Author Topic: What comes after the ACA?  (Read 1565905 times)

pecunia

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Re: What comes after the ACA?
« Reply #6750 on: April 17, 2021, 07:13:12 AM »
Another societal benefit of retiring early is freeing up high paying jobs for the next generation.

Yeh - I take a philosophical difference with this one.  It's like the "pie"is not limited.  A valid economy should be an expanding pie creating ever more creative opportunities for people.  There are many millions of people on this Earth who have wants and have real needs.  There are a nearly infinite amount of ideas out there waiting to be implemented to help folks with new technology.  If things were done right and not as they are done today, it would be that way.  New jobs should be created and not old ones being "Freed up."

Good jobs for all.  Health care for all.

Omy

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Re: What comes after the ACA?
« Reply #6751 on: April 17, 2021, 07:54:31 AM »
That would be nice. In our particular example, a younger person who worked for DH was promoted when DH left (at DH's recommendation).  Because DH knew he was leaving earlier than most would expect, he spent time helping less experienced colleagues grow into more responsible positions.

jim555

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Re: What comes after the ACA?
« Reply #6752 on: April 28, 2021, 07:45:24 AM »
The proposed American Families Plan will make the temporary ACA subsidy improvements for 2021 and 2022 permanent, goodbye 4X FPL cliff!

"The biggest improvement in health care affordability since the Affordable Care Act, the American Rescue Plan provided two years of lower health insurance premiums for those who buy coverage on their own, saving families an average of $50 per person per month.  The American Families Plan will make those premium reductions permanent, a $200 billion investment. "

https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/28/fact-sheet-the-american-families-plan/

Biden's families plan would make Obamacare permanently cheaper for millions

"Along with delivering the third round of stimulus checks, President Joe Biden’s $1.9 trillion relief package included a major expansion of federal subsidies for health insurance plans.

On April 1, the marketplace Healthcare.gov, where people from 36 states sign up for health insurance under Obamacare, was updated to reflect the policy, giving millions of Americans the opportunity to reduce their health insurance premiums by hundreds of dollars a month — or even eliminate them entirely."

https://finance.yahoo.com/news/bidens-families-plan-obamacare-permanently-173300849.html
« Last Edit: April 29, 2021, 06:40:59 PM by jim555 »

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6753 on: April 30, 2021, 12:30:35 PM »
So it's still not going to affect cost sharing towards the annual deductible, right? I'm still years away from FIRE but it looks like the general healthcare landscape we see come into effect in this term of congress is likely to be the landscape in use for probably years to come. I say that as a pragmatist looking at the 2012 passage of the ACA and potential 2022 completion of this massive update. Roughly 10 years between them, and with honestly a lot smaller changes with this update, telling me that any future changes would probably be even smaller.

So from what I've been able to gather, you qualify for pretty decent rates as an individual at just about anything below 300%, but only cost sharing (reduced deductibles & copays) if you stay under 200% FPL. In fact it was earlier in this thread that I learned about that and was able to see it in action when all those online ACA rate shopping sites got updated. I can't find any specifics though and don't have the time to locate and read some huge omnibus bill. Does anyone else have confirmation that the cost sharing still has a hard cutoff at 200% FPL? I can still work with that, but it of course affects exactly where I have to make sure to cut off my Roth ladder every year.

secondcor521

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Re: What comes after the ACA?
« Reply #6754 on: April 30, 2021, 12:38:01 PM »
So it's still not going to affect cost sharing towards the annual deductible, right? I'm still years away from FIRE but it looks like the general healthcare landscape we see come into effect in this term of congress is likely to be the landscape in use for probably years to come. I say that as a pragmatist looking at the 2012 passage of the ACA and potential 2022 completion of this massive update. Roughly 10 years between them, and with honestly a lot smaller changes with this update, telling me that any future changes would probably be even smaller.

So from what I've been able to gather, you qualify for pretty decent rates as an individual at just about anything below 300%, but only cost sharing (reduced deductibles & copays) if you stay under 200% FPL. In fact it was earlier in this thread that I learned about that and was able to see it in action when all those online ACA rate shopping sites got updated. I can't find any specifics though and don't have the time to locate and read some huge omnibus bill. Does anyone else have confirmation that the cost sharing still has a hard cutoff at 200% FPL? I can still work with that, but it of course affects exactly where I have to make sure to cut off my Roth ladder every year.

There are three different levels of cost sharing reductions (CSRs), and they are at 150%, 200%, and 250% of FPL.  The levels are CSR73, CSR87, and CSR94, where the numbers represent the amount of actuarial value.

Also, remember that CSRs only apply to Silver metal plans, and that due to silver loading a bronze or gold plan may actually make more sense depending on the state you live in.

Mr. Green

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Re: What comes after the ACA?
« Reply #6755 on: April 30, 2021, 01:36:11 PM »
I would trade Biden's proposed permanent ACA fixes for a lowering of the Medicare age in a heartbeat. Further reducing ACA premiums does nothing to address overall healthcare costs, which are the real killer in the US. Lowering the Medicare eligibility age seems like a no brainer. The new pool of individuals will collectively be healthier than existing patients so the average cost of care per person will drop. Cost of care will drop as Medicare is able to negotiate better rates. Younger people will seek treatment sooner, ultimately leading to less expensive care later in life.

If Republicans regain power in both the legislative and executive branches they will continue trying to mess with the ACA anyway they can, where as lowering the Medicare eligibility age is most definitely something that can never be undone as tens of millions of Americans will instantly have comprehensive coverage.

