losing medicaid, needing to go on affordable care act

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LearningAlot
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losing medicaid, needing to go on affordable care act

Post by LearningAlot »

I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She was on SSI and medicaid. She now turned 62, and is receiving social security survivor income of $20,000 annually. This
pushes her just beyond medicaid eligibility and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.

Any advice would be greatly appreciated.

Thanks in advance!
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Phineas J. Whoopee
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Re: losing medicaid, needing to go on affordable care act

Post by Phineas J. Whoopee »

Everything you asked about is based on Modified Adjusted Gross Income, MAGI, but that can be a little confusing because the modifications are different for different programs.

For Affordable Care Act purposes here's the MAGI definition.

PJW
mhalley
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Re: losing medicaid, needing to go on affordable care act

Post by mhalley »

The obvious place to start is healthcare.gov
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Sandtrap
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Re: losing medicaid, needing to go on affordable care act

Post by Sandtrap »

LearningAlot wrote: Mon Jun 17, 2019 3:03 pm I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She was on SSI and medicaid. She now turned 62, and is receiving social security survivor income of $20,000 annually. This
pushes her just beyond medicaid eligibility and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.

Any advice would be greatly appreciated.

Thanks in advance!
Can you talk to her accountant or CPA to seek out deductions, contributions, etc, that will bring her back into medicaid eligibility. Do everything she can to get that MAGI adjusted down.
The ACA route can sometimes turn pricey very fast and with less coverage.

Can you give more info so others can help with details on this?
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dodecahedron
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Re: losing medicaid, needing to go on affordable care act

Post by dodecahedron »

Sandtrap wrote: Mon Jun 17, 2019 3:42 pm
Can you talk to her accountant or CPA to seek out deductions, contributions, etc, that will bring her back into medicaid eligibility. Do everything she can to get that MAGI adjusted down
No point. The only potential deductions that could make a difference would be contributions to tax-deferred retirement plans (e.g., tIRA or trad 401k, 403b) or HSA contributions. But the former is out because she has no earned income. The latter is out because she does not have a qualifying high deductible plan and she is really not in a position to take advantage of one, given her circumstances.
The ACA route can sometimes turn pricey very fast and with less coverage.
Depends on the state! In NY, someone in her shoes (i.e., MAGI up to 200% of Federal poverty level) would be eligible for the Essential Plan, which is pretty much the same as Medicaid except that it has a premium ranging from $0 per month to a max of $20 per month.
Can you give more info so others can help with details on this?
Yes--in particular, we really need to know the state. The county of residence might potentially also be helpful information.
MnD
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Re: losing medicaid, needing to go on affordable care act

Post by MnD »

Sandtrap wrote: Mon Jun 17, 2019 3:42 pm
LearningAlot wrote: Mon Jun 17, 2019 3:03 pm I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She was on SSI and medicaid. She now turned 62, and is receiving social security survivor income of $20,000 annually. This
pushes her just beyond medicaid eligibility and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.

Any advice would be greatly appreciated.

Thanks in advance!
Can you talk to her accountant or CPA to seek out deductions, contributions, etc, that will bring her back into medicaid eligibility. Do everything she can to get that MAGI adjusted down.
Very low income people on Medicaid/SSI don't generally have CPA's/accountants. Just sayin.......
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Sandtrap
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Re: losing medicaid, needing to go on affordable care act

Post by Sandtrap »

MnD wrote: Mon Jun 17, 2019 9:46 pm
Sandtrap wrote: Mon Jun 17, 2019 3:42 pm
LearningAlot wrote: Mon Jun 17, 2019 3:03 pm I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She was on SSI and medicaid. She now turned 62, and is receiving social security survivor income of $20,000 annually. This
pushes her just beyond medicaid eligibility and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.

Any advice would be greatly appreciated.

Thanks in advance!
Can you talk to her accountant or CPA to seek out deductions, contributions, etc, that will bring her back into medicaid eligibility. Do everything she can to get that MAGI adjusted down.
Very low income people on Medicaid/SSI don't generally have CPA's/accountants. Just sayin.......
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Flobes
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Re: losing medicaid, needing to go on affordable care act

Post by Flobes »

LearningAlot wrote: Mon Jun 17, 2019 3:03 pm I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She now turned 62 ...income of $20,000 annually ...and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.
ACA Cliff Notes:

ACA accepts new participants during Open Enrollment and when they have a special qualifying event. Losing her Medicaid should constitute her exception.

ACA application process varies by state.

In order to get ACA subsidies and cost-sharing reductions, she'll need to purchase her insurance on The Exchange (and not in the free market).

All pricing is based on income, age, smoking, and location. Plans are Bronze, Silver, Gold, Platinum.

