medicaid as early retirement medical insurance (or maybe Obamacare)

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datamonkee
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medicaid as early retirement medical insurance (or maybe Obamacare)

Post by datamonkee » Thu May 24, 2018 8:17 pm

Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?

delamer
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by delamer » Thu May 24, 2018 8:58 pm

I found this as the second result searching with “medicaid income texas.”



https://www.benefits.gov/benefits/benefit-details/1640

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Pajamas
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by Pajamas » Thu May 24, 2018 9:12 pm

datamonkee wrote:
Thu May 24, 2018 8:17 pm
Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?
It varies by state and plan but my ACA coverage is basically Medicaid coverage with additional costs such as premiums, copays, and deductibles. Can't imagine that ACA coverage would be less expensive but it might have more choice in providers.

In my state, you don't really get a choice between the two. If you qualified for Medicaid you would have to take it instead of the ACA coverage or take neither.

The key thing to keep in mind is that this type of coverage can change. For instance, Texas might implement Medicaid work requirements or ACA coverage cost could increase significantly, etc.

donall
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by donall » Thu May 24, 2018 9:26 pm

I thought Texas did not expand Medicaid.

datamonkee
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by datamonkee » Thu May 24, 2018 9:31 pm

delamar, thanks for the link. i saw that but was skeptical. the income limit seems high to me. also, i did not see anything about assets limits.

donall, texas did not expand medicaid.

pajamas, if i wanted to be eligible for obamacare, i figured i could set my net income by converting some traditional IRA money to roth IRA.

randomguy
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by randomguy » Thu May 24, 2018 9:33 pm

Pajamas wrote:
Thu May 24, 2018 9:12 pm
datamonkee wrote:
Thu May 24, 2018 8:17 pm
Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?
It varies by state and plan but my ACA coverage is basically Medicaid coverage with additional costs such as premiums, copays, and deductibles. Can't imagine that ACA coverage would be less expensive but it might have more choice in providers.

In my state, you don't really get a choice between the two. If you qualified for Medicaid you would have to take it instead of the ACA coverage or take neither.

The key thing to keep in mind is that this type of coverage can change. For instance, Texas might implement Medicaid work requirements or ACA coverage cost could increase significantly, etc.
What state is this? In my state I get the same BCBS network that you get from private insurance companies either on the individual market or from group insurance. That isn't close to Medicaid level care. I am not as familiar with the 3 other networks being offered but I am guessing Kaiser on ACA is would be the same as Kaiser you get elsewhere.

In general you can't say anything in general about ACA health care plans. They vary from state to state (actually zip code to zip code) and from plan to plan inside that region. You should to to healthcare.gov and see what is available in the region you want to live. And yeah the big risk with any of these type of things is the political risk of dramatic changes.

randomguy
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by randomguy » Thu May 24, 2018 9:37 pm

datamonkee wrote:
Thu May 24, 2018 9:31 pm
delamar, thanks for the link. i saw that but was skeptical. the income limit seems high to me. also, i did not see anything about assets limits.

Read the next line
" You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older."

I am guessing that eliminates most early retirees. Not many 60+ year olds with kids under 19 or pregnant. That leaves getting qualified as disabled....

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Pajamas
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by Pajamas » Thu May 24, 2018 9:38 pm

donall wrote:
Thu May 24, 2018 9:26 pm
I thought Texas did not expand Medicaid.
Texas could still impose work requirements on people who qualify because they are the parent or caretaker of a child. Several states that did not expand Medicaid have already asked permission to do so.
datamonkee wrote:
Thu May 24, 2018 9:31 pm
pajamas, if i wanted to be eligible for obamacare, i figured i could set my net income by converting some traditional IRA money to roth IRA.
Yes, you could do that. Here's some other information that might help planning around in regards to income:

https://www.google.com/search?q=aca+mag ... eheads.org

It is Modified Adjusted Gross Income or MAGI that is the measure, so it's important to understand how that is figured.

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MP123
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by MP123 » Thu May 24, 2018 10:03 pm

randomguy wrote:
Thu May 24, 2018 9:37 pm
datamonkee wrote:
Thu May 24, 2018 9:31 pm
delamar, thanks for the link. i saw that but was skeptical. the income limit seems high to me. also, i did not see anything about assets limits.

Read the next line
" You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older."

I am guessing that eliminates most early retirees. Not many 60+ year olds with kids under 19 or pregnant. That leaves getting qualified as disabled....
This. Funny how they buried the truth.

