Health insurance (ACA) for adult child 26+

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beyou
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Health insurance (ACA) for adult child 26+

Post by beyou »

Unfortunately have an adult child who became ill after college, not working, and moved back home.

When he turns 26, will need to explore ACA for first time.
He has been on my employer plan through and after college. My state extends family coverage to age 29, except this does not apply to self-insured plans (which we have). My employer indicated they have some option for 26-29 despite not being required per state regulation, but even if he goes on that, I am nearing layoff/retirement, so best case could help son one more year on current employer plan (under cobra).

So my main question is about healthcare options for him and family.

I dont have all the facts/options, gathering.
Potential options :

1) Current plan COBRA - 1 extra year
2) Wife has unsubsidized plan at work that is more likely subject to state regs (not large enough to self-insure). No idea of cost but again, no employer subsidy and small business plan. Option to age 29 maybe.
3) ACA. which if he is eligible for a subsidy, might be most economical and no particular end date in sight.

If an adult son 26+ living at home and no personal income yet, would he get ACA subsidy or could our income exclude him if parents are over the cliff ?

And when I lose COBRA, if DW and I go on ACA instead of wife’s plan then do we separately buy couples plan and son gets single plan ?

I have read about this on state exchange site, unclear to me. Has anyone made the move to ACA with an adult son 26+ and how did things work with ACA ?

This loss of good subsidized employer healthcare is my biggest financial concern about retirement. In the long run maybe all will be fine, meaning he’ll recover and get employer coverage, and parents (us) go on Medicare. But in the short run, I am almost a decade from Medicare for DW and I, and son not making much progress yet.

Sharing any experience and advice would be appreciated.
Thanks in advance.
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Kenkat
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Re: Health insurance (ACA) for adult child 26+

Post by Kenkat »

Did he work for some period of time? If so, you should also look into social security disability if you expect him to be disabled for some period of time or are not sure. SSDI includes Medicare coverage after two years. The two years is from the onset of the disability, not the application or award date.
terran
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Re: Health insurance (ACA) for adult child 26+

Post by terran »

Kenkat wrote: Sun Jun 14, 2020 7:56 am Did he work for some period of time? If so, you should also look into social security disability if you expect him to be disabled for some period of time or are not sure. SSDI includes Medicare coverage after two years. The two years is from the onset of the disability, not the application or award date.
And if he didn't work consider SSI and medicaid. Even if not on SSI he might be forced onto medicaid since he doesn't have an income, but I'm not sure if this is effected by the status of medicaid expansion in your state, or whether your income is considered if he's your dependent. If he is found to be disabled then he can also be covered by your social security and get on medicare that way once you start collecting.
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beyou
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Re: Health insurance (ACA) for adult child 26+

Post by beyou »

He became ill during grad school and dropped out.
He had been preparing for a career, looking for a job post-grad school, but never made it unfortunately.
Damn shame, was getting good grades in a very difficult school/program, but just couldn't physically handle continuing.
Fortunately I had bought tuition insurance and got back part of what was paid...but now here we are.

So SSI seems not likely, given lack of work history on SS.
In my state they referred me to a local Social Services office and/or call the ACA exchange where you can find out about both Medicaid and ACA options. Not sure how far in advance he would need to apply for Medicaid, nothing we ever imagined we'd be considering.
For regular insurance, you usually sign up each fall, and I was planning to help him sign up for ACA just before his 26th birthday.
But maybe Medicaid process takes much longer and I need to start the process sooner ?

Thanks for the suggestions so far.
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Watty
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Re: Health insurance (ACA) for adult child 26+

Post by Watty »

One big factor is if your state has expanded Medicaid or not. (Medicaid, not Medicare)

If your state has not expanded Medicaid then he could be in a "catch-22" situation because you cannot get an ACA subsidy if your income is too low since it is assumed that you will be on Medicaid, but if your state has not expanded Medicaid then he may not be able to get on Medicaid.

Most likely what you need to focus on is what it would take in your state for him to get on Medicaid.
beyou wrote: Sun Jun 14, 2020 7:51 am Sharing any experience and advice would be appreciated.
My situation was a lot different but I retired early and used COBRA for as long as I could then switched to an ACA policy.

One thing to watch out for is that the networks of doctors with some ACA plans may be very limited. When I was on COBRA I had a Blue Cross plan. When I was switching to an ACA plan there was also a Blue Cross ACA plan that looked like a logical choice. When I looked at the details though none of my doctors who were in my COBRA Blue Cross Network were in the ACA Blue Cross network. Even though they were both Blue Cross they totally different networks. The ACA Blue Cross network were very limited and most of the primary care doctors were not taking new patients. I ended up selecting a Kaiser ACA plan in part to ensure that I would have good access to doctors if I needed them. Being with Kaiser will also help eliminate the the chance of a large surprise billing when some out of network doctor is used.

In my research this it was also clear that the list of "in-network" doctors that you might see on the internet is often very inaccurate. If having access to a particular doctor is important for your sons care then you need to be sure to verify that they will be In-network in his new plan even if they are listed as being in-network on the internet.
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teen persuasion
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Re: Health insurance (ACA) for adult child 26+

Post by teen persuasion »

Applying for ACA coverage is more complicated than I expected. We applied when DH was between jobs a few years back. If/when we use it again, we will definitely use a navigator to do the application for us - the navigators know all the ins and outs of the process and options and gotchas.