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6756 on: April 30, 2021, 03:25:45 PM »
There are three different levels of cost sharing reductions (CSRs), and they are at 150%, 200%, and 250% of FPL.  The levels are CSR73, CSR87, and CSR94, where the numbers represent the amount of actuarial value.

Also, remember that CSRs only apply to Silver metal plans, and that due to silver loading a bronze or gold plan may actually make more sense depending on the state you live in.

OK, well at least for my state the gap is HUGE from the 200% to 250% levels when comparing deductibles. Example, when comparing two of the same silver plans on the Health Sherpa website for a 55 year old male in my county:

At $25,500/year: <200% FPL:
$42/mo, $250 deductible, $2700 OOPM

At $25,550/year: >200% FPL
$43/mo, $2995 deductible, $5400 OOPM

At $32,000/year: >250% FPL
$108/mo, $5450 deductible, $8400 OOPM

Due to CSR for silver, none of the bronze or gold planes make any economic sense, at least for 2021 and for my county and age. Saying CSR87 and CSR94 makes it sound like they should have similar deductibles and OOPM but in reality the gap is enormous, with <250%FPL having 1200% the deductible and 200% the OOPM of <200%FPL. I get it though; that's basically the game to play in order to try to stay under a given income cap, as there's a huge jump at the next level as well when the CSRs go away entirely.

I also understand that because we have to estimate our income a year in advance, it's not the same as tax brackets where it can be accurate to the nearest $50 or whatever. So as it stands I'm guessing I'll either target my income at 195% or 245% when the time comes. I don't expect to have a whole lot of ordinary income in my early FIRE as something like 5/6th of my money will be in pre-tax accounts and only 1/6th in post-tax. So if I generate $5000 of dividends and capital gains that should give me the ability to rollover $20,000 to a Roth to reach about $25k of income and stay under that $25,500 mark for example. Then as my taxable income goes down I would be raising my Roth rollover to improve the ladder, or so goes the plan.

I agree with the post that having medicare eligibility at age 60 would be wonderful, but unless and until that happens (if it even happens before I turn 65 anyway) I have to make plans working with what I've got available to me. Seeing the ACA at least shored up to some degree would be great.

reeshau

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Re: What comes after the ACA?
« Reply #6757 on: April 30, 2021, 11:41:50 PM »
I would trade Biden's proposed permanent ACA fixes for a lowering of the Medicare age in a heartbeat. Further reducing ACA premiums does nothing to address overall healthcare costs, which are the real killer in the US. Lowering the Medicare eligibility age seems like a no brainer. The new pool of individuals will collectively be healthier than existing patients so the average cost of care per person will drop. Cost of care will drop as Medicare is able to negotiate better rates. Younger people will seek treatment sooner, ultimately leading to less expensive care later in life.

If Republicans regain power in both the legislative and executive branches they will continue trying to mess with the ACA anyway they can, where as lowering the Medicare eligibility age is most definitely something that can never be undone as tens of millions of Americans will instantly have comprehensive coverage.

To me, one issue that needs to be resolved before / with Medicare expansion is the calculation of the reimbursement rate, and particularly ones that are below provider cost.  Providers take Medicare patients because they are plentiful and help fill up schedules, but they do not fully cover their costs.  (Kind of like coach fliers on international flights)  If more people were put in this situation, that would exacerbate the problem, and be a pressure to push up private pay rates.

It's funny, because it kind of opposite to the prohibition on negotiating drug prices.  Both methods are artifical bureaucratic processes, and both distort the overall market, but in opposite ways.  They might cancel each other out to some extent, except the counterparties are different in each case.  I would be in favor of allowing Medicare to negotiate, as a market participant, but there also needs to be some way to provide transparency on the service costs, whether it's fee-for-service, or outcome-based. 

jim555

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Re: What comes after the ACA?
« Reply #6758 on: May 01, 2021, 05:14:55 AM »
I would trade Biden's proposed permanent ACA fixes for a lowering of the Medicare age in a heartbeat. Further reducing ACA premiums does nothing to address overall healthcare costs, which are the real killer in the US. Lowering the Medicare eligibility age seems like a no brainer. The new pool of individuals will collectively be healthier than existing patients so the average cost of care per person will drop. Cost of care will drop as Medicare is able to negotiate better rates. Younger people will seek treatment sooner, ultimately leading to less expensive care later in life.

If Republicans regain power in both the legislative and executive branches they will continue trying to mess with the ACA anyway they can, where as lowering the Medicare eligibility age is most definitely something that can never be undone as tens of millions of Americans will instantly have comprehensive coverage.

To me, one issue that needs to be resolved before / with Medicare expansion is the calculation of the reimbursement rate, and particularly ones that are below provider cost.  Providers take Medicare patients because they are plentiful and help fill up schedules, but they do not fully cover their costs.  (Kind of like coach fliers on international flights)  If more people were put in this situation, that would exacerbate the problem, and be a pressure to push up private pay rates.

It's funny, because it kind of opposite to the prohibition on negotiating drug prices.  Both methods are artifical bureaucratic processes, and both distort the overall market, but in opposite ways.  They might cancel each other out to some extent, except the counterparties are different in each case.  I would be in favor of allowing Medicare to negotiate, as a market participant, but there also needs to be some way to provide transparency on the service costs, whether it's fee-for-service, or outcome-based.
Do you mean Medicaid expansion?  Medicare didn't have an expansion.

stoaX

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Re: What comes after the ACA?
« Reply #6759 on: May 01, 2021, 05:18:13 AM »
I would trade Biden's proposed permanent ACA fixes for a lowering of the Medicare age in a heartbeat. Further reducing ACA premiums does nothing to address overall healthcare costs, which are the real killer in the US. Lowering the Medicare eligibility age seems like a no brainer. The new pool of individuals will collectively be healthier than existing patients so the average cost of care per person will drop. Cost of care will drop as Medicare is able to negotiate better rates. Younger people will seek treatment sooner, ultimately leading to less expensive care later in life.

