it's hard for me to imagine that if she can afford to pay the premiums she can't simply apply for insurance.
There are income minimums for. Subsidies to pay for Obamacare. If some is below the minimum value ncome, it is medicaid for them.

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simplesimon
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Re: How to financially assist DD to help continue her Obamacare

Post by simplesimon » Fri Dec 29, 2017 7:44 am

What are her current premiums and deductible? Can she shop for a plan that has a lower deductible? It sounds like the increase in premium would be worth it for her situation.

Find out which providers in her area will accept Medicaid.

Did her previous employer provide group long term disability?

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Fri Dec 29, 2017 8:53 am

Simple Simon says: (OK I have to admit typing that makes me laugh)
What are her current premiums and deductible? Can she shop for a plan that has a lower deductible? It sounds like the increase in premium would be worth it for her situation.

Find out which providers in her area will accept Medicaid.

Did her previous employer provide group long term disability?
I think we need to help her keep ACA with subsidies. The added Native American benefit of zero costs sharing with any metal level on the Marketplace is immense. She is not eligible for Medicaid in our state. She was an independent contractor, so no long term disability.

I wanted to answer your comments because I find this whole discussion very helpful. I have done some more research and thinking and am going to make another post with some of those finding.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Fri Dec 29, 2017 8:56 am

OP here again

This discussion had helped me clarify that DD needs ACA with the subsidies. I considered the Native American cost sharing reductions to be part of ACA, but they appear to be part of the subsidies. The cost sharing reductions are no copay and no deductibles, a tremendous savings, especially with drugs.

Thanks to this group, I realize that gifting her from one of our older mutual funds is a really good way for her to achieve the cost gains needed to achieve the minimum needed for the ACA subsidies. I was unaware that cost basis carried with the gift. I will have to research the cost basis, but that is doable. Tedious, but doable. DH and I will gift the nontaxable limit in 2018 and 2019. This and her own cost gain should cover the necessary amount. DH and I can gift more and fill out the appropriate tax form if necessary.

I believe that DD will not be asked to repay the subsidy for this year. I have found no personal irate online discussions about being asked to repay, which I would expect if someone had been asked to do so. In October of 2014, Kaiser Health News stated that they were told that “since the marketplace always makes the eligibility determination for tax credits, no one whose income ends up below the poverty level should have to repay them….” This seems to be policy rather than law, but I will think that repayment will not be asked for this year (2017). The subsidy itself is not as much a concern as the copays and deductibles, but if repayment is not asked for one, it probably will not be asked for the other. I am trying to find this information in the 74 pages of IRS publication 974 Premium Tax Credit. I generally have problems finding the information I want in IRS publications, which have a lot of information but not the specific information I want. Somewhere in there is information about Advanced Tax Credit Repayment limits. The page reference I found online is incorrect for the current form. I may have to print out the pages rather than try to read them online.

I want to thank everyone who responded to my problem for their advice. You guys rock!

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Re: How to financially assist DD to help continue her Obamacare

Post by NYC_Guy » Fri Dec 29, 2017 9:19 am

SaveAShilling wrote:
Fri Dec 29, 2017 8:56 am
OP here again

This discussion had helped me clarify that DD needs ACA with the subsidies. I considered the Native American cost sharing reductions to be part of ACA, but they appear to be part of the subsidies. The cost sharing reductions are no copay and no deductibles, a tremendous savings, especially with drugs.

Thanks to this group, I realize that gifting her from one of our older mutual funds is a really good way for her to achieve the cost gains needed to achieve the minimum needed for the ACA subsidies. I was unaware that cost basis carried with the gift. I will have to research the cost basis, but that is doable. Tedious, but doable. DH and I will gift the nontaxable limit in 2018 and 2019. This and her own cost gain should cover the necessary amount. DH and I can gift more and fill out the appropriate tax form if necessary.

