Author Topic: fire in medicaid expansion state?  (Read 2542 times)

billy

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fire in medicaid expansion state?
« on: September 06, 2020, 03:46:07 PM »
I'm looking for a medicaid expansion state that others have fired in. I'm in N. Cal. and trying to find something with lower cost of living (will have a small pension later), I don't have to move out of state for my fire (fire in 1.5 yrs.) plan to work for just my wife and I, but trying to come up with a plan "B". So far it seems Cheyenne Wyoming seems interesting, I'm a big Costco fan but didn't see any in Wyoming, and the long freezing weather would be a hard sell for my wife.

Paul der Krake

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Re: fire in medicaid expansion state?
« Reply #1 on: September 06, 2020, 04:00:46 PM »
Wyoming has not expanded Medicaid.

The vast majority of states have, or are in the process of implementing it. You should have no trouble finding none that suits your criterias.

ysette9

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Re: fire in medicaid expansion state?
« Reply #2 on: September 06, 2020, 05:45:47 PM »
Can you help us understand what are the criteria you are looking for in a Plan B? Lower cost of living just because? Or are you looking for something in addition, activities, weather, politics, access to X, something else...?

billy

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Re: fire in medicaid expansion state?
« Reply #3 on: September 06, 2020, 09:47:55 PM »
That's right, I got Wyoming crossed with another state.

I was looking for lower cost of living because I'll have less of a reason to pay the CA. tax as it seems less of a value in the future to stay. I'm willing to be open minded to the state, I know she wants an area where the cold season is not too severe and not too rural. I'm not concerned with politics. An area were there there's multiple races getting along would be good.

nalor511

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Re: fire in medicaid expansion state?
« Reply #4 on: September 06, 2020, 11:40:32 PM »
That's right, I got Wyoming crossed with another state.

I was looking for lower cost of living because I'll have less of a reason to pay the CA. tax as it seems less of a value in the future to stay. I'm willing to be open minded to the state, I know she wants an area where the cold season is not too severe and not too rural. I'm not concerned with politics. An area were there there's multiple races getting along would be good.

CA COL is high, but if you are specifically talking about income tax, then those are actually quite low if your income will be lower in fire. Quite low.

secondcor521

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Re: fire in medicaid expansion state?
« Reply #5 on: September 07, 2020, 12:24:15 AM »
Portland, OR.

Greystache

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Re: fire in medicaid expansion state?
« Reply #6 on: September 07, 2020, 08:08:32 AM »
If tax is the reason you want to leave CA, make sure you take a careful look at your post FIRE tax situation. It could be dramatically different from your present situation. CA income tax is very progressive. It's pretty bad if you are a high income earner, but not bad at all if your income is around the national mean. Our household income was just over $200K when we were both working. We FIREd quite comfortably on $60K and our AGI is even lower, around $43K. Our CA income tax is less than $600.  If you have owned your home for a long time, your property tax is probably a lower rate than just about anywhere in the US. It's true, you could get a lower priced house elsewhere and even with the higher property tax rate, it would be a wash.  CA has a very high sales tax, but it really does not affect us very much. It does not apply to food, and we simply don't buy much stuff.  These days most of the stuff I buy comes from thrift stores and offerup.
BTW, the biggest reason to avoid Wyoming is not the cold, it's the wind. It never stops blowing except on a hot August day when a breeze would be nice, then it stops.

spartana

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Re: fire in medicaid expansion state?
« Reply #7 on: September 07, 2020, 09:41:49 AM »
OP if you qualify to be on expanded Medicaid once FIRE then your MAGI income will be low enough that yoh won't need to pay much, if any, state or fed income taxes. However if housing costs are your issue, then getting out of Calif (or moving to lower cost part of Calif) will greatly help reach your FIRE goals.

As for suggestions for places to live I think we need .more info on your preferences then just "not too cold and Medicaid expansion state. Also if you are counting on Medicaid or the ACA to be around "always" you should have a backup plan in case it isn't. Especially if you are lean FIREing.

billy

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Re: fire in medicaid expansion state?
« Reply #8 on: September 07, 2020, 03:15:28 PM »
That's true my income tax will be lower in the future and CA overall is considered a moderate tax state.

Currently my property tax for the year came to $4,743 for a 1,200 sq ft house on 4,500 sq ft lot, which includes tax percentage of 1% base, plus a ton of city bonds, and $944 special assessment tax which I definitely regret now. Water seems too high and most of the bill is a fixed amount $217 right now for 65 days of service, gas for cars is too much. I'm a big fan of thrift stores and offer up (RIP let go). There's other states which seems lower cost of living but property tax may be as high or higher than CA. I just saw this somewhat funny 10 min skit on youtube with this college kid, called Wyoming doesn't exist.