If Republicans regain power in both the legislative and executive branches they will continue trying to mess with the ACA anyway they can, where as lowering the Medicare eligibility age is most definitely something that can never be undone as tens of millions of Americans will instantly have comprehensive coverage.

To me, one issue that needs to be resolved before / with Medicare expansion is the calculation of the reimbursement rate, and particularly ones that are below provider cost.  Providers take Medicare patients because they are plentiful and help fill up schedules, but they do not fully cover their costs.  (Kind of like coach fliers on international flights)  If more people were put in this situation, that would exacerbate the problem, and be a pressure to push up private pay rates.

It's funny, because it kind of opposite to the prohibition on negotiating drug prices.  Both methods are artifical bureaucratic processes, and both distort the overall market, but in opposite ways.  They might cancel each other out to some extent, except the counterparties are different in each case.  I would be in favor of allowing Medicare to negotiate, as a market participant, but there also needs to be some way to provide transparency on the service costs, whether it's fee-for-service, or outcome-based.


I agree with you that the reimbursement issue needs to be resolved.  I'm not confident that it will be.  But it's an important point to bring up.

reeshau

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Re: What comes after the ACA?
« Reply #6760 on: May 01, 2021, 10:53:10 AM »

Do you mean Medicaid expansion?  Medicare didn't have an expansion.


No, I meant the potential Medicare expansion that Mr. Green mentioned, as talked about in some Democratic circles.  An idea that Medicare coverage could begin at 60 or 50, in recognition that the average retirement age in the US is less than 65.

JGS1980

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Re: What comes after the ACA?
« Reply #6761 on: May 01, 2021, 11:06:02 AM »

Do you mean Medicaid expansion?  Medicare didn't have an expansion.


No, I meant the potential Medicare expansion that Mr. Green mentioned, as talked about in some Democratic circles.  An idea that Medicare coverage could begin at 60 or 50, in recognition that the average retirement age in the US is less than 65.

That brings up an idea. Why not allow Medicare signup for anyone over 50 who chooses to retire? If they were working solely for coverage, they will move on, still get healthcare access, and open up a potential senior spot at some company. If they want to continue working (through company coverage or individual plans), they do so.

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6762 on: May 02, 2021, 07:56:15 PM »
Providers take Medicare patients because they are plentiful and help fill up schedules, but they do not fully cover their costs.  (Kind of like coach fliers on international flights)  If more people were put in this situation, that would exacerbate the problem, and be a pressure to push up private pay rates.

Medicare's payroll tax is only 2.9% and currently isn't in the dire financial condition that Social Security and it's 12.4% tax is in. So in a sense, if the age & reimbursement rate problem is relatively easy to fix because adding a quarter to Medicare's tax "only" raises it by 725 basis points to 3.63% (we'll round it to 3.7%) but if we dramatically shore up Social Security with a 25% increase, that's 3100 basis points to 15.5%. IIRC the last proposal in congress for Social Security 2100 or whatever involved raising the tax to 15%, so I don't think my estimates are way off.

Anyway, point is that raising people's taxes by 2.6% or 3.1% for Social Security is going to be a hard sell and is probably why nobody has fixed it even though we've known about the problem for decades. However if you can shore up Medicare with a mere 0.7% or 0.8% tax increase, that's way easier to sell to people and if that proposal includes raising reimbursement rates slightly it even gets medical providers to back it since they'll be getting paid more too.

American GenX

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Re: What comes after the ACA?
« Reply #6763 on: May 02, 2021, 08:14:31 PM »
The proposed American Families Plan will make the temporary ACA subsidy improvements for 2021 and 2022 permanent, goodbye 4X FPL cliff!

I'm definitely pro-ACA, but I oppose that plan and all of the big spending items in it.  The ACA changes don't address some of the issues that I'm concerned about.  And at this point, we don't know with certainty that the ACA will stand for the most part until the SCOTUS ruling.  The key word being "certainty" as there is much speculation and opinion from legal experts and non-experts on the matter.

American GenX

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Re: What comes after the ACA?
« Reply #6764 on: May 02, 2021, 08:18:46 PM »
I would trade Biden's proposed permanent ACA fixes for a lowering of the Medicare age in a heartbeat.

My retirement planning budget goes up $200/mo at age 65 due to the higher costs of  Medicare vs. my expected ACA premiums and out of pocket health care costs, so I'm not a big fan of having to jump on Medicare vs. the lower cost ACA.  And since Medicare is running out of funds, you can expect a lot more out of pocket, so I think my $200/mo is underestimated.  I don't believe any changes will bring down the premiums and out of pocket costs and that they will only go up, much faster than inflation, which is already skyrocketing.  Not a good sign of things to come.

maizefolk

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Re: What comes after the ACA?
« Reply #6765 on: May 02, 2021, 08:37:27 PM »
Medicare's payroll tax is only 2.9% and currently isn't in the dire financial condition that Social Security and it's 12.4% tax is in. So in a sense, if the age & reimbursement rate problem is relatively easy to fix because adding a quarter to Medicare's tax "only" raises it by 725 basis points to 3.63% (we'll round it to 3.7%) but if we dramatically shore up Social Security with a 25% increase, that's 3100 basis points to 15.5%. IIRC the last proposal in congress for Social Security 2100 or whatever involved raising the tax to 15%, so I don't think my estimates are way off.

