I am having a hard time following these posts. I am retired now and my wife is retiring soon. We were planning on converting about 50K per year from TIRA to ROTH. But what I think I picked up, is that at that income level our child would have to go on Medicaid. Is that right? Is there a hard line where children can go onto ACA and not Medicaid or is it different from state to state? And if you reach that line then you probably price out of subsidies???
I'm not sure if it's a required component of Medicaid in all states but the ones I'm familiar with have programs that will insure children at higher income limits than traditional medicaid. The idea is to make sure kids get healthcare. The programs change with age too. I think one program supports kids from birth through age 6 and another will cover them through to adulthood. Each of those programs has a different income threshold.
In the event you have a child that qualifies for those programs based on your income, that child will not be eligible for ACA insurance subsidies. The expectation is that the child would enroll in the state insurance program. Adults will still qualify for subsidies and your insurance premiums will be priced based on the number of household members who only have ACA insurance as an option, not the total number of household members.
Supporting Mr. Green with additional details:
@MattyP, fear not, it's going to work.
1. It's state to state where the line is between ACA and Medicaid, but within each state, it's a hard line in the sense that the "line" is a set of qualification rules related to income, family status, etc. If the child qualifies, the child qualifies.
2. Something to know is that there are 2 kinds of states: states with "Medicaid expansion" (most states; roughly, the liberal states and some of the others), and states without Medicaid expansion (some of the conservative states, like Texas, where I live). This will come into play below if you follow the links.
3. The result is summarized from a Medicaid viewpoint in this link (one of many consumer explanations, though not a complete one).
https://www.verywellhealth.com/your-assets-magi-and-medicaid-eligibility-41449754. Above a certain income, you have to buy your own insurance instead of using ACA, but that income is more than 50k. Under the max parental income (this year $86,600 for a family of 3), each person in the family will individually either qualify for ACA or Medicaid, one or the other. I guess there are cases where parent has ACA and kid has Medicaid, but it still works. Medicaid will be subsidized for sure. ACA will have subsidies from the lowest eligible income up to the highest eligible income. The lower limit depends on Medicare expansion in your state but the upper limit is federal. See the table and calculators in the following links to verify that a household of 3 people qualifies for premium subsidy up to $86,600 income.
https://obamacarefacts.com/2021-obamacare-eligibility-chart-and-subsidy-calculator/https://www.healthinsurance.org/obamacare/subsidy-calculator/5. The details are particularly beneficial this year and next year because of the American Rescue Plan (ARP), the Biden stimulus bill that became law in March. Basically the underlying ACA had relatively few holes of the type you're worried about, so it's already much better than you'd think, but the ARP temporarily fills in the few gaps. Here is an article with detailed explanations of the regular long term ACA, and what the extra benefits of the ARP are.
https://www.healthinsurance.org/obamacare/beware-obamacares-subsidy-cliff/PS. Fwiw, I've been on ACA for over five years, using "income" from tIRA->Roth transfers while spending down other assets. Also I have repeatedly helped my ex-GF do her ACA paperwork for her and her child. The state always does a Medicaid determination for the child. So far they've always concluded child is ineligible for Medicaid, at which point instantly the child qualifies for ACA. Once the paperwork is finished, the policy activates on the first of the following month.
For me, next year might be when I finally start drawing from Roths instead of just transferring, but the ACA piece works great. My premiums net of subsidy are usually between $0/month and $54/month, depending on details that year.