Author Topic: Time off to travel the world, going on medicaid???  (Read 25204 times)

zing12

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Time off to travel the world, going on medicaid???
« on: September 21, 2014, 09:00:41 AM »
Hi all, long time reader, first time poster.

I am a 26 year old single male CPA living in Ohio. I've been working for 4 years and I'm considering quitting my job and taking some time off to travel, something I've always wanted to do. I'll have my student loans all paid off and some decent savings built up a year from now, so I'm starting to do research on the logistics of taking this trip.

I've spent some time the past few days reading up on health insurance, trying to get a handle on how I would remain covered during this year of international travel.

I looked at just having travel medical insurance but basically what you're covered for with those plans is emergency care in the country you're in, and emergency evacuation to your home country. So if anything catastrophic were to happen, I'd be back in the US and need coverage.

In addition, the Affordable Care Act requires us all to have coverage now. (There are certain exemptions possible if I were to stay out of the country for almost the entire year, and/or make nothing in income... but say I decide to come home after 6 months and start working again, I'm now on the hook for penalties for not being covered for those 6 months.)

So, I knew I could do COBRA or purchase insurance on the exchanges. COBRA would be crazy expensive, so I started looking into how much the exchanges would cost, and what the requirements for the subsidies are. Because I am assuming no income, all the information and ehealthinsurance.com starting pointing towards the new, expanded medicaid as the best option. Ohio is one of the states that expanded medicaid, so now it appears to me that any adult of any age under a given income threshold can get medicaid. It is highly probable that my income would be less than the 138% of federal poverty threshold, currently around $15,000, for the year, once I quit my job.

What I would do is get the medicaid for coverage at home and purchase the travel medical insurance that covers emergency care abroad and evacuation home if necessary.

"Medicaid?," I thought. "I can't go on medicaid. I'll have to buy the unsubsidized insurance on the exchange." It's the stigma of it. I feel like I don't deserve it because I am opting for this low income by choice, rather than those who have those low incomes because they're down on their luck, or whatever. I would feel like a fool, and be highly embarrassed, going in to talk to a social worker about going on medicaid, when I am obviously perfectly able to provide for myself. I'd feel like a cheat, milking the system. I'd be embarrassed to tell friends and family. I'm not trying to make a statement about this, or talk down to anyone who has ever had to rely on government assistance... It's just a very emotional reaction... that's just the way our culture is in the US, for better or worse.

Now, there is obviously another side to this. First, all I am doing is trying to be compliant with the law of our land, which is that I am required to have health insurance. Why would I voluntarily fork over $170/month for the exchange plan to be compliant when medicaid would be free? Second, I have paid into the system plenty over the past 4 years of full time work and many years before that of part time work. Third, I would most likely not go to any doctors, and not cost the state a dime, unless something absolutely catastrophic were to occur.

So, the questions I have for anyone with experience are,

a)What is it like to apply for medicaid? What will I need to do to prove that my income is zero? Also, will they want to check up on me regularly? Should I tell them I am going out of the country or keep that to myself?
b)Is there some sort of "you have to prove you are trying to find a job" requirement that the program has (like TANF or other programs) that I'm not seeing? Because I, by definition of what I am trying to do here, would not be trying to find a job at all, the entire time.
c)Are people going to look at me funny? Will the social workers not want to work with me? Will anyone give me a hard time? I know that Ohio has an online application system, so hopefully I can minimize any contact with them and just discretely get my medicaid...

I actually posted this on another website... a health insurance discussion forum. It was really stupid of me to post on there as most of the people on there were seniors who were trying to get health care for under like $2,000 a month, or people who were actually struggling in life, or people with kids, etc... and I think they all got pretty pissed off at my post, and thought I should just get a job instead of "gaming the system" so the "taxpayers are on the hook for my health care" while I am off taking my over-entitled gen-Y "vacation from reality," and that I was a textbook reason for public anger about Obamacare. All those lazy young kids these days, don't want to work, want the gub'mint to pay for everything. Which is of course, exactly why I feel uncomfortable with this, and why I need a judgement-free zone. I should have come to MMM first, I don't know what I was thinking.

And you know what? All those people on there are probably getting their mortgage interest deductions and whatever else. Me, as a single guy who rents, I pay some of the highest taxes in this damn country. My taxes subsidize my boss' $750,000 (absurdly expensive in OH) house every year. I don't get squat! God forbid I get health coverage for a year when I won't even be here to use it!

The crazy thing is the way our government designs eligibility for these programs, solely based on income. They can't fathom that anyone making under $15,000 could be anything less than positively destitute, with no consideration that people sometimes live off savings for a time, or that people even have savings in our country these days.

I know there have been a few threads about the new medicaid eligibility on here, so I apologize for the redundancy, however, I really wanted to get others' opinions who have been through the process on what the actual process is like.

Thanks all!
« Last Edit: September 21, 2014, 09:31:41 AM by zing12 »

Krnten

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Re: Time off to travel the world, going on medicaid???
« Reply #1 on: September 21, 2014, 12:28:26 PM »
No specific advice, except to make sure that you have a way to receive domestic mail while you're abroad.  You may have recertifications every few months, and if you miss one you could be cut off.  You may have to certify that you're an OH resident.  Will you meet the legal definition of that?  OH might also be skeptical about your eligibility esp if you've left your job recently, so be prepared to have to do an administrative hearing to establish your right to benefits. 

I can't believe I missed the end of the resource test for Medicaid.  I had no idea!  That is pretty amazing.  In the recent past, you couldn't have more than a few thousand of assets and still qualify. 

I imagine if you correctly entreated your info into OH's enrollment system, you'd be pushed into Medicaid anyways.  I'm not too concerned about the ethics of it, more the logistics.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #2 on: September 21, 2014, 01:31:47 PM »
No specific advice, except to make sure that you have a way to receive domestic mail while you're abroad.  You may have recertifications every few months, and if you miss one you could be cut off.  You may have to certify that you're an OH resident.  Will you meet the legal definition of that?  OH might also be skeptical about your eligibility esp if you've left your job recently, so be prepared to have to do an administrative hearing to establish your right to benefits. 

I can't believe I missed the end of the resource test for Medicaid.  I had no idea!  That is pretty amazing.  In the recent past, you couldn't have more than a few thousand of assets and still qualify. 

I imagine if you correctly entreated your info into OH's enrollment system, you'd be pushed into Medicaid anyways.  I'm not too concerned about the ethics of it, more the logistics.

Well, I would just change my address for all my bank accounts and registrations and whatnot to good ol' mom and dad's house, and presumably just be a regular guy who lives there but happens to be on a really long vacation. As far as if that would meet the legal definition of residency, I'm not sure, that's a whole other thing I have to research, but I assume so... I've been an Ohioan all my life other than three months, so I don't think(...?) they'll challenge that one too much. Plus with Americans abroad, the IRS anyways, typically will give you a harder time if you claim to not be a resident, than if you are trying to say you are.

Yes, it looks like if I tried to do Healthcare.gov or call the phone number they'd recommend Medicaid when I set my income to zero. I didn't try healthcare.gov, because you have to sign up for an account just to get a quote. But, I did try it on ehealthinsurance.com yesterday and they said "Medicaid," and that's how this whole thing started.

As far as the ethics, while I do feel a certain level of discomfort about it, at the end of the day, in the more logical parts of my brain, it's no different than claiming every tax deduction and credit I'm eligible for. So I don't think it's unethical.

I do however, worry about other people thinking it's unethical and shaming me about it. I know we're not supposed to worry about what others think and all that, but hey, I'm only human. :D

Especially if those other people happen to be the ones in charge of deciding if I get the coverage or not!