I believe that DD will not be asked to repay the subsidy for this year. I have found no personal irate online discussions about being asked to repay, which I would expect if someone had been asked to do so. In October of 2014, Kaiser Health News stated that they were told that “since the marketplace always makes the eligibility determination for tax credits, no one whose income ends up below the poverty level should have to repay them….” This seems to be policy rather than law, but I will think that repayment will not be asked for this year (2017). The subsidy itself is not as much a concern as the copays and deductibles, but if repayment is not asked for one, it probably will not be asked for the other. I am trying to find this information in the 74 pages of IRS publication 974 Premium Tax Credit. I generally have problems finding the information I want in IRS publications, which have a lot of information but not the specific information I want. Somewhere in there is information about Advanced Tax Credit Repayment limits. The page reference I found online is incorrect for the current form. I may have to print out the pages rather than try to read them online.

I want to thank everyone who responded to my problem for their advice. You guys rock!
Also consider whether employing your daughter yourself may work. You can hire her as a personal assistant/property manager/etc. There will be tax leakage (FICA in particular), but she would be getting quarterly credit and wages for social security purposes and, given her circumstances, social security disability (SSDI credit requirements are a bit wacky). There may be a sweet spot whereby you use some gifted appreciated property and some wage income.

clip651
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Re: How to financially assist DD to help continue her Obamacare

Post by clip651 » Fri Dec 29, 2017 11:26 am

One other thing to consider ...

If her income in 2017 is too low, it may make it more difficult to qualify (enroll) for 2019. At that point, the marketplace will be aware of her 2017 income tax return, but she won't have filed yet for 2018. At that point (when her most recent tax return doesn't match her projected income on her application) they may ask for proof of future income. That may just be a paperwork hassle, not a major snag, but I am not sure how easy it is to prove future income.

If you want to avoid the future issue, you could have her realize enough of her own capital gains TODAY before market close so that her income meets the projection made when she applied for her 2017 coverage. That may simplify future applications. (I dont think there is time to get some of your shares tranferred to her and sold by her today.)

All of this assumes no major changes to the law and program in coming years, which of course may not be a safe assumption.

Also I agree with previous posters suggesting to consider hiring her as household help of some sort, if she can legitimately do some work for you in future years. This would have her paying more into social security, which is an advantage over realizing capital gains. The earned income can even help her quaify to contribute to a Roth IRA (avoid traditional IRA as this reduces AGI, while Roth does not). And you can increase or decrease the hours she works for you depending on how much she is able to work her other job, so you can help her hit her target income for ACA each year.

I'm no expert, just some thoughts to consider.

best wishes,
cj

JGoneRiding
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Re: How to financially assist DD to help continue her Obamacare

Post by JGoneRiding » Fri Dec 29, 2017 2:06 pm

To have 2017 income she needs to sell today! I don't want that to get overlooked in the rest of the discussion. Not having any 2017 income might not appear to matter for 2017 but it will for sure affect 2018 and you are to late to do any 2018 plan changes so getting kicked off Aca for lack of income and not being Medicaid eligible would be very bad!

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Fri Dec 29, 2017 3:46 pm

I believe she is OK for 2018. She signed up in November and has already paid her first premium. I will make sure she has the income she needs by November 2018 for sign up for 2019. She has to call in because they can never find her in the system, so she can explain on the phone.

Good ideas on hiring her and giving her income. My DH and I will talk to her about this.

I found the information about continuing with a lower income in form 974 and form 8962. She should be OK.

Thank you again for helping me think this through.

jj
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Re: How to financially assist DD to help continue her Obamacare

Post by jj » Fri Dec 29, 2017 4:18 pm

JGoneRiding wrote:
Fri Dec 29, 2017 2:06 pm
To have 2017 income she needs to sell today! I don't want that to get overlooked in the rest of the discussion. Not having any 2017 income might not appear to matter for 2017 but it will for sure affect 2018 and you are to late to do any 2018 plan changes so getting kicked off Aca for lack of income and not being Medicaid eligible would be very bad!
+1

If she has unrealized capital gain in her taxable account, whether it's long term or short term it would not matter, do that today to give her income for 2017. Income level needs to be at 100% of federal poverty level for 2016 when looking at ACA for 2017.

