What comes after the ACA?

[The 585]

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.

In my personal experience qualifying for Medicaid in two different states (neither was NY), all they cared about was monthly income. You could make $50K/month for the first 6 months of a year, get laid off, and qualify for Medicaid the following month. The fact that you made $300K in the first half of the year would be irrelevant, as long as, moving forward, your income was low enough to qualify. In 2015, I quit my job on June 15, went home, and immediately called our local Medicaid office, applied over the phone, and started receiving benefits on the first of July. As Jim said, don't wait. Apply now, so you can get coverage asap.

I think my concern is that for income, they give.the option of averaging your monthly income for.the year (would make me ineligible based on my first four months of income) OR I have the option of saying my income is different than the average... And then I.have to specify my income for the precious calendar month. And since i still received paychecks in May, it appears I'm still making significant income.

[jim555]

I think my concern is that for income, they give.the option of averaging your monthly income for.the year (would make me ineligible based on my first four months of income) OR I have the option of saying my income is different than the average... And then I.have to specify my income for the precious calendar month. And since i still received paychecks in May, it appears I'm still making significant income.

May is history and doesn't matter.  The current income limit is $1,482 a month for a 1 person house.

The PHE expires in July and renews in 3 month chunks.  They promised to give 60 days notice that they are not going to renew the PHE.

[FIRE 20/20]

If this isn't the right place to ask, please let me know and I'll start a new thread.  But with so many people who are knowledgeable about the ACA I thought I might try asking here first.

Because of the changes made to the ACA this year in the American Rescue Plan, I think my premiums should drop a bit.  It's not a huge amount - maybe a few hundred $ total for the rest of the year.  However, each time I've adjusted something in my state's ACA website I've had unintended consequences.  Once they signed me up for Medicaid and I had to spend a lot of time convincing them that I earn too much to be on Medicaid.  So I really don't want to change anything if I don't have to.

So my question is, if I don't change anything and keep paying my current premiums, will I be able to get the over-paid premiums back as a tax refund when I file my taxes next year?  I assume that's how it works, but I want to be certain.  The amount of money is so small that I'm totally willing to give the government a 9 month loan of that small amount of money rather than spend a bunch of time updating my income and possibly screwing up my health insurance again because of a finicky website.  On the other hand, if I won't get the money back then I will take the time to change my income because I don't want to lose (rather than temporarily loan) a few hundred dollars to the gov't. 

Thanks!

[The 585]

I think my concern is that for income, they give.the option of averaging your monthly income for.the year (would make me ineligible based on my first four months of income) OR I have the option of saying my income is different than the average... And then I.have to specify my income for the precious calendar month. And since i still received paychecks in May, it appears I'm still making significant income.

May is history and doesn't matter.  The current income limit is $1,482 a month for a 1 person house.

The PHE expires in July and renews in 3 month chunks.  They promised to give 60 days notice that they are not going to renew the PHE.

Well what I'm saying is, at least for New York State's application process, they let you use your "average monthly income" as if it were spread throughout the year (I earned roughly $40k before quitting -- so it would average out to over $3.3k monthly), OR alternatively use your "current income" instead if it differs from that. But they define "current income" as your previous month earnings. So last month, May, I ended employment and earned just over the $1,482 limit and I'm afraid they'd deny me based on that month.

Based on that "current income" referring to the previous month, I'd have to wait until the beginning of July and claim that I had no employment income for the month of June to qualify. Does that make sense? Please correct me if my logic is wrong here!

[Paul der Krake]

If this isn't the right place to ask, please let me know and I'll start a new thread.  But with so many people who are knowledgeable about the ACA I thought I might try asking here first.

Because of the changes made to the ACA this year in the American Rescue Plan, I think my premiums should drop a bit.  It's not a huge amount - maybe a few hundred $ total for the rest of the year.  However, each time I've adjusted something in my state's ACA website I've had unintended consequences.  Once they signed me up for Medicaid and I had to spend a lot of time convincing them that I earn too much to be on Medicaid.  So I really don't want to change anything if I don't have to.