A few things I learned the hard way:

Apply several months in advance of losing coverage. If you apply before the fifteenth of the month, your coverage can begin the first of the next month. If you wait until the second half of the month to apply, your coverage can't begin until the first of the month following the next month.

Subsidies are for ACA policies, but your application will also consider whether you are eligible for Medicaid. If you are Medicaid eligible, you are NOT ACA subsidy eligible. Medicaid eligibility looks at current monthly income, while ACA looks at projected annual income, thus they can be contradictory (so Medicaid is tested first).

At least on my state's website (NY) you can (now) explore costs and options without starting an application (was not an option before, when we applied). Just be aware that a notice that you are not eligible for a subsidy might obliquely mean you are eligible for something else, like Medicaid, not that you are ineligible for any coverage.

Depending on your state, there may be a third option - NY has a middle-ground between Medicaid and full ACA subsidized policies, called Essential plans. These function like ACA plans, but are zero to $20/month.
grok87
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Re: Health insurance (ACA) for adult child 26+

Post by grok87 »

if i'm understanding correctly in NY they can stay on parents work insurance till 29 and in NJ till 31
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beyou
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Re: Health insurance (ACA) for adult child 26+

Post by beyou »

What I found complicated was the idea that son lives with us and they refer to “household” income. So not sure how parental income affects ACA subsidy for 26+ child. Also unclear to me if we can/should get
family plan to share deductibles. I think in NY that is feasible to age 29.

As to medicaid and disability, will be one of those borderline cases or not eligible. Per SS, even ability to do some other job at lower income can disqualify disability.

I read conflicting info but seems without disability determination, Medicaid is not an option based in low income alone.

Regarding the ACA “network” comments, I see the same in NY, limited networks and often inaccurate info online. I know for sure a critical component of my wife’s care would need to move from a top notch cancer treatment hospital to somewhere else, if we go with ACA. I would almost consider going uninsured and paying for her care out of pocket, to get the same/best treatment. Seems crazy, but it is another option. I am willing to pay more for a plan that covers what we need, but if a bad ACA plan is the only option, maybe self insured is best.

Complicated between son’s issues and wife’s, and nearing loss of my job in late 50s. I have assets to pay for care until we reach 65, so son is my long term concern. I will look into Essential plan and Medicare as well as ACA, thanks.
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beyou
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Re: Health insurance (ACA) for adult child 26+

Post by beyou »

grok87 wrote: Sun Jun 14, 2020 10:59 am if i'm understanding correctly in NY they can stay on parents work insurance till 29 and in NJ till 31
Unless the employer plan is self-insured (NY).
My employer is self-insured and under no obligation, but they did mention a blurb on our intranet about something they offer post 26, no details. Have to ask hr, but since no legal obligation, and I will be part of layoff, at best could be only a temp solution through cobra period. Since our plan is great, I’d take Cobra, but this only kicks the can down the road another 18 months.
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Re: Health insurance (ACA) for adult child 26+

Post by donall »

Former navigator here. Just follow how you or son would file income taxes. If your son Is a dependent on your taxes, then household income and number in household is used for ACA. If son is not on your taxes, then his income is separate from yours for ACA purposes. If son has no income and your state has expanded Medicaid, then he will be eligible for Medicaid. If he gets a job, then the ACA application must be updated to reflect having income and health insurance from his job. Medicaid uses actual monthly income for determining eligibility. ACA uses estimated yearly income to determine cost and subsidies. The ACA subsidies are trued up on federal taxes.

Just FYI, if your son was applying for SNAP benefits then the income from family living at same address or apartment would be included in the application even if they all filed separately.

There should be a smooth transition from your insurance to ACA/Medicaid. About a month And a half before his insurance ends, start the enrollment process. The application will have a place to indicate that this is a special enrollment (due to ending of insurance) and also a place to indicate when the current insurance ends. The ACA/Medicaid health insurance will become effective the day after the ending of the current insurance.
grok87
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Re: Health insurance (ACA) for adult child 26+

Post by grok87 »

beyou wrote: Sun Jun 14, 2020 11:05 am
grok87 wrote: Sun Jun 14, 2020 10:59 am if i'm understanding correctly in NY they can stay on parents work insurance till 29 and in NJ till 31
Unless the employer plan is self-insured (NY).
My employer is self-insured and under no obligation, but they did mention a blurb on our intranet about something they offer post 26, no details. Have to ask hr, but since no legal obligation, and I will be part of layoff, at best could be only a temp solution through cobra period. Since our plan is great, I’d take Cobra, but this only kicks the can down the road another 18 months.
maybe you can get them to stretch it to 36 months?
https://www.dfs.ny.gov/consumers/health ... _36_Months
ny state cobra continuation coverage?
may not apply in your situation as you said...
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Kenkat
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Re: Health insurance (ACA) for adult child 26+

Post by Kenkat »

SSDI is based on work credits; even if he worked a part time job, he could qualify. You get 1 credit for every $1400 or so earned up to 4 per year. At age 26, you would need 10-12 credits to qualify. There are no asset limits on SSDI.

SSI is needs based; a big disqualifier is total assets. You can’t have more than $2000 typically and have to manage this very closely or you lose benefits. There are also rules around support to navigate.