It's important to keep in mind that medicare costs the federal government much MUCH more ($800B/year) than the medicare payroll tax brings in ($275B/year).

Social security costs the federal government ~$900B/year and the social security payroll tax raises about $800B/year (with another $35B in revenue from taxes on social security benefits that go back to the program).

So the cost of social security and medicare is actually roughly equivalent. It's just that social security's dedicated revenue stream comes sort of close to covering its expenditures and medicare's isn't even in the same ballpark.

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6766 on: May 03, 2021, 10:26:44 PM »
It's important to keep in mind that medicare costs the federal government much MUCH more ($800B/year) than the medicare payroll tax brings in ($275B/year).

Social security costs the federal government ~$900B/year and the social security payroll tax raises about $800B/year (with another $35B in revenue from taxes on social security benefits that go back to the program).

So the cost of social security and medicare is actually roughly equivalent. It's just that social security's dedicated revenue stream comes sort of close to covering its expenditures and medicare's isn't even in the same ballpark.

I'm just going off the trustee data: https://www.ssa.gov/OACT/TRSUM/index.html

If you scroll down to "Chart B—OASDI and HI Income and Cost as Percentages of Their Respective Taxable Payrolls" the OASDI (Old Age Survivors and Disability Insurance) is both dramatically higher cost and projected to have a far higher gap than HI (Hospitalization Insurance) over the same time period. Scrolling down further to Chart C, it shows that actually the payroll tax covers only a modest portion of Medicare's total revenue and again, the deficit isn't terrible. The program will still need some updates to properly account for funding, but look at the numbers being thrown around these days.

The government just threw multiple trillions of dollars of deficit spending at 1 year of pandemic costs alone. The deficit for HI is shown as only 5.8 billion last year as a reference point. If we can afford to throw trillions a year at the pandemic, I have total confidence they can cover the small deficit shown in charts B & C through relatively modest tax increases of both the flat payroll type and increased marginal / ordinary income taxes to support increased "general revenue transfers" to help in keeping our tax system progressive while also keeping the key programs solvent.

maizefolk

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Re: What comes after the ACA?
« Reply #6767 on: May 04, 2021, 05:32:56 AM »
I appreciate you citing your sources so well!

I think the issue is that chart B in your source is only showing the hospital insurance fund (HI), which is medicare part A. It doesn't include the costs of medicare part B (doctors visits) or part D (prescriptions). In the report you linked to, the funding for part B and part D are both combined and referred to as "SMI" throughout the document.

If you look at table 3 in your linked source, you can see that the total cost of HI + SMI comes out to >800B/year, and that the federal government is kicking in about $350B/year out of the general fund to offset that cost. That's actually the same thing chart C shows: payroll taxes are projected to cover a shrinking proportion of medicare's costs, meaning more and more of the federal government's general revenue (predominately personal and corporate income tax) gets eaten up by the cost of medicare.

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6768 on: May 06, 2021, 06:48:48 PM »
Well I think I would then sum up my thoughts as this: Raise the medicare and social security taxes, but stop treating the programs as if they need to run in their own budgets. Make them both mandatory spending as part of the general budget. If the general budget is already kicking in extra anyway, I don't think it makes sense to keep playing the game of "Social Security is almost out of money!" when all they have to do is make it part of the general funding of the federal government and then it has unlimited money forever. No more games.

pecunia

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Re: What comes after the ACA?
« Reply #6769 on: May 06, 2021, 09:18:37 PM »
Well I think I would then sum up my thoughts as this: Raise the medicare and social security taxes, but stop treating the programs as if they need to run in their own budgets. Make them both mandatory spending as part of the general budget. If the general budget is already kicking in extra anyway, I don't think it makes sense to keep playing the game of "Social Security is almost out of money!" when all they have to do is make it part of the general funding of the federal government and then it has unlimited money forever. No more games.

Will you have no more games?  Is there more or less chance for the public to spot the lack of fiscal responsibility if these are lumped in with the money to pay for endless wars overseas and the Bureau of Indian Affairs?  Would this make it even easier for the Feds to take money that probably should go to help somebody's grandma and instead spend it on a CIA adventure creating a coup in a small Central American country?

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Re: What comes after the ACA?
« Reply #6770 on: May 07, 2021, 12:15:13 AM »
Well I think I would then sum up my thoughts as this: Raise the medicare and social security taxes, but stop treating the programs as if they need to run in their own budgets. Make them both mandatory spending as part of the general budget. If the general budget is already kicking in extra anyway, I don't think it makes sense to keep playing the game of "Social Security is almost out of money!" when all they have to do is make it part of the general funding of the federal government and then it has unlimited money forever. No more games.

Will you have no more games?  Is there more or less chance for the public to spot the lack of fiscal responsibility if these are lumped in with the money to pay for endless wars overseas and the Bureau of Indian Affairs?  Would this make it even easier for the Feds to take money that probably should go to help somebody's grandma and instead spend it on a CIA adventure creating a coup in a small Central American country?

Here's the thing: we deficit spend for the endless wars and all the other stuff. We don't deficit spend for social security, at least we won't once the "trust fund" from prior surpluses is exhausted. That decision explicitly places social security at a lower priority than other government spending, and I'd bet most voters would say it should be the opposite.

pecunia

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Re: What comes after the ACA?
« Reply #6771 on: May 07, 2021, 07:00:01 AM »
I voted for Ross Perot umpteen years ago.  Now, while I think John Maynard Keynes was a great economist, I think deficit spending should be avoided, period.  Chickens do come home to roost.