So my question is, if I don't change anything and keep paying my current premiums, will I be able to get the over-paid premiums back as a tax refund when I file my taxes next year?  I assume that's how it works, but I want to be certain.  The amount of money is so small that I'm totally willing to give the government a 9 month loan of that small amount of money rather than spend a bunch of time updating my income and possibly screwing up my health insurance again because of a finicky website.  On the other hand, if I won't get the money back then I will take the time to change my income because I don't want to lose (rather than temporarily loan) a few hundred dollars to the gov't. 

Thanks!

Yes, you will be able to claim the full premium credit for which you were eligible, just like if you withhold too much income taxes on your paycheck you eventually get it back. Advance credits are just that, an advance. If you get it "wrong", whether because the calculation changed or because you messed up, it doesn't matter because it gets reconciled.

The only time it could make a substantial difference is when you would have qualified for cost sharing reductions (CSRs). If any of the provisions in the new law may make you suddenly eligible for more of it, that may make poking the bear worth it.

[jim555]

Well what I'm saying is, at least for New York State's application process, they let you use your "average monthly income" as if it were spread throughout the year (I earned roughly $40k before quitting -- so it would average out to over $3.3k monthly), OR alternatively use your "current income" instead if it differs from that. But they define "current income" as your previous month earnings. So last month, May, I ended employment and earned just over the $1,482 limit and I'm afraid they'd deny me based on that month.

Based on that "current income" referring to the previous month, I'd have to wait until the beginning of July and claim that I had no employment income for the month of June to qualify. Does that make sense? Please correct me if my logic is wrong here!

It is current month income, not last month income.  That is the legal definition.

[The 585]

Well what I'm saying is, at least for New York State's application process, they let you use your "average monthly income" as if it were spread throughout the year (I earned roughly $40k before quitting -- so it would average out to over $3.3k monthly), OR alternatively use your "current income" instead if it differs from that. But they define "current income" as your previous month earnings. So last month, May, I ended employment and earned just over the $1,482 limit and I'm afraid they'd deny me based on that month.

Based on that "current income" referring to the previous month, I'd have to wait until the beginning of July and claim that I had no employment income for the month of June to qualify. Does that make sense? Please correct me if my logic is wrong here!

It is current month income, not last month income.  That is the legal definition.

Yeah, that's what it seems it should be, which frustrates me. I even contacted customer service and they were quite rude, they said "Well what is the question asking? It says previous month". So I don't know, I'd be lying if I said my previous calendar month employment income was $0.

[jim555]

Yeah, that's what it seems it should be, which frustrates me. I even contacted customer service and they were quite rude, they said "Well what is the question asking? It says previous month". So I don't know, I'd be lying if I said my previous calendar month employment income was $0.

You could go on a regular plan for one month and drop in next month if that makes you more comfortable.  You would put in your estimated calendar year income and get a subsidy.  That would be reconciled at tax time next year.  If you are under 200% FPL you don't have to worry, you would get the Essential Plan, which is free.

[The 585]

Yeah, that's what it seems it should be, which frustrates me. I even contacted customer service and they were quite rude, they said "Well what is the question asking? It says previous month". So I don't know, I'd be lying if I said my previous calendar month employment income was $0.

You could go on a regular plan for one month and drop in next month if that makes you more comfortable.  You would put in your estimated calendar year income and get a subsidy.  That would be reconciled at tax time next year.  If you are under 200% FPL you don't have to worry, you would get the Essential Plan, which is free.

Maybe that's what I'll do so I can faithfully apply with accurate income information. Thanks again, I appreciate all the insight and ideas!

[The 585]

But also if you qualify for medicaid, they can cover any medical bills within the previous three months correct? So theoretically it might be risky but I could just have a gap month, and if anything happens medicaid enrollment in the future should cover it.

[subhobroto]

The main issue with U.S. healthcare are costs. The costs are insane.

