What are the drawbacks for a young person to have Medicaid?

[flyingaway]

My son makes little money and is qualified for Medicaid. In previous years, he used capital gains and Roth conversion to inflate his taxable income to qualify for ACA with subsidies. It seems that manipulation of income is difficult to continue with his very limited assets. So what are the drawbacks for a young person to get on Medicaid? It seems to me that most people prefer ACA to Medicaid even if they have to manipulate taxable income.   

[Cranky]

Medicaid is pretty good insurance but in some areas there aren’t many doctors who accept it because the reimbursement rate is low.

[Morning Glory]

Also it doesn't usually cover dental for adults and you can't go on aca dental without aca medical.  It may be cheaper to take the Medicaid and just pay for the dentist though.

[Rob_bob]

Also it doesn't usually cover dental for adults and you can't go on aca dental without aca medical.  It may be cheaper to take the Medicaid and just pay for the dentist though.

That probably varies by State.  While on Medicaid in Oregon I had dental and when on ACA my dental was the same coverage and price whether I got it though ACA or went directly to the insurer.

[lhamo]

Varies greatly by state/city. Here in Seattle, Medicaid can actually provide MORE treatment options than many ACA or even employer-sponsored plans.  I've been very happy with my options on Medicaid, including dental (can get one cleaning/year).

PS:  In states that expanded medicaid coverage under the ACA the asset test only applies to Medicaid for those 65 and older who qualify for Medicare.  Under 65 asset test was dropped as part of the ACA.

[spartana]

My sister was on medicaid after she got laid off once her unemployment benefits ran out. She just transitioned from her work provided medical insurance (Kaiser) to a Kaiser ACA bronze plan while collecting UE,  then to a Kaiser Medicaid plan once her income was lower. Zero costs, same benefits, doctor and providers and also included dental, vision, and hearing all for free. This was in Calif so YMMV. Calif also doesn't count assets just MAGI income.

[ejmyrow]

Medicaid in Colorado is very good. I suppose it depends on the state and their facilities. States with "medicaid expansion" probably have the best medicaid service.

[kite]

1. Estate recovery:
Mine is one, the state wanted the entirety of my brother’s estate after he died because he was on Medicaid. It works out to be a 100% inheritance tax on the poor.

2. Different tiers of medical care relative to screenings:
CMS declined a CT scan of my brother’s neck when a lump appeared nearby an earlier cancerous tumor. After 6 months of appeals, they approved it, but scheduling as a Medicaid patient meant waiting another month. In those 7 months, the metastatic cancer became inoperable. See item 1 above.
In the same years, I was referred for a CT scan in the same area. I was able, with zero pre-approvals, to get the scan 45 minutes after requested with Aetna as my insurer and a high-deductible plan. I’m alive, he’s dead. See Item 1 above.

3. Different tiers of medication:
I have a condition for which there are a few different medications, each at different price points and effectiveness. Medicaid will pay for only the one that I already know is least effective for me. It’s probably not fatal, but it will be disabling on the Medicaid drug.

[jim555]

1. Estate recovery:
Mine is one, the state wanted the entirety of my brother’s estate after he died because he was on Medicaid. It works out to be a 100% inheritance tax on the poor.

Estate recovery is only for age 55+ and most of the time for institutionalized care costs only.

[jim555]

Medicaid is the best coverage you can get, $200 max out of pocket and complete protection from billing.  Even includes dental and vision, transport to appointments, and Rx that is usually $1 or $3 co-pays.

[sonofsven]

I would think lack of doctors and long wait times would be the biggest potential problem for your son.
But that's a potential problem for ACA coverage as well.

My own recent ACA experience is that it can take a long time to get your care lined up. It took almost a year for my hip replacement, from the day my PCP suggested it after my x ray to the surgery was 11 months.
It could have been quicker but I was holding out for one of the top specialists in the nearest big city; I've heard too many horror stories about our local hospital.
After I met my $2k max out of pocket, my ACA silver plan paid over $42k for the surgery and around $20k in other care.

I'm going on to Medicare this coming year, Oregon Health Plan. They are offering expanded Medicare this year, and raising the income level to $30 k for singles.
I like my existing PCP but he doesn't take Medicare. There is a small clinic that sees the majority of the Medicare patients in my county and they are building a bigger facility right now, but it probably won't be open until next summer.
My plan right now is to be on Medicare, but also see my PCP as needed and pay cash. Last week I called on Monday for an appointment and got in Wednesday; can't beat that.

I would encourage your son to find a PCP as soon as possible, rather than wait until he needs care. A friend told me it took him six months to get an initial appointment with a new PCP after his old one retired.

[jim555]

I would think lack of doctors and long wait times would be the biggest potential problem for your son.
But that's a potential problem for ACA coverage as well.

This has not been my experience the Provider list is not a problem, YMMV.  The again I don't live in a state that hates Medicaid.

[Catbert]

I would think that a young, healthy person is the best candidate for Medicaid.  At least compared to someone with chronic, complicated problems and multiple specialized health care providers.  This assumes that it's a state that doesn't hate Medicaid.

[seattlecyclone]

I would think lack of doctors and long wait times would be the biggest potential problem for your son.
But that's a potential problem for ACA coverage as well.

This has not been my experience the Provider list is not a problem, YMMV.  The again I don't live in a state that hates Medicaid.

Our experience in a state that also doesn't hate Medicaid was that we were able to find providers for all necessary services. The reality is that Medicaid doesn't pay providers as much as other plans do, so the folks who tend to have little trouble filling up their calendars tend not to accept it. What this meant is that we often had to call around a lot to find someone accepting new patients and/or travel to less convenient locations, as the selection was not as numerous as we enjoy on our current employer-provided insurance plan.