Subsidies reduce the cost of buying health insurance. The subsidy is actually a tax credit that can be taken one of two ways: in advance or in arrears. She'll want to take it in advance, and that money will be paid directly to the insurance company. At tax filing time, she will reconcile the amount of her subsidy vs the guesstimate of her income at application. If her income is higher, she may owe some clawback of the advance subsidy payment; if her income is lower, she may get additional tax credits. Subsidy is computed by her income vis a vis cost of second lowest Silver plan available to her; it will be calculated as part of application process and not by you.

Cost-sharing benefits reduce the costs of actually using the health care benefits by lowering deductibles, copays, and out-of-pocket expenses. At her income level, she is eligible to get cost-sharing benefits. Cost-sharing benefits are only available for certain Silver Plans. They are not reconciled at tax time, and they can not be clawed back.

As a general rule, her application should be honest with regards to income, but guesstimate on the low (rather than high) side of reasonable.

Depending on what's available where she lives -- and this varies widely -- she may be able to get a high-deductible Bronze plan for close to free,perhaps even an HSA-eligible insurance. But she may want/need to opt to pay a bit to garner a Silver plan's cost-sharing benefits, which can be quite substantial, to deal with health issues. This will be your biggest decision.
michaeljc70
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Re: losing medicaid, needing to go on affordable care act

Post by michaeljc70 »

She should receive documentation (from the government) that would indicate she qualifies for a qualifying event so she doesn't have to wait until open enrollment. At $20k, she should be able to get a big subsidy and possibly qualify for cost reductions as well. As others said, the state/county makes a difference. If you know this information you can go to healthcare.gov or https://www.kff.org/interactive/subsidy-calculator/. The later is less fussy to deal with for calculating the subsidy. Hopefully there is a reasonable option that works for her for the next few years until she can go on Medicare.
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LearningAlot
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Re: losing medicaid, needing to go on affordable care act

Post by LearningAlot »

Thanks all for your guidance. Between healthcare.gov and www.kff.org/interactive/subsidy-calculator/, I have been able to
gain a pretty good understanding of options and costs.

She provided me her doctors and drugs, so I have been able to find a silver plan which includes most of her providers and drugs.
Her monthly premium will be $66 (after tax credit) and out of pocket maximum will be $2,600. All in all, seems like a
pretty good solution for her.

Thanks again!
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Flobes
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Re: losing medicaid, needing to go on affordable care act

Post by Flobes »

LearningAlot wrote: Tue Jun 18, 2019 6:56 am Thanks all for your guidance.
I sent you a private message.
ctuser1
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Re: losing medicaid, needing to go on affordable care act

Post by ctuser1 »

LearningAlot wrote: Mon Jun 17, 2019 3:03 pm I will be helping a friend of the family, who is very low income, navigate some insurance issues.

She was on SSI and medicaid. She now turned 62, and is receiving social security survivor income of $20,000 annually. This
pushes her just beyond medicaid eligibility and needs to go the ACA route.

I am trying to learn as much as I can as fast as I can about getting her the maximum subsidies/cost reductions/tax credits possible.

Any advice would be greatly appreciated.

Thanks in advance!
Which state?
Some states protect such cases, especially if disabled (do you get SSI otherwise??), and still provide medicaid.
.e.g. Utah. https://chip.health.utah.gov/Medicaidpo ... dowers.htm
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dm200
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Re: losing medicaid, needing to go on affordable care act

Post by dm200 »

LearningAlot wrote: Tue Jun 18, 2019 6:56 am Thanks all for your guidance. Between healthcare.gov and www.kff.org/interactive/subsidy-calculator/, I have been able to
gain a pretty good understanding of options and costs.

She provided me her doctors and drugs, so I have been able to find a silver plan which includes most of her providers and drugs.
Her monthly premium will be $66 (after tax credit) and out of pocket maximum will be $2,600. All in all, seems like a
pretty good solution for her.

Thanks again!
Yes - if that is correct - seems very good.

Then, in three years, she will be eligible for Medicare.
michaeljc70
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Re: losing medicaid, needing to go on affordable care act

Post by michaeljc70 »

dm200 wrote: Tue Jun 18, 2019 12:54 pm
LearningAlot wrote: Tue Jun 18, 2019 6:56 am Thanks all for your guidance. Between healthcare.gov and www.kff.org/interactive/subsidy-calculator/, I have been able to
gain a pretty good understanding of options and costs.

She provided me her doctors and drugs, so I have been able to find a silver plan which includes most of her providers and drugs.
Her monthly premium will be $66 (after tax credit) and out of pocket maximum will be $2,600. All in all, seems like a
pretty good solution for her.

Thanks again!
Yes - if that is correct - seems very good.

Then, in three years, she will be eligible for Medicare.
Yes. She should also get the CSRs and not have to pay all of the $2600. You only get those on the silver plans.
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