Ya if ACA goes away that would be a big problem, I'll need to get liberty health share.

sailinlight

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Re: fire in medicaid expansion state?
« Reply #9 on: September 07, 2020, 03:24:44 PM »
California is a huge state with communities that range from somewhere in the State of Jefferson to downtown LA. Taxes are incredibly low if you're retired due to their progressive income taxes and prop 13. If you want useful advice you might want to specify what kind of life you're looking for. We live in a large house on several acres of land on a lake in Northern California and pay way less in property taxes than you do and have a well, septic, and solar so essentially no utility bills.

American GenX

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Re: fire in medicaid expansion state?
« Reply #10 on: September 07, 2020, 05:45:16 PM »

FYI:  The Medicaid expansion is part of the ACA (Affordable Care Act).  SCOTUS will be hearing a lawsuit in November to potentially overturn the ACA, with a decision expected by June 2021, so there may be no ACA by 2022, which also means no Medicaid Expansion.  I wouldn't make any firm plans if you are relying on expanded Medicaid or ACA.  And even if the lawsuit comes out with the ACA standing, if Trump wins another term, he will chip away at the program however he can, fill one or more Supreme Court justices, and will have a better chance of killing the ACA going forward.

spartana

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Re: fire in medicaid expansion state?
« Reply #11 on: September 07, 2020, 06:42:34 PM »
That's true my income tax will be lower in the future and CA overall is considered a moderate tax state.

Currently my property tax for the year came to $4,743 for a 1,200 sq ft house on 4,500 sq ft lot, which includes tax percentage of 1% base, plus a ton of city bonds, and $944 special assessment tax which I definitely regret now. Water seems too high and most of the bill is a fixed amount $217 right now for 65 days of service, gas for cars is too much. I'm a big fan of thrift stores and offer up (RIP let go). There's other states which seems lower cost of living but property tax may be as high or higher than CA. I just saw this somewhat funny 10 min skit on youtube with this college kid, called Wyoming doesn't exist.

Ya if ACA goes away that would be a big problem, I'll need to get liberty health share.
You need to consider the costs for heating (and cooling) a colder weather place. They can be huge compared to the average Calif climate and can often run thousands a year. Prop taxes can also increase pretty drasticly in other states in comparison to Calif. So look at all the factors involved. I live in coastal SoCal in Orange County which is very HCOL for housing but my overall expenses are low for everything from utilities (under $200/month for gas, electric, water, trash and sewer) to taxes. I don't drive much since FIRE so gas isn't much of an issue and fresh food is cheap.
« Last Edit: September 07, 2020, 06:44:30 PM by spartana »

billy

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Re: fire in medicaid expansion state?
« Reply #12 on: September 07, 2020, 07:45:35 PM »
spartana, That's a good point that other states property taxes can vary in the future since they may not a prop 13 equivalent.

I haven't considered relocating in CA, it seems if I'm going to pay the transaction cost of selling my house why not get the most value and move out of state. My plan "B" is something like 50,000+ population town where my lady won't feel she living in a farm town, that and no nasty winters.

Sparks, NV seems interesting and there's a Costco! But other Californians are driving up real estate before I have a chance to move there and drive up real estate.   

lhamo

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Re: fire in medicaid expansion state?
« Reply #13 on: September 07, 2020, 08:58:18 PM »
I have been mostly happy with the healthcare my family and I have received in WA, with the exception of mental health options being limited/not very good. So I am paying out of pocket for that. Other stuff, including specialists, has been fine. But I'm in seattle, so not sure what access is like in other parts of the state.

Property taxes are around 1 percent of assessed value. Sales tax is around 10 per cent, except on most food. No income taxes.  They are supposed to be developing a state healthcare plan that will go into effect in a couple of years, but the pandemic effect on the state budget may delay that..

Abe

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Re: fire in medicaid expansion state?
« Reply #14 on: September 07, 2020, 10:44:02 PM »
I would highly recommend keeping private insurance or living in a less rural area if you have any significant health issues or genetic predisposition to them. Medicaid is often not accepted by many private specialist clinics, especially in rural areas struggling to keep hospitals open, and most state hospital systems (I.e. University of ____) are overflowing with Medicaid recipients in clinics as a result. If itís not urgent (ie an emergency room visit, hospitalization, cancer or cardiac operation, etc) you will not get timely care in most areas. I live in California and worked at a major state hospital, and can compared to other states Iíve worked, the Medicaid patients got better care from us. Iím a cancer specialist so we have an urgency that many other specialties donít have. Even then getting some tests beyond the basics is a teeth-pulling exercise. Elective operations? Ha!