When my son was in this position a couple of years ago this is what we did to get him up to the required level - otherwise the healthcare.gov employees on the phone said he could have no subsidy, but he could have some kind of code to submit along with his taxes which would have him not be subject to the tax penalty for having no insurance! As he/we wanted the insurance - and for it to be subsidized if at all possible - we went with the realizing capital gains for current year's income method. Converting a Traditional IRA to Roth IRA, realizing income that way, would also do the trick.
...it is madness to risk losing what you need in pursuing what you simply desire. Warren E. Buffett

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Sat Dec 30, 2017 9:24 am

JJ posted
If she has unrealized capital gain in her taxable account, whether it's long term or short term it would not matter, do that today to give her income for 2017. Income level needs to be at 100% of federal poverty level for 2016 when looking at ACA for 2017.

When my son was in this position a couple of years ago this is what we did to get him up to the required level - otherwise the healthcare.gov employees on the phone said he could have no subsidy, but he could have some kind of code to submit along with his taxes which would have him not be subject to the tax penalty for having no insurance! As he/we wanted the insurance - and for it to be subsidized if at all possible - we went with the realizing capital gains for current year's income method. Converting a Traditional IRA to Roth IRA, realizing income that way, would also do the trick.
But I saw it too late. She is enrolled for 2018. Hopefully she'll be able to argue in November 2019 that she already has the required minimum. Some days you just do the best you can and call it a day.

jj
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Re: How to financially assist DD to help continue her Obamacare

Post by jj » Sat Dec 30, 2017 10:09 am

SaveAShilling wrote:
Sat Dec 30, 2017 9:24 am
JJ posted
If she has unrealized capital gain in her taxable account, whether it's long term or short term it would not matter, do that today to give her income for 2017. Income level needs to be at 100% of federal poverty level for 2016 when looking at ACA for 2017.

When my son was in this position a couple of years ago this is what we did to get him up to the required level - otherwise the healthcare.gov employees on the phone said he could have no subsidy, but he could have some kind of code to submit along with his taxes which would have him not be subject to the tax penalty for having no insurance! As he/we wanted the insurance - and for it to be subsidized if at all possible - we went with the realizing capital gains for current year's income method. Converting a Traditional IRA to Roth IRA, realizing income that way, would also do the trick.
But I saw it too late. She is enrolled for 2018. Hopefully she'll be able to argue in November 2019 that she already has the required minimum. Some days you just do the best you can and call it a day.
Be thankful that she is enrolled for 2018... my best wishes to you and your family :happy
...it is madness to risk losing what you need in pursuing what you simply desire. Warren E. Buffett

scouter
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Re: How to financially assist DD to help continue her Obamacare

Post by scouter » Sat Dec 30, 2017 3:14 pm

maria00200 wrote:
Thu Dec 28, 2017 3:50 pm
2.) Pre-existing conditions are covered by every insurance company in the U.S. now, Obamacare or not.
Someone correct me if I’m wrong.
This is not true. My wife and I were just turned down by United Health (Farm Bureau) for pre-existing conditions. Health Insurance companies can still sell "traditional" health insurance policies which require underwriting and will exclude you if you have a pre-existing condition. These policies do not count as health insurance as far as ACA rules are concerned so the insured must pay the penalty for "not having insurance".

We were forced to try this route as United Health pulled out of the individual insurance market and on Mon. we'll lose our insurance. The same thing happened to us in the preceding 2 years with Blue Cross and Aetna. United Health encouraged us to apply for one of their traditional plans but after reviewing our medical history, we were turned down. There are only two companies on the ACA exchange in our state and neither company covers our doctors or preferred hospitals.

rec7
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Re: How to financially assist DD to help continue her Obamacare

Post by rec7 » Sat Dec 30, 2017 7:58 pm

SaveAShilling wrote:
Thu Dec 28, 2017 10:28 am
30-something DD can no longer work in her chosen profession due to back problems. (She has had surgery. The doctor told her not to continue in that profession.) She is trying to find another job. She has psychological issues (crowd anxiety and depression) which complicate finding a new job. She hopes to work from home and is willing to take courses and retrain. She has lived with DH and me since graduation with her MFA when she worked and then through the surgery.