I am not going to beat the regulation horse to death because it's too big a fight for me to handle and I want solutions now instead of 30 years from now.
So I cross the border to Mexico when I need medical care where I am comfortable working in a significantly less regulated environment.
For those procedures where I want to be more comfortable, I stay in the U.S. with my blank check in hand hoping the hospital don't bill me $50k to stitch my elbow, sucking up the next year of my life as I go back and forth between multiple phone calls and emails about deductibles, network coverage and all those nice details that really make my life a joy everytime I have to seek care that goes beyond a casual check up.

So, how about this:

1. Individuals get the exact same tax benefits for buying their health insurance from anywhere they want as companies (or their employers) do.

In other words, it does not matter, from a tax perspective to me, whether I, the employee purchase health insurance through my employer or another place. What I could lose out on are some additional benefits the employer gives if I don't part take in the employer-sponsored health insurance. If a health policy costs $2500/mo total (employee + employer premiums), I should be able to purchase the same $2500/mo plan and get all the same tax deductions that my employer can currently take.

2. All qualified medical expenses get tax credits.

If my co-pay was $50, that's a tax credit.
If I carried no insurance, got a $50k invoice from my nice hospital for stitching my elbow and I pay it, I get a $50k tax credit.
What doesn't get a tax credit is if I botoxed the hell out of my butt because it attracts more eyeballs and that makes me happy. If I want eyeballs on my butt, that's on my dime.

This is going to get our insane medical costs under control real quick as the huge weight of our govt. clamps down on hospitals that charge $100,000 when it actually should have been $782.29: https://www.prnewsonline.com/100k-hospital-bill-that-shrank-to-800-illustrates-healthcare-communicators-dilemma/

Do you know why all U.S. hospitals operate at a loss? Because they charge $100,000 when it actually should have been $782.29 and write off the $99217.71 as a loss.

Every qualified medical expense we incur gets a dollar for dollar offset in our taxes.

3. All health insurance companies are incentivized to offer an app that takes the NPI and CPT code and spits out the contracted (or not) price for that procedure.

I'm not talking about the amount approved by the provider for the claimant - I'm talking about "how much will this provider bill my insurance for this procedure".

Any health insurance company that does not offer this will have to apply a IncompetentCompany(TM) credit to the monthly premium as long as they are not compliant.

This allows a customer/person to find out their total financial liability for selecting a provider for a procedure. There will be no restriction on whether the customer can then upload this information to a publicly accessible website.

[American GenX]

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

There are a few possibilities, with one of them being that the whole thing would be overturned because the mandate is ruled unconstitutional.   But they could have made this ruling in previous months as well, but since that didn't happen, we should hear a decision by the end of June.

[subhobroto]

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

There are a few possibilities, with one of them being that the whole thing would be overturned because the mandate is ruled unconstitutional.   But they could have made this ruling in previous months as well, but since that didn't happen, we should hear a decision by the end of June.

See here's the rub I have with the government: really, the only way to get them to act is by suing them, and suing is very expensive, especially the government.

For example, constitutional or not, California will - and has been - enforcing gun control and the ACA until the Communist party of California drives the state bankrupt.

So as a resident of California, subject to California jurisdiction, I have to put up with these things - constitutional or not.

SOlution - keep the frigging government out of every damn thing until it hurts. That's the right balance. When it starts to hurt removing the last piece.

Right now, California is hurting and not because due to lack of government (maybe due to lack of good governance but this weekend is too short to get into that)

[pecunia]

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

There are a few possibilities, with one of them being that the whole thing would be overturned because the mandate is ruled unconstitutional.   But they could have made this ruling in previous months as well, but since that didn't happen, we should hear a decision by the end of June.

See here's the rub I have with the government: really, the only way to get them to act is by suing them, and suing is very expensive, especially the government.

For example, constitutional or not, California will - and has been - enforcing gun control and the ACA until the Communist party of California drives the state bankrupt.

So as a resident of California, subject to California jurisdiction, I have to put up with these things - constitutional or not.

SOlution - keep the frigging government out of every damn thing until it hurts. That's the right balance. When it starts to hurt removing the last piece.

Right now, California is hurting and not because due to lack of government (maybe due to lack of good governance but this weekend is too short to get into that)

You know - It could be that the reverse is true.  At least as it regards health care.  Canada seems to be doing OK as do many other countries with government health care.

