Health Care Options for 26 year old

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yankeefan4065
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Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 3:45 pm

Hi All,

I'm trying to help out a friend who is planning a career change. She is currently 26 and has been a teacher for 5 years. She has decided to leave the profession and has been accepted into nursing school which begins in May, 2019. As part of her planning for this transition she had questions about health coverage after she leaves. I wanted to ask the Bogleheads who I know offer excellent insight and advice.

Questions:
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?

2. One option is COBRA coverage. However, as I understand it she would have to pay her entire premium plus an administrative fee. Is this correct?

3. If she goes the ACA route she could possibly get a subsidy because she'll only be employed from January-April 2019. On the questionnaire at healthcare.gov they ask for current income. (they say use adjusted gross income from tax return). If she's only working the 4 months in 2019 what's the easiest way for her to calculate this number?

4. Is it possible for her to get Medicaid? When applying for Medicaid do they look at all assets someone owns or simply current income? She will be attending school full-time from May 2019-June 2020 and will have no income.

5. Since COBRA coverage will most likely be too expensive, what, in your opinion, would be her best bet?

Thanks, in advance, for your help!

John

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Thu Oct 18, 2018 4:44 pm

However, as I understand it she would have to pay her entire premium plus an administrative fee. Is this correct?
Yes. I believe the maximum admin fee is 2%, but not all employers add that to COBRA.

Usually (but not always) employer coverage last until end of month. She should verify.

Not sure if being a full time student can work with Medicaid. I doubt it, though.

I suspect there must be other such nursing students in a similar situation. Perhaps the nursing school can offer a plan.

How long will she be in school to get the Nursing degree? Might it be shorter for her since she already has a college degree?

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 4:47 pm

Thanks so much for responding.....her schooling should last from May 2019-June 2020

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Thu Oct 18, 2018 4:56 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 4:47 pm
Thanks so much for responding.....her schooling should last from May 2019-June 2020
OK - as I suspected, a relatively short time.

Not sure about ACA eligibility and subsidies - but maybe - since she will have significant income in both 2019 and 2020. Others may have some knowledge or views.

This time is well within the up to 18 months of COBRA. I assume she will become employed full time, with benefits, soon after June 2020.

I would also check with the Nursing school about what kind of plan(s) they might offer and what the costs might be.

She is very wise to be thinking about this now -- and not at the last minute.

BeneIRA
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Re: Health Care Options for 26 year old

Post by BeneIRA » Thu Oct 18, 2018 4:57 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
Hi All,

I'm trying to help out a friend who is planning a career change. She is currently 26 and has been a teacher for 5 years. She has decided to leave the profession and has been accepted into nursing school which begins in May, 2019. As part of her planning for this transition she had questions about health coverage after she leaves. I wanted to ask the Bogleheads who I know offer excellent insight and advice.

Questions:
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?
It will last until the end of the month, tops. A lot of employers end it the day of termination. It is something to look into because it might make sense to work one or two days in a month and then get coverage until the end of that month.

2. One option is COBRA coverage. However, as I understand it she would have to pay her entire premium plus an administrative fee. Is this correct?
Correct. Employee portion plus employer portion plus an admin fee of 2%.

3. If she goes the ACA route she could possibly get a subsidy because she'll only be employed from January-April 2019. On the questionnaire at healthcare.gov they ask for current income. (they say use adjusted gross income from tax return). If she's only working the 4 months in 2019 what's the easiest way for her to calculate this number?

4. Is it possible for her to get Medicaid? When applying for Medicaid do they look at all assets someone owns or simply current income? She will be attending school full-time from May 2019-June 2020 and will have no income.

5. Since COBRA coverage will most likely be too expensive, what, in your opinion, would be her best bet?

Look into ACA.

Thanks, in advance, for your help!

John

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 5:10 pm

I will definitely suggest contacting the school.....didn’t even think of that

Thanks!

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Re: Health Care Options for 26 year old

Post by aspirit » Thu Oct 18, 2018 5:14 pm

-deleted- Good luck!
Last edited by aspirit on Fri Oct 19, 2018 4:24 pm, edited 1 time in total.
Time & tides wait for no one. A man has to know his limitations.

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 5:17 pm

Thanks for taking the time, all

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Thu Oct 18, 2018 5:23 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 5:10 pm
I will definitely suggest contacting the school.....didn’t even think of that
Thanks!
Maybe a "nursing school" has connections to a good deal.