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Re: What comes after the ACA?
« Reply #6772 on: May 07, 2021, 07:26:04 AM »
Well I think I would then sum up my thoughts as this: Raise the medicare and social security taxes, but stop treating the programs as if they need to run in their own budgets. Make them both mandatory spending as part of the general budget. If the general budget is already kicking in extra anyway, I don't think it makes sense to keep playing the game of "Social Security is almost out of money!" when all they have to do is make it part of the general funding of the federal government and then it has unlimited money forever. No more games.

I have mixed feelings about this.  I think that keeping Social Security "separate" is more logical than Medicare.  Medicare will likely morph into some sort of single player system for the entire population at some point and makes more sense to manage within the overall budget.  Social Security is much more consistent with the accounting and actuarial analyses of a private pension and should be managed as such.

Sid Hoffman

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Re: What comes after the ACA?
« Reply #6773 on: May 07, 2021, 02:53:03 PM »
I have mixed feelings about this.  I think that keeping Social Security "separate" is more logical than Medicare.  Medicare will likely morph into some sort of single player system for the entire population at some point and makes more sense to manage within the overall budget.  Social Security is much more consistent with the accounting and actuarial analyses of a private pension and should be managed as such.

That's very reasonable and I think you probably have the right answer here.

talltexan

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Re: What comes after the ACA?
« Reply #6774 on: May 11, 2021, 08:37:18 AM »
I voted for Ross Perot umpteen years ago.  Now, while I think John Maynard Keynes was a great economist, I think deficit spending should be avoided, period.  Chickens do come home to roost.

Can you go into more detail about how you came to believe this?

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Re: What comes after the ACA?
« Reply #6775 on: June 02, 2021, 05:51:08 PM »
This change from the COVID relief bill and health care has been confusing.  I was not aware of this whole cliff-is-gone development until:   #1, I got an unexpected refund of my subsidy repayment from the IRS months after filing taxes, #2, saw my bronze HSA plan health premium drop to $4 (that is FOUR dollars) per month, and #3, was invited to shop for a silver plan to "save money."   

Last year, my first full FIRE year, I threaded a fine needle in selling my investments to be sure I stayed away from the 400% FPL cliff edge.  When filing I ended up owing a little due to the medical subsidy repayment but that was refunded now with the passing of the relief bill.  That made my tax burden zippo-nada, and somewhere out there Go Curry Cracker cheered (https://www.gocurrycracker.com/never-pay-taxes-again).   

This week I got an invitation from my state's Healthplan Finder web site to get a silver plan but I still want that HSA as a Roth replacement and a way to reduce taxable income, so I won't be doing that unless one of you smart folks can tell me why I am screwed up on that for this weird COVID bill.  When my premium dropped to only $4 per month I immediately went in to the system and bumped my monthly premium back up so I avoid any sort of repayment until I can figure out some shit. 

My question is-- with the cliff gone, how much can my taxable income be to avoid repayment of anything?  Is it unlimited for the next couple years?  I would like to gross out a large amount to remodel my kitchen and I am thinking I will have the chance to bank a ton more than I usually would and not have the subsidy repayment thing bite my ass. 

Am I understanding this right?  Thanks for any advice in language suitable for helping Michael Scott set up this lemonade stand.         

     

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Re: What comes after the ACA?
« Reply #6776 on: June 02, 2021, 06:45:26 PM »
My question is-- with the cliff gone, how much can my taxable income be to avoid repayment of anything?     
For 2021, the case study spreadsheet includes ACA effects in its tax calculations.  You could try that for an estimate.

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Re: What comes after the ACA?
« Reply #6777 on: June 02, 2021, 06:47:06 PM »
It is for 2021 and 2022.  So max cost of the Second Lowest Cost Silver plan will be capped at 8.5% of income, no income limit.  You are mentioning repayment, but more likely you get a refund due to the change since the subsidy percentages have been increased through the income ranges.

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Re: What comes after the ACA?
« Reply #6778 on: June 02, 2021, 06:54:02 PM »
This change from the COVID relief bill and health care has been confusing.  I was not aware of this whole cliff-is-gone development until:   #1, I got an unexpected refund of my subsidy repayment from the IRS months after filing taxes, #2, saw my bronze HSA plan health premium drop to $4 (that is FOUR dollars) per month, and #3, was invited to shop for a silver plan to "save money."   

Last year, my first full FIRE year, I threaded a fine needle in selling my investments to be sure I stayed away from the 400% FPL cliff edge.  When filing I ended up owing a little due to the medical subsidy repayment but that was refunded now with the passing of the relief bill.  That made my tax burden zippo-nada, and somewhere out there Go Curry Cracker cheered (https://www.gocurrycracker.com/never-pay-taxes-again).   

This week I got an invitation from my state's Healthplan Finder web site to get a silver plan but I still want that HSA as a Roth replacement and a way to reduce taxable income, so I won't be doing that unless one of you smart folks can tell me why I am screwed up on that for this weird COVID bill.  When my premium dropped to only $4 per month I immediately went in to the system and bumped my monthly premium back up so I avoid any sort of repayment until I can figure out some shit. 

My question is-- with the cliff gone, how much can my taxable income be to avoid repayment of anything?  Is it unlimited for the next couple years?  I would like to gross out a large amount to remodel my kitchen and I am thinking I will have the chance to bank a ton more than I usually would and not have the subsidy repayment thing bite my ass. 