TX didn't expand medicaid when ACA started. In most if not all non-expansion states medicaid is severely restricted.

As mentioned above Roth conversions to boost income over the lower "ACA cliff" would be a good idea. Likely you could get ACA coverage for almost free. For now at least...

delamer
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by delamer » Thu May 24, 2018 10:46 pm

randomguy wrote:
Thu May 24, 2018 9:37 pm
datamonkee wrote:
Thu May 24, 2018 9:31 pm
delamar, thanks for the link. i saw that but was skeptical. the income limit seems high to me. also, i did not see anything about assets limits.

Read the next line
" You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older."

I am guessing that eliminates most early retirees. Not many 60+ year olds with kids under 19 or pregnant. That leaves getting qualified as disabled....

Exactly — if you don’t meet the above qualifications, your income isn’t relevant.

Also, no one has to qualify for ObamaCare; anyone can enroll. What people have to qualify for is the premium subsidy.

lawman3966
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by lawman3966 » Thu May 24, 2018 11:06 pm

datamonkee wrote:
Thu May 24, 2018 9:31 pm
i did not see anything about assets limits.
The below link addresses the asset limits for Medicaid in Texas.
https://www.familyassets.com/nursing-ho ... caid/texas

You should actually be quite happy if your assets don't qualify you for Medicaid in Texas, as you might experience a grim retirement on a lump sum of $2,000 or less.

If you are inclined to move to Washington or other Medicaid-expansion state, you could fare much better. I am in Washington, and for a while in early 2017, I was on the local version of Medicaid, called Apple Health. Prior to that period, and afterwards, I was on, and am now on, ACA plans that cost me about $400 a month in premiums along with modest co-pays. While on Medicaid, I saw the same doctors, and used the same facilities (testing labs etc) that I saw/used while on the ACA. However, during my Medicaid period, all of the services were completely free.

I did some asking around to ensure that all the "parts" of the system hooked up properly, and in the end, it all worked. I had free health care for a few months. I had return to the ACA once a benefit came through that raised my MAGI above the threshold for Medicaid. As one above poster noted, if you qualify for Medicaid WA, you can't sign up for the ACA. Upon entering income numbers below the threshold for getting a subsidized ACA plan, the site will respond with a message to access the Apple Health site (Medicaid's name in WA). I note that, since WA is a Medicaid expansion state, eligibility for Medicaid and for ACA premiums depends only on income, and not on assets. If Warren Buffett had his assets solely in tax-free bonds and non-dividend paying stocks (like Berkshire), he could get on Medicaid on Washington state.

I used a provider network in WA that used to be called Group Health that was taken over by Kaiser on Jan. 1, 2017. Group Health wasn't merely a network, it actually had a set of buildings, doctors, and facilities. I mention this to emphasize that my care didn't change one bit upon switching from the ACA to Medicaid (and then back to the ACA again).

donall
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by donall » Fri May 25, 2018 7:56 pm

Lawman: pretty sure Warren Buffett would not be able to get a health insurance subsidy as income is determined by a modified MAGI that includes social security and tax-free bonds.

Though if someone only had Roth IRAs then there would be no income and theoretically one could be on Medicaid.

SimonJester
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by SimonJester » Fri May 25, 2018 11:24 pm

donall wrote:
Fri May 25, 2018 7:56 pm
Lawman: pretty sure Warren Buffett would not be able to get a health insurance subsidy as income is determined by a modified MAGI that includes social security and tax-free bonds.

Though if someone only had Roth IRAs then there would be no income and theoretically one could be on Medicaid.
Not sure about Texas but dont most states require you to list all bank accounts, brokerage accounts, assets, etc when applying?
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin

randomguy
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by randomguy » Fri May 25, 2018 11:36 pm

lawman3966 wrote:
Thu May 24, 2018 11:06 pm
datamonkee wrote:
Thu May 24, 2018 9:31 pm
i did not see anything about assets limits.
The below link addresses the asset limits for Medicaid in Texas.
https://www.familyassets.com/nursing-ho ... caid/texas

You should actually be quite happy if your assets don't qualify you for Medicaid in Texas, as you might experience a grim retirement on a lump sum of $2,000 or less.

Long term care is not really the medicaid we are talking about.It has a whole different set of rules

Since 2014
https://www.medicaid.gov/medicaid/eligibility/

The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.