She has $119,000 in a taxable account. She has $80,000 in a Roth and $56,000 in a Roth 401K. All are at Vanguard in VTSMS and VTIAX.

She has health insurance through Obamacare. She pays no copays and no deductibles as she is a voting member of a federally recognized Native American tribe. Keeping her health insurance is very important. She made no money last year as she was working her way through the system with periodic steroid shots before the insurance would consider surgery. I think she needs to make the minimum amount of $12,071 in order to keep Obamacare by staying above Medicaid threshold. (It’s a little confusing. She may just need to say she thinks she will make the minimum.)

Right now she has $30,000 in capital gains in her taxable account. She could sell some of her funds now to earn the amount she needs and some later if needed, rebuying immediately.

DH and I are considering gifting her money to invest so she can have a source for money from dividends. I am 68 and retired. He is 67 and continually considering retirement. (I keep telling him we have enough money for him to retire, but the good parts of his well-paying job continue to be stronger than the bad parts.) We can continue our present lifestyle on his pension and social security. We have 1.5 million in investments to live on until SS at age 70. Our house is paid for. Long term care will be paid for this year in the last of ten-year payment plan. DD is our only heir.

I am looking for suggestions for suggestions for ways to help her financially in order to help her keep her health insurance. Please don’t suggest Tough Love. Thank you for your help.
I bought oakbx one year to get my income up for ACA. I had the same problem as her one year my income was to low. Most years it has capital gains and dividends of around 8%. That is if she is ok with the risk of a balanced fund. You can check its history here https://www.oakmark.com/Our-Funds/Distr ... utions.htm
She still might need a little money help from you also.
Last edited by rec7 on Sun Dec 31, 2017 10:00 pm, edited 1 time in total.
Disclaimer: You might lose money doing anything I say. Although that was not my intent. | Favorite song: Sometimes He Whispers Jay Parrack

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dm200
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Re: How to financially assist DD to help continue her Obamacare

Post by dm200 » Sun Dec 31, 2017 11:02 am

There are only two companies on the ACA exchange in our state and neither company covers our doctors or preferred hospitals.
That is, in my opinion, your choice to not get insurance that includes coverage for pre-existing conditions. Just get new doctors and, if needed, go to a different hospital. It is certainly possible (my experience several times) that new doctors and hospital for you may be just as good or better than your existing ones.
We were forced to try this route as United Health pulled out of the individual insurance market and on Mon. we'll lose our insurance.
No, you were not "forced" to go this route. You chose it.

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Re: How to financially assist DD to help continue her Obamacare

Post by sciliz » Sun Dec 31, 2017 11:44 am

To summarize some of the above conversation, this is my understanding:
1) In non-Medicaid expansion states, you can "make too little" for Medicaid, and this is the position the original poster's DD is in
2) There are ways to gift appreciated stocks to generate income for Obamacare purposes, and since some of the original poster's assets are in taxable accounts, this is likely the best strategy to make a specific amount of taxable income with minimal long term impact on the investable resources
3) In the long run, it may be more optimal to have wage income to ensure payment into social security, but there will be a "goldilocks" effect, given the need to stay on ACA (not too little or too much)

In addition to these points, I googled "Native Americans Medicaid" and got directed to the healthcare.gov site which mentions that the rules to qualify for Medicaid may be different for qualified individuals from registered tribes. I urge the original poster to look into how a tribal member qualifies for Medicaid, because it's not identical to other people qualifying for Medicaid... https://www.healthcare.gov/american-ind ... caid-chip/

Apparently there was a law a while back where the federal government agreed to cover 100% of the cost of covering Native Americans who qualify for Medicaid. Since many of the states that did not expand Medicaid did so out of concern about covering part of the cost, even a state that is "stingy" with Medicaid in general (i.e. a non-Medicaid expansion state) may be a bit more lenient in the circumstances relevant to the original poster where it's covered entirely by the federal government.