EDIT: "Residence in Ohio for Medicaid purposes continues when a medicaid applicant/recipient is in another state or country if he is only absent from his home on a temporary basis and plans to return to Ohio. Absence for more than thirty days constitutes evidence of intent to establish residence elsewhere unless a written statement is submitted by the applicant/recipient or his authorized representative indicating the intent to return to Ohio. The statement must include the reason for the absence and the expected date of return. However, a statement is not considered acceptable proof of intent to return to Ohio when the individual contradicts the statement by giving up housing arrangements in Ohio, by receiving medicaid in another state, or by securing long-term housing in another state."

from http://www.odjfs.state.oh.us/clearances/show.asp?id=1718

Based on this now I'm not sure, there's a chance I'd be better off just buying a high deductible exchange plan. I don't want the whole trip to be ruined by bureaucrats coming after me trying to get me to prove residency the whole time. Then again, I wouldn't give up housing arrangements in Ohio, I wouldn't receive medicaid in another state, and if I secured long-term housing out of the country for whatever reason, I would be able to obtain health insurance in that country. But then if Medicaid kicked me off, I could face the Obamacare penalties for not having coverage.

This is going to be a nightmare.
« Last Edit: September 21, 2014, 02:32:41 PM by zing12 »

lizzzi

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Re: Time off to travel the world, going on medicaid???
« Reply #3 on: September 21, 2014, 04:09:33 PM »
I'm not a Medicaid worker, but in NY I ran a caseload of Medicaid-billed patients for 19 years, and I also have a Colorado family member on Medicaid--so have some seat-of-the-pants familiarity with it. First of all, ethics are a non-issue. Medicaid is health insurance for people with a certain level of income and resources. It's funded by the federal and state governments, and each state gets to pick a menu of what Medicaid can offer in that particular state. It isn't "welfare", it isn't "public assistance", it is simply health insurance.  In New York at least, a Medicaid application can take six months to be approved. Medicaid workers in NY are terribly over-burdened , and I'm guessing it's the same everywhere. That might throw a spoke in your wheel. I don't quite see the residence as being a problem, if you are using your parents' address and getting your mail there. How is Medicaid going to know whether you're in Peru, or where ever for 30 days, 32 days,  90 days…six months? Just be excruciatingly meticulous when you need to re-certify. Make sure you get that signed paperwork back to your Medicaid worker, or they'll close your case so fast your head will spin. I don't think you need to re-certify in person. You probably do have to apply in person…so make sure you just stick with the facts (no income, live with parents…they'll probably wonder if you are looking for work, and if not, why not…just be careful how you present yourself and what you say…remember if you irritate them for some reason they can and will put your folder on the very bottom of the pile, buried deep.

lizzzi

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Re: Time off to travel the world, going on medicaid???
« Reply #4 on: September 21, 2014, 04:17:31 PM »
I didn't see the part where you said Ohio has an online Medicaid application. If it really can all be done online, that could make things easier. I think you will find a Medicaid application requires a lot of documentation. The NY applications could be done in a couple of minutes, but it was the required documentation list that kept folks doing a lot of legwork. Not trying to put ideas in your head, but is it possible that your parents have some health issues of their own that require some help from you? So that you live with them and had to quit the CPA job? Remember that statistically, 100% of the population above age 45 have a little arthritis.  Just saying.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #5 on: September 21, 2014, 04:36:57 PM »
You can enroll in coverage outside of the open enrollment period if you have a qualifying life event. Moving to the US from abroad is a qualifying life event (as is moving from one state to the next). So if you come back to the US mid-year, you have 60 days to enroll. You don't get penalized for the time you're out of the country.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #6 on: September 21, 2014, 04:56:34 PM »
Hi Lizzzi,

Thanks for the info. As far as the six month thing, that would make it absolutely a no-go for me. I'd rather drop 170/month than wait that long, absolutely.

However, things are different now with the ACA and the expanded medicaid. How can they justify making somebody wait 6 months when there is a penalty if you don't have insurance for more than three months? Additionally, how can they turn people down for medicaid when we are all required to get care now?

As far as the arthritis thing, that's just not how I roll. I'm not even trying to judge people who may roll that way, more power to them, but it's not how I roll. My body won't even physically let me do something like that. I'd probably break out into hives or convulsions or something if I even tried to say something like that, haha.

I would be more the type to just sit down and tell them 100% honestly my dilemma, try to be really nice and tell them how iffy I feel about it, and just say if you're going to turn me down, please do it ASAP so I can buy exchange insurance. Hopefully it would be different with the new law... I can just tell them I know we are required to have health care now and that I'm just trying to avoid the penalty. What are they going to say to that?

Basically, I am thinking that medicaid is different now than it has been with this individual mandate.

Check out this poster's story: http://forum.mrmoneymustache.com/index.php?topic=17302.msg335876#msg335876

Also the guy a few messages below him. It almost seems like they were forced or at least highly encouraged to go on medicare by their state exchanges.
« Last Edit: September 21, 2014, 05:21:11 PM by zing12 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #7 on: September 21, 2014, 04:58:20 PM »
You can enroll in coverage outside of the open enrollment period if you have a qualifying life event. Moving to the US from abroad is a qualifying life event (as is moving from one state to the next). So if you come back to the US mid-year, you have 60 days to enroll. You don't get penalized for the time you're out of the country.

As I understand it the penalty is only forgiven if you spend at least 330 days out of the country? While it is possible I would be gone that long, I would feel more comfortable reserving the right to come home whenever I want without getting hit with a penalty. So if I were to be uninsured for 8 months, return home after 8 months, get a job and coverage for the other 4 months, I would still be charged the penalty... it would be prorated to the 8 uninsured months, but I'd be hit with it regardless. As I understand it.
« Last Edit: September 21, 2014, 05:04:41 PM by zing12 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #8 on: September 21, 2014, 06:07:51 PM »
Here's a plan B:

This company based in Indianapolis offers a more comprehensive travel medical insurance plan. It doesn't solely cover the emergency and evacuation home like some of the other travel insurances, it appears to cover doctor visits and procedures all over the earth. You can even get "end of trip insurance" that covers incidents in the states for a month or two when you return, before you get your life set up again.

http://www.imglobal.com/en/img-insurance/travel-medical-insurance/patriot-travel-medical-insurance/benefits.aspx

It does not meet Obamacare's minimum coverage requirements, however, so I'd still be subject to penalty. But, at that point, I could either

A)stay out of the country for 330+ days and be exempt;
B)make less than the IRS tax filing limit and be exempt, which is likely. I'd just have to read up on foreign income in case I decide to work abroad;
C)get on medicaid for the purpose of avoiding the penalty penalized; OR
D)pay the penalty if I have to

If I got cancer, which I just like to use as a worst-case scenario, I could just return home and purchase any exchange plan because of the ACA's new preexisting condition rules. We all in this country have to change the way we think about insurance... you can get new coverage now even if you're already sick, the catch is, we have to force everyone to have insurance... otherwise people would wait until they got sick to get insured. It's really quite clever. I'm sure this law will have some kinks that will need to be worked out, but I really think it is a good thing for our society as a whole and even for individual freedom. Before, if you or a family member was sick, you effectively could never leave your job because you'd never get coverage again. What kind of freedom is that?

Subsidies and medicaid for mustachian types is just an added bonus. It's amazing how expensive it is to have a high income in this country.
« Last Edit: September 21, 2014, 06:15:16 PM by zing12 »

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #9 on: September 21, 2014, 06:21:41 PM »
Considering that moving back to the States would be a qualifying event that would allow you to get health insurance upon your return, I'd seriously consider deliberately forgoing US-based insurance and simply paying the penalty.  The max penalty you're looking at in 2016 and beyond is the greater of $695 or 2.5% of salary.  If you're anticipating earning less than $15k, it'd just be $695.  That might be a small price to pay to avoid discomfort at enrolling in Medicaid.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #10 on: September 21, 2014, 06:31:32 PM »
Considering that moving back to the States would be a qualifying event that would allow you to get health insurance upon your return, I'd seriously consider deliberately forgoing US-based insurance and simply paying the penalty.  The max penalty you're looking at in 2016 and beyond is the greater of $695 or 2.5% of salary.  If you're anticipating earning less than $15k, it'd just be $695.  That might be a small price to pay to avoid discomfort at enrolling in Medicaid.