Am I understanding this right?  Thanks for any advice in language suitable for helping Michael Scott set up this lemonade stand.

There is a lot to unpack here.

There are three different things that the fourth COVID relief bill did that are affecting you:

1.  It eliminated subsidy repayments for 2020.  Normally if you get too much premium subsidy during the year for whatever reason, you have to pay some back.  This is done at the bottom of Form 8962.  For people who were affected by this provision, the IRS generally just added back the subsidy repayment to their tax refund.

2.  It eliminated the 400% FPL cap for subsidies for 2021 and 2022.  For 2020 and previous, if you were over 400% FPL, then you didn't qualify for any premium subsidies (and if you got them you had to pay them all back).  For this year and next, if you're over 400% FPL you can get a subsidy so that your insurance premium will be 8.5% of AGI.

3.  It makes the subsidies more generous for 2021 and 2022.  If you're in the 133% to 400% of FPL range, they lowered the percentage of your AGI that you're expected to pay towards HI premiums, which is a roundabout way of increasing the subsidies.

Separately, the President also opened the exchanges for everyone so people could either (a) sign up if they weren't currently on an ACA plan, or (b) switch plans for any (or no) reason if they were on an ACA plan they didn't like.  I believe this was done via executive action.

So for you, MissNancyPryor:

A.  The refund of your subsidy repayment is because of item #1 above.

B.  The reduction in your bronze premium is due to item #3 above.

C.  The invitation to shop for a silver plan is a result of item #3 and the President's executive action.

Since you still want an HSA, you can stay with your current bronze HSA plan and do everything as you normally would in terms of making an HSA contribution.  You *might* be able to switch from a bronze HSA to a silver HSA but note that (a) you might have to restart your deductible, and (b) the silver HSA will probably cost more.

If your subsidized premium is now $4 a month, then that's all you need to pay.  If you choose to overpay, eventually your HI company will probably get in touch with you to refund the overpayment to you.

Repayment is back in play for 2021 (and presumably 2022).  So you'll have to repay any excess premium subsidy you get this year.  The "not having to repay" thing was only for 2020.

One way to make sure you won't have to repay is to make sure that your actual AGI and family size on your tax return match or are better than the AGI and family size you reported to your state marketplace.  In the case of AGI, your actual tax return AGI would need to be lower than your estimated AGI, and your family size would have to be equal to or larger than your reported family size.  And of course you'd have to report your zip code correctly.

A second way to avoid repayment is to refuse the advanced premium tax credit (aka subsidy) during the year, pay your full bronze HSA premium now, and collect the premium tax credit as part of your tax return.  Most people don't like to do this because the unsubsidized premiums are generally high, but it's another way to guarantee not having to repay anything.

If your AGI is higher than you estimate, then I think you'll still be required to repay any excess subsidy even though the 400% cliff is gone.  You just might not have to repay as much, because instead of being entitled to a subsidy of $0, you'll be entitled to a subsidy of (cost of your bronze HSA plan - 8.5% of your AGI).  Note that for very high incomes and or relatively young people, that amount still could be $0.

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Re: What comes after the ACA?
« Reply #6779 on: June 02, 2021, 08:28:48 PM »
quote from @secondcor521
~~snip
One way to make sure you won't have to repay is to make sure that your actual AGI and family size on your tax return match or are better than the AGI and family size you reported to your state marketplace.  In the case of AGI, your actual tax return AGI would need to be lower than your estimated AGI, and your family size would have to be equal to or larger than your reported family size.  And of course you'd have to report your zip code correctly.

A second way to avoid repayment is to refuse the advanced premium tax credit (aka subsidy) during the year, pay your full bronze HSA premium now, and collect the premium tax credit as part of your tax return.  Most people don't like to do this because the unsubsidized premiums are generally high, but it's another way to guarantee not having to repay anything.

If your AGI is higher than you estimate, then I think you'll still be required to repay any excess subsidy even though the 400% cliff is gone.  You just might not have to repay as much, because instead of being entitled to a subsidy of $0, you'll be entitled to a subsidy of (cost of your bronze HSA plan - 8.5% of your AGI).  Note that for very high incomes and or relatively young people, that amount still could be $0.

~~snip

Excellent detail, thanks for the effort in responding to that level. 

I did exactly as you say in the first quoted paragraph above; it was my first year and I knew I was underpaying on my health premiums and there would be a reckoning.  At the end of the year through stock sales I controlled my taxable income to avoid the cliff and was prepared to give back some of the advance subsidy (which they refunded after the bill passed).   

I am currently doing what you note in the second quoted paragraph; for now I bumped that $4 premium way back upwards to avoid surprises and I understand a reconciliation will happen and I may get it all back.  I am fine overpaying all year while I figure it out.  I don't think there is an HSA silver option in my county but I am fine with that since I have no health issues and only need preventative things like an annual physical.  Knock wood for continued good health.     

My question seems to be entirely encapsulated in your third paragraph-  if there is now no cliff and I am still very much in control of how much my taxable income will be, what does the meandering downward slope look like?  I looked for a calculator online to test various AGIs but am stumped, maybe too early yet for good ones to become available. 

MissNancyPryor

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Re: What comes after the ACA?
« Reply #6780 on: June 02, 2021, 08:31:41 PM »
My question is-- with the cliff gone, how much can my taxable income be to avoid repayment of anything?     
For 2021, the case study spreadsheet includes ACA effects in its tax calculations.  You could try that for an estimate.

Thanks, I will check this out! 