I have an adult son currently on SSDI; we have not pursued SSI as there are too many limitations with it for the small additional benefit over SSDI in his situation.
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Re: Health insurance (ACA) for adult child 26+

Post by terran »

beyou wrote: Sun Jun 14, 2020 10:18 am So SSI seems not likely, given lack of work history on SS.
Social Security Disability Income (SSDI) requires a work history, but Supplemental Security Income (SSI) does not. I would suggest speaking with a disability attorney to find out what your options are. It can be difficult to get on, but probably worthwhile. It should be a little under $800/month, but you'd need to be careful with what expenses you pay for as that can reduce the benefit.
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Re: Health insurance (ACA) for adult child 26+

Post by KlangFool »

OP,

1) What state are you in?

2) Are you sure that your adult kid does not qualify for MEDICAID?

I would start with (1) and (2) first before you go into ACA.

Are you from New York?

https://www1.nyc.gov/assets/ochia/downl ... dicaid.pdf

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beyou
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Re: Health insurance (ACA) for adult child 26+

Post by beyou »

terran wrote: Sun Jun 14, 2020 1:57 pm
beyou wrote: Sun Jun 14, 2020 10:18 am So SSI seems not likely, given lack of work history on SS.
Social Security Disability Income (SSDI) requires a work history, but Supplemental Security Income (SSI) does not. I would suggest speaking with a disability attorney to find out what your options are. It can be difficult to get on, but probably worthwhile. It should be a little under $800/month, but you'd need to be careful with what expenses you pay for as that can reduce the benefit.
Thanks, took a look at the SS site and yes I would say from their description he may well qualify.

What I wonder, is if I keep my son on my employer health plan, will that be deemed financial support that would somehow impact his eligibility
for SSI ? We have much better coverage under my employer plan than any public plans, but then again, that may be an option for only another couple of years (expected layoff due to company relocation and retirement plans). Obviously one would support an ill child, giving him a roof over his head, food and healthcare, just wondering if any of that disqualifies for assistance like SSI.
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Re: Health insurance (ACA) for adult child 26+

Post by terran »

Providing food or housing will reduce any SSI by 1/3rd. Since it sounds like he's under 26 you could look in to whether he qualifies for an ABLE account as that can pay for housing without reducing SSI (still need to pay for food from his own income), so you could contribute to that and then pay yourself for fair market rent. Of course, the rental "income" this would generate and the hassle factor might not be worth it for the extra 1/3rd. Again, I would suggest you get help from a disability lawyer to help get him on SSI and to help understand the rules.
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Re: Health insurance (ACA) for adult child 26+

Post by beyou »

terran wrote: Sun Jun 14, 2020 9:54 pm Providing food or housing will reduce any SSI by 1/3rd. Since it sounds like he's under 26 you could look in to whether he qualifies for an ABLE account as that can pay for housing without reducing SSI (still need to pay for food from his own income), so you could contribute to that and then pay yourself for fair market rent. Of course, the rental "income" this would generate and the hassle factor might not be worth it for the extra 1/3rd. Again, I would suggest you get help from a disability lawyer to help get him on SSI and to help understand the rules.
Thank you, that is very helpful.
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New York expanded Medicaid vs ACA

Post by beyou »

[Thread merged into here, see below. --admin LadyGeek]

Have adult son who on his own could quality for expanded Medicaid at very low cost, but I am concerned about doctors actually seeing Medicaid patients. He is not in a position to bump up income now so the only way I think he could consider ACA plan would be to take advantage of a rule in NY that up to age 29 you can stay on a parent's plan. We could get ACA for 3 of us at some point. Biggest problem there is that I don't want to use ACA any sooner than I need to. I am on employer plan but facing layoff. I would prefer COBRA to ACA, and will keep adult son with me on COBRA until age 26, maybe first few months under COBRA. But then he needs his own plan. I think if I keep him as a dependent he would use my income to qualify for ACA instead of Medicaid even if we stay on COBRA, but not get any subsidy.

So the question is, worth paying full price for ACA in NY vs free Medicaid ? Does it really make that much of a difference in seeing in-network docs ? They have managed Medicaid in NY with lots of "in-network" docs on the list, but does that matter ? I have seen threads about docs refusing new patients in other states, even if in-network. What about in NY ?

Worth mentioning my adult son is not healthy, which is both why he needs access to good doctors and why he has low income.
He is unable to work at this point and seeing excellent docs on my employer plan (though little progress solving his main health problem impacting employment).
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Re: New York expanded Medicaid vs ACA

Post by terran »

Have you spoken with his current doctors to find out if they'd be able to work with medicaid if he goes that route?
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Re: New York expanded Medicaid vs ACA

Post by BarbBrooklyn »

I think the first thing to do is find out if these excellent doctors would continue to see him if he was on Medicaid, or if they could recommend of of their colleagues who does accept it.

I'm in NYC, and one of my kids (and her family, including my grandchild) are on a Medicaid-expansion managed care plan.

They have no issues getting good healthcare and see the same internist and dentist that we do.
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Re: New York expanded Medicaid vs ACA

Post by Rex66 »

Be sure they take the Obama care plans as well.

I find fewer colleagues are willing to take Obama care than Medicaid although both can be a struggle.
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Re: New York expanded Medicaid vs ACA

Post by JackoC »

Rex66 wrote: Sat Sep 26, 2020 2:17 pm Be sure they take the Obama care plans as well.