Would it be a qualifying event though, if I never actually establish any kind of permanent residency abroad? I'm still going to keep my address, bank accounts, and everything at my parents' house. I'm not sure what the burden of proof is on a qualifying event.

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #11 on: September 21, 2014, 06:42:00 PM »
Considering that moving back to the States would be a qualifying event that would allow you to get health insurance upon your return, I'd seriously consider deliberately forgoing US-based insurance and simply paying the penalty.  The max penalty you're looking at in 2016 and beyond is the greater of $695 or 2.5% of salary.  If you're anticipating earning less than $15k, it'd just be $695.  That might be a small price to pay to avoid discomfort at enrolling in Medicaid.

Would it be a qualifying event though, if I never actually establish any kind of permanent residency abroad? I'm still going to keep my address, bank accounts, and everything at my parents' house. I'm not sure what the burden of proof is on a qualifying event.

I don't see why not.  You have to remain a tax resident of a state, but you wouldn't actually be resident in that state while you were abroad.  You can read the text of the rules for yourself to see if you think they would qualify:
http://www.law.cornell.edu/cfr/text/45/155.420
(see number 7)

MikeBear

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Re: Time off to travel the world, going on medicaid???
« Reply #12 on: September 21, 2014, 08:58:52 PM »
Don't forget that if you go on Medicaid, once you die the government WILL grab any assets they can to reimburse for anybody that has received Medicaid benefits under the program. That can be a big problem... No, you can NOT hide assets to avoid that.

Here's the rules for Michigan:

http://www.michigan.gov/mdch/0,1607,7-132-2943_4860_56113_58553---,00.html

Quote
    What is Estate Recovery?
 Medicaid is a State and Federally funded program that pays for healthcare if you have limited income.  The Federal government requires state Medicaid programs to seek recovery from the estates of certain deceased beneficiaries who have received benefits from a state Medicaid program.
Under the Estate Recovery program, the Michigan Department of Community Health (MDCH) will seek repayment of benefits received from Medicaid.  Under some circumstances, the state may choose not to seek recovery from your estate. 

 

Josiecat

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Re: Time off to travel the world, going on medicaid???
« Reply #13 on: September 21, 2014, 09:03:48 PM »
Sounds like a lot of hassle to me.  Think I'd just pay for regular insurance and move on with my life.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #14 on: September 22, 2014, 01:25:37 PM »
Considering that moving back to the States would be a qualifying event that would allow you to get health insurance upon your return, I'd seriously consider deliberately forgoing US-based insurance and simply paying the penalty.  The max penalty you're looking at in 2016 and beyond is the greater of $695 or 2.5% of salary.  If you're anticipating earning less than $15k, it'd just be $695.  That might be a small price to pay to avoid discomfort at enrolling in Medicaid.

There shouldn't be a penalty for the time spend living outside the country.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #15 on: September 22, 2014, 01:30:49 PM »
Don't forget that if you go on Medicaid, once you die the government WILL grab any assets they can to reimburse for anybody that has received Medicaid benefits under the program. That can be a big problem... No, you can NOT hide assets to avoid that.

Here's the rules for Michigan:

http://www.michigan.gov/mdch/0,1607,7-132-2943_4860_56113_58553---,00.html

Quote
    What is Estate Recovery?
 Medicaid is a State and Federally funded program that pays for healthcare if you have limited income.  The Federal government requires state Medicaid programs to seek recovery from the estates of certain deceased beneficiaries who have received benefits from a state Medicaid program.
Under the Estate Recovery program, the Michigan Department of Community Health (MDCH) will seek repayment of benefits received from Medicaid.  Under some circumstances, the state may choose not to seek recovery from your estate. 

I'm not 100% sure, but I believe that "traditional" Medicaid (what existed before the ACA--and still exists--and has eligibility such as being disabled, pregnant, a child, etc) is different than "expanded" Medicaid (the new form of Medicaid with eligibility only dependent on income) with respect to this provision. I also believe that I've read that this provision is not widely utilized. And I think it would generally apply to people who are expensive and die on Medicaid. But again I'm not 100% sure on that.

Traditional Medicaid does require people to spend down their assets in many cases to get certain coverages. Expanded Medicaid does not.

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #16 on: September 22, 2014, 02:05:46 PM »
Considering that moving back to the States would be a qualifying event that would allow you to get health insurance upon your return, I'd seriously consider deliberately forgoing US-based insurance and simply paying the penalty.  The max penalty you're looking at in 2016 and beyond is the greater of $695 or 2.5% of salary.  If you're anticipating earning less than $15k, it'd just be $695.  That might be a small price to pay to avoid discomfort at enrolling in Medicaid.

There shouldn't be a penalty for the time spend living outside the country.

I agree, but if the OP doesn't have qualifying insurance in another country, then the penalty isn't for time spent living outside the country -- the penalty is for not having insurance.  And yes, there are international health policies that count as having insurance.

Bob W

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Re: Time off to travel the world, going on medicaid???
« Reply #17 on: September 22, 2014, 02:40:20 PM »
All my clients have Medicaid.   In Missouri you're required to have less than $999 in assets.   A test you would surely fail.    I'm guessing it is the same in most states?

I believe your best bet is the Gold level exchange.   Your coverage would probably cost less than $100 per month since your sub poverty.  Don't know what the international type of travel stuff cost.  Best to shop around.   

With any luck you won't need to use any of this.   

And by the way,  in case your wondering,  Medicaid covers 100% generally.   It is pretty gold plated for my guys.   No script, copays etc... 

It is the most abused system in the world other than Medicare. 

Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

TreeTired

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Re: Time off to travel the world, going on medicaid???
« Reply #18 on: September 22, 2014, 02:54:52 PM »
Let's try reading the link:

Quote
Estate Recovery only applies to Medicaid beneficiaries who:
·  are 55 years of age or older; and
·  have received long-term care services anytime on or after September 30, 2007.

That does not sound like someone under 55 years of age (or older for that matter)  who has applied for and received Medicaid health insurance under the ACA.   

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #19 on: September 22, 2014, 03:01:12 PM »
All my clients have Medicaid.   In Missouri you're required to have less than $999 in assets.   A test you would surely fail.    I'm guessing it is the same in most states?

I believe your best bet is the Gold level exchange.   Your coverage would probably cost less than $100 per month since your sub poverty.  Don't know what the international type of travel stuff cost.  Best to shop around.   

With any luck you won't need to use any of this.   

And by the way,  in case your wondering,  Medicaid covers 100% generally.   It is pretty gold plated for my guys.   No script, copays etc... 

It is the most abused system in the world other than Medicare. 

Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.

Bob W

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Re: Time off to travel the world, going on medicaid???
« Reply #20 on: September 22, 2014, 04:17:14 PM »
All my clients have Medicaid.   In Missouri you're required to have less than $999 in assets.   A test you would surely fail.    I'm guessing it is the same in most states?

I believe your best bet is the Gold level exchange.   Your coverage would probably cost less than $100 per month since your sub poverty.  Don't know what the international type of travel stuff cost.  Best to shop around.   

With any luck you won't need to use any of this.   

And by the way,  in case your wondering,  Medicaid covers 100% generally.   It is pretty gold plated for my guys.   No script, copays etc... 

It is the most abused system in the world other than Medicare. 

Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.

Not sure which year or which state you're referring to.   I receive asset tests from our Social Service dept. monthly from Jan 2014 to today Sep 22 2014.    I've had 3 clients this year lose Medicaid due to having assets over $999. 

There may be state by state guidelines but in our state attorneys still advertise to set people up to avoid paying for their own damn nursing homes by diverting assets ahead of time.  I can't imagine the attorneys would allow that to go away?

I'm not a Medicaid expert,  just know how it works in Missouri.   I'm sure the initiator of this thread can google his state requirements pretty easily.  The Medicaid expansion is not approved in Missouri or several other states.

The way the ACA is implemented varies by state as well.   But you can go to the Kaiser calculator and check pretty quickly. 

If this gentleman was in Missouri his annual premium for a Silver level plan would be $300, if he claimed $15,000 in income.   The silver plan is pretty shitty, that is why I would recommend the gold plan.  It won't cover you as nicely as Medicaid of course. 

