Hoping for some advice... family member with health insurance trouble in NYC

[minority_finance_mo]

Hi there -

I have a family member in her mid-50's who is working a fast food minimum wage job in New York. NYC just raise minimum wage pretty significantly over the last few years. Although that's great for this person, she was previously on Medicaid, and now no longer qualifies.

It looks like the income limit in NYC is $16,754 annually / ~$1400 per month (https://www.health.ny.gov/health_care/medicaid/). She makes ~$1,800-2,000 per month.

Without Medicaid she is looking at individual plans on the market that range around $400-500/month. Her health isn't great and her employer has been looking to cut hours, so she's considering cutting down on work to meet the income minimum for Medicaid. This would put her in some trouble in terms of making ends meet, however.

What I'm hoping, my NYC mustachian friends, is that you might be aware of any programs that aid lower income older Americans pay for health insurance. I've already spoken to her about her spending, but really spending ~25% of her income on health insurance will be a strain regardless of budget. Anyone aware of any such program?

What I'm not looking for (thank you):

• chastisement on working a fast food job in 50s (you don't know her life situation, trust me)
• chastisement for her using the public health system

Thanks in advance for the help. I want to help her, but I'm struggling to find resources.

[DreamFIRE]

so she's considering cutting down on work to meet the income minimum for Medicaid.  This would put her in some trouble in terms of making ends meet, however.

Making monthly Traditional IRA contributions will decrease MAGI without needing to cut down on work.  Of course, that doesn't help with the making ends meet part.

[ltt]

I can't think of any programs.  The only thing I can think of is to work an additional 8-10 hours a week at another place to be able to pay the monthly premium for health care.

I don't think cutting her hours to make under the income requirement is prudent.  She would simply be losing income, as well as having to pay the additional premium.

Do you have a local "Office on Aging" you could call to see if they might know of some programs? 

[minority_finance_mo]

so she's considering cutting down on work to meet the income minimum for Medicaid.  This would put her in some trouble in terms of making ends meet, however.

Making monthly Traditional IRA contributions will decrease MAGI without needing to cut down on work.  Of course, that doesn't help with the making ends meet part.

Do medicaid income levels apply to your MAGI or gross income? If MAGI, this might be sensible as it would allow her to save some more money for the future as well.

Do you have a local "Office on Aging" you could call to see if they might know of some programs? 

That's a good point. Wasn't aware of this. Will try giving them a call this week to see what they recommend. Thanks.

[DreamFIRE]

so she's considering cutting down on work to meet the income minimum for Medicaid.  This would put her in some trouble in terms of making ends meet, however.

Making monthly Traditional IRA contributions will decrease MAGI without needing to cut down on work.  Of course, that doesn't help with the making ends meet part.

Do medicaid income levels apply to your MAGI or gross income? If MAGI, this might be sensible as it would allow her to save some more money for the future as well.

Expanded Medicaid is part of the ACA, which uses MAGI, including for Medicaid eligibility.  New York, of course, is one of the states that expanded Medicaid under the ACA.

[jim555]

NY has the Essential Plan for those under 200% FPL, @ $20 a month. 

Contributing to a Traditional IRA can reduce your MAGI if you are over.

[nancy33]

Cut her hours back to qualify for Medicaid and do a cash job under the table like babysit, dog walk, housecleaning ? Because if she doesn't have Medicaid not only will she have the monthly premium but also the copays and deductibles, it won't be affordable

[Paul der Krake]

Something isn't adding up.

Many plans for way less than $500/month for a 52 year old woman in 10001 with income of $25,000. Below that she should be eligible for Medicaid.

Can you get her to a navigator?
https://nystateofhealth.ny.gov/agent/navigators

[jim555]

NY State of Health - Essential Plan Fact Sheet
https://info.nystateofhealth.ny.gov/sites/default/files/Essential%20Plan%20Fact%20Sheet_0.pdf

[SimpleCycle]

At her income, she should get substantial subsidies for a marketplace plan plus cost sharing assistance to help with deductibles/copays/coinsurance.  Run her numbers through the actual exchange, rather than the estimator that lets you see plans without entering financial details.  It appears the estimator is broken.

[MMMarbleheader]

Can she be a bank teller?

If she works the register at a fast food place maybe?

It seems like banks are one of the few places that give health insurance to part time employees

https://ptmoney.com/the-ten-best-part-time-jobs-with-benefits/amp/

[DreamFIRE]

NY has the Essential Plan for those under 200% FPL, @ $20 a month. 

Contributing to a Traditional IRA can reduce your MAGI if you are over.

This looks like the best answer in NY.