I can never remember if this applies to all states or just those that expanded medicaid but in at least some states as long as you don't have income, you are fine. Of course if you have income, the cost difference between medicaid and ACA are pretty lower if you income is right at the eligibility line.

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munemaker
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by munemaker » Sat May 26, 2018 6:19 am

Pajamas wrote:
Thu May 24, 2018 9:12 pm
It varies by state and plan but my ACA coverage is basically Medicaid coverage with additional costs such as premiums, copays, and deductibles.
While we have never been on Medicaid, we are under the impression that many doctors will not accept Medicaid patients. From our experience, doctors do not shun ACA (aka ObamaCare) in the same way. There is a social stigma attached to using Medicaid, not with ObamaCare. We are on ObamaCare until we reach Medicare age. We could have adjusted our taxable income to qualify for Medicaid but did not because choice of care is very limited and due to the social stigma; people associate Medicaid with welfare, or being on the dole.

As I approach age 65, I have been looking into Medicare plans. ObamaCare seems to be more like a Medicare Advantage plan.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by Spirit Rider » Sat May 26, 2018 8:56 am

2018 ACA Federal Poverty Level: 1 person = $12,060, 2 persons = $16,240, etc... 1 Person FPL levels: 100% = $12,060, 138% = $16,643, 150% = $18,090

Some basic Medicaid/ACA rules:
  • Medicaid expansion state
    • No Medicaid asset tests
    • ACA eligibility 138% FPL
    • ACA maximum subsidy/cost sharing reduction (CSR)(94%) 138% - $150% FPL ($16,643 - $18,090)
  • Non-Medicaid expansion state
    • Medicaid asset tests
    • ACA eligibility 100% FPL
    • ACA maximum subsidy/CSR (94%) 100% - $150% FPL ($12,060 - $18,090)
For example, in Austin, TX 73301 and a single MAGI of $12,500. A male age 60 can get a 2018 Silver ACA CSR plan with a $100 deductible and $1,000 maximum Out-Of-Pocket (OOP) for $21.19/month.

Note: The 2019 ACA Federal Poverty Levels only go up to: 1 person = $12,140, 2 persons = $16,460, etc...

datamonkee
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by datamonkee » Sat May 26, 2018 9:13 am

Thanks, all, for your insights, especially for the links to the eligibility requirements.

one last question:
has anyone had personal experience with Texas medicaid plans? good/bad?

it sounds like ACA is probably the better option if one gets it subsidized by the US govt.

kd2008
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by kd2008 » Sat May 26, 2018 9:15 am

Spirit Rider wrote:
Sat May 26, 2018 8:56 am
2018 ACA Federal Poverty Level: 1 person = $12,060, 2 persons = $16,240, etc... 1 Person FPL levels: 100% = $12,060, 138% = $16,643, 150% = $18,090

Some basic Medicaid/ACA rules:
  • Medicaid expansion state
    • No Medicaid asset tests
    • ACA eligibility 138% FPL
    • ACA maximum subsidy/cost sharing reduction (CSR)(94%) 138% - $150% FPL ($16,643 - $18,090)
  • Non-Medicaid expansion state
    • Medicaid asset tests
    • ACA eligibility 100% FPL
    • ACA maximum subsidy/CSR (94%) 100% - $150% FPL ($12,060 - $18,090)
For example, in Austin, TX 73301 and a single MAGI of $12,500. A male age 60 can get a 2018 Silver ACA CSR plan with a $100 deductible and $1,000 maximum Out-Of-Pocket (OOP) for $21.19/month.

Note: The 2019 ACA Federal Poverty Levels only go up to: 1 person = $12,140, 2 persons = $16,460, etc...
Thank you! This summary is invaluable to me!

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Pajamas
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by Pajamas » Sat May 26, 2018 10:13 am

munemaker wrote:
Sat May 26, 2018 6:19 am
Pajamas wrote:
Thu May 24, 2018 9:12 pm
It varies by state and plan but my ACA coverage is basically Medicaid coverage with additional costs such as premiums, copays, and deductibles.
While we have never been on Medicaid, we are under the impression that many doctors will not accept Medicaid patients. From our experience, doctors do not shun ACA (aka ObamaCare) in the same way.
It does vary by location. One of my doctors who was always in my employer-provided plans doesn't take either Medicaid or ACA coverage. It just depends. They don't get paid very much from Medicaid.