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Re: What comes after the ACA?
« Reply #6781 on: June 02, 2021, 08:36:25 PM »
I am currently doing what you note in the second quoted paragraph; for now I bumped that $4 premium way back upwards to avoid surprises and I understand a reconciliation will happen and I may get it all back.  I am fine overpaying all year while I figure it out.  I don't think there is an HSA silver option in my county but I am fine with that since I have no health issues and only need preventative things like an annual physical.  Knock wood for continued good health.     

If you just increased what you're paying your insurance company, then they'll eventually refund you the overpayment.  What you can also do is go to your ACA marketplace people and say, effectively, "Hey, I know I'm entitled to $300 (or whatever) in ACA premium subsidy, but I don't want it."  Then your insurance company would bill you for the full premium and you'd straighten it out on your tax return on Form 8962.

In the big scheme of things, it doesn't really matter.  You're either creating a credit with your insurance company (which is what it sounds like to me), or the IRS (which is what I was suggesting).  But it doesn't matter really except for your short term cash flow and knowing with whom you need to settle up with at some point in the future.

And yeah, silver HSA plans are rare.  There are a bunch of Bronze HSAs in my county and only one Silver HSA.  I personally am on a bronze HSA, probably for reasons similar to yours.

My question seems to be entirely encapsulated in your third paragraph-  if there is now no cliff and I am still very much in control of how much my taxable income will be, what does the meandering downward slope look like?  I looked for a calculator online to test various AGIs but am stumped, maybe too early yet for good ones to become available.

The best one I know of is here.  It includes the effects of the COVID relief bill to which you and I have been alluding:

https://www.kff.org/interactive/subsidy-calculator/

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Re: What comes after the ACA?
« Reply #6782 on: June 02, 2021, 09:13:46 PM »
My question is-- with the cliff gone, how much can my taxable income be to avoid repayment of anything?     
For 2021, the case study spreadsheet includes ACA effects in its tax calculations.  You could try that for an estimate.
The best one I know of is here.  It includes the effects of the COVID relief bill to which you and I have been alluding:

https://www.kff.org/interactive/subsidy-calculator/
Appears those each give the same answer, at least for the handful of situations I tried.  Nice when different approaches reach the same conclusion.

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Re: What comes after the ACA?
« Reply #6783 on: June 02, 2021, 09:46:02 PM »
Appears those each give the same answer, at least for the handful of situations I tried.  Nice when different approaches reach the same conclusion.

The person who writes the CSS is pretty capable I hear.

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Re: What comes after the ACA?
« Reply #6784 on: June 03, 2021, 04:52:13 AM »
You can also just go to healthcare.gov and game out different income scenarios.

MissNancyPryor

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Re: What comes after the ACA?
« Reply #6785 on: June 03, 2021, 07:37:22 AM »
Thanks everyone-

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Re: What comes after the ACA?
« Reply #6786 on: June 03, 2021, 09:30:23 AM »
Don't forget in 2022 if you go to the ER you won't get any nasty surprises when it comes to billing time.. You will only pay your in-network rate whether you go to an in- or out of network facility or whatever provider spends 2 minutes looking at your notes.

Want to take a road trip around the country?.. You can do this and not get na$ty surprised if you end up in the ER...:)

Speaking of the ACA, wasn't SCOTUS supposed to rule on whether the whole thing was constitutional this month??

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Re: What comes after the ACA?
« Reply #6787 on: June 10, 2021, 05:51:55 AM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!

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Re: What comes after the ACA?
« Reply #6788 on: June 10, 2021, 06:45:15 AM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!
NY has free cover for under 200% FPL for 2021 and 2022.  If your current monthly income is low you will get Medicaid for at least a year, since they do it in 1 year blocks.  MAGI doesn't consider tax exempt or deductions.

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Re: What comes after the ACA?
« Reply #6789 on: June 10, 2021, 07:29:57 AM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!
NY has free cover for under 200% FPL for 2021 and 2022.  If your current monthly income is low you will get Medicaid for at least a year, since they do it in 1 year blocks.  MAGI doesn't consider tax exempt or deductions.

Is that based on monthly income or overall annual income at the end of the year? Since I stopped working last month, that makes a huge difference!

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Re: What comes after the ACA?
« Reply #6790 on: June 10, 2021, 07:40:52 AM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!
NY has free cover for under 200% FPL for 2021 and 2022.  If your current monthly income is low you will get Medicaid for at least a year, since they do it in 1 year blocks.  MAGI doesn't consider tax exempt or deductions.

Is that based on monthly income or overall annual income at the end of the year? Since I stopped working last month, that makes a huge difference!
Medicaid is based on monthly income, ACA is based on annual AGI.  Very confusing.

NY has its own marketplace, NYStateOfHealth.  You can experiment with income numbers before creating an account and applying, but only for incomes above the Medicaid/Essential Plan levels.

You also want to apply early - applications before the 15th of the month can go into effect on the first of the next month.  After the 15th of the month, your coverage goes into effect the first of month after the next month.  So an application today can begin July 1; next week, August 1.

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Re: What comes after the ACA?
« Reply #6791 on: June 10, 2021, 03:37:09 PM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!
NY has free cover for under 200% FPL for 2021 and 2022.  If your current monthly income is low you will get Medicaid for at least a year, since they do it in 1 year blocks.  MAGI doesn't consider tax exempt or deductions.

Is that based on monthly income or overall annual income at the end of the year? Since I stopped working last month, that makes a huge difference!
Medicaid is based on monthly income, ACA is based on annual AGI.  Very confusing.