I find fewer colleagues are willing to take Obama care than Medicaid although both can be a struggle.
That may depend on state. In NJ there's really no such thing as 'Obamacare plans'. If you buy individual insurance from Horizon Blue Cross Blue Shield your insurance is just HBCBS, biggest insurer in the state, accepted pretty much universally. And if you buy it from them directly or on ACA exchange it's the same line up of plans at same prices (so the ACA exchange is only necessarily if you quality for a premium subsidy from the government). There is a difference in acceptance rate of *companies* offering individual health insurance in NJ. This year we got Amerihealth because the cost difference was big enough to justify the fact that fewer providers accept that company than accept Horizon.

Broadly speaking though I agree you have to look at who is going to take insurance that you buy, whether it has anything directly to do with the ACA or not.
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Re: New York expanded Medicaid vs ACA

Post by beyou »

Thanks for the responses. Yes I realize this is a localized issue, hence the New York in the title of the thread.
We are lucky in NY to have expanded Medicaid for those who need it, assuming it actually works.

Since I am going to keep my son on our employer/COBRA until he ages out, I will be sure to ask our doctors over the next few months as we have visits. A great deal may change over the next year anyway, given the state of ACA, and also given the budget crisis facing NY.

I was even concerned about ACA suitability as the plans we have do not allow for out of network, and some plans have documented very limited coverage. What the threads I see on Medicaid made me realize that even for plans that have ample in-network listings, that does not guarantee you can see any particular providers on the list.

I only changed insurance once in the last decade, and the idea that your doctors will try to continue caring for you does not seem to be the case.
Our dermatologist was on our old United Healthcare plan but not on our newer Aetna plan. He made it clear, he will not take Aetna and you will pay full price, not negotiated prices if you come back again. We didn't return and found many other choices that take Aetna.
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Re: New York expanded Medicaid vs ACA

Post by Rex66 »

It is state dependent.

In my state a provider who takes bcbs does not necessarily take all bcbs plans

Obama care plans typically pay Medicaid type rates.

I’ve also had patients who “could” qualify for Obama care plans have to decide to work less to qualify for Medicaid and continue to see providers they needed. I should add I believe the problem has been reduced where those who took Medicaid now also take these plans.
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Re: New York expanded Medicaid vs ACA

Post by beyou »

In NY it is definitely the case that providers do not take all insurance contracts from same insurance firm.
My wife has ongoing care from a major NY cancer center, and right on their website they list many insurance companies they take,
but go out of their way to make it clear they won't take ACA plans from these same insurance companies.
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Re: New York expanded Medicaid vs ACA

Post by Rex66 »

Yep that’s what I’m talking about
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Health insurance for unemployed 26 year old

Post by beyou »

[Thread merged into here, see below. --admin LadyGeek]

One of my kids is struggling medically and career wise, and currently unable to work. We are still on my family medical insurance but he will turn 26 in a year or so. I have been lucky to have really good employer insurance so I kept my kids on this plan all through college and after, but all good things come to an end.

In this case, I also am facing a layoff (company relo).
So I will likely go on Cobra next year, and have to plan for one of my kids who ages out at 26.

As he is not working and struggling with medical problems, it is important he get insurance covering pre-existing conditions. Options :

1) Cobra allows a 26 year old 3 years of coverage with their own policy at seperate cost from my plan. Expensive I assume but top quality coverage.

2) Medicaid. Our state has expanded Medicaid, so he may qualify for free health insurance. There seem to be managed medicaid plans with good in network lists including key current docs.

3) Our state extends 26 to 29 and we could possibly get high cost employer plan through DW small bus employer. No idea what it would cost but if a good plan, could be family coverage to cover kids.

Medicaid certainly seems most economical option but I understand many docs wont take it, but for meds and hospitals would definitely work. Existing docs “in net” I assume would continue seeing him. Still it has to be a reduction in options for care.

Also wondering about logistics if anyone did this.

1) Should adult child file a tax return showing minimal income even though not required by IRS, just to document need for Medicaid ?

2) Birthday is Jan, so he could get one more month coverage, but given deductibles, it’s like no coverage in Jan. So I assume it best to switch (during Cobra) from family to couple coverage, dropping children, during my employer annual election before his Jan birthday. Unemployed child can immediately get in medicaid for Jan 1 ? Other child can enroll in employer plan during their annual eelction.

Any suggestions as to what insurance to get and how/when to get it are appreciated.
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arcticpineapplecorp.
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Re: Health insurance for unemployed 26 year old

Post by arcticpineapplecorp. »

i don't think you'd need to file a tax return for medicaid but you would need to provide a statement of support explaining why he hasn't had income if he hasn't within the past few months, i.e., how he's been supporting himself with no income. If he had employment in the past few months he might be required to document when it was terminated and his final pay. Is he getting unemployment compensation? If so that would need to be reported and the medicaid office likely would be able to confirm that income.
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Re: Health insurance for unemployed 26 year old

Post by JBTX »

I'm not a Medicaid expert (yet) but I have heard examples in the behavior health realm where Medicaid has significantly better coverage. A private insurer may pay for 6 weeks in a mental hospital where Medicaid pays 6 months. Or in some cases you can actually have both, but that may be expensive for the incremental additional coverage.
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beyou
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Re: Health insurance for unemployed 26 year old