[OT comments removed by admin LadyGeek]

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MP123
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by MP123 » Sat May 26, 2018 12:06 pm

Spirit Rider wrote:
Sat May 26, 2018 8:56 am
For example, in Austin, TX 73301 and a single MAGI of $12,500. A male age 60 can get a 2018 Silver ACA CSR plan with a $100 deductible and $1,000 maximum Out-Of-Pocket (OOP) for $21.19/month.

Note: The 2019 ACA Federal Poverty Levels only go up to: 1 person = $12,140, 2 persons = $16,460, etc...
And to expand on this example a bit the same person with a MAGI of $12,139 wouldn't be eligible for any healthcare insurance (ACA or Medicaid) in Texas unless they were disabled.

So being able to generate at least $1 in income via Roth conversion or otherwise would be very valuable to them.

furwut
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by furwut » Sat May 26, 2018 12:08 pm

Keep in mind, should you receive Medicaid benefits after age 55, that the state has the right to recover payments from your estate.

mrgeeze
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by mrgeeze » Sat May 26, 2018 12:23 pm

So far the ACA has been very good to me as an individual and very terrible to me as a taxpayer.

My wife and I are both 59.

In my state (NC) we manage our income (mostly investments) via tax harvesting to keep our MAGI under the ACA cliff.
We purchase the cheapest bronze plan (with HSA) and it we pay $0 as a monthly premium.
Aside from mandatory stuff required by law we pay for everything to a maximum of about $7000 per person.
It costs us out of pocket, we have no premium, and in the event of a castastrophe we have coverage.

Last year neither of us got sick and we probably saved $7500 or more by having the zero premiums.
Deductibles and drugs were a few grand out of pocket. Much less than the premiums for a decent plan.

That is good for me as a short run utility maximizing individual.

The bad is that this plan is valued at almost twice what a better plan by the same provider would cost if I i paid for it personally.
It makes no sense yet is absolutely true.
I ''m afraid this inflated value is what we the taxpayers reimburse the insurance company for my healthcare.

Go figure.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by LadyGeek » Sat May 26, 2018 12:24 pm

I removed an off-topic comment and reply related to the socio-economic status of those on Medicaid. The discussion was derailed.

Please stay on-topic.
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David Jay
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by David Jay » Sat May 26, 2018 12:41 pm

In Michigan, the income level for Medicare Medicaid [sorry, typo!] qualification is ~$22,000 a year for Married family of 2.

So if you can show an income under that level (say, by living out of Roth funds) then you qualify. Premium is something like $38 a month. Co-pays are minimal ($5 for office visit, $2for generic prescription, etc.)

I looked at it carefully, but burning through my Roth’s while NOT spending my deferred balances causes problems in my financial plan in the out years.
Last edited by David Jay on Sat May 26, 2018 11:05 pm, edited 1 time in total.
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by dodecahedron » Sat May 26, 2018 1:32 pm

David Jay wrote:
Sat May 26, 2018 12:41 pm
In Michigan, the income level for Medicare qualification is ~$22,000 a year for Married family of 2.
Medicare is not means-tested anywhere in the US. Anyone over 65 (including Warren Buffett) qualifies for Medicare in any state in the country, regardless of income or assets. Younger people with disabilities and/or kidney disease may also qualify for Medicare, again regardless of income or assets. Premiums do start to go up as income increases past $170K for a married couple, but there is no income cutoff for eligibility. State of residence makes no difference for Medicare eligibility.

I assume you mean Medicaid. This is common point of confusion on this forum, and even moreso outside it.

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dm200
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by dm200 » Sat May 26, 2018 1:50 pm

dodecahedron wrote:
Sat May 26, 2018 1:32 pm
David Jay wrote:
Sat May 26, 2018 12:41 pm
In Michigan, the income level for Medicare qualification is ~$22,000 a year for Married family of 2.
Medicare is not means-tested anywhere in the US. Anyone over 65 (including Warren Buffett) qualifies for Medicare in any state in the country, regardless of income or assets. Younger people with disabilities and/or kidney disease may also qualify for Medicare, again regardless of income or assets. Premiums do start to go up as income increases past $170K for a married couple, but there is no income cutoff for eligibility. State of residence makes no difference for Medicare eligibility.
I assume you mean Medicaid. This is common point of confusion on this forum, and even moreso outside it.
Yes - especially for those under 65 - who qualify for Medicare due to Social Security Disability - these are often confused. As best I understand, those under 65 who qualify for Medicare have no "means testing" to qualify.