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Thu Oct 18, 2018 6:10 pm

Meet and marry a Doctor - with family benefits ;)

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 6:13 pm

One other question regarding her 403b and pension. Since she is not vested in her pension she can do a direct rollover to an IRA. She can do the same with her 403b. Can those two amounts be co-mingled in the same IRA or should they go in separate IRAs (they are both pre-tax).

Thank you.

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Thu Oct 18, 2018 6:28 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 6:13 pm
One other question regarding her 403b and pension. Since she is not vested in her pension she can do a direct rollover to an IRA. She can do the same with her 403b. Can those two amounts be co-mingled in the same IRA or should they go in separate IRAs (they are both pre-tax).
Thank you.
Is there any possibility that she could return to a Nursing position from an employer with the same pension plan?

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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 6:30 pm

No chance of that

delamer
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Re: Health Care Options for 26 year old

Post by delamer » Thu Oct 18, 2018 6:40 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 5:10 pm
I will definitely suggest contacting the school.....didn’t even think of that

Thanks!
I know someone in med school who gets inexpensive coverage through her school.

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Watty
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Re: Health Care Options for 26 year old

Post by Watty » Thu Oct 18, 2018 7:04 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?
.

It varies by employer but something to check on is if she could save up vacation time and take that starting in mid-May and possibly make her official last day be in June.

Some teachers also work on a 12 month pay schedule even when they have the summer off so that they get paid and benefits through the summer. Is there any chance she could switch to that pay schedule and get pro-rated pay and benefits through August?

If by any chance they are not renewing her contract then there is a chance that she might be able to get unemployment. Being in a job training program might satisfy the job search requirement depending on the state laws.
yankeefan4065 wrote:
Thu Oct 18, 2018 5:10 pm
I will definitely suggest contacting the school.....didn’t even think of that

Thanks!
In addition to the school administration if she can connect with students who are already in the nursing program she should see if they have any suggestion. They might be able to provide useful input from a different perspective.

One advantage of COBRA is that she will not have to change doctors if she will be in the same city. If she is moving to a different city for the nursing program then one thing to check on is if there are in-network doctors there. Sometimes a plan will not have in-network doctors outside of a limited area

She would also not have to start her 2019 deductible all over again with COBRA which could be a factor if she has significant medical expenses early in 2019.

COBRA lasts for at least 18 months and in some states it goes for 36 months. An advantage of that is even with 18 months that would take her through most of 2020 and there is no telling what the affordable care policies will be like in 2020. If the choice is close between COBRA and an ACA policy then I would choose COBRA since you know what it will be like in 2020. She may also be able to keep her dental and vision benefits with COBRA.

I used COBRA for 18 months when I retired and a couple of things to keep in mind.

1) In the fall there will be an open enrolment period just like for active employees so your rates could go up or the employer could insurance companies.

2) You have to really keep on top of paying the bills with COBRA. The company that administered my COBRA plan did the bare minimum that they legally had to do and you could tell that they would really be glad if I missed a payment and was forced out of the plan. As I recall if you are more than 30(?) days late with a payment then you are dropped out of COBRA and there is no way to get back in.

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Thu Oct 18, 2018 7:11 pm

Thank you Watty for that detailed post. Unfortunately the answer is no to your first three points but I will pass along all your information.

Many thanks!

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Re: Health Care Options for 26 year old

Post by mnnice » Thu Oct 18, 2018 9:48 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
4. Is it possible for her to get Medicaid? When applying for Medicaid do they look at all assets someone owns or simply current income? She will be attending school full-time from May 2019-June 2020 and will have no income
What is her state of residence while completing the program?

HereToLearn
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Re: Health Care Options for 26 year old

Post by HereToLearn » Thu Oct 18, 2018 10:16 pm

Watty wrote:
Thu Oct 18, 2018 7:04 pm
yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?
.

It varies by employer but something to check on is if she could save up vacation time and take that starting in mid-May and possibly make her official last day be in June.

Some teachers also work on a 12 month pay schedule even when they have the summer off so that they get paid and benefits through the summer. Is there any chance she could switch to that pay schedule and get pro-rated pay and benefits through August?

If by any chance they are not renewing her contract then there is a chance that she might be able to get unemployment. Being in a job training program might satisfy the job search requirement depending on the state laws.
yankeefan4065 wrote:
Thu Oct 18, 2018 5:10 pm
I will definitely suggest contacting the school.....didn’t even think of that

Thanks!
In addition to the school administration if she can connect with students who are already in the nursing program she should see if they have any suggestion. They might be able to provide useful input from a different perspective.