Really, these libertarian ideas of an anarchist Republic with no government sound like the kind of folks that killed President McKinley years ago.  I really don't think the philosophy of zero government has a historical precedent of working very well.  There would be a vacuum.  Maybe big business would happily fill this vacuum.  You might not like that.

Texas may be a better place for one who hates taxes and government.

[bacchi]

For example, constitutional or not, California will - and has been - enforcing gun control and the ACA until the Communist party of California drives the state bankrupt.

California has at least a budget surplus of $12B this year (+$26B from the feds). It also has a $38B surplus that's specific for education (some of that may be from the feds). That usually doesn't happen with bankrupt entities.

As a comparison, Texas has a budget surplus of $725M this year.

[bacchi]

Well, that's good news. The SC sidestepped the issue, by making it about standing, but the ACA continues.

[jim555]

https://www.supremecourt.gov/opinions/20pdf/19-840_6jfm.pdf

"Held: Plaintiffs do not have standing to challenge §5000A(a)’s minimum essential  coverage  provision  because  they  have  not  shown  a  past or future injury fairly traceable to defendants’ conduct enforcing the specific statutory provision they attack as unconstitutional."

[secondcor521]

I don't know if all dissents are as forceful, but I thought Justice Alito's dissent made more sense than the majority opinion.  (And this is apart from whether my opinion matches the majority or the dissent.)

Ending lines of Justice Alito's dissent:

"No one can fail to be impressed by the lengths to which this Court has been willing to go to defend the ACA against all threats. A penalty is a tax. The United States is a State.  And 18 States who bear costly burdens under the ACA cannot even get a foot in the door to raise a constitutional challenge. So a tax that does not tax is allowed to stand and support one of the biggest Government programs in our Nation’s history. Fans of judicial inventiveness will applaud once again.
 But I must respectfully dissent."

[American GenX]

I've been waiting since February 2018 for this lawsuit to make its way through the courts to get to this point, delaying FIRE along the way.  In the end, a ruling that would keep most or all of the ACA in place was expected.  This might not be the preferred way for it to happen, but I'll take it.

[jim555]

I've been waiting since February 2018 for this lawsuit to make its way through the courts to get to this point, delaying FIRE along the way.  In the end, a ruling that would keep most or all of the ACA in place was expected.  This might not be the preferred way for it to happen, but I'll take it.

So will you retire now?

[WhiteTrashCash]

Now all that needs to happen is for the temporary increase in ACA subsidies to be made permanent and everything will be set for most of the nation. I was closely following this lawsuit going through the Supreme Court, but now it looks safe to start long-term planning for FIRE.

[bacchi]

I don't know if all dissents are as forceful, but I thought Justice Alito's dissent made more sense than the majority opinion.  (And this is apart from whether my opinion matches the majority or the dissent.)

Ending lines of Justice Alito's dissent:

"No one can fail to be impressed by the lengths to which this Court has been willing to go to defend the ACA against
all threats. A penalty is a tax. The United States is a State.  And 18 States who bear costly burdens under the ACA cannot even get a foot in the door to raise a constitutional challenge. So a tax that does not tax is allowed to stand and support one of the biggest Government programs in our Nation’s history. Fans of judicial inventiveness will applaud once again.
 But I must respectfully dissent."

With a brief read, I more-or-less agree. However, it's not like Alito would've changed his opinion if the case was decided on its merits. He agreed with Scalia's nonsense in King v Burwell (talk about judicial inventiveness) and he wouldn't have recognized any severability or Congress' will.

[American GenX]

I've been waiting since February 2018 for this lawsuit to make its way through the courts to get to this point, delaying FIRE along the way.  In the end, a ruling that would keep most or all of the ACA in place was expected.  This might not be the preferred way for it to happen, but I'll take it.

So will you retire now?

Now, I am more certain on FIRE next spring.

https://forum.mrmoneymustache.com/welcome-to-the-forum/2021-fire-cohort/msg2858839/#msg2858839

[Mr. Green]

For example, constitutional or not, California will - and has been - enforcing gun control and the ACA until the Communist party of California drives the state bankrupt.