Our healthcare system is a mess where only the richest succeed. Get good private insurance, then switch to Medicare when eligible. Otherwise stay in CA and the doctor will see you eventually, but sooner than elsewhere.
« Last Edit: September 07, 2020, 10:45:57 PM by Abe »

jim555

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Re: fire in medicaid expansion state?
« Reply #15 on: September 08, 2020, 06:13:25 AM »
The quality depends on your state, NY has Managed Care companies run the coverage for the expansion group.  I haven't found any real difference between my old work plan and the Medicaid plans I have been in, they both had the same doctors, but Medicaid has lower costs.  Also NY has set up a group of plans between 138-200% FPL that have a max cost of $20 per month per person or $0.

spartana

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Re: fire in medicaid expansion state?
« Reply #16 on: September 08, 2020, 09:24:06 PM »
True. My sister went on Medicaid after her unemployment ran out following a lay off. She had been on Kaiser through her work, then transitioned to the same Kaiser plan via the ACA while collecting unemployment, then to the same Kaiser plan once her UI ran out and her income was too low for the ACA. There was no noticible change in her care, she kept the same Dr. and used the same medical center.

Paul der Krake

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Re: fire in medicaid expansion state?
« Reply #17 on: September 08, 2020, 09:48:11 PM »
Even if we lived in a good Medicaid state (we donít, it is comically bad here) Iíd still avoid it because it will leave us hanging in the worst possible moment: when traveling.

https://www.healthinsurance.org/faqs/can-i-use-my-medicaid-coverage-in-any-state/

This isnít just theoretical. We just spent 6 weeks on the west coast. During that time, my wife and I indulged in hobbies that routinely put me at risk of blunt force trauma, getting eaten by wild marine animals, getting eaten by wild mountain animals, drowning, severe poisoning, and requiring costly evacuation. And, as a bonus, the state of California added burning alive to that list of hazards.

We are not idiots and mitigate these risks as best we can, but it just comes with the territory. The last thing I want in an emergency is trying to convince hospital or medivac staff that I am not a penniless hippie.

spartana

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Re: fire in medicaid expansion state?
« Reply #18 on: September 08, 2020, 10:11:19 PM »
Even if we lived in a good Medicaid state (we don’t, it is comically bad here) I’d still avoid it because it will leave us hanging in the worst possible moment: when traveling.

https://www.healthinsurance.org/faqs/can-i-use-my-medicaid-coverage-in-any-state/

This isn’t just theoretical. We just spent 6 weeks on the west coast. During that time, my wife and I indulged in hobbies that routinely put me at risk of blunt force trauma, getting eaten by wild marine animals, getting eaten by wild mountain animals, drowning, severe poisoning, and requiring costly evacuation. And, as a bonus, the state of California added burning alive to that list of hazards.

We are not idiots and mitigate these risks as best we can, but it just comes with the territory. The last thing I want in an emergency is trying to convince hospital or medivac staff that I am not a penniless hippie.
Good point. If someone has a big stash or NW then getting an ACA policy is probably much better. You can still manipulate your MAGI income to low levels and get max subsidies and cost-sharing.

That way you'll get treatment if injured while running from a bear off a cliff into a raging ocean wildfire filled with man eating sharks and mountain goats while out of state,  plus you won't have to worry about losing all your stash to pay those costs that your state Medicaid won't cover. I've heard some horror stories of people who are on state Medicaid who receive treatment in another state while travelling and are billed thousands or tens (hundreds?) of thousands for treatment as their state Medicaid wouldn't pay. Not sure if those are embellished stories but if not then maybe being a penniless hippie is a good thing.
« Last Edit: September 08, 2020, 10:13:43 PM by spartana »

cooking

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Re: fire in medicaid expansion state?
« Reply #19 on: September 22, 2020, 05:35:07 PM »
NJ (don't laugh, it can be a great place to live) has Medicaid expansion, but as others have pointed out, property taxes can have a big effect on retirement spending.  Ours are the highest in the nation.

whiskeyjack

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Re: fire in medicaid expansion state?
« Reply #20 on: September 25, 2020, 04:56:20 PM »
Even if we lived in a good Medicaid state (we donít, it is comically bad here) Iíd still avoid it because it will leave us hanging in the worst possible moment: when traveling.

https://www.healthinsurance.org/faqs/can-i-use-my-medicaid-coverage-in-any-state/

This isnít just theoretical. We just spent 6 weeks on the west coast. During that time, my wife and I indulged in hobbies that routinely put me at risk of blunt force trauma, getting eaten by wild marine animals, getting eaten by wild mountain animals, drowning, severe poisoning, and requiring costly evacuation. And, as a bonus, the state of California added burning alive to that list of hazards.

