ACA for Children (higher tax) or Medicaid/CHIP (Lower taxes)

[tooqk4u22]

I am doing some figuring on health insurance:

1. I can do Roth conversions to get our income up to keep whole family on ACA/single insurer but it would require paying higher, but reasonable, income taxes and higher premiums based on playing around with tax calculator and exchange inputs.
 
2. I can keep income lower and DW and I would be on ACA and children would be on Medicaid/CHIP.  Would basically be very little tax and very low to no premium.


There are benefits to converting to Roth at lower rates and having access to those funds sequentially starting in 5 years but money now is a good thing and helps with SORR.   

Also, I think the medicaid/CHIP coverage is pretty good but I have heard access (doctors that accept it) is pretty limited - that has me a little concerned.

Setting aside quality/access of medicaid for kids, the financial side is pay now or later for health care and taxes as kids will eventually roll off as dependents. 

I am thinking that lower tax/insurance cost is probably the better way and I should still be able to convert some roth dollars each year.

FYI - we have enough in taxable accounts to see us through to 59.5. 

[Morning Glory]

Don't forget to take cost sharing reduction (lower deductible and copay if you are under ~200% FPL) into account!  In our case we would have lost out on the CSRs if we bumped our income high enough to put the kids on ACA instead of Medicaid.  I seem to recall that you have some older teens but not whether you are in an expansion state so they may age out of eligibility long before they are no longer a dependent for other purposes depending on where you live.

[TreeLeaf]

I have thought about this some for my situation, and basically concluded that Medicaid / chips is the way to go vs doing higher rollovers and keeping everyone on an aca plan.

The details are so complicated though, I don't think there is one size that fits everyone or a particular absolute best answer for everyone. The answer for us is largely - in what scenario do we sleep better at night? And that's basically how we made our decision..

[tooqk4u22]

Don't forget to take cost sharing reduction (lower deductible and copay if you are under ~200% FPL) into account!  In our case we would have lost out on the CSRs if we bumped our income high enough to put the kids on ACA instead of Medicaid.  I seem to recall that you have some older teens but not whether you are in an expansion state so they may age out of eligibility long before they are no longer a dependent for other purposes depending on where you live.

looks like the age out of chip at 19 and would be on regular ACA plan at that point so I should look at that as well, thanks for pointing that out and CSRs. 

I think I will have better success with understanding Egyptian hieroglyphs!

I have thought about this some for my situation, and basically concluded that Medicaid / chips is the way to go vs doing higher rollovers and keeping everyone on an aca plan.

The details are so complicated though, I don't think there is one size that fits everyone or a particular absolute best answer for everyone. The answer for us is largely - in what scenario do we sleep better at night? And that's basically how we made our decision..

That's fair. Lower costs/taxes would help sleep better and is probably less complicated.  I need to play around to be sure where the cutoffs are to see how much room there is in case of a surprise capital gain or something like that.

[yachi]

Also, I think the medicaid/CHIP coverage is pretty good but I have heard access (doctors that accept it) is pretty limited - that has me a little concerned.

I'm dealing with this stuff too, trying to get CHIP to accept my proof of income and communicate when they're going to mess with benefits is the pits.  I have a post here asking for experiences in other states.

When you're looking at coverage for medicaid/CHIP, you might need to differentiate between the two. In PA, less than $40,000 for a family of 4 gets you kicked off of CHIP and into "Medical Assistance".  That's what I would consider medicaid.  In fact, my daughter's therapist said they would participate with CHIP but not the next level down.  Up to $94,000 you get CHIP, at various subsidized levels.  Higher then that income, you can keep CHIP at full cost, or get something else on the ACA.  We've had great coverage and participation for healthcare, dental care and eyecare on CHIP.  The only provider problem was with an ahole of an eyecare company I'll call ByeDieProctor.  I'm still not convinced they weren't just confused about the coverage and insurance type, but frankly I'll never do business with them again.