Post by beyou »

arcticpineapplecorp. wrote: Thu Nov 19, 2020 8:31 am i don't think you'd need to file a tax return for medicaid but you would need to provide a statement of support explaining why he hasn't had income if he hasn't within the past few months, i.e., how he's been supporting himself with no income. If he had employment in the past few months he might be required to document when it was terminated and his final pay. Is he getting unemployment compensation? If so that would need to be reported and the medicaid office likely would be able to confirm that income.
Yes statement would help,but I figured tax return showing little income might be more concrete. I am definitely leaning towards getting him to apply for medicaid when he ages out of my plan. I could have forced the move sooner and reduced my own policy cost for couple only, but had it in my head that my policy is better , and it’s subsidized now, so not terribly costly while employed. But when I retire the COBRA costs will rise and dropping the kids would be great as long as I know they can get coverage.
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Re: Health insurance for unemployed 26 year old

Post by Kagord »

Check your ACA marketplace, I've seen on FIRE boards, very well off "pre-medicare" people with sizable portfolios, getting practically free health insurance with some creative income planning. I'm assuming if someone is actually in poverty, these programs may be available to them as well.
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Kenkat
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Re: Health insurance for unemployed 26 year old

Post by Kenkat »

Hi -

I know we have chatted before and I have a son who is in similar circumstances.

If your child worked for a period of time but now cannot work, Social Security Disability is an option to look into if you haven’t yet. Your child would qualify for Medicare after two years under that program.

In addition to that, I would probably pursue Medicaid. I don’t think it is necessary to file a tax return as you will be required to provide a statement of income when you file regardless. They may also qualify for other assistance such as SSI although the asset limits are very strict there while Medicaid expansion eliminated most of those considerations.

My son is on SSDI, recently became eligible for Medicare and was approved for Medicaid as well. Social security forwarded his information to our local job and family service office. There is some lead time involved - the Medicaid app was dated 5/1 but not approved until November. I do think benefits are retroactive to some degree. The Medicaid supplements the Medicare deductibles and co-pays as well as pays the Part B premium.

In my case, my son was on my employer HDHP. We were going to have to deal with the age 26 issue in 2022, but I went ahead and dropped him from the employer plan for next year since the Medicare/Medicaid will cover most of his medical and the extra coverage just complicates things without paying anything out until the high deductible would be hit.

This can all be pretty complicated and I am learning as I go. PM me if I can help in any way.
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Re: Health insurance for unemployed 26 year old

Post by snowman »

Kagord wrote: Fri Nov 20, 2020 5:57 am Check your ACA marketplace, I've seen on FIRE boards, very well off "pre-medicare" people with sizable portfolios, getting practically free health insurance with some creative income planning. I'm assuming if someone is actually in poverty, these programs may be available to them as well.
That's not how ACA works, and I am pretty sure OP already knows it's not an option for his son. You need to have certain minimum level of income to qualify for ACA coverage. OP's unemployed son does not meet that requirement.
stats99
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Re: Health insurance for unemployed 26 year old

Post by stats99 »

Check when your employer plan will end coverage. My son turned 26 in February of this year but the plan provides coverage through the end of the calendar year. That was a nice surprise!
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Re: Health insurance for unemployed 26 year old

Post by Watty »

beyou wrote: Thu Nov 19, 2020 12:35 am 2) Birthday is Jan.....
If it is January 1st then be sure to read the details of eligibility carefully. Sometimes when a birthday is on the 1st of the month it will be treated as if it was in the prior month or in this case year.
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beyou
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Re: Health insurance for unemployed 26 year old

Post by beyou »

Watty wrote: Fri Nov 20, 2020 10:51 am
beyou wrote: Thu Nov 19, 2020 12:35 am 2) Birthday is Jan.....
If it is January 1st then be sure to read the details of eligibility carefully. Sometimes when a birthday is on the 1st of the month it will be treated as if it was in the prior month or in this case year.
Thanks but he is not a New Years baby !

Note I am planning way ahead here, he turns 26 Jan 2022. I am trying to decide what I need to do in 2021 to prepare for this.
I hope things improve in the next year but his illness is causing him to not even look for work at the moment. He had dropped out of grad
school with an illness, tried on and off to look for work but at the moment not even trying. Very upsetting situation. Have another younger child who could get on employer insurance now, but since his older brother has none, I am paying for family insurance. Once the older child ages out in a year, the younger one should be able to just do annual enrollment if I drop them in my annual enrollment next year. That said, I am wondering if for any reason I would be better off enrolling as a family, knowing my eldest would age out at end of Jan 2022 ? Not sure if my employer (or Cobra if "retired" by then) would let me change midstream to a lower cost choice for this "life event" (birth of new child yes but not sure in this case). Seems to me as it's just one month before age 26, might as well plan for it a month early and start the application process for Medicaid for him, tell my other child to enroll in his employer plan. My main concern is if I drop family coverage and there are complications with Medicaid application.... Hence my trying to determine what should we do in 2021 to prepare for Jan 1 2022 expanded Medicaid coverage.
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beyou
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Re: Health insurance for unemployed 26 year old

Post by beyou »

stats99 wrote: Fri Nov 20, 2020 10:28 am Check when your employer plan will end coverage. My son turned 26 in February of this year but the plan provides coverage through the end of the calendar year. That was a nice surprise!
End of the month of the birthday at my employer. We have good coverage but the only option they offer is you can BUY coverage for your child a little longer past 26 (separate policy, separate premium, separate deductible). Assuming we still have expanded Medicaid that has to be the lowest cost option and if eligible, you can join anytime during the year (no annual "enrollment" period for medicaid).