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munemaker
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by munemaker » Sat May 26, 2018 3:11 pm

Pajamas wrote:
Sat May 26, 2018 10:13 am
One of my doctors who was always in my employer-provided plans doesn't take either Medicaid or ACA coverage.
Our plan has a network (which is the major provider in our area), and every doctor in that network accepts the plan, by definition. Now if you go outside the network, they may take a different ObamaCare plan, or perhaps none. As long as we stay in the network (not a problem), all doctors accept our plan.

ObamaCare has been a blessing for us. I would have wait until I was within 18 months of Medicare (COBRA) to retire, if it had not been for ObamaCare. Not only that, but ObamaCare costs us far, far less than using COBRA and far, far less than what Medicare will be; very reasonable.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by freebeer » Sat May 26, 2018 4:35 pm

datamonkee wrote:
Thu May 24, 2018 8:17 pm
Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?
I'm confused by the "early retirement" part as I thought you had to be 65 to qualify for Medicaid (barring disability and a few other special cases).

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by sailaway » Sat May 26, 2018 4:43 pm

freebeer wrote:
Sat May 26, 2018 4:35 pm
datamonkee wrote:
Thu May 24, 2018 8:17 pm
Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?
I'm confused by the "early retirement" part as I thought you had to be 65 to qualify for Medicaid (barring disability and a few other special cases).
That is Medicare.

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MP123
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by MP123 » Sat May 26, 2018 4:44 pm

freebeer wrote:
Sat May 26, 2018 4:35 pm
datamonkee wrote:
Thu May 24, 2018 8:17 pm
Questions:
1. Is medicaid (Texas) a feasible medical insurance option for early retirees? What are the eligibility requirements (i had a hard time finding this online)?
2. Is Obamacare insurance a better option if you get it subsidized fully by the federal government?
I'm confused by the "early retirement" part as I thought you had to be 65 to qualify for Medicaid (barring disability and a few other special cases).
You're thinking of Medicare which is a Federal program for people over 65.

Medicaid is run by individual states in different ways but generally focuses on low income people regardless of age.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by jalbert » Sat May 26, 2018 10:59 pm

datamonkee wrote:
Sat May 26, 2018 9:13 am
Thanks, all, for your insights, especially for the links to the eligibility requirements.

one last question:
has anyone had personal experience with Texas medicaid plans? good/bad?

it sounds like ACA is probably the better option if one gets it subsidized by the US govt.
You don’t get to choose between Medicaid and ACA with a tax credit. In a state that expanded Medicaid, if you are not a dependent of a parent and your MAGI is in the range to qualify for a premium tax credit, you don’t qualify for Medicaid. If your income is too low to qualify for an ACA premium tax credit, you qualify for Medicaid.

In a state that did not expand Medicaid, you can be in a position where you don’t earn enough to qualify for a premium tax credit, but earn too much or have too much assets to qualify for Medicaid. TX definitely did not expand Medicaid and accounts for a large fraction of uninsured citizens who can’t afford health insurance without a tax credit, but don’t earn enough for a tax credit, while still not qualifying for Medicaid.

It appears that TX does not run its own enrollment site but uses the federal exchange. The easiest thing to do is go to healthcare.gov and go through the qualification process to see what you qualify for.
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by randomguy » Sat May 26, 2018 11:05 pm

jalbert wrote:
Sat May 26, 2018 10:59 pm
datamonkee wrote:
Sat May 26, 2018 9:13 am
Thanks, all, for your insights, especially for the links to the eligibility requirements.

one last question:
has anyone had personal experience with Texas medicaid plans? good/bad?

it sounds like ACA is probably the better option if one gets it subsidized by the US govt.
You don’t get to choose between Medicaid and ACA with a tax credit. In a state that expanded Medicaid, if you are not a dependent of a parent and your MAGI is in the range to qualify for a premium tax credit, you don’t qualify for Medicaid. If your income is too low to qualify for an ACA premium tax credit, you qualify for Medicaid.