NY has its own marketplace, NYStateOfHealth.  You can experiment with income numbers before creating an account and applying, but only for incomes above the Medicaid/Essential Plan levels.

You also want to apply early - applications before the 15th of the month can go into effect on the first of the next month.  After the 15th of the month, your coverage goes into effect the first of month after the next month.  So an application today can begin July 1; next week, August 1.

VERY confusing. I didn't know about medicaid being based on monthly income! So let's say near the end of the year I convert $15k from pre-tax IRA to Roth, would that "realized" income make me ineligible for that month?

secondcor521

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Re: What comes after the ACA?
« Reply #6792 on: June 10, 2021, 03:51:54 PM »
Anyone know how the ACA expansion has impacted coverage in New York State? I'll be moving there next month (job-free) and wanted to weigh my options. Current earned income is around $40k (will be tax-exempt under FEIE) but wanted to use my standard deduction and $3k in previous year tax loss harvesting to make a $15k roth conversion. I understand ACA credits are based on MAGI, not AGI, right? So foreign earned income still counts in calculating ACA credits?

Hope someone knows the best tool to evaluate this scenario. Thanks!
NY has free cover for under 200% FPL for 2021 and 2022.  If your current monthly income is low you will get Medicaid for at least a year, since they do it in 1 year blocks.  MAGI doesn't consider tax exempt or deductions.

Is that based on monthly income or overall annual income at the end of the year? Since I stopped working last month, that makes a huge difference!
Medicaid is based on monthly income, ACA is based on annual AGI.  Very confusing.

NY has its own marketplace, NYStateOfHealth.  You can experiment with income numbers before creating an account and applying, but only for incomes above the Medicaid/Essential Plan levels.

You also want to apply early - applications before the 15th of the month can go into effect on the first of the next month.  After the 15th of the month, your coverage goes into effect the first of month after the next month.  So an application today can begin July 1; next week, August 1.

VERY confusing. I didn't know about medicaid being based on monthly income! So let's say near the end of the year I convert $15k from pre-tax IRA to Roth, would that "realized" income make me ineligible for that month?

Ask your state Medicaid people.  Someone either here or on another forum indicated that in their state, one month of high income is considered a blip and would not throw you off Medicaid nor make you ineligible that month.  But I don't know which state they were in, and Medicaid is a state run (but largely federally funded?) program and each state sets their own rules within Federal requirements.

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Re: What comes after the ACA?
« Reply #6793 on: June 10, 2021, 03:55:09 PM »
Just contacted the state medicaid people and they said eligibility is based on total annual gross income... not monthly. So it looks like I wouldn't qualify.

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Re: What comes after the ACA?
« Reply #6794 on: June 10, 2021, 04:04:34 PM »
Just contacted the state medicaid people and they said eligibility is based on total annual gross income... not monthly. So it looks like I wouldn't qualify.
They don't know what they are talking about.  The Federal rules are monthly.  However if income is periodic and recurring but lumpy it can be averaged over a year.  One off lumps generally are not counted, but if a periodic and recurring pattern happens then they may count it as averaged.  Each state has its own methodology.

Say you get laid off mid year and your income drops, you would definitely qualify since going forward income is low.

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Re: What comes after the ACA?
« Reply #6795 on: June 10, 2021, 04:28:27 PM »
Just contacted the state medicaid people and they said eligibility is based on total annual gross income... not monthly. So it looks like I wouldn't qualify.
They don't know what they are talking about.  The Federal rules are monthly.  However if income is periodic and recurring but lumpy it can be averaged over a year.  One off lumps generally are not counted, but if a periodic and recurring pattern happens then they may count it as averaged.  Each state has its own methodology.

Say you get laid off mid year and your income drops, you would definitely qualify since going forward income is low.

Hmmm ok that makes me feel a bit better. I'll have to do some more digging, but quickly if I need to apply before the 15th!

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Re: What comes after the ACA?
« Reply #6796 on: June 10, 2021, 04:49:07 PM »
Hmmm ok that makes me feel a bit better. I'll have to do some more digging, but quickly if I need to apply before the 15th!
Since we are in a declared public health emergency anyone currently on Medicaid will keep it at least until the PHE has ended.  Most think the PHE will last through 2021.

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Re: What comes after the ACA?
« Reply #6797 on: June 10, 2021, 05:44:59 PM »
Hmmm ok that makes me feel a bit better. I'll have to do some more digging, but quickly if I need to apply before the 15th!
Since we are in a declared public health emergency anyone currently on Medicaid will keep it at least until the PHE has ended.  Most think the PHE will last through 2021.
Will it though? Vaccines are now widely available to anyone to wants one, nationwide, even the most far flung locations. States are reinstating job search requirements. Eviction bans are on the way out. Every school is expected to reopen in the fall.

I don't see how they can maintain the status quo through the end of the year. The current order expires mid-July. There is already tremendous political pressure to kickstart the economy and country back to life. I have no internal knowledge of how HHS makes those determinations, but I wouldn't count on it lasting much longer.


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Re: What comes after the ACA?
« Reply #6798 on: June 10, 2021, 05:52:53 PM »
And one more quick question on medicaid eligibility, would I need one full calendar month of no earned income to qualify? Because my previous month I still worked and received a paycheck. But June and going forward will be $0 earned income.

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Re: What comes after the ACA?
« Reply #6799 on: June 10, 2021, 05:57:15 PM »
And one more quick question on medicaid eligibility, would I need one full calendar month of no earned income to qualify? Because my previous month I still worked and received a paycheck. But June and going forward will be $0 earned income.

You can apply now