One advantage of COBRA is that she will not have to change doctors if she will be in the same city. If she is moving to a different city for the nursing program then one thing to check on is if there are in-network doctors there. Sometimes a plan will not have in-network doctors outside of a limited area

She would also not have to start her 2019 deductible all over again with COBRA which could be a factor if she has significant medical expenses early in 2019.

COBRA lasts for at least 18 months and in some states it goes for 36 months. An advantage of that is even with 18 months that would take her through most of 2020 and there is no telling what the affordable care policies will be like in 2020. If the choice is close between COBRA and an ACA policy then I would choose COBRA since you know what it will be like in 2020. She may also be able to keep her dental and vision benefits with COBRA.

Agree with your other points above, but am questioning your statement that some states offer COBRA for 36 months. COBRA is a federal law that offers continuation for 18, 29 or 36 months. 29 is for fully-disabled individuals, 36 is for divorce/widow and people who exceed the limiting age of the plan, so when F/T college students age off parents' plan and when one spouse retires and enrolls in Medicare.

HereToLearn
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Re: Health Care Options for 26 year old

Post by HereToLearn » Thu Oct 18, 2018 10:21 pm

yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
Hi All,

I'm trying to help out a friend who is planning a career change. She is currently 26 and has been a teacher for 5 years. She has decided to leave the profession and has been accepted into nursing school which begins in May, 2019. As part of her planning for this transition she had questions about health coverage after she leaves. I wanted to ask the Bogleheads who I know offer excellent insight and advice.

Questions:
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?

2. One option is COBRA coverage. However, as I understand it she would have to pay her entire premium plus an administrative fee. Is this correct?

3. If she goes the ACA route she could possibly get a subsidy because she'll only be employed from January-April 2019. On the questionnaire at healthcare.gov they ask for current income. (they say use adjusted gross income from tax return). If she's only working the 4 months in 2019 what's the easiest way for her to calculate this number?

4. Is it possible for her to get Medicaid? When applying for Medicaid do they look at all assets someone owns or simply current income? She will be attending school full-time from May 2019-June 2020 and will have no income.

5. Since COBRA coverage will most likely be too expensive, what, in your opinion, would be her best bet?

Thanks, in advance, for your help!

John
I wonder if her four months of income will place her earnings above the Medicaid level?

Most colleges offer very good and relatively inexpensive medical insurance plans to current students. The plans offered to undergrad run August 1 to July 31, or thereabouts. Assuming that dates of her enrollment in the nursing program correspond with the rest of the students in the same program, she may find that coverage is available for those dates. One caveat: these plans are not group plans and do not offer a COBRA continuation option at the end, so if she has not started working when the school coverage ends, she will need to enroll in an AHC plan.

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 5:18 am

Her state of residence is New Jersey

mnnice
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Re: Health Care Options for 26 year old

Post by mnnice » Fri Oct 19, 2018 7:38 am

HereToLearn wrote:
Thu Oct 18, 2018 10:21 pm
yankeefan4065 wrote:
Thu Oct 18, 2018 3:45 pm
Hi All,

I'm trying to help out a friend who is planning a career change. She is currently 26 and has been a teacher for 5 years. She has decided to leave the profession and has been accepted into nursing school which begins in May, 2019. As part of her planning for this transition she had questions about health coverage after she leaves. I wanted to ask the Bogleheads who I know offer excellent insight and advice.

Questions:
1.If she leaves mid-month will her current coverage last until the end of that month or possibly longer?

2. One option is COBRA coverage. However, as I understand it she would have to pay her entire premium plus an administrative fee. Is this correct?

3. If she goes the ACA route she could possibly get a subsidy because she'll only be employed from January-April 2019. On the questionnaire at healthcare.gov they ask for current income. (they say use adjusted gross income from tax return). If she's only working the 4 months in 2019 what's the easiest way for her to calculate this number?

4. Is it possible for her to get Medicaid? When applying for Medicaid do they look at all assets someone owns or simply current income? She will be attending school full-time from May 2019-June 2020 and will have no income.

5. Since COBRA coverage will most likely be too expensive, what, in your opinion, would be her best bet?

Thanks, in advance, for your help!

John
I wonder if her four months of income will place her earnings above the Medicaid level?