We are not idiots and mitigate these risks as best we can, but it just comes with the territory. The last thing I want in an emergency is trying to convince hospital or medivac staff that I am not a penniless hippie.

This hasn't come up yet, but we were planning to purchase travel insurance to cover travel to other states, much as we would do if traveling out of the country.  Would that work, or am I overestimating how available that kind of insurance is within the US?

terran

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Re: fire in medicaid expansion state?
« Reply #21 on: September 26, 2020, 08:25:32 AM »

Paul der Krake

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Re: fire in medicaid expansion state?
« Reply #22 on: September 26, 2020, 09:52:50 AM »
Even if we lived in a good Medicaid state (we donít, it is comically bad here) Iíd still avoid it because it will leave us hanging in the worst possible moment: when traveling.

https://www.healthinsurance.org/faqs/can-i-use-my-medicaid-coverage-in-any-state/

This isnít just theoretical. We just spent 6 weeks on the west coast. During that time, my wife and I indulged in hobbies that routinely put me at risk of blunt force trauma, getting eaten by wild marine animals, getting eaten by wild mountain animals, drowning, severe poisoning, and requiring costly evacuation. And, as a bonus, the state of California added burning alive to that list of hazards.

We are not idiots and mitigate these risks as best we can, but it just comes with the territory. The last thing I want in an emergency is trying to convince hospital or medivac staff that I am not a penniless hippie.

This hasn't come up yet, but we were planning to purchase travel insurance to cover travel to other states, much as we would do if traveling out of the country.  Would that work, or am I overestimating how available that kind of insurance is within the US?
I have not seen policies for travel within the US, only overseas travel. But I admit not having looked into this very thoroughly. Do you have an example in mind?

Padonak

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Re: fire in medicaid expansion state?
« Reply #23 on: September 26, 2020, 09:56:37 AM »
Even if we lived in a good Medicaid state (we donít, it is comically bad here) Iíd still avoid it because it will leave us hanging in the worst possible moment: when traveling.

https://www.healthinsurance.org/faqs/can-i-use-my-medicaid-coverage-in-any-state/

This isnít just theoretical. We just spent 6 weeks on the west coast. During that time, my wife and I indulged in hobbies that routinely put me at risk of blunt force trauma, getting eaten by wild marine animals, getting eaten by wild mountain animals, drowning, severe poisoning, and requiring costly evacuation. And, as a bonus, the state of California added burning alive to that list of hazards.

We are not idiots and mitigate these risks as best we can, but it just comes with the territory. The last thing I want in an emergency is trying to convince hospital or medivac staff that I am not a penniless hippie.

This hasn't come up yet, but we were planning to purchase travel insurance to cover travel to other states, much as we would do if traveling out of the country.  Would that work, or am I overestimating how available that kind of insurance is within the US?
I have not seen policies for travel within the US, only overseas travel. But I admit not having looked into this very thoroughly. Do you have an example in mind?
Are there ACA policies that cover overseas travel? I tried to find one and couldn't. Not even for emergency expenses

ysette9

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Re: fire in medicaid expansion state?
« Reply #24 on: September 26, 2020, 11:28:02 AM »
Iím no expert but I have heard several podcast guests talk about slow travel or even living abroad. They all get an international medical insurance policy that will cover you everywhere except the US and/or pay put of pocket for anything they need.

Paul der Krake

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Re: fire in medicaid expansion state?
« Reply #25 on: September 26, 2020, 11:29:40 AM »
Are there ACA policies that cover overseas travel? I tried to find one and couldn't. Not even for emergency expenses
We have an ACA plan with the local blue cross affiliate in Hawaii (HMSA) and it covers claims around the world, treating them as a regular out of network claim, i.e. a 30% coinsurance instead of the in-network 10% standard. There is also the ability to find a blue card provider that has special pricing arrangements with all blue cross companies. I have no idea how common they are, and it probably wouldnít help in a true emergency in Indonesia or wherever. There is a warning in the guide to benefits that claim payment could take a while, and I would likely have to pay the provider out of pocket first, then get reimbursed. But Iím really not worried about out of pocket costs outside the US.

I assume most PPO plans operate in the same way. If your only options are restricted network plans from lesser known insurance companies, then you likely wonít find any.