One complication I have is my employer is relocating where I don't want to move, I will be laid off at some point.
Any option to buy insurance for the 26 year old is tied to my still being employed OR COBRA rules (which allow my son to get his own policy
for 3 years from my employer starting from date of my termination). So many variables, so complicated to plan. So I am trying to plan for Medicaid and if any better options are accessible I will explore them as we get closer to the date. I do plan to keep myself on Cobra before looking at ACA or my wife's small business plan (which I assume would be just as expensive as our Cobra since not subsidized for her, and also coverage through 26). COBRA may give my son another expensive alternative to Medicaid, but you take it or leave it, can't change your mind later with COBRA, AFAIK.
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Re: Health insurance for unemployed 26 year old

Post by Da5id »

snowman wrote: Fri Nov 20, 2020 10:04 am
Kagord wrote: Fri Nov 20, 2020 5:57 am Check your ACA marketplace, I've seen on FIRE boards, very well off "pre-medicare" people with sizable portfolios, getting practically free health insurance with some creative income planning. I'm assuming if someone is actually in poverty, these programs may be available to them as well.
That's not how ACA works, and I am pretty sure OP already knows it's not an option for his son. You need to have certain minimum level of income to qualify for ACA coverage. OP's unemployed son does not meet that requirement.
Yep. It apparently differs by states, in particular whether they expanded Medicaid. 12 states have elected not to do so as of now. But it seems like MAGI below somewhere in the neighborhood of 138% FPL (133%, but 5% is discounted?) will put you into Medicaid in most states, including OPs per his post. see e.g. https://www.macpac.gov/subtopic/medicaid-expansion/

I gather Medicaid has network issues and so forth. Always worth checking if key providers take it.
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Re: Health insurance for unemployed 26 year old

Post by beyou »

Da5id wrote: Fri Nov 20, 2020 11:18 am
snowman wrote: Fri Nov 20, 2020 10:04 am
Kagord wrote: Fri Nov 20, 2020 5:57 am Check your ACA marketplace, I've seen on FIRE boards, very well off "pre-medicare" people with sizable portfolios, getting practically free health insurance with some creative income planning. I'm assuming if someone is actually in poverty, these programs may be available to them as well.
That's not how ACA works, and I am pretty sure OP already knows it's not an option for his son. You need to have certain minimum level of income to qualify for ACA coverage. OP's unemployed son does not meet that requirement.
Yep. It apparently differs by states, in particular whether they expanded Medicaid. 12 states have elected not to do so as of now. But it seems like MAGI below somewhere in the neighborhood of 138% FPL (133%, but 5% is discounted?) will put you into Medicaid in most states, including OPs per his post. see e.g. https://www.macpac.gov/subtopic/medicaid-expansion/

I gather Medicaid has network issues and so forth. Always worth checking if key providers take it.
Regarding income and expanded Medicaid, yes we live in one of those states. If you go on the exchange website and input income it says "call us as you may qualify for Medicaid" and they clearly will not quote an ACA policy if you put in a very low income.

Regarding the "network" yes I am concerned and will speak to existing provider offices next year before we decide what to do.
I did check online in that there is one firm that sells Managed Medicaid in our state, which seems similar to Medicare Advantage plans.
They did have a network that included a couple of important existing doctors, and even had Vision and Dental (limited network for these).
I even checked the formulary and they cover existing medication though he has had many different medications for varying medical problems so it's going to be hard to find any plan that may cover all past and future meds. But the managed care option advertised NOW seems pretty good. My only concern is there are doctors who say they take Medicaid but then reject new patients. I wonder if the managed care changes this issue for the better (not directly dealing with Medicaid from docs POV). Given these plans change regularly like Medicare plans, will have to see what is available as he nears his birthday, but the option I found sounds good on paper. I do know others who went on Medicaid in our state recently and did say for some types of specialist where they had no existing doctor, finding a new one was very difficult. All that said, even my expensive employer plan has gaps where we can't find good options for certain types of important specialists. Also note one of the major expensive treatments my wife had was covered by employer plan and Medicaid but NOT by ACA plans, at least not at the location she had treatment (a top speciality hospital). So in some ways the Medicaid Managed care may be better than ACA in our area. Almost incentive to not work (not that I would advise my son to not work).
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Re: Health insurance for unemployed 26 year old

Post by snowman »

We have friends that are dealing with somewhat similar situation, it's tough. OP has my sympathy, and good on him for planning ahead.

Our friends are retired, husband on Medicare already, wife on ACA but transitioning to Medicare next year. All good so far. However, their youngest son in his mid-30s has bounced around for a while - mostly drug issues, then divorce, followed by lack of employment, resulting in more drugs... They finally took him back in this year. Medicaid was the only option for health insurance, so that's where he ended up.