In retirement, you maybe able manipulate your income to allow you to choose if you want to be in medicaid or ACA, For example I could take 20k out of my traditional IRA and buy an ACA plan. OR I could take 20k out of my ROTH and be eligible for medicaid. This allows me to choose between medicaid and ACA.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by David Jay » Sat May 26, 2018 11:07 pm

dm200 wrote:
Sat May 26, 2018 1:50 pm
dodecahedron wrote:
Sat May 26, 2018 1:32 pm
David Jay wrote:
Sat May 26, 2018 12:41 pm
In Michigan, the income level for Medicare qualification is ~$22,000 a year for Married family of 2.
Medicare is not means-tested anywhere in the US. Anyone over 65 (including Warren Buffett) qualifies for Medicare in any state in the country, regardless of income or assets. Younger people with disabilities and/or kidney disease may also qualify for Medicare, again regardless of income or assets. Premiums do start to go up as income increases past $170K for a married couple, but there is no income cutoff for eligibility. State of residence makes no difference for Medicare eligibility.
I assume you mean Medicaid. This is common point of confusion on this forum, and even moreso outside it.
Yes - especially for those under 65 - who qualify for Medicare due to Social Security Disability - these are often confused. As best I understand, those under 65 who qualify for Medicare have no "means testing" to qualify.
Again, sorry. I meant Medicaid (corrected above). Michigan uses Medicaid expansion for low income ACA
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by jalbert » Sun May 27, 2018 12:25 am

randomguy wrote:
Sat May 26, 2018 11:05 pm
jalbert wrote:
Sat May 26, 2018 10:59 pm
datamonkee wrote:
Sat May 26, 2018 9:13 am
Thanks, all, for your insights, especially for the links to the eligibility requirements.

one last question:
has anyone had personal experience with Texas medicaid plans? good/bad?

it sounds like ACA is probably the better option if one gets it subsidized by the US govt.
You don’t get to choose between Medicaid and ACA with a tax credit. In a state that expanded Medicaid, if you are not a dependent of a parent and your MAGI is in the range to qualify for a premium tax credit, you don’t qualify for Medicaid. If your income is too low to qualify for an ACA premium tax credit, you qualify for Medicaid.

In retirement, you maybe able manipulate your income to allow you to choose if you want to be in medicaid or ACA, For example I could take 20k out of my traditional IRA and buy an ACA plan. OR I could take 20k out of my ROTH and be eligible for medicaid. This allows me to choose between medicaid and ACA.
Yes, that is correct, but not in a state that didn’t expand Medicaid as the Roth income landing in a checking account will push one over Medicaid limits for assets even in the unlikely event that nothing else does.
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by jim234 » Sun May 27, 2018 5:04 am

18 to 64 able bodied adults are categorically disqualified from Medicaid in Texas.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by munemaker » Sun May 27, 2018 7:13 am

David Jay wrote:
Sat May 26, 2018 11:07 pm
Michigan uses Medicaid expansion for low income ACA
I don't think this is technically correct. ACA (aka ObamaCare) is one thing and Medicaid is another. If your income is too low to qualify for ObamaCare, you get Medicaid.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by dodecahedron » Sun May 27, 2018 7:33 am

munemaker wrote:
Sun May 27, 2018 7:13 am
David Jay wrote:
Sat May 26, 2018 11:07 pm
Michigan uses Medicaid expansion for low income ACA
I don't think this is technically correct. ACA (aka ObamaCare) is one thing and Medicaid is another. If your income is too low to qualify for ObamaCare, you get Medicaid.
To clarify, the ACA (also known as Obamacare) is a complex bill with many provisions, INCLUDING Medicaid expansion and more, with details that vary state to state.

One of the ACA provisions provided financing to enable states to expand Medicaid and to simplify qualifications, e.g., removing the asset test and removing categorical requirements such as age, disability, pregnancy, etc. (Most, though not all, states took advantage of this provision of the ACA. Folks in states that did not expand Medicaid have no options under this provision, other than moving to a state that did expand, so for them it is not necessarily true that "If your income is too low to qualify Obamacare, you get Medicaid.")

Another provision of the ACA enabled states to set up "exchanges" where individuals and families not otherwise eligible for affordable coverage can purchase Bronze, Silver, Gold, or Platinum policies ("metal plans") that qualify for subsidies via Premium Tax Credits for households with MAGI below 400% of poverty level. For those with incomes below 250% of poverty, there are Silver plans that reduce cost sharing features such as coinsurance, copays, and deductibles. Folks in states that did not choose to set up their own state ACA exchanges may purchase their "metal" policies on the federal ACA exchange (healthcare.gov).