Most colleges offer very good and relatively inexpensive medical insurance plans to current students. The plans offered to undergrad run August 1 to July 31, or thereabouts. Assuming that dates of her enrollment in the nursing program correspond with the rest of the students in the same program, she may find that coverage is available for those dates. One caveat: these plans are not group plans and do not offer a COBRA continuation option at the end, so if she has not started working when the school coverage ends, she will need to enroll in an AHC plan.
Medicaid is by monthly income. I think unless she has some medical needs where she wants/needs a particular provider that Medicaid is her best (I.e.) cheapest option.

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 9:15 am

In fact after speaking with her she indicated that she may be leaving earlier than April reducing her income even more. How should she calculate her income for Medicaid purposes ( gross pay from January ?).Also, when should she begin the application process?
Last edited by yankeefan4065 on Fri Oct 19, 2018 9:26 am, edited 1 time in total.

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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 9:16 am

One more variable .....does a loan from a family member to aid in tuition payment affect Medicaid qualification ?

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dodecahedron
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Re: Health Care Options for 26 year old

Post by dodecahedron » Fri Oct 19, 2018 9:39 am

mnnice wrote:
Fri Oct 19, 2018 7:38 am

Medicaid is by monthly income. I think unless she has some medical needs where she wants/needs a particular provider that Medicaid is her best (I.e.) cheapest option.
This is only true in ¨Medicaid expansion¨ states (i.e., the 34 states that chose to exercise their ACA-permitted option to expand Medicaid.)

Fortunately for the OP´s friend, NJ is a Medicaid Expansion state. In other states, it can be much harder to qualify (e.g., asset tests, etc.), particularly for a non-elderly, non-disabled childless nonpregnant person.

That said, Medicaid is not a monolithic option. A state may offer traditional Medicaid, which can be very bleak and have very few participating doctors, as well as ¨managed Medicaid,¨ privately operated HMOs that offer a far greater list of providers.

In our area (Upstate NY), some of the managed Medicaid options have excellent networks. Some of the top rated HMOs at private employers also run managed Medicaid plans and their list of network providers for the private employer plan and the managed Medicaid plan are almost the same. (I understand that there are a few dermatologists who choose to belong to the HMO´s private employer plan but not the Managed Medicaid plan, but otherwise it is hard to see much difference between the two lists.) That said, bear in mind that not all docs who participate in Medicaid and/or an HMO are accepting new patients. NJ is one of the lowest five states in the country for the percentage of doctors accepting new Medicaid patients. If she already has physicians she likes and wants to keep, she is in a better position than if starting from scratch.

I do a lot of volunteer work with folks who are on managed Medicaid. They seem pretty happy with the coverage. Managed Medicaid does require referrals from their primary care practitioner to see specialists (which traditional Medicaid does not), but they seem pretty happy with their access to care. I have talked about it with doctors I know socially in a variety of specialties and they seem pretty happy with managed Medicaid as well. Their office staff prefers dealing with the HMO providers rather than directly with the Medicaid system.

I think the idea of contacting the intended nursing school is excellent. They have surely dealt with many students in her circumstances, some of whom may have required extensive care due to an accident, injury, or illness while attending school, and should know about the best managed Medicaid choices in their particular area.

yankeefan4065
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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 10:00 am

Terrific information....one potentially complicating factor is the nursing program is in New York State and she will be living in New Jersey

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Artful Dodger
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Re: Health Care Options for 26 year old

Post by Artful Dodger » Fri Oct 19, 2018 11:18 am

As mnnice and dodecahedron noted, Medicaid will likely be the best option. New Jersey is an expansion state and residence and monthly income determines eligibility, not place of school or work. She could contact them now, and find out when she needs to apply.

Some schools have student medical programs, though these seem to be going by the wayside. Worth checking into, especially if subsidized by the school.

COBRA will likely be prohibitively expensive.

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dm200
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Re: Health Care Options for 26 year old

Post by dm200 » Fri Oct 19, 2018 11:20 am

Artful Dodger wrote:
Fri Oct 19, 2018 11:18 am
As mnnice and dodecahedron noted, Medicaid will likely be the best option. New Jersey is an expansion state and residence and monthly income determines eligibility, not place of school or work. She could contact them now, and find out when she needs to apply.

Some schools have student medical programs, though these seem to be going by the wayside. Worth checking into, especially if subsidized by the school.

COBRA will likely be prohibitively expensive.
I could be wrong, but I would doubt a voluntary full time student would qualify for medicaid.