Problem is the network and services covered. I don't know exact details (it's painful for them to talk about it), but they shared that it costs them over $100 every week for counseling service. They are paying out of pocket and it's a significant expense item for them. They are hoping treatment will be successful and he can find employment with health insurance in the near future. But there are no guarantees of course.
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Re: Health insurance for unemployed 26 year old

Post by MildlyEccentric »

If you want to try the Medicaid route, you might have to answer the question of whether your son is an adult dependent (i.e., his income is under $4,300 and you arrange for more than half of his support.) If so, you may have to consider your total household income when determining Medicaid eligibility. Even worse, the tax advantage for claiming him as a dependent has been greatly reduced as part of the Tax Cuts and Jobs Act (TCJA) because you no longer get a dependent deduction on your Federal taxes. Just another thing to worry about (as if you didn't have enough already.)
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Re: Health insurance for unemployed 26 year old

Post by snowman »

MildlyEccentric wrote: Fri Nov 20, 2020 12:08 pm Even worse, the tax advantage for claiming him as a dependent has been greatly reduced as part of the Tax Cuts and Jobs Act (TCJA) because you no longer get a dependent deduction on your Federal taxes.
That's not entirely correct. While the TCJA eliminated deduction, it added $500 tax credit for qualifying adult dependents. If OP's son meets income and support IRS requirements, OP can claim him (and probably did) to receive $500 tax credit.
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Re: Health insurance for unemployed 26 year old

Post by beyou »

snowman wrote: Fri Nov 20, 2020 1:02 pm
MildlyEccentric wrote: Fri Nov 20, 2020 12:08 pm Even worse, the tax advantage for claiming him as a dependent has been greatly reduced as part of the Tax Cuts and Jobs Act (TCJA) because you no longer get a dependent deduction on your Federal taxes.
That's not entirely correct. While the TCJA eliminated deduction, it added $500 tax credit for qualifying adult dependents. If OP's son meets income and support IRS requirements, OP can claim him (and probably did) to receive $500 tax credit.
Well in reality he is depending on me, in that he moved back and and I pay for this food. He is not working.
That said because of my own income, I did not get the credit for 2019 when he first moved home. My income will decline when I am forced to retire and maybe I'll be able to get the $500 credit, but that's nothing compared to the cost of med insurance. I would gladly not declare him a dependent give up the $500 if he can get Medicaid. So the question is if I simply drop him as a dependent on my 1040, that is not enough for Medicaid to consider him independent ? If he was declared a dependent, then we could apply for ACA but 1) I want to go with Cobra for me and 2) my income even in retirement may be over the cliff since my wife still works (with a highly variable unpredictable income that will like put us over). So if he is my dependent and I am forced to declare him as so, he can apply for ACA himself, I will have to pay the full cost for his single policy instead of what would be a better quality Managed Medicaid plan. I need to research the dependent declaration issue further.
Last edited by beyou on Fri Nov 20, 2020 1:11 pm, edited 1 time in total.
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Re: Health insurance for unemployed 26 year old

Post by beyou »

MildlyEccentric wrote: Fri Nov 20, 2020 12:08 pm If you want to try the Medicaid route, you might have to answer the question of whether your son is an adult dependent (i.e., his income is under $4,300 and you arrange for more than half of his support.) If so, you may have to consider your total household income when determining Medicaid eligibility. Even worse, the tax advantage for claiming him as a dependent has been greatly reduced as part of the Tax Cuts and Jobs Act (TCJA) because you no longer get a dependent deduction on your Federal taxes. Just another thing to worry about (as if you didn't have enough already.)
Thanks for your response (my comments above).
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Re: Health insurance for unemployed 26 year old

Post by fortunefavored »

Not a dependent, but similar family situations in the past.. I would strongly recommend trying the disability path. Once on disability, everything is a lot easier. As you can see from this thread, there are endless gotchas. You will likely need a lawyer to help with this and it may take up to 2+ years and multiple appeals. Do not try to go this alone as it is also pitfall laden.

I'd probably just pay full freight for an outside marketplace plan (they are typically the same, just offered directly) OR do the COBRA thing if you think it is more temporary.. but at 26 and no path forward.. disability will give the most options.
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Re: Health insurance for unemployed 26 year old

Post by tashnewbie »

You and your son have my sympathies.

I think it might be helpful to consult a Social Security Income/Disability specialist. This stuff can get complicated really quickly. For example, see the following link regarding credits needed for disability (SSDI) benefits: https://www.ssa.gov/benefits/retirement ... edits.html.

I think your son should definitely look into SSI & Medicaid and SSDI & Medicare. A specialist should be able to help you all navigate these processes.
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Re: Health insurance for unemployed 26 year old

Post by snowman »

beyou wrote: Fri Nov 20, 2020 1:10 pm
snowman wrote: Fri Nov 20, 2020 1:02 pm
MildlyEccentric wrote: Fri Nov 20, 2020 12:08 pm Even worse, the tax advantage for claiming him as a dependent has been greatly reduced as part of the Tax Cuts and Jobs Act (TCJA) because you no longer get a dependent deduction on your Federal taxes.
That's not entirely correct. While the TCJA eliminated deduction, it added $500 tax credit for qualifying adult dependents. If OP's son meets income and support IRS requirements, OP can claim him (and probably did) to receive $500 tax credit.
Well in reality he is depending on me, in that he moved back and and I pay for this food. He is not working.
That said because of my own income, I did not get the credit for 2019 when he first moved home. My income will decline when I am forced to retire and maybe I'll be able to get the $500 credit, but that's nothing compared to the cost of med insurance. I would gladly not declare him a dependent give up the $500 if he can get Medicaid. So the question is if I simply drop him as a dependent on my 1040, that is not enough for Medicaid to consider him independent ? If he was declared a dependent, then we could apply for ACA but 1) I want to go with Cobra for me and 2) my income even in retirement may be over the cliff since my wife still works (with a highly variable unpredictable income that will like put us over). So if he is my dependent and I am forced to declare him as so, he can apply for ACA himself, I will have to pay the full cost for his single policy instead of what would be a better quality Managed Medicaid plan. I need to research the dependent declaration issue further.
ACA is not an option for him even if he is your dependent, because it has the same age (26) limitation as your employer-sponsored plan. In theory, you could all go on ACA in 2021, but it looks like you got 2021 covered through your employer already. Come January 2022, he is losing dependent coverage - COBRA or ACA. Not sure what to tell you, as I am not familiar with Medicaid. Good news is you started your research early, and have one year to figure it out.
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Re: Health insurance for unemployed 26 year old

Post by beyou »

Well they have to offer him aca or medicaid, can’t be locked out of both (in my expanded Medicaid state).
I will call the exchange helpline at some points.