Sandi_k

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Re: fire in medicaid expansion state?
« Reply #26 on: September 26, 2020, 11:47:00 AM »
spartana, That's a good point that other states property taxes can vary in the future since they may not a prop 13 equivalent.

I haven't considered relocating in CA, it seems if I'm going to pay the transaction cost of selling my house why not get the most value and move out of state. My plan "B" is something like 50,000+ population town where my lady won't feel she living in a farm town, that and no nasty winters.

You do know that once you're over 55, CA allows you to transfer your existing property tax base to some other counties, right?

https://assessor.saccounty.net/LowerMyTaxes/BaseYearValueTransfers/Pages/default.aspx#:~:text=Propositions%2060%2F90%3A%20Under%20certain,Revenue%20and%20Taxation%20Code%2069.5).

We're staying in CA in retirement (at least until Medicare age) because it's clear that CA is committed to something like the ACA, regardless of how SCOTUS rules on the ACA.

There are many charming smaller towns in CA - if you could transfer your Prop 13 tax base, AND move to a smaller, less expensive house & town, that might be the best of all worlds.

I'd look at places like:

- Folsom (halfway between Tahoe and Bay Area, relatively affordable real estate)
- Redlands (lovely small town in San Bernardino county, near the foothills in SoCal)
- Davis (more expensive now that UC Davis has grown, but nice, medium-sized college town)
- San Clemente (near San Diego and on the coast in SoCal; US Marine town)
- Watsonville (coastal ag town, near Santa Cruz but cheaper)
- Petaluma (nice small town with lots of amenities, on the edges of Napa area)
- Rocklin (on the outskirts of Sacramento, more mountain town, with easy access to shopping and Tahoe)
- San Luis Obispo (college town, near Pismo - probably too expensive, but lovely. Maybe Templeton or Paso Robles instead)
- Lompoc (an hour from Santa Barbara, a small military town near the central CA coast).

Not all counties allow it, but it's a good weapon in your arsenal if you're inclined to stay in CA for the mild climate and well-educated populace.

Padonak

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Re: fire in medicaid expansion state?
« Reply #27 on: September 26, 2020, 12:06:35 PM »
Are there ACA policies that cover overseas travel? I tried to find one and couldn't. Not even for emergency expenses
We have an ACA plan with the local blue cross affiliate in Hawaii (HMSA) and it covers claims around the world, treating them as a regular out of network claim, i.e. a 30% coinsurance instead of the in-network 10% standard. There is also the ability to find a blue card provider that has special pricing arrangements with all blue cross companies. I have no idea how common they are, and it probably wouldnít help in a true emergency in Indonesia or wherever. There is a warning in the guide to benefits that claim payment could take a while, and I would likely have to pay the provider out of pocket first, then get reimbursed. But Iím really not worried about out of pocket costs outside the US.

I assume most PPO plans operate in the same way. If your only options are restricted network plans from lesser known insurance companies, then you likely wonít find any.

I am in NJ and I have the following providers available on the marketplace (either HMO or EPO plans).

AmeriHealth
Horizon
Oscar
Oxford

Are those restricted network plans? I'm not sure what EPO is and how different it is from PPO. I have checked a few plan summaries and they don't cover Non-emergency care when traveling outside the U.S. There is nothing about emergency care.

Paul der Krake

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Re: fire in medicaid expansion state?
« Reply #28 on: September 26, 2020, 03:15:29 PM »
EPO are basically a middle ground between a PPO and an HMO.

Here is a sample EPO plan sold by Horizon in Atlantic City:
https://www.horizonblue.com/qhp/files/2020/SMG%20OMNIA%20BRONZE_OFF%20EXCHANGE.pdf

They do cover true emergencies overseas with a 50% coinsurance. They do not cover any non-emergencies outside the US.

TomTX

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Re: fire in medicaid expansion state?
« Reply #29 on: September 27, 2020, 12:34:34 PM »
Sparks, NV seems interesting and there's a Costco! But other Californians are driving up real estate before I have a chance to move there and drive up real estate.

I think the bigger influence on house prices is the industrial boom surrounding the Tesla Gigafactory.

the_fixer

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Re: fire in medicaid expansion state?
« Reply #30 on: October 07, 2020, 04:58:20 PM »
BTW, the biggest reason to avoid Wyoming is not the cold, it's the wind. It never stops blowing except on a hot August day when a breeze would be nice, then it stops.

As someone that works in Wyoming a bunch I can confirm that it is always windy.

Do you know why it is always blowing in Wyoming?

Because Nebraska sucks...

Told to me by a co-worker in Wyoming


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