The State of California is the 5th largest economy in the world, preceded only by four countries, of which the United States is one (obviously). I don't think they're worried about money.

[teen persuasion]

Well what I'm saying is, at least for New York State's application process, they let you use your "average monthly income" as if it were spread throughout the year (I earned roughly $40k before quitting -- so it would average out to over $3.3k monthly), OR alternatively use your "current income" instead if it differs from that. But they define "current income" as your previous month earnings. So last month, May, I ended employment and earned just over the $1,482 limit and I'm afraid they'd deny me based on that month.

Based on that "current income" referring to the previous month, I'd have to wait until the beginning of July and claim that I had no employment income for the month of June to qualify. Does that make sense? Please correct me if my logic is wrong here!

It is current month income, not last month income.  That is the legal definition.

Yeah, that's what it seems it should be, which frustrates me. I even contacted customer service and they were quite rude, they said "Well what is the question asking? It says previous month". So I don't know, I'd be lying if I said my previous calendar month employment income was $0.

Yeah, I've been having lots of fun trying to apply, too.  DH's last "day" is in early July (not a worked day, a school holiday pay day), and first told him we'd have medical coverage thru July.  Then a union rep said HR had it wrong, if he didn't actually work in July, coverage only went thru June.  So a scramble to apply before June 15.

First they ask what income we each expect this year.  I respond with our taxable (AGI) numbers, not gross numbers (we have lots going to pre-tax retirement accounts and HSA), because that's what eligibility is based on.  The website averages that to monthly, and asks if it matches our monthly income.  NO!  Plus, we have a 22 yo son, who will not be our tax dependent this year, but as he is under 26 he SHOULD be able to stay on our health insurance, and thus his income should be included in household income.  He started a job mid April, so his annual income doesn't match weekly * 52, either.

Put our numbers in, and first they break up the household of 4 to a household of 1 (DS4) on ACA, and household of 3 not sure(eventually on Medicaid).  By my calculations, we should be on Essential plan for household of 4 with combined income.  It's all preliminary, until we prove numbers with uploaded documents, even for teen with no income.  I tried calling.  Got cut off once.  Second attempt - they want a month's pay stubs from workers, and we need a letter of termination from DH's employer with estimated income.  Also need a letter of termination from health insurance company.  Call health insurance company - can't send a letter of termination, because employer hasn't sent them notice, yet.  So request employer craft letters for NYSofHealth and health insurance company.  Of course, employer letter of termination has gross income, but labels it taxable (way off), and now says health coverage goes thru July.  (Also as per phone call, for teen, upload parents' documents again, as family income).

Upload pay stubs and letter of termination.  Now website doesn't like son's pay stubs - need more current ones.  Everyday I get a new email about something urgently needed.

Had annual eye exam today.  Booking next year's appointment, I asked about changes in health insurance.  They can't do Medicaid; can do Medicare, not Medicaid.  Gave me the name of the one doctor who can do Medicaid, because I'd have to switch.  Apparently only one doctor in an area can be the Medicaid doctor (at least for eyes); Dr So-and-So wanted to also accept Medicaid patients, but was refused, because Dr First was the designated Medicaid Dr here.  Really!  So was trying to reschedule our sons' appointments from August 2 to within July.  Got younger son in (because going to Medicaid) but older will likely have own insurance on ACA, so COULD be covered if he picks the right affiliates (Eyemed, Davis - good; lots of others - not affiliated).  Or, as an established patient, could pay OOP, $95 (but was unclear if additional fees for etc.).

This is just the eye doc.  No idea about pediatrician, DH's doctor, specialists, dentist...