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Re: Health Care Options for 26 year old

Post by Artful Dodger » Fri Oct 19, 2018 11:28 am

dm200 wrote:
Fri Oct 19, 2018 11:20 am
Artful Dodger wrote:
Fri Oct 19, 2018 11:18 am
As mnnice and dodecahedron noted, Medicaid will likely be the best option. New Jersey is an expansion state and residence and monthly income determines eligibility, not place of school or work. She could contact them now, and find out when she needs to apply.

Some schools have student medical programs, though these seem to be going by the wayside. Worth checking into, especially if subsidized by the school.

COBRA will likely be prohibitively expensive.
I could be wrong, but I would doubt a voluntary full time student would qualify for medicaid.
There would be no problem for an adult, as we are discussing here. You could run into a problem with a dependent child in college, as family income would be the determining factor.

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Re: Health Care Options for 26 year old

Post by dm200 » Fri Oct 19, 2018 11:46 am

Artful Dodger wrote:
Fri Oct 19, 2018 11:28 am
dm200 wrote:
Fri Oct 19, 2018 11:20 am
Artful Dodger wrote:
Fri Oct 19, 2018 11:18 am
As mnnice and dodecahedron noted, Medicaid will likely be the best option. New Jersey is an expansion state and residence and monthly income determines eligibility, not place of school or work. She could contact them now, and find out when she needs to apply.

Some schools have student medical programs, though these seem to be going by the wayside. Worth checking into, especially if subsidized by the school.

COBRA will likely be prohibitively expensive.
I could be wrong, but I would doubt a voluntary full time student would qualify for medicaid.
There would be no problem for an adult, as we are discussing here. You could run into a problem with a dependent child in college, as family income would be the determining factor.
thanks. I learn something new almost every day here. ;)

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dodecahedron
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Re: Health Care Options for 26 year old

Post by dodecahedron » Fri Oct 19, 2018 12:12 pm

dm200 wrote:
Fri Oct 19, 2018 11:46 am
Artful Dodger wrote:
Fri Oct 19, 2018 11:28 am

There would be no problem for an adult, as we are discussing here. You could run into a problem with a dependent child in college, as family income would be the determining factor.
thanks. I learn something new almost every day here. ;)
The MAGI that counts for Medicaid is based on a very specific definition of ¨tax household.¨ If someone else will be properly claiming the OP´s friend as a dependent, then she could be part of their tax household. But that seems completely out of the question. There are two potential kinds of dependency, Qualifying Child (QC) and Qualifying Relative (QR), with slightly different rules. At 26, she does not pass the age test to be a QC dependent (unless she is considered ¨totally & permanently disabled,¨ which seems implausible if working and planning to attend nursing school.) If she will be working fulltime for five months in 2019, she would also make too much money to pass the gross income test to be a QR dependent in tax year 2019.

Assuming she is unmarried and plans to stay that way in 2019 (???), then her tax household for Medicaid qualification will simply be herself and only her own MAGI will count towards Medicaid eligibility. The proceeds of bona fide loans (or gifts, for that matter) are not included in MAGI. For most people, MAGI is very close to their AGI. The few exceptions which involve modification are described here. They involve things like adding in foreign earned income, nontaxable Social Security benefits, and tax-exempt bond interest. They do NOT involve adding things like gifts or loan proceeds.

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Re: Health Care Options for 26 year old

Post by sailaway » Fri Oct 19, 2018 12:15 pm

Has your friend looked into student insurance through the school?

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Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 12:58 pm

Great information everyone !!! Thank you .

A few lingering questions
1. She will be in school for the first half of 2020 and hopefully working soon after......will that have an effect on Medicaid eligibility for the first half of 2020?

2. Still not sure how to calculate her MAGI assuming she only works 3 or 4 months in 2019. She’ll have her pay stubs. Any way to calculate off of that or does she need last years taxes?

3. She will be calling the school soon and hopefully they’ll have some guidance; however, if the school is unable to help regarding managed Medicaid is calling them directly the best option ?

4. If she does go the Medicaid route does she sign up through healthcare.gov?

I’ve learned so much from this discussion. We both are very appreciative of all who took the time to respond. Many thanks!!

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Re: Health Care Options for 26 year old

Post by blevine » Fri Oct 19, 2018 1:20 pm

Even if cobra is expensive, I would think it temporary.
Many colleges have platinum plans at reasonable cost since the students are young and healthy. Not all, but that is the best option if it exists. Shouldn’t take more than a quick search online, usually posted on the achool website.