[mattp]

I though IRA contributions DO NOT reduce MAGI: https://www.thebalance.com/how-to-calculate-your-modified-adjusted-gross-income-4047216

[Paul der Krake]

I though IRA contributions DO NOT reduce MAGI: https://www.thebalance.com/how-to-calculate-your-modified-adjusted-gross-income-4047216

That link is incorrect. For purposes of ACA calculations, IRA contributions are not added back to determine MAGI.
https://www.healthcare.gov/glossary/modified-adjusted-gross-income-magi/

MAGI is kind of a catchall term that means different things in different worksheets. It's hella confusing.

[swampwiz]

I though IRA contributions DO NOT reduce MAGI: https://www.thebalance.com/how-to-calculate-your-modified-adjusted-gross-income-4047216

That link is incorrect. For purposes of ACA calculations, IRA contributions are not added back to determine MAGI.
https://www.healthcare.gov/glossary/modified-adjusted-gross-income-magi/

MAGI is kind of a catchall term that means different things in different worksheets. It's hella confusing.

I concur.  MAGI is kind of like credit scores - they are all different.  With respect to ACA "income", it's pretty much AGI + (foreign income that is below the deductible for inclusion to AGI) + (tax-free bond interest), with a few other, obscure things that aren't included in AGI.

[DreamFIRE]

I though IRA contributions DO NOT reduce MAGI: https://www.thebalance.com/how-to-calculate-your-modified-adjusted-gross-income-4047216

That link is incorrect. For purposes of ACA calculations, IRA contributions are not added back to determine MAGI.
https://www.healthcare.gov/glossary/modified-adjusted-gross-income-magi/

MAGI is kind of a catchall term that means different things in different worksheets. It's hella confusing.

I concur.  MAGI is kind of like credit scores - they are all different.  With respect to ACA "income", it's pretty much AGI + (foreign income that is below the deductible for inclusion to AGI) + (tax-free bond interest), with a few other, obscure things that aren't included in AGI.

As I've pointed out before, when calculating MAGI for ACA, a big one is Social Security income, including non-taxable social security.  Since many people take SS at 62, they would not yet be eligible for Medicare, so SS would be very relevant to ACA PCT and CSR.

[MrUpwardlyMobile]

Hi there -

I have a family member in her mid-50's who is working a fast food minimum wage job in New York. NYC just raise minimum wage pretty significantly over the last few years. Although that's great for this person, she was previously on Medicaid, and now no longer qualifies.

It looks like the income limit in NYC is $16,754 annually / ~$1400 per month (https://www.health.ny.gov/health_care/medicaid/). She makes ~$1,800-2,000 per month.

Without Medicaid she is looking at individual plans on the market that range around $400-500/month. Her health isn't great and her employer has been looking to cut hours, so she's considering cutting down on work to meet the income minimum for Medicaid. This would put her in some trouble in terms of making ends meet, however.

What I'm hoping, my NYC mustachian friends, is that you might be aware of any programs that aid lower income older Americans pay for health insurance. I've already spoken to her about her spending, but really spending ~25% of her income on health insurance will be a strain regardless of budget. Anyone aware of any such program?

What I'm not looking for (thank you):

• chastisement on working a fast food job in 50s (you don't know her life situation, trust me)
• chastisement for her using the public health system

Thanks in advance for the help. I want to help her, but I'm struggling to find resources.

 Not chastising but as a New Yorker, I really must offer this up
https://www1.nyc.gov/jobs/index.page

Government jobs with the city of New York often have comparable work skills and requirements but amazing benefits and strong pay.  If she lives in the city, at least propose she look for nyc government jobs.  Increased pay and healthcare coverage might be a 2 birds 1 stone option.

[MrUpwardlyMobile]

Cut her hours back to qualify for Medicaid and do a cash job under the table like babysit, dog walk, housecleaning ? Because if she doesn't have Medicaid not only will she have the monthly premium but also the copays and deductibles, it won't be affordable

Probably not a good idea to tacitly recommend tax fraud.

[RedwoodDreams]

Just went through this dizzying exercise when we lost our employer health insurance, though in CA. My son qualified for Medicaid (Medi-Cal) but my husband didn't, but my husband DID qualify for a very low-cost ACA plan (Kaiser, $37/month).

See the section "See what’s included in MAGI and how to estimate it." at this page:
https://www.healthcare.gov/income-and-household-information/income/

I reduced our family's MAGI by making two $6500 contributions to my own and my husband's traditional IRA's (thank you, HELOC), as well as $5100 in a family HSA.

Has your friend tried punching in their numbers on the NY exchange to see what ACA subsidies they might qualify for? https://nystateofhealth.ny.gov/