Author Topic: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)  (Read 1930 times)

FIREin2018?

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FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« on: February 23, 2019, 08:03:07 AM »
i got laid off last year.
my company health insurance expires this April.

im single, age 48, no kids, and live in Northern Virginia.
i have over $600k in 401k/ira/Roth/after tax brokerage accts and a $400k house with mortgage paid off.
my expenses are $20k/year.

i'm going to give early retirement a try but need advice on healthcare.
With Roth conversions, i can get income to $17k to meet the minimum Obamacare requirement.
When i was on Obamacare years ago, my premiums were $60/month with maxed out subsidies. my healthcare provider was Kaiser permanente.

Now that Virginia has expanded Medicaid, i can go on that by not doing any Roth conversions and have my income = near $0.

Anyone have experience with Medicaid in Northern Virginia?
Which should i choose for 2019? Obamacare or Medicaid?
WHY?
« Last Edit: February 24, 2019, 04:02:35 AM by FIREin2018? »

HipGnosis

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #1 on: February 23, 2019, 09:54:51 AM »
Unfortunately, ASA will likely change with every president for the foreseeable future.
They may change medicaid too.
Which makes choosing a bit of a lottery.

stoaX

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #2 on: February 23, 2019, 10:01:13 AM »
Wouldn't the benefits under medicaid be richer than those under an ACA plan?  So from a purely financial point of view the medicaid plan would be better. 

seattlecyclone

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #3 on: February 23, 2019, 11:11:32 AM »
Wouldn't the benefits under medicaid be richer than those under an ACA plan?  So from a purely financial point of view the medicaid plan would be better. 

I think this depends a lot on the state. There are many places where doctors who take Medicaid are few and far between, but many ACA plans also use very narrow networks of physicians.

jim555

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #4 on: February 24, 2019, 09:19:49 AM »
Medicaid is much more comprehensive and lower OOP costs.

Look through the managed care providers in VA for a list of doctors.

https://www.coverva.org/main_plans.cfm

Managed Care Organizations (MCO)

Most Medicaid and FAMIS enrollees get their care through a Managed Care Organization (MCO). An MCO (also known as a health plan) is an organization with a network of primary care providers (PCPs), specialists, hospitals and other health care providers. A PCP is the doctor you choose to provide and coordinate your or your childís health care. MCOs that provide health care to Medicaid and FAMIS enrollees include Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Magellan Complete Care of Virginia, OptimaHealth Family Care, UnitedHealthcare Community Plan, and Virginia Premier.

FIREin2018?

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #5 on: June 07, 2019, 10:07:46 PM »
well, i applied to Obamacare because i plan to do Roth conversions which will put me over the limit for Medicaid.

interesting verbage that wasnt there when i was on obamacare in 2015 along the lines of:
if it's to be found that you qualified for Medicaid, then your subsidies will be disallowed.

back in 2015, all you had to do is say you have 138% of poverty level income ($17k) and there was no claw back of subsidies if your didnt.
i guess now when you file your taxes and dont have $17k, the Fed govt will not  pay the subsidies.
thus if they paid the health insurance company on your behalf ($600/month), then you owe the fed govt ALOT of $$$!

DaMa

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #6 on: June 08, 2019, 06:10:21 AM »
I did a lot of analysis on this recently, but I'm in southeast Michigan.  If you have doctor(s) you don't want to give up, check with them.  I have a primary care doctor that I would rather not lose.  She does not take Medicaid.  She also takes only 4 of the 6 ACA plans that I was considering.


FIREstache

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #7 on: June 08, 2019, 07:44:35 AM »
Which should i choose for 2019? Obamacare or Medicaid?


Obamacare is just a non-official name given to the health care law "Affordable Care Act".   The Medicaid expansion is simply part of the ACA.  So, you are not choosing between them.

jim555

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #8 on: June 08, 2019, 08:45:22 AM »
Medicaid has no minimum income requirement.  You are probably thinking of people in non-expansion states that need at least 100% FPL ($12,490) to bridge the gap to get to ACA metal plans.  Medicaid has no subsidies so that is a non issue since it is not insurance.
« Last Edit: June 08, 2019, 08:47:53 AM by jim555 »

BuildingFrugalHabits

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #9 on: June 08, 2019, 12:19:24 PM »
Aren't the income limits based on AGI?  If so, don't forget about your standard deduction. 

BicycleB

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #10 on: June 08, 2019, 01:50:56 PM »
Aren't the income limits based on AGI?  If so, don't forget about your standard deduction.

Every time I've read about it, they are based on MAGI. Deductions for contributing to 401k plans reduce income for this purpose, but the standard deduction does not.

https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/

well, i applied to Obamacare because i plan to do Roth conversions which will put me over the limit for Medicaid.

interesting verbage that wasnt there when i was on obamacare in 2015 along the lines of:
if it's to be found that you qualified for Medicaid, then your subsidies will be disallowed.

back in 2015, all you had to do is say you have 138% of poverty level income ($17k) and there was no claw back of subsidies if your didnt.
i guess now when you file your taxes and dont have $17k, the Fed govt will not  pay the subsidies.
thus if they paid the health insurance company on your behalf ($600/month), then you owe the fed govt ALOT of $$$!

I think you did a logical move. I do about the same, though in a non-expansion state.