One caution is that the "year" as they define it appears to be a calendar year.   It is a projected number.  So one may need to be cautious about dividends and shifting income from one year to another.   

Our CPA here is probably pretty good at moving things around on paper to define his own income I'm guessing.

The ACA is the greatest gift an early retiree could ever wish for.   I know many people for decades now that continued working to keep health insurance or would not switch jobs or go out alone.     Now they can.


Spartana

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Re: Time off to travel the world, going on medicaid???
« Reply #21 on: September 22, 2014, 04:29:14 PM »
All my clients have Medicaid.   In Missouri you're required to have less than $999 in assets.   A test you would surely fail.    I'm guessing it is the same in most states?

I believe your best bet is the Gold level exchange.   Your coverage would probably cost less than $100 per month since your sub poverty.  Don't know what the international type of travel stuff cost.  Best to shop around.   

With any luck you won't need to use any of this.   

And by the way,  in case your wondering,  Medicaid covers 100% generally.   It is pretty gold plated for my guys.   No script, copays etc... 

It is the most abused system in the world other than Medicare. 

Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.
It depends on the state. In Calif they have expanded Medicaid so they won't count assets - only taxable income (MAGI) toward getting on Medicaid. As long as you taxable income is below the approx. $16K you can go on Medicaid with any amount of assets. Other states still count assets in order to qualify for Medicaid so it just depends on what state you are in and what their income & asset limits are. But you are correct that, at least in Medicaid expanded states, you can't get subsidies if your income is below the lowest subsidy level - only Medicaid.

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #22 on: September 22, 2014, 04:37:38 PM »
The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.

Not sure which year or which state you're referring to.   I receive asset tests from our Social Service dept. monthly from Jan 2014 to today Sep 22 2014.    I've had 3 clients this year lose Medicaid due to having assets over $999. 

There may be state by state guidelines but in our state attorneys still advertise to set people up to avoid paying for their own damn nursing homes by diverting assets ahead of time.  I can't imagine the attorneys would allow that to go away?

I'm not a Medicaid expert,  just know how it works in Missouri.   I'm sure the initiator of this thread can google his state requirements pretty easily.  The Medicaid expansion is not approved in Missouri or several other states.

The way the ACA is implemented varies by state as well.   But you can go to the Kaiser calculator and check pretty quickly. 

If this gentleman was in Missouri his annual premium for a Silver level plan would be $300, if he claimed $15,000 in income.   The silver plan is pretty shitty, that is why I would recommend the gold plan.  It won't cover you as nicely as Medicaid of course. 

One caution is that the "year" as they define it appears to be a calendar year.   It is a projected number.  So one may need to be cautious about dividends and shifting income from one year to another.   

Our CPA here is probably pretty good at moving things around on paper to define his own income I'm guessing.

The ACA is the greatest gift an early retiree could ever wish for.   I know many people for decades now that continued working to keep health insurance or would not switch jobs or go out alone.     Now they can.

Fascinating.  Apparently that rule is one of the ones tossed out by the Supreme Court when they ruled that states were not required to expand Medicaid. 

In states that expanded Medicaid, it is required that they use only an income test.  See http://theincidentaleconomist.com/wordpress/bye-bye-medicaid-asset-test/ and http://www.hca.wa.gov/hcr/me/Pages/faq.aspx#new10 and http://healthaffairs.org/blog/2014/02/24/implementing-health-reform-medicaid-asset-rules-and-the-affordable-care-act/

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #23 on: September 22, 2014, 04:55:02 PM »
There have been a lot of responses since I last signed on, so I'll respond to everyone....

Don't forget that if you go on Medicaid, once you die the government WILL grab any assets they can to reimburse for anybody that has received Medicaid benefits under the program. That can be a big problem... No, you can NOT hide assets to avoid that.

MikeBear, that is only for people over 55 and in long term care. It's a very unfortunate hole in the law because there are some people who are over 55, retired early with low income, but too young for medicare, who either can buy unsubsidized plans at exorbitant prices, or go on medicaid and risk their assets. So they are opting to go without insurance until eligible for medicare. Unfortunate but wouldn't affect me in this case.

Quote from: beltim
I agree, but if the OP doesn't have qualifying insurance in another country, then the penalty isn't for time spent living outside the country -- the penalty is for not having insurance.  And yes, there are international health policies that count as having insurance.

beltim, there are US polices that meet the coverage requirements, that offer international benefits, but their international benefits are not as good as the international health insurance plans. but those plans don't count for meeting the ACA requirement. See imglobal.com - they are one of the better international providers out there and they say right on their website that it doesn't satisfy the ACA.

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Re: Time off to travel the world, going on medicaid???
« Reply #24 on: September 22, 2014, 05:05:58 PM »
You can enroll in coverage outside of the open enrollment period if you have a qualifying life event. Moving to the US from abroad is a qualifying life event (as is moving from one state to the next). So if you come back to the US mid-year, you have 60 days to enroll. You don't get penalized for the time you're out of the country.
For Medicaid in Calif (which is one of the states that has expanded Medicaid) you can enroll at anytime for Medicaid but not for premium subsidies unless, as you pointed out, he/she has a "qualifying life event". So if the OP's state has the same policy he/she may not have to wait for the open enrollment period or have a qualifying life event to get Medicaid.  Also if their income is below $16K there is no penalty at all for not having medical insurance even if they choose not to go on Medicaid. From Cali's exchange website:

 5. When will I be able to get coverage through Covered California?

Covered California will begin enrollment on Oct. 1, 2013, for coverage that will take effect Jan. 1, 2014. The open-enrollment period for coverage during 2014 will run from Oct. 1, 2013, to March 31, 2014. If you are eligible for Medi-Cal (Cali's Medicaid program), the open enrollment period does not matter.


According to the law, the people who do not have to comply with Obamacare's mandate, and who will not face any penalty for noncompliance, are:
1.Individuals who cannot afford coverage. For 2014, this means people who cannot afford health insurance because the premium (based on the lowest-cost Bronze plan, or the individual's share of an employer-sponsored plan) exceeds 8 percent of their household income. After 2014, the Secretary of Health and Human Services may revise the threshold.



OP (Zing 12) If your state has expanded Medicaid you should just be able to sign up online - at your states exchange or the federal exchange - and they will automatically put you into Medicaid if your taxable income is low enough. They did this with me even though I didn't want to get on Medicaid but was trying to sign up for a Silver Level plan on my state's exchange. They may ask you to send in some additional paperwork to determine you income level if your last years taxes are higher then what you said your income is, so be prepared for that. I was already ER'd for over 10 years before the ACA came into effect and bought my own low cost catastrophic plan until  it was cancelled in Jan. Since my taxable income is too low (even though I have high assets and other, non-taxable, income from the VA) and because I can use the VA hospitals or free I wasn't able to get subsidies, only Medicaid. I chose not to get it (cancelled it...for now) and just use the VA but if I could I would continue to buy a catastrophic plan as I think it allows me more freedom to move around, travel, etc... without the specter of Medicaid hanging over my head. I'm too old to get one of those but I think if you are under 30 you can. So you might want to check that out if it suits your travel needs better. Otherwise go with Medicaid and don't worry about the ethical issue surrounding it. Many people are taking the full subsidies and fiddling with their incomes and taxes to get better subsidies so they can FIRE. This is really not too different. And as Forummm pointed out to me in another thread,  it really doesn't cost the taxpayers anything for you to go on Medicaid unless you use it. Itactaully costs the taxpayer MORE to fund the subsidies to pay the private insurers big bucks every month for insurance premiums that, maybe, many people never use for health care.
« Last Edit: September 22, 2014, 05:23:15 PM by Spartana »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #25 on: September 22, 2014, 05:11:52 PM »
Bob Werner and beltim, to reply to the discussion you guys have been having....

