Hi all,
We're planning out our transition from COBRA to the ACA. Two adults, two kids. We're in Silicon Valley. We're not expecting a lot of health care expenses next year. We have tons of income flexibility with a mix of earned* and dividends and optional capital gains. We're expecting about $60k gross, but could make that as much higher as we want (by selling stock) or as much as ~35k less (IRA/401k/HSA.) So we can apply based on an expected income of 15k -> whatever, without lying. I'm trying to decide what I want our plan to be and hence where I want to put our income next year.
Concern/Question #1:
According to The Chart**, kiddos are on Medi-Cal (medicaid) up through $66,766. So keeping the kids off of Medicaid would require giving up a lot of premium subsidies for us and all options for CSRs. I've heard the quality of Medicaid varies a lot by state.
Does anyone here have any experiences with Medi-Cal specifically for their kids who can recommend or warn me off of it? If we went this way we'd probably continue to pay the same pediatrician out of pocket for primary/routine care because that's an important relationship, but I want to understand how good the care availability is if they need something more serious.
Concern/Question #2:
I don't love any of the networks on the lower-cost plans and am loathe to pay a $500/mo bump to get a couple of our preferred primary care providers into our network. So I'm thinking of just getting a cheaper plan and relying on it only for expensive/emergency care that might hit the $12k deductible. The biggest risk with that would be accidentally receiving care out of the network (or being forced to by circumstances) in the event that we do need serious care. So I'm thinking of *gulp* just getting Kaiser for this for my wife and I (at least), on the theory that if we wind up needing complex care we'll be in a system that won't accidentally screw us by leaning on out-of-network providers. My wife would want to rely on her existing non-Kaiser primaries and probably use Kaiser as catastrophic coverage.
Does any of that that seem crazy?Concern/Question #3:
I'm not sure I won't go back to work eventually. If I did that, we'd lose subsidies and quickly wind up ineligible for Medi-Cal. I'm not worried about losing subsidies because my understanding is we'd just have to pay the government back for what they paid the insurer and I understand those amounts. No problem.
How do any clawbacks work if my kids wind up ineligible for Medi-Cal after all?Thanks everyone!
* Don't call the retirement police, but my wife is still working a little bit.
**
https://www.coveredca.com/PDFs/FPL-chart.pdf