Yes, in 2015, the documentation requirements were lower. I perceive that to be part of the process where ACA was implemented with purposely gentle requirement levels at first to maximize participation and stabilize insurance markets for products available through the federal and state exchanges. Over time, the system became more thorough about requiring documentation from the income tax system.

Fishindude

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #11 on: June 08, 2019, 03:17:31 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.

NV Teacher

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #12 on: June 08, 2019, 03:38:37 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.

Thatís what I was thinking.

RedmondStash

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #13 on: June 08, 2019, 08:10:52 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.

Thatís what I was thinking.

+1

the_fixer

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #14 on: June 08, 2019, 08:17:51 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.
I thought it was for people with a certain MAGI?

Take a person in the Bay area for example, they could have a modest house that is worth 800k that was purchased many years ago and a small nest egg of 200k locked up in retirement. They are unable to work due to health, lost their job or work part time while raising kids as a single person.

They are millionaires by your definition is it wrong for them to be qualified for subsidies or Medicaid?
______________

Ok so you are not talking about those people...

Just the ones that saved up up a million dollars in a pension / retirement, live a basic life and spend $23k a year from their nest egg.

Does it matter what age they are? 30? 40? 50? 60? Does it depend on their situation? Are they able to work? Do they have bad health? Do they work for a non profit and make very little money yet managed to scrimp and save by not being consumer suckers?

What about the people that have new fancy cars in the driveway, eat out everyday, buy the latest greatest huge flat screen TV and do not work? Is it ok for them? They have no assets but could be able to work just refuse as they would lose benefits.

Where do you draw the line? How many people are we really talking about? Is the system perfectly imperfect? How much would enforcement cost?




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BicycleB

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #15 on: June 08, 2019, 08:51:38 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.

Thatís what I was thinking.

+1

Who it's for is a matter for public debate. In most of Europe, publicly funded health care is for everyone, broke or rich. In America, our discussion ended up with a state by state system. In states with "expanded Medicare", there is no assets test, so it's for anybody with low MAGI, even if they are millionaires. Almost like Europe.

If you want good oldfashioned pay out the wazoo unless you're absolutely broke scenarios, you move to states that don't have Medicaid expansion. 

https://www.verywellhealth.com/no-asset-tests-for-aca-subsidies-1738965

FIREin2018?

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #16 on: June 08, 2019, 09:00:12 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.
for medicaid food and housing assistance, yes you're right. thus there's an income AND asset test. ie: house, bank accounts, brokerage accts, 401k, etc.
for medicaid health insurance, no. Just an income test.
« Last Edit: June 08, 2019, 09:01:43 PM by FIREin2018? »

jim555

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #17 on: June 09, 2019, 09:00:24 AM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.
for medicaid food and housing assistance, yes you're right. thus there's an income AND asset test. ie: house, bank accounts, brokerage accts, 401k, etc.
for medicaid health insurance, no. Just an income test.
If you are over 65, blind, or disabled they test income and resources.

FIREstache

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #18 on: June 09, 2019, 12:11:21 PM »
Isn't Medicaid for broke people?
Doesn't seem right that a person with $1mil in assets should get the same coverage at same cost as a poor broke person.

Legislators disagree with your opinion because they passed the ACA as it is, and there are millionaires, including on this forum, that are on Medicaid.  The trick is keeping your MAGI low enough to qualify.

jim555

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #19 on: June 09, 2019, 01:36:32 PM »
Medicaid over 54 can be subject to estate recovery, it depends on how each state interprets the Federal law on it.  ACA subsidies are not subject to estate claw back.  Medicaid is a glorified loan.

FIREstache

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #20 on: June 09, 2019, 03:04:09 PM »

super hans

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #21 on: June 09, 2019, 03:06:35 PM »
There is another option, moving to another country in which healthcare is a universal right and not something debatable as it is in US.

FIREin2018?

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #22 on: June 09, 2019, 09:14:49 PM »
There is another option, moving to another country in which healthcare is a universal right and not something debatable as it is in US.
which countries?
and how hard is it to become a citizen in one of these countries?

TomTX

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #23 on: June 10, 2019, 05:55:51 AM »
Which should i choose for 2019? Obamacare or Medicaid?


Obamacare is just a non-official name given to the health care law "Affordable Care Act".   The Medicaid expansion is simply part of the ACA.  So, you are not choosing between them.

Misleading pedantry.

DaMa

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #24 on: June 10, 2019, 10:12:34 AM »
When I referred to Medicaid, I meant Medicaid Expansion, not original Medicaid.  Medicaid Expansion is part of the ACA and is available to people below a certain income level, who do NOT qualify for original Medicaid.  Original Medicaid is for very low income people who meet strict criteria and have almost no assets. 

Sorry, I thought that went without saying, since all (?) the people here would not be talking about getting original Medicaid.

FIREstache

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Re: FIREd: Need advice on Healthcare (Obamacare vs Medicaid)
« Reply #25 on: June 10, 2019, 03:05:31 PM »
When I referred to Medicaid, I meant Medicaid Expansion, not original Medicaid.  Medicaid Expansion is part of the ACA

This is something I pointed out earlier as well.  There is still a lot of confusion out there - and I've seen it on this forum also.  Many people don't even know that Obamacare and ACA refer to the same thing.