Bob, Ohio has expanded medicaid and MO hasn't and all signs point to that I'm perfectly eligible with no consideration of my assets. Also, the problem with me going for a subsidized exchange plan is that I wouldn't qualify for the subsidy unless I made more than 138% of federal poverty... which is around $15k this year. While I am certainly open to making money while on the trip, I'm not going to plan for it, I'm going to plan for $0 income. If you plan on $15,000 and get subsidies on the exchange, and make less than that, you have to pay the subsidies back on your tax return. So you obviously want to play cautious with that.

So, assuming $0 income, if I went on the exchange, a bronze plan, unsubsidized, would cost me something like $2k for the year.

(Which, by the way, I wouldn't be opposed to spending that amount to be covered adequately. I'm not just trying to get free shit. The issue I have with it is to have adequate coverage overseas, I'd also want to drop another grand on travel insurance. I'm not going to do a grand on travel insurance and a 2 grand on crappy US insurance just to comply with the law.)

So really when it comes down to it, when you're at $0 in income, the law is designed for you to go on (expanded) medicaid. At the $0 income level, my options would be

1. Medicaid for free
2. Bronze exchange plan, which is probably worse care than medicaid, for $2,000+
3. Pay a penalty. (My trip would probably be in 2016 so I'd be looking at the real, $695 penalty. not the phasing-it-in-slowly $95 penalty they are doing this year.)

So really, the more research I do about this, it seems like what I am supposed to do under the law, is go on medicaid. In light of that, when applying for medicaid, I would just be honest about my travel plans, and say I'm trying to follow the law and avoid the penalty.

As far as states that didn't expand medicaid, unfortunately it's totally screwed the law up for now, because only people in between 138%-400% of federal poverty get help with insurance now.... the actual people below the poverty line don't get any help. Eventually those states will all cave though, it's just political posturing it's only a matter of time before pressure from hospitals, insurance companies, citizens, etc, gets to them... even in the red states.

Spartana

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Re: Time off to travel the world, going on medicaid???
« Reply #26 on: September 22, 2014, 05:20:24 PM »


So, assuming $0 income,  3. Pay a penalty.
If your income is below the cut off of approx. $15500 you do not have to pay a penalty for not having insurance. you would be in one of the approx. 8 or 9 exempt groups.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #27 on: September 22, 2014, 05:23:46 PM »
You can enroll in coverage outside of the open enrollment period if you have a qualifying life event. Moving to the US from abroad is a qualifying life event (as is moving from one state to the next). So if you come back to the US mid-year, you have 60 days to enroll. You don't get penalized for the time you're out of the country.
For Medicaid in Calif (which is one of the states that has expanded Medicaid) you can enroll at anytime for Medicaid but not for premium subsidies unless, as you pointed out, he/she has a "qualifying life event". So if the OP's state has the same policy he/she may not have to wait for the open enrollment period to get Medicaid.  Also if their income is below $16K there is no penalty at all for not having medical insurance even if they choose not to go on Medicaid. From Cali's exchange website:

 5. When will I be able to get coverage through Covered California?

Covered California will begin enrollment on Oct. 1, 2013, for coverage that will take effect Jan. 1, 2014. The open-enrollment period for coverage during 2014 will run from Oct. 1, 2013, to March 31, 2014. If you are eligible for Medi-Cal, the open enrollment period does not matter.


OP (Zing 12) If your state has expanded Medicaid you should just be able to sign up online - at your states exchange or the federal exchange - and they will automatically put you into Medicaid if your taxable income is low enough. They did this with me even though I didn't want to get on Medicaid but was trying to sign up for a Silver Level plan on my state's exchange. They may ask you to send in some additional paperwork to determine you income level if your last years taxes are higher then what you said your income is, so be prepared for that. I was already ER'd for over 10 years before the ACA came into effect and bought my own low cost catastrophic plan until  it was cancelled in Jan. Since my taxable income is too low (even though I have high assets and other, non-taxable, income from the VA) and because I can use the VA hospitals or free I wasn't able to get subsidies, only Medicaid. I chose not to get it (cancelled it...for now) and just use the VA but if I could I would continue to buy a catastrophic plan as I think it allows me more freedom to move around, travel, etc... without the specter of Medicaid hanging over my head. I'm too old to get one of those but I think if you are under 30 you can. So you might want to check that out if it suits your travel needs better. Otherwise go with Medicaid and don't worry about the ethical issue surrounding it. Many people are taking the full subsidies and fiddling with their incomes and taxes to get better subsidies so they can FIRE. This is really not too different. And as Forummm pointed out to me in another thread,  it really doesn't cost the taxpayers anything for you to go on Medicaid unless you use it. Itactaully costs the taxpayer MORE to fund the subsidies to pay the private insurers big bucks every month for insurance premiums that, maybe, many people never use for health care.

Yes spartana, the more research I do, the way the law was created, I am supposed to go on medicaid if I have no income. It's that simple. Or pay a penalty, or pay for crappier insurance, as seen in my previous post.

I did want to make one comment on the ethical thing. I struggle with it. In my thinking brain, it is appropriate to take advantage of any tax break or government benefit you are legally entitled to... especially as we all pay taxes and we did not choose the system we live in. Emotionally, it's harder to accept. I would compare it to Catholic guilt. Like, as a thinking adults, many people don't believe that premarital sex is wrong... but due to conditioning, can't help but feel a little bit guilty about doing it. That's how I feel about the medicaid thing. I pay taxes, I should be able to claim the benefit... but I feel guilty even considering it, I feel like a freeloader... and it's just due to the predominant attitudes in our society. And also due to the fact that the plan that fits me best just so happens to be called "medicaid" and what the connotations of that term are. I'll have to get over it I guess and just do what's best for me... but it kinda sucks.
« Last Edit: September 22, 2014, 05:40:15 PM by zing12 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #28 on: September 22, 2014, 05:27:38 PM »


So, assuming $0 income,  3. Pay a penalty.
If your income is below the cut off of approx. $15500 you do not have to pay a penalty for not having insurance. you would be in one of the approx. 8 or 9 exempt groups.

Damn, you're right... I did know that but it's hard to keep all the rules straight. It's actually the tax filing minimum, so closer to $10k, but still, zero is exempt.

However, I would want to plan it out so that I could earn income if I wanted, but didn't have to earn income. In other words -

1. if I planned on no income, didn't get insurance, but then earned $20k, now I owe the penalty.
2. if I plan on income, get the subsidized exchange plan, but don't make the income - now I pay full price for my plan
3. if I plan on income, don't get insurance, and make the income, I owe the penalty.
4. if I plan on no income, and get medicaid, now if I earn $20k, I simply tell medicaid I'm no longer eligible. And, that's a qualifying event to then go buy a new plan. Still by far the best option and clearly the option the legislation would intend me to take.

Even if you don't have to pay a penalty, the qualifying event thing can be a type of penalty. If you don't have insurance, you can only get it in certain times of year. But if you do, and lose it, you can easily go get more. The law is set up to penalize not having it in more ways than one.
« Last Edit: September 22, 2014, 05:31:42 PM by zing12 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #29 on: September 22, 2014, 05:36:18 PM »
Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

Love it haha

JoJo

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Re: Time off to travel the world, going on medicaid???
« Reply #30 on: September 22, 2014, 06:42:19 PM »
I traveled around the world for 20 months at age 31.  Maybe I was naive but I got by with a cheap-o emergency plan.  Sure, it doesn't cover the big stuff (cancer) but you'll find that visiting hospitals in other countries, even developed ones won't even match the deductible.  I also got my regular dental cleaning & check up done in Thailand for about $15.

Spartana

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Re: Time off to travel the world, going on medicaid???
« Reply #31 on: September 22, 2014, 06:52:25 PM »


So, assuming $0 income,  3. Pay a penalty.
If your income is below the cut off of approx. $15500 you do not have to pay a penalty for not having insurance. you would be in one of the approx. 8 or 9 exempt groups.

Damn, you're right... I did know that but it's hard to keep all the rules straight. It's actually the tax filing minimum, so closer to $10k, but still, zero is exempt.