I would strongly suggest consulting with state or local professionals who regularly provide health coverage advice to tribal members for the original poster

I personally found the Native American ACA rules a bit interesting, and I suspected that got shoehorned into the Obamacare law after someone objected to the idea that the ACA would leave some tribal members worse off than they were previously. Since there are different rules for qualifying for Medicaid for tribal members, and there is more cost sharing by the federal government for their Medicaid, this could indeed be what happened.

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dm200
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Re: How to financially assist DD to help continue her Obamacare

Post by dm200 » Sun Dec 31, 2017 12:37 pm

1) In non-Medicaid expansion states, you can "make too little" for Medicaid, and this is the position the original poster's DD is in



I don't think this is correct. In non-Medicaid expansion states, you can make too much to qualify for Medicaid, but too little for an Obamacare credit/subsidy. I don't think you can ever make too little for Medicaid.

scouter
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Re: How to financially assist DD to help continue her Obamacare

Post by scouter » Sun Dec 31, 2017 8:11 pm

dm200 wrote:
Sun Dec 31, 2017 11:02 am
There are only two companies on the ACA exchange in our state and neither company covers our doctors or preferred hospitals.
That is, in my opinion, your choice to not get insurance that includes coverage for pre-existing conditions. Just get new doctors and, if needed, go to a different hospital. It is certainly possible (my experience several times) that new doctors and hospital for you may be just as good or better than your existing ones.
Well, my pre-existing condition is Granulamatosis with Polyangiitis and it nearly took my life in 2014. We’re fortunate to live near one of the top University hospitals in the country, with doctors who are well abreast of the latest research and treatments. A team of four docs, led by a rheumatologist (because it's an auto-immune disease), saved my life and after several relapses I’ve now been in remission for 1.5 years. On an ACA plan, not only would I lose these docs and access to this Medical Center, the hospital that the ACA plans would send me to doesn’t even have a rheumatologist on staff! These two ACA insurance companies are also both known for declining to pay for the treatment that finally put me into remission.

So yes, you can say this is my choice, but for me it’s a choice between life and death. For you to say, “Just get new doctors, they might be better” is pretty smug.

delamer
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Re: How to financially assist DD to help continue her Obamacare

Post by delamer » Mon Jan 01, 2018 12:04 pm

scouter wrote:
Sun Dec 31, 2017 8:11 pm
dm200 wrote:
Sun Dec 31, 2017 11:02 am
There are only two companies on the ACA exchange in our state and neither company covers our doctors or preferred hospitals.
That is, in my opinion, your choice to not get insurance that includes coverage for pre-existing conditions. Just get new doctors and, if needed, go to a different hospital. It is certainly possible (my experience several times) that new doctors and hospital for you may be just as good or better than your existing ones.
Well, my pre-existing condition is Granulamatosis with Polyangiitis and it nearly took my life in 2014. We’re fortunate to live near one of the top University hospitals in the country, with doctors who are well abreast of the latest research and treatments. A team of four docs, led by a rheumatologist (because it's an auto-immune disease), saved my life and after several relapses I’ve now been in remission for 1.5 years. On an ACA plan, not only would I lose these docs and access to this Medical Center, the hospital that the ACA plans would send me to doesn’t even have a rheumatologist on staff! These two ACA insurance companies are also both known for declining to pay for the treatment that finally put me into remission.

So yes, you can say this is my choice, but for me it’s a choice between life and death. For you to say, “Just get new doctors, they might be better” is pretty smug.
An awful situation. So what are you going to do?