Still another provision of the ACA enables states to apply for waivers to create an alternative plan that is sort of intermediate between Medicaid and the exchange metal plans for those with incomes up to 200% of poverty level. NY and Minnesota are the two states that I know have done this. New York's waiver program is called the Essentials Plan.

There are many, many complications and wrinkles in the laws and the ways in which they are interpreted from state to state. In many places there are nonprofits that provide trained ACA "Navigators" to help people understand their options. Costs and premium subsidies can be different even in different parts of the same state, depending on how much competition there is among insurers, cost factors, etc.

There are continuing ongoing controversies and lawsuits yet to be resolved about how to resolve some of the technical contradictions in the wording of the ACA. As far as planning for the future, there is an annual repricing of exchange policies based on regulatory procedures by state insurance regulators (which approve the unsubsidized premiums on which Premium Tax Credit subsidies are calculated.) Right now, health insurers in my state (NY) are in the process of finalizing their proposed rate increases for 2019, at some point this summer the NYS insurance regulators will allow some unknown portion of what they are asking for, then various provisions of the subsidy formulas can be calculated (based on the "Second Lowest Cost Silver Policy" available in each part of the state.)

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by FrugalProfessor » Sun May 27, 2018 7:50 am

We had anywhere between 2-5 kids while in our 7 years of grad school. We qualified for food stamps in one state and medicaid in two states. Our assets, which were in the range of $150-$250k precluded us from food stamps in one state as well as medicaid for me (but my wife and kids were OK). In another state, these same assets did not preclude us from receiving full benefits with both programs.

It was our experience that Medicaid was not very restrictive in terms of which doctors you saw. Sure, there are a few that don't take you, but you simply choose another. We didn't pay a single dollar in medical expenses while on medicaid.

This guy is playing the heavily subsidized early retirement ACA game despite a net worth of $2M: https://rootofgood.com/. A search for the term "ACA" on his site will lead to some very thoughtful discussion: https://www.google.com/search?q=https%3 ... com%3A+aca

People on other threads of this forum have labeled him as unethical. I label him as a smart individual rationally responding to poorly constructed incentives. Both the tax system & welfare system systematically punish high earners and reward low earners. It's inherently built into our safety net systems as well as our progressive tax code (extremely progressive tax code when considering the negative income tax region covered by the EITC).

Given how inconsistent asset tests are incorporated across state lines, I'm unsure why people don't more readily exploit this opportunity by moving to states with lower thresholds in early retirement.
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by SimonJester » Sun May 27, 2018 8:28 am

I will throw a cautionary tale, this happened to a family member. He was on Medicare with Medicaid as the secondary and it was working well for several years. However he receive the annual Social Security COLA, which then pushed him out of the Medicaid qualification. However this did not become known until March of this year and open enrollment is of course closed. So now he is without a secondary for the rest of this year unless he pays a penalty...
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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by Epsilon Delta » Sun May 27, 2018 9:01 am

jalbert wrote:
Sun May 27, 2018 12:25 am
Yes, that is correct, but not in a state that didn’t expand Medicaid as the Roth income landing in a checking account will push one over Medicaid limits for assets even in the unlikely event that nothing else does.
You could make the Roth withdrawals $1000 at a time and spend each one before you make another. You could make over $100k of withdrawals per year before that starts to be infeasible. However you would almost certainly fall afoul of something else.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by munemaker » Sun May 27, 2018 3:39 pm

FrugalProfessor wrote:
Sun May 27, 2018 7:50 am


This guy is playing the heavily subsidized early retirement ACA game despite a net worth of $2M: https://rootofgood.com/. A search for the term "ACA" on his site will lead to some very thoughtful discussion: https://www.google.com/search?q=https%3 ... com%3A+aca

People on other threads of this forum have labeled him as unethical. I label him as a smart individual rationally responding to poorly constructed incentives.
I have been doing the same thing, and my net worth is substantially higher. Optimizing ObamaCare subsidies is no different than maximizing your income tax deductions and tax credits or maximizing college financial aid. It's just being smart. What's unethical in my mind is charging a family $20,000/year for health insurance while providing the same health insurance policy to another family for less than $1,000/year.

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Re: medicaid as early retirement medical insurance (or maybe Obamacare)

Post by LadyGeek » Sun May 27, 2018 9:27 pm

I removed an off-topic post. The discussion has derailed into the ethics of insurance premium pricing. This thread has run its course and is locked.

Also see: A reminder that non-investing general comment threads are OT
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