However, I would want to plan it out so that I could earn income if I wanted, but didn't have to earn income. In other words -

1. if I planned on no income, didn't get insurance, but then earned $20k, now I owe the penalty.
2. if I plan on income, get the subsidized exchange plan, but don't make the income - now I pay full price for my plan
3. if I plan on income, don't get insurance, and make the income, I owe the penalty.
4. if I plan on no income, and get medicaid, now if I earn $20k, I simply tell medicaid I'm no longer eligible. And, that's a qualifying event to then go buy a new plan. Still by far the best option and clearly the option the legislation would intend me to take.

Even if you don't have to pay a penalty, the qualifying event thing can be a type of penalty. If you don't have insurance, you can only get it in certain times of year. But if you do, and lose it, you can easily go get more. The law is set up to penalize not having it in more ways than one.
Welcome to the Thunder Dome - where no one gets out alive!

In your case, since this is going to be a temp thing and not longer then a year or so, I'd opt for the no income/on Medicaid option. Just don't earn any money in that time, or if you do keep it below the cut off, and you'll be OK.  If things change financially you can always cancel Medicaid and then buy a plan off the exchange (there are plans you can buy that will cover the months between open enrollment from private companies to meet that need called Gap Plans or something like that) or just pay the penalty. 

Bob W

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Re: Time off to travel the world, going on medicaid???
« Reply #32 on: September 22, 2014, 09:21:54 PM »
Since you'll be leaving the US one would think you could choose any state you like to declare residency.  Thus in a non expansion state your insurance is capped at 2% of income.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #33 on: September 23, 2014, 11:35:16 AM »
Let's try reading the link:

Quote
Estate Recovery only applies to Medicaid beneficiaries who:
·  are 55 years of age or older; and
·  have received long-term care services anytime on or after September 30, 2007.

That does not sound like someone under 55 years of age (or older for that matter)  who has applied for and received Medicaid health insurance under the ACA.

The key part there is "long-term care services". That's for very expensive services like being in a nursing home for a long time.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #34 on: September 23, 2014, 11:42:04 AM »
All my clients have Medicaid.   In Missouri you're required to have less than $999 in assets.   A test you would surely fail.    I'm guessing it is the same in most states?

I believe your best bet is the Gold level exchange.   Your coverage would probably cost less than $100 per month since your sub poverty.  Don't know what the international type of travel stuff cost.  Best to shop around.   

With any luck you won't need to use any of this.   

And by the way,  in case your wondering,  Medicaid covers 100% generally.   It is pretty gold plated for my guys.   No script, copays etc... 

It is the most abused system in the world other than Medicare. 

Enjoy your mini retirement!  If you get good at it and start a little blog, you might be able to extend it indefinitely.   Be sure to deduct the entire trip as a business expense and carry the loss forward!

The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.

Asset tests are not in effect for the "expanded" Medicaid (up to 133% of the federal poverty level). They remain in effect for other "traditional" Medicaid program eligibility requirements (foster care children, SSI/SSDI recipients, the elderly, etc).

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #35 on: September 23, 2014, 11:48:00 AM »
But, at that point, I could either

A)stay out of the country for 330+ days and be exempt;
B)make less than the IRS tax filing limit and be exempt, which is likely. I'd just have to read up on foreign income in case I decide to work abroad;
C)get on medicaid for the purpose of avoiding the penalty penalized; OR
D)pay the penalty if I have to


You are correct about the 330 days issue. I didn't realize you were only planning to be gone a short time. If your income is above the IRS filing limit, and above 138% FPL, you could get a tax credit for a private plan--maybe $25-$50 for a silver plan that includes cost sharing reductions. If your income is low (say 150% FPL) you can get a cheap bronze plan for free due to the way the tax credits work. They are calculated as a flat dollar amount of credit based on you paying a certain percent of your income in premiums for the second lowest cost silver plan where you live. If you get a cheaper plan than the 2nd lowest cost silver plan, then your premium amount goes down. It gets down to being free in many cases. But you can only get the cost sharing reductions (available up to 250% FPL) if you get a silver plan.

http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision

http://www.irs.gov/uac/ACA-Individual-Shared-Responsibility-Provision-Exemptions

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #36 on: September 23, 2014, 11:56:43 AM »
The ACA eliminated asset tests for Medicaid eligibility starting this year. And the OP won't be eligible for a subsidy if they are eligible for Medicaid.

Not sure which year or which state you're referring to.   I receive asset tests from our Social Service dept. monthly from Jan 2014 to today Sep 22 2014.    I've had 3 clients this year lose Medicaid due to having assets over $999. 

There may be state by state guidelines but in our state attorneys still advertise to set people up to avoid paying for their own damn nursing homes by diverting assets ahead of time.  I can't imagine the attorneys would allow that to go away?

I'm not a Medicaid expert,  just know how it works in Missouri.   I'm sure the initiator of this thread can google his state requirements pretty easily.  The Medicaid expansion is not approved in Missouri or several other states.

The way the ACA is implemented varies by state as well.   But you can go to the Kaiser calculator and check pretty quickly. 

If this gentleman was in Missouri his annual premium for a Silver level plan would be $300, if he claimed $15,000 in income.   The silver plan is pretty shitty, that is why I would recommend the gold plan.  It won't cover you as nicely as Medicaid of course. 

One caution is that the "year" as they define it appears to be a calendar year.   It is a projected number.  So one may need to be cautious about dividends and shifting income from one year to another.   

Our CPA here is probably pretty good at moving things around on paper to define his own income I'm guessing.

The ACA is the greatest gift an early retiree could ever wish for.   I know many people for decades now that continued working to keep health insurance or would not switch jobs or go out alone.     Now they can.

Fascinating.  Apparently that rule is one of the ones tossed out by the Supreme Court when they ruled that states were not required to expand Medicaid. 

In states that expanded Medicaid, it is required that they use only an income test.  See http://theincidentaleconomist.com/wordpress/bye-bye-medicaid-asset-test/ and http://www.hca.wa.gov/hcr/me/Pages/faq.aspx#new10 and http://healthaffairs.org/blog/2014/02/24/implementing-health-reform-medicaid-asset-rules-and-the-affordable-care-act/

No, not quite. I know this is very confusing. But, as the links you posted point out, asset tests are still in effect for certain Medicaid programs. There are no asset tests for the Medicaid expansion program. But even in states that expanded Medicaid, a beneficiary may have qualified under a non-expansion method. And the benefits they get are actually a different set of benefits than the people in the same state that qualified through the expansion. Yes, it's very confusing. Maybe we should just have single payer, and pay half as much for better care like the rest of the rich countries.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #37 on: September 23, 2014, 12:04:14 PM »


So, assuming $0 income,  3. Pay a penalty.
If your income is below the cut off of approx. $15500 you do not have to pay a penalty for not having insurance. you would be in one of the approx. 8 or 9 exempt groups.

Damn, you're right... I did know that but it's hard to keep all the rules straight. It's actually the tax filing minimum, so closer to $10k, but still, zero is exempt.

However, I would want to plan it out so that I could earn income if I wanted, but didn't have to earn income. In other words -

1. if I planned on no income, didn't get insurance, but then earned $20k, now I owe the penalty.
2. if I plan on income, get the subsidized exchange plan, but don't make the income - now I pay full price for my plan
3. if I plan on income, don't get insurance, and make the income, I owe the penalty.
4. if I plan on no income, and get medicaid, now if I earn $20k, I simply tell medicaid I'm no longer eligible. And, that's a qualifying event to then go buy a new plan. Still by far the best option and clearly the option the legislation would intend me to take.

Even if you don't have to pay a penalty, the qualifying event thing can be a type of penalty. If you don't have insurance, you can only get it in certain times of year. But if you do, and lose it, you can easily go get more. The law is set up to penalize not having it in more ways than one.

Not quite. You only owe a penalty if the premiums for plans available to you are less than 8% of your income. If your income changes significantly, and pushes you out of the tax credit window, there is a cap on how much you have to pay back (something like $1k).