Still have to pick plans.  Waiting until it all shakes out - I expect them to look at our gross income numbers and change everything.  And, of course, if DS4 picks an HSA plan he could drop his AGI down.  The Essential plan really messes with the Silver CSR - under 200% FPL, you have to do Essential plan, no ACA subsidy for you.  From 200-250% FPL you get ACA subsidies, but those aren't enough to get a silver plan for free or cheap, and CSR are not as good.  DS4 would need to pay ~$150/mo for silver.  A bronze could be free, but no CSR and high deductibles/OOP max.  So it's a catch-22: he could pick an HSA plan, fund an HSA, drop his AGI - and now be below 200% FPL and in Essential plan range - and not eligible for an HSA!  Round and round we go.

[jim555]

Kind of puzzling over your experience.  They let you have Medicaid as fee for service without being in a Managed Care plan?  I didn't think that was even a choice.  Usually you pick your Managed Care plan and stay within the provider network and have no problems.

As far as the Essential Plan under 200% FPL, there are no subsidies because Essential Plan is not regular ACA insurance, there are no CSR reductions, because the EP is actually MORE generous than any regular Silver plan.  NY invoked the BHP provision of the ACA, that means EP is better than any regular Silver.  EP is free for 2021 and 2022.  HSA doesn't apply to the EP since HSA is for high deductible plans, EP is not high deductible.

Some quirks to remember, ACA and EP are based on calendar year income, Medicaid is monthly based.  You could have made a ton in the beginning of the year and still qualify for Medicaid because your current monthly income dropped (under the monthly Medicaid number) due to retirement.

[teen persuasion]

Kind of puzzling over your experience.  They let you have Medicaid as fee for service without being in a Managed Care plan?  I didn't think that was even a choice.  Usually you pick your Managed Care plan and stay within the provider network and have no problems.

As far as the Essential Plan under 200% FPL, there are no subsidies because Essential Plan is not regular ACA insurance, there are no CSR reductions, because the EP is actually MORE generous than any regular Silver plan.  NY invoked the BHP provision of the ACA, that means EP is better than any regular Silver.  EP is free for 2021 and 2022.  HSA doesn't apply to the EP since HSA is for high deductible plans, EP is not high deductible.

Some quirks to remember, ACA and EP are based on calendar year income, Medicaid is monthly based.  You could have made a ton in the beginning of the year and still qualify for Medicaid because your current monthly income dropped (under the monthly Medicaid number) due to retirement.

I'm puzzled, too.  Nothing seems to work the way it's supposed to (as I understand it from researching things ahead of time).

I don't know how Medicaid works, at all, no experience with it, so don't know what I'm doing there.  What does fee for service vs managed care mean?  How do I know which I'm placed in?  Right now I believe it just says eligible for Medicaid.  I did think that NY did Medicaid thru insurance providers, so I was surprised that the eye doctor's office couldn't do Medicaid patients at all, but again - no experience here, so...

My comments about DS4 and Essential plan vs ACA - the issue is that yes, Essential plan would be better than ACA for under 200% FPL, but w/o an HSA option (doesn't exist in Essential plan) he can't get his AGI to < 200% FPL.  If he's in ACA, he has HSA option, can reduce AGI, to the point he's no longer eligible for subsidies, because he's now in Essential plan income range.  In other states w/o Essential plan, he'd still have ACA option at < 200% FPL which would cost less.   I know I'm not explaining it well - it's an unintended quirk he's in, somewhat like the family glitch, or the way an employer's SIMPLE ira mucks up a backdoor Roth IRA.

Biggest issue - how to get us treated as a single household of 4 people consolidating everyone's income.  He's under 26; he can therefore stay on our (parents') insurance; his income should then be included in household income and he is counted in household size; then we all qualify for Essential plan.

But he's not our tax dependent, so NYSofHealth  is treating him as separate household.

[jim555]

But he's not our tax dependent, so NYSofHealth  is treating him as separate household.

Household is defined by tax dependents, if he is not a dependent he isn't part of your household.

When you sign up on NYSOH Medicaid you will need to pick a plan.  Look over the Managed Care plans for what best suits your needs, look at the formularies and doctor networks.  Fee for service is old style Medicaid that no one takes.  Stay in your plan and you will not have a provider problem.

[FireLane]

I'm also planning to use the NY Essential Plan, so this is useful info to read. It sounds like a big bureaucratic headache, but it helps to know what