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Re: How to financially assist DD to help continue her Obamacare

Post by dm200 » Tue Jan 02, 2018 10:21 am

scouter wrote:
Sun Dec 31, 2017 8:11 pm
dm200 wrote:
Sun Dec 31, 2017 11:02 am
There are only two companies on the ACA exchange in our state and neither company covers our doctors or preferred hospitals.
That is, in my opinion, your choice to not get insurance that includes coverage for pre-existing conditions. Just get new doctors and, if needed, go to a different hospital. It is certainly possible (my experience several times) that new doctors and hospital for you may be just as good or better than your existing ones.
Well, my pre-existing condition is Granulamatosis with Polyangiitis and it nearly took my life in 2014. We’re fortunate to live near one of the top University hospitals in the country, with doctors who are well abreast of the latest research and treatments. A team of four docs, led by a rheumatologist (because it's an auto-immune disease), saved my life and after several relapses I’ve now been in remission for 1.5 years. On an ACA plan, not only would I lose these docs and access to this Medical Center, the hospital that the ACA plans would send me to doesn’t even have a rheumatologist on staff! These two ACA insurance companies are also both known for declining to pay for the treatment that finally put me into remission.
So yes, you can say this is my choice, but for me it’s a choice between life and death. For you to say, “Just get new doctors, they might be better” is pretty smug.
I cannot comment on almost all medical conditions, unless I might have personal experience; I related my multiple experiences.

From your post, you are, apparently, choosing to be uninsured instead of being on a plan that does not have your providers.

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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Tue Jan 02, 2018 10:45 am

dm200 posted
I don't think this is correct. In non-Medicaid expansion states, you can make too much to qualify for Medicaid, but too little for an Obamacare credit/subsidy. I don't think you can ever make too little for Medicaid.
To clarify, DD does not qualify for Medicaid. The information I found at benefits.gov says one must be“a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, under age 21 and in foster care, adoption assistance or a nursing facility, blind, disabled, or be 65 years of age or older. The Medicaid income limits are different, depending on which group of individuals you fall into: nursing facility, blind, disabled, or be 65 years of age or older." Although DD has low income, she doesn’t meet the other requirements.

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Re: How to financially assist DD to help continue her Obamacare

Post by miamivice » Tue Jan 02, 2018 10:54 am

Shallowpockets wrote:
Thu Dec 28, 2017 12:03 pm
The federal gift tax exemption is 14k. Don't know if you could do 14k each, but that is a paltry amount to expect any significant dividends to live on even if you can do 28k. Unless you are willing to go higher and incur the taxes.
Your retirements are close, if you are planning on 70. I would certainly start to entertain the possibility of retiring for three people.
The federal gift tax applies only to folks that have estates in excess of $11 million single / $22 million jointly, so I don't think that going above the $14 gift tax exemption amount is an issue.

SaveAShilling
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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Tue Jan 02, 2018 10:58 am

Sciliz posted the following:
To summarize some of the above conversation, this is my understanding:
1) In non-Medicaid expansion states, you can "make too little" for Medicaid, and this is the position the original poster's DD is in
2) There are ways to gift appreciated stocks to generate income for Obamacare purposes, and since some of the original poster's assets are in taxable accounts, this is likely the best strategy to make a specific amount of taxable income with minimal long term impact on the investable resources
3) In the long run, it may be more optimal to have wage income to ensure payment into social security, but there will be a "goldilocks" effect, given the need to stay on ACA (not too little or too much)

In addition to these points, I googled "Native Americans Medicaid" and got directed to the healthcare.gov site which mentions that the rules to qualify for Medicaid may be different for qualified individuals from registered tribes. I urge the original poster to look into how a tribal member qualifies for Medicaid, because it's not identical to other people qualifying for Medicaid... https://www.healthcare.gov/american-ind ... caid-chip/

Apparently there was a law a while back where the federal government agreed to cover 100% of the cost of covering Native Americans who qualify for Medicaid. Since many of the states that did not expand Medicaid did so out of concern about covering part of the cost, even a state that is "stingy" with Medicaid in general (i.e. a non-Medicaid expansion state) may be a bit more lenient in the circumstances relevant to the original poster where it's covered entirely by the federal government.