#4 is what you are supposed to do. In most states it doesn't cost Medicaid anything for you to be enrolled. It only costs them something if you get care.

forummm

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Re: Time off to travel the world, going on medicaid???
« Reply #38 on: September 23, 2014, 12:06:13 PM »
Since you'll be leaving the US one would think you could choose any state you like to declare residency.  Thus in a non expansion state your insurance is capped at 2% of income.

No. The tax credits are only there for people in the 100%-400% range in non-expansion states. So you'd need to have income of at least 100% FPL to get a tax credit. That's right, if you're below 100% you are too poor to get assistance paying for coverage.

beltim

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Re: Time off to travel the world, going on medicaid???
« Reply #39 on: September 23, 2014, 12:15:38 PM »
No, not quite. I know this is very confusing. But, as the links you posted point out, asset tests are still in effect for certain Medicaid programs. There are no asset tests for the Medicaid expansion program. But even in states that expanded Medicaid, a beneficiary may have qualified under a non-expansion method. And the benefits they get are actually a different set of benefits than the people in the same state that qualified through the expansion. Yes, it's very confusing. Maybe we should just have single payer, and pay half as much for better care like the rest of the rich countries.

It gets even more complicated!

I would say, though, that there are plenty of countries without single payer that have better quality and cheaper healthcare than the US.  Single payer is one option, but far from the only option.

El_Viajero

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Re: Time off to travel the world, going on medicaid???
« Reply #40 on: February 12, 2015, 06:21:59 AM »
I realize this is an old topic, but I couldn't help bringing it back to our attention as I don't think the OP's problem was solved.

As someone who recently spent two years backpacking through 10+ countries and had to address the same conundrum, I feel like I can speak with some authority. Ahem...

If you're income is zero and you qualify for Medicaid, just get Medicaid so you can comply with the law. Don't feel bad about getting it even though you have assets that could pay for your care in the event you were sick or injured. Why not? Because you won't actually be using Medicaid to pay for care while you're abroad. Remember: healthcare is much cheaper outside of the US. You will either pay for services with cash or you will purchase a travel policy that covers you while you are away.

My wife and I used World Nomads while we were away: http://www.worldnomads.com/ It's the insurance all the backpackers use. I only had to file a claim once when I injured my foot in Peru. I think my bills for an x-ray + visit with the doctor + adhesive bandages (to stabilize my foot, not to heal a wound) amounted to around $150 USD, and the insurance company immediately mailed a check to my US address after I emailed them copies of the medical bills. This insurance is eminently affordable and the company has a good reputation among travel junkies like yours truly. It's not just for medical insurance, though. It's a full-on travel policy that covers every possible contingency. Read about it for yourself.

Just be sure you have a US address so you can receive claims checks. You'll need to maintain a US address anyway for a whole host of reasons. The government doesn't need to know you were abroad.  You just need a place for the bank to send your statements, a place to list as your address on your tax return, et al. I ran a business while we were traveling. It was a US-based business. The fact that I was doing the work from my laptop via an Internet connection on some other continent was beside the point.

Anyhow, there's no use buying an insurance policy you're unable to actually use. The cheapest private plans aren't going to cover you outside your network anyway, so they obviously will do you no good if you're in another country. Get Medicaid to comply with the law and to pay $0 in premiums for insurance that you aren't going to use anyway. Problem solved.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #41 on: March 31, 2016, 12:52:25 PM »
Hello all, I wanted to post the conclusion to this topic that is a year and a half old. I'm going to give a lot of detail because it might help the mustachian posterity, but it's going to be long:

I left my job on January 15 and applied for Ohio Medicaid the next day. I left for my trip on February 3. Currently I'm spending 3 months doing a bit of "voluntourism" teaching English on a volunteer basis in an Italian high school... that ends on April 30. Then, I'm going to travel Europe for 4 and a half months. I have a flight home booked in September for some weddings I have that month. After the weddings, I may travel a bit more from October to mid December. I'll be home for Christmas and that'll conclude the trip.

After applying for Medicaid, the website allows you to upload documents to prove your income, identity, residence, etc. I uploaded a letter from my employer stating that my employment had ended as a proof of zero income. I anticipated that they would ask me what the heck I'm doing with my life now that I have no job, so I uploaded the information about the volunteer program.

I heard nothing. I called the central office for my county (a large urban county with several offices) at the end of January and they said I only need to wait and the local office will get in touch with me. I waited and waited and waited. I got to Italy and forgot about it for a while as I had other things to worry about. I had a 3 month window to enroll in COBRA which backdates so I figured if there were any emergencies I could just do that. Also I have travel insurance which covers me pretty well while I'm abroad.

I waited some more. I called the number for my local office which always went straight to voice mail, and I left a few messages. I heard nothing. Finally I got fed up and decided the call the state agency (with my Skype #). The guy there acted oh so flabbergasted that it had been two months since I applied and hadn't heard anything. He told me I should "go down there and see what's the problem." Obviously I couldn't "go down there" from Italy so once again I called the central office, the only phone number available online which seems to actually pick up. They also acted shocked and appalled that I hadn't heard back yet. They gave me some direct lines for caseworkers, which was really what I needed the whole time. I left a voice mail.

A week or so later I finally heard back. The caseworker was very friendly and professional. She said she wasn't sure I could be eligible while out of the country, as Ohio law stipulates you must be a resident of the state to receive Medicaid benefits. I explained that I considered myself a permanent resident of Ohio just on a long trip. She was once again understanding and she said she'd leave it to her supervisor to make the decision.

They ended up turning me down. I'm sure that I could have appealled or something but I don't really have the stomach for it. To be honest, I was never really comfortable going on Medicaid to begin with, as mentioned above. They said that the second I return home I'd become eligible, and that I can apply again at that date. They also said that Medicaid can retroactively cover old medical bills, so if God forbid I have to be evacuated home for a medical emergency, the coverage can actually be backdated to cover that.

I thought about this and decided I'm just not into it. I'm relatively anxious about being uninsured and I don't think I'd be able to relax about it as I travel the world. To enjoy my trip, I want insurance, for piece of mind. I looked at "short-term medical" which doesn't satisfy the Obamacare requirements (but I shouldn't have to pay a penalty because my income will be under the filing threshold) but is reasonably priced. I also looked at the marketplace plans, because getting denied for medicaid is a qualifying event for special enrollment period, if your medicaid application was done during open enrollment.

I probably could have just not said anything about leaving the country when I applied, just said I'm living off savings, but I figured I'd get a lot of questions about what I was doing with my life and I don't like lying (or lying by omission). So, it is what it is.

tl;dr - medicaid denied me because they are taking the position that I'm not living in Ohio.

The story's not over yet, I'll continue below with part 2.
« Last Edit: March 31, 2016, 02:24:10 PM by zing12 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #42 on: March 31, 2016, 02:18:52 PM »
Part 2, see previous post.

While the Medicaid caseworkers turned me down, and were slower than I thought possible, they were knowledgeable, courteous, and professional. I respected their decision.

My experience with HealthCare.gov (still currently in process) has been miserable. (I'm not sure if this belongs in the current thread, I considered starting a new one or placing it in an Obamacare thread, but I'll leave it here as it completes the story.)

When you're rejected for Medicaid, if you applied during open enrollment, they send your info back to the marketplace and you get a special enrollment period. They start your application for you. I got an email with instructions for how to go onto the website and finish the application. It contained an application ID# for reference.

We've all heard how bad that website was when it launched. It still pretty much sucks. I could not get the thing to pull up the application that had been started for me. There's a link that says "find my application" for this exact situation, and you can enter the app ID# and continue the app. It would not work. I ended up having to call.

I explained my situation to the rep in detail. She told me I was ineligible for coverage because I'm out of the country. I was getting angry. I understand if Medicaid doesn't want to give it to me for free, but you're telling me I can't buy it myself?

The law states that unless you are out of the country for more than 335 days in a calendar year, you are required to buy coverage. I won't be gone that long. I asked her, "you're telling me that I'm required to buy coverage, but I'm not allowed to buy it?"

She could not grasp this concept. She was just not the brightest and couldn't think original thoughts, frankly. She kept telling me "I know it's frustrating." I asked her to cite the law. She read to me where the law requires you must be "legally present" in the United States to buy the coverage. Since I'm not present, I can't buy, according to her logic. I tried to nicely explain to her that that means you can't be an illegal immigrant. Once again, couldn't grasp the concept.

She told me I would be eligible for a qualifying event when I come home as I'm moving back home, based on a move. I wasn't buying it, because I don't think I'm really "moving" home and I never "moved out." I asked to appeal and she put me on hold.

She came back and said surprise, her supervisor said if I am only out of the country temporarily, I can apply. Sheesh.

I got the application through and she said I'd be able to look at the plans online. However, for whatever reason the stupid website still doesn't show my application properly. I'm going to have to enroll over the phone I think.

There's some good news... I realized that if I convert my 401(k), or part of it, to a Roth IRA, I'd get taxed at very low levels since I'm not working, and it'd bring my income up to the level where I get subsidies. Two birds with one stone.

I considered doing the rollover before enrolling (I have 60 days to enroll) then changing my application, but I don't want to have to apply again and be asked more questions about where I am, I'd rather just get enrolled, then do the rollover, and then call and have the subsidy adjusted.

tl;dr - at first the marketplace gave me trouble for being abroad as well, but I talked my way into them letting me in. Going to go with a marketplace plan.
« Last Edit: March 31, 2016, 02:25:23 PM by zing12 »

jim555

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Re: Time off to travel the world, going on medicaid???
« Reply #43 on: March 31, 2016, 08:49:29 PM »
Open enrolment does not apply to Medicaid, you can apply at any time.  You confused them by saying you are out of the country.  If you want to do Roth conversions to get over 138% FPL, do them MONTHLY.  This is because of the way income is considered. 

You can always buy a policy outside the Marketplace on your own for full price.

jim555

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Re: Time off to travel the world, going on medicaid???
« Reply #44 on: March 31, 2016, 08:59:40 PM »
a)What is it like to apply for medicaid? What will I need to do to prove that my income is zero? Also, will they want to check up on me regularly? Should I tell them I am going out of the country or keep that to myself?
I applied through NY's web site.  Declared my estimated income.  Never was asked for documentation.  No one has checked up with me.

b)Is there some sort of "you have to prove you are trying to find a job" requirement that the program has (like TANF or other programs) that I'm not seeing? Because I, by definition of what I am trying to do here, would not be trying to find a job at all, the entire time.
Work requirements are NOT permitted under the ACA.

c)Are people going to look at me funny? Will the social workers not want to work with me? Will anyone give me a hard time? I know that Ohio has an online application system, so hopefully I can minimize any contact with them and just discretely get my medicaid...
The system in my state is seamless and I have never dealt with Social Services at all.


zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #45 on: April 01, 2016, 01:58:56 AM »
Open enrolment does not apply to Medicaid, you can apply at any time.  You confused them by saying you are out of the country.  If you want to do Roth conversions to get over 138% FPL, do them MONTHLY.  This is because of the way income is considered. 

You can always buy a policy outside the Marketplace on your own for full price.

Yes I know open enrollment doesn't apply to medicaid, but if you get denied for medicaid, in order to get a special enrollment period in the marketplace, you need to have applied for medicaid during open enrollment.

I know there's no work requirement per se, but I did figure they would ask what I'm doing with my life, just for the purposes of verifying if I truly have zero income. I talked to an early retiree poster on here via PM last year, who said her Ohio Medicaid caseworkers didn't believe that they were early retired, asked lots of questions, called their former employers, etc... so I was trying to avoid that process by just giving them a believable, true story.

Interesting point on the monthly roth conversions. Are you sure about that though? I think Medicaid goes off monthly but the marketplace is annual. Looking at the tax forms it seems to be based on annual income, and when I applied they asked for annual income. Also here they say "estimated 2016 income" https://www.healthcare.gov/income-and-household-information/income/

Can anyone confirm?
« Last Edit: April 01, 2016, 04:00:04 AM by zing12 »

jim555

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Re: Time off to travel the world, going on medicaid???
« Reply #46 on: April 01, 2016, 04:16:34 AM »
Just tell them you are unemployed, which is true.

Legally, Medicaid is monthly.  Whether the brainiacs at social services know this is another question.  Since it is based on monthly income if you do the conversion all at once the 11 other months will show no income and you would drop back to Medicaid. 

To stay in Medicaid, since you have no plan right now, do the conversion now.  Then apply, the conversion will not be considered at all, since it happened in the previous month. 

Also Medicaid is retroactive 3 months (if you were eligible in those months) so you should be covered in the event of an emergency.

« Last Edit: April 01, 2016, 04:58:54 AM by jim555 »

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #47 on: April 01, 2016, 05:18:30 AM »
But if you  were already enrolled in a marketplace plan and your income dropped to zero, I don't believe they'd actually kick you off the marketplace plan, because you always have the option to buy those plans.

Since on the tax forms it seems to be based on annual income, I think you'd still get subsidies. I was saying this on the other thread, but it seems like it's possible to be eligible for both medicaid and subsidy at that point.

Also you're right about the medicaid retroactive thing, the caseworker told me that as well. She did say that if I came home for a medical emergency I'd be eligible upon arriving so theoretically speaking I could get that care covered after the fact. I wasn't sure how much I trusted that "theoretically speaking" though.
« Last Edit: April 01, 2016, 07:02:08 AM by zing12 »

jim555

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Re: Time off to travel the world, going on medicaid???
« Reply #48 on: April 01, 2016, 07:18:31 AM »
But if you  were already enrolled in a marketplace plan and your income dropped to zero, I don't believe they'd actually kick you off the marketplace plan, because you always have the option to buy those plans.

Since on the tax forms it seems to be based on annual income, I think you'd still get subsidies. I was saying this on the other thread, but it seems like it's possible to be eligible for both medicaid and subsidy at that point.

Also you're right about the medicaid retroactive thing, the caseworker told me that as well. She did say that if I came home for a medical emergency I'd be eligible upon arriving so theoretically speaking I could get that care covered after the fact. I wasn't sure how much I trusted that "theoretically speaking" though.
I reported a drop in income mid year and they dis enrolled me from my Platinum plan and I went to Medicaid.  I got subsidies for the 6 months I had the Platinum plan.  No subsidies are involved with Medicaid since it is free.

zing12

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Re: Time off to travel the world, going on medicaid???
« Reply #49 on: April 01, 2016, 07:32:30 PM »
But if you  were already enrolled in a marketplace plan and your income dropped to zero, I don't believe they'd actually kick you off the marketplace plan, because you always have the option to buy those plans.

Since on the tax forms it seems to be based on annual income, I think you'd still get subsidies. I was saying this on the other thread, but it seems like it's possible to be eligible for both medicaid and subsidy at that point.

Also you're right about the medicaid retroactive thing, the caseworker told me that as well. She did say that if I came home for a medical emergency I'd be eligible upon arriving so theoretically speaking I could get that care covered after the fact. I wasn't sure how much I trusted that "theoretically speaking" though.
I reported a drop in income mid year and they dis enrolled me from my Platinum plan and I went to Medicaid.  I got subsidies for the 6 months I had the Platinum plan.  No subsidies are involved with Medicaid since it is free.

But we both agree you always have the right to pay full price for a marketplace plan, even if you are eligible for Medicaid, correct?

You could have said, "no thanks, I want to stay with my platinum plan. I can pay the full premium each month." (Assuming you had the cash flow) Maybe they would have taken away your advance subsidy and you would have paid the full premium for the rest of the year, maybe not. I don't really know how they operate.

But then, when you would have done your taxes, only annual income is considered. I know because I just looked at all the forms. Your annual income would've been between 138-400% FPL. You would have gotten subsidy for all months enrolled.

This is what I mean when I said you can choose either medicaid or marketplace w/ subsidies. At that moment you were eligible for both. This is a quirk, due to the fact Medicaid eligibility is monthly income and PTC eligibility is annual income. You went with Medicaid because it was a way better deal for you - not because it was required.
« Last Edit: April 01, 2016, 07:37:35 PM by zing12 »