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Artful Dodger
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Re: Health Care Options for 26 year old

Post by Artful Dodger » Fri Oct 19, 2018 1:30 pm

I would probably address these to the New Jersey marketplace or healthcare.gov, as HHS actually runs the NJ exchange.

But, in general...
1. She will be in school for the first half of 2020 and hopefully working soon after......will that have an effect on Medicaid eligibility for the first half of 2020?
She'll need to reapply during open enrollment (fall 2019) for 2020, and they should use her current monthly income. She may very well get instructions from either the Medicaid plan or NJ exchange on simplified re-enrollment.
2. Still not sure how to calculate her MAGI assuming she only works 3 or 4 months in 2019. She’ll have her pay stubs. Any way to calculate off of that or does she need last years taxes?
Don't worry about it. They'll use current monthly income for Medicaid.
3. She will be calling the school soon and hopefully they’ll have some guidance; however, if the school is unable to help regarding managed Medicaid is calling them directly the best option ?
Start with the NJ Marketplace or healthcare.gov. Certainly talk with the school. They may have some helpful resources.
4. If she does go the Medicaid route does she sign up through healthcare.gov?
They (healthcare.gov) are the normal first step in determining eligibility. They may need to refer you to a state agency for actual application and enrollment, but maybe not. I'm not familiar with New Jersey, per se. Medicaid is run by the individual states, so procedures vary.

yankeefan4065
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Joined: Fri May 23, 2008 9:35 am

Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 2:53 pm

Great! Thank you

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dodecahedron
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Re: Health Care Options for 26 year old

Post by dodecahedron » Fri Oct 19, 2018 4:14 pm

yankeefan4065 wrote:
Fri Oct 19, 2018 12:58 pm
Great information everyone !!! Thank you .

A few lingering questions
1. She will be in school for the first half of 2020 and hopefully working soon after......will that have an effect on Medicaid eligibility for the first half of 2020?

2. Still not sure how to calculate her MAGI assuming she only works 3 or 4 months in 2019. She’ll have her pay stubs. Any way to calculate off of that or does she need last years taxes?

3. She will be calling the school soon and hopefully they’ll have some guidance; however, if the school is unable to help regarding managed Medicaid is calling them directly the best option ?

4. If she does go the Medicaid route does she sign up through healthcare.gov?

I’ve learned so much from this discussion. We both are very appreciative of all who took the time to respond. Many thanks!!
1. Being in school should have no effect.

2. For Medicaid, they will base decision on annual proration of last four week´s income. They may or may not ask for paystubs but she should certainly answer all questions honestly. At that point, she will be qualified for the following 12 months without the need to come in monthly to continue to verify.

3/4. The intake people at the reputable managed Medicaid places that I am familiar with should be very helpful in providing some information now. When she is ready to sign up, she can go directly to the managed Medicaid provider of her choice and one of their employees can manage the application process for her. At least in NY, most of the managed Medicaid providers have walk-in signup sites in a variety of convenient locations, often with extended hours. I assume it is similar in NJ. The walk-in signup places have staff who are happy to answer questions from the general public (including random policy wonks like moi, who just want to understand how the system works.)

Healthcare.gov would be ZERO use to her since NJ is one of the states that set up its own exchange. But even then she would not be buying an exchange policy (the Bronze/Silver/Gold/Platinum policies you might have heard about that are designed for folks over 138% of the poverty level for their household size.) She can do tire-kicking of networks, talk to her current docs about what plans they would recommend, and then sign up when she reaches the point of eligibility after her job ends and employer coverage expires.

yankeefan4065
Posts: 120
Joined: Fri May 23, 2008 9:35 am

Re: Health Care Options for 26 year old

Post by yankeefan4065 » Fri Oct 19, 2018 5:30 pm

Thank you. Any idea if she can apply while she’s still employed so there’s no gap in coverage?

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Artful Dodger
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Re: Health Care Options for 26 year old

Post by Artful Dodger » Mon Oct 22, 2018 3:16 pm

I think that makes sense.

You might try calling -

The State's Health Benefits Coordinator for Medicaid and/or NJ FamilyCare can be reached toll free at 1-800-701-0710 .

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sunny_socal
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Re: Health Care Options for 26 year old

Post by sunny_socal » Mon Oct 22, 2018 5:11 pm

dm200 wrote:
Thu Oct 18, 2018 6:10 pm
Meet and marry a Doctor - with family benefits ;)
I came here to post that :wink:

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