I did look a bit into SS disability, that route would be difficult in his current condition.
It's one of these things where you have to go downhill to get help and we're trying to do all we can to get him uphill.
I considered consulting with an attorney but all I read it sounds unlikely unless things get worse (as if they aren't already bad).

Also in my state if you have true insurance (as opposed to large employers who are self-insured) you can get an exception to the age 26 rule
extended to age 29 as a dependent on your parent's policy, which should apply to ACA or employer policies (as long as not self-insured employer). The gotcha there is my employer is self-insured and I want to stay on their plan as long as I can, until forced retirement and then COBRA for 18 months. During that time my son will hit 26 and I think all I can do is get him his own policy through my employer (their way of half complying with the rule without having to subsidize it). Any money I save by switching from family to couple on my own policy will be spent buying him a separate policy with another deductible. If I am employed not so terrible since my policy would be subsidized, just not my son. But once on COBRA neither is subsidized, AND even worse, my firm will only offer the 26-29 coverage while I am employed, after that my son can get COBRA for 3 years from day of my termination. So I am considering just pay up to keep he and us on COBRA when the time comes until COBRA ends. Hopefully by then he'll either improve and be able to work but if he declines in health maybe he can go the disability route and get on Medicaid in any state. I just want to see if he can go on it sooner, since we have expanded Medicaid in my state. He is unemployed and expanded medicaid is supposed to only be based on need, so it only hinges on whether he is my dependent or not. If he is not then he should quality for Medicaid, if he is my dependent and they count my income, even retirement income, he would not qualify for Medicaid. By then maybe I'll get a group policy from ACA and include him...until his 30th birthday. At which point back to the same problem. So as said above, this is a series of gotchas.
Last edited by beyou on Fri Nov 20, 2020 2:32 pm, edited 5 times in total.
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Re: Health insurance for unemployed 26 year old

Post by galawdawg »

If your son's medical issues are so severe he is incapable of working and effective treatment still will not result in his being capable of working in January 2022, then looking into disability would be a good first step. As far as medical coverage, unless you are willing to foot the bill for private coverage, he will likely need to apply for medicaid if he has no income and no ability to earn an income.
'
If he has not already done so, he may wish to broaden his consideration of employment possibilities. While I don't know any details about his situation, even those with serious medical situations and profound disabilities are often capable of being employable. A local government service provider may be able to help him find job opportunities that are compatible with his medical condition(s).

In some states, a person may not qualify for either medicaid or ACA coverage, depending on the medicaid eligibility requirements of that particular state. A family member recently experienced this when unemployed...they didn't qualify for medicaid under the state eligibility rules and didn't qualify for ACA as they had no income. Thankfully, they were able to find employment within a few months and now have employer-provided health coverage. The guidelines of your son's state will govern what public coverage he may qualify for, if any.

Good luck!
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Re: Health insurance for unemployed 26 year old

Post by beyou »

Does anyone differ in their interpretation of this :

https://www.health.ny.gov/health_care/medicaid/

"The Marketplace, (NY State of Health) determines eligibility using Modified Adjusted Gross Income (MAGI) Rules.
In general, income is counted with the same rules as the Internal Revenue Service (IRS) with minor variations."
https://info.nystateofhealth.ny.gov/sit ... -12-15.pdf

"If a non-tax filer applies, but is expected to be claimed as a tax dependent by someone else, they need to apply within that taxpayer’s household, if living together."

"Non-tax filers follow different household composition rules than tax filers.
Adults: The household size is the individual and, if living together, spouse and children who
are under 19..... Consumers who do not file taxes should let the Marketplace know the names of the
parents, step-parents, spouse, children and siblings of the person who wants health
insurance (if living together), even if those individuals are not applying."

My son does indeed live with me but if I do not declare him as a dependent and give up the tax credit, then this would seem to indicate he can
be treated as his own single person for ACA/Medicaid application. If I file my own tax return and do NOT declare my son as a dependent and separately he files a return showing his tiny interest income and no employment income, wouldn't this satisfy this criterial (which I think only applies in expanded Medicaid states) ? He has almost zero income though, any reason he CAN'T file a tax return ?

The question is if they will try to determine he SHOULD be my dependent given his living situation even if I don't declare him as such.
If that is going to be a problem then I'll kick the can down the road and get him COBRA 3 year coverage when I am terminated and he turns 26, which ever comes second. In addition to speaking to NYS Exchange, I need to talk to my employer. I think if I drop my family coverage my son would lose ability to get on the 3 year 26+ Cobra. But if I keep it then I will have to pay for family coverage for a full year after getting only 1 month of coverage out of it. This health care insurance is a real maze.
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