I would strongly suggest consulting with state or local professionals who regularly provide health coverage advice to tribal members for the original poster

I personally found the Native American ACA rules a bit interesting, and I suspected that got shoehorned into the Obamacare law after someone objected to the idea that the ACA would leave some tribal members worse off than they were previously. Since there are different rules for qualifying for Medicaid for tribal members, and there is more cost sharing by the federal government for their Medicaid, this could indeed be what happened.
I also find the Native American ACA rules interesting. In fact, as I said earlier, I originally thought it was too good to be true. However so far it has worked for DD. She is happy with her doctors and her care, so I would prefer to keep her in ACA with the subsidy which she needs in order to also receive the Native American benefits. (Or so the ACA representative told DD.) But looking into the Medicaid rules is a possibility if she has problems keeping the ACA subsidy.

For now, she is going to take some cost gains from her taxable account after she changes her cost basis rules to SpecID. Unfortunately she is in Total Stock Index and Vanguard won't let her buy it again for 30 days. She will either buy S&P 500 index or buy elsewhere, maybe Fidelity. DH and I plan to gift her some of our taxable index funds, but the youngish and foolish people we were when we bought it did not keep good records. I need to research the cost basis. We do have every year ever paper copies of our income tax returns, so it should be doable.

I appreciate the thought all of the posters put into our difficulty.

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Re: How to financially assist DD to help continue her Obamacare

Post by dm200 » Tue Jan 02, 2018 11:09 am

SaveAShilling wrote:
Tue Jan 02, 2018 10:45 am
dm200 posted
I don't think this is correct. In non-Medicaid expansion states, you can make too much to qualify for Medicaid, but too little for an Obamacare credit/subsidy. I don't think you can ever make too little for Medicaid.
To clarify, DD does not qualify for Medicaid. The information I found at benefits.gov says one must be“a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, under age 21 and in foster care, adoption assistance or a nursing facility, blind, disabled, or be 65 years of age or older. The Medicaid income limits are different, depending on which group of individuals you fall into: nursing facility, blind, disabled, or be 65 years of age or older." Although DD has low income, she doesn’t meet the other requirements.
and, as stated on other posts, the specific rules and income requirements can be very different in different states.

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Re: How to financially assist DD to help continue her Obamacare

Post by Pajamas » Tue Jan 02, 2018 12:40 pm

There is quite a bit of incorrect information in this thread.

Since your daughter is Native American, is there some sort of local tribal health care office or social services office that could provide accurate information and assistance with obtaining health care coverage?

ACA ("Obamacare") and Medicaid and similar health care coverage varies by state and Native American status.

https://www.ihs.gov/aca/
The ACA provides American Indians and Alaska Natives with more choices; depending on your eligibility and the coverage available in your state, you can:

Continue to use IHS, tribal, and/or urban Indian health programs
Enroll in a qualified health plan (QHP) through the Marketplace
Access coverage through Medicare, Medicaid, and the Children's Health Insurance Program
If you choose to enroll in a QHP through the Health Insurance Marketplace plan, you may qualify for special benefits and protections offered to American Indians and Alaska Natives.

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Re: How to financially assist DD to help continue her Obamacare

Post by SaveAShilling » Tue Jan 02, 2018 3:49 pm

Pajamas posted
There is quite a bit of incorrect information in this thread.

Since your daughter is Native American, is there some sort of local tribal health care office or social services office that could provide accurate information and assistance with obtaining health care coverage?

ACA ("Obamacare") and Medicaid and similar health care coverage varies by state and Native American status.

https://www.ihs.gov/aca/
While my DH is proud of his Native American heritage, we do not live near any local tribal offices. We live in a large Metropolitan area. DD is on the books at ACA as Native American because she was asked while first registering "Are you a voting member of an American Indian Tribe?" As she is, she said "Yes" and has benefited from the result. I am comfortable taking advantage of a situation the representative of the ACA originated.

I think the gifting of our older mutual funds to her to sell for the cost gain is the best solution.

Please do correct any misinformation for the benefit of any Bogleheads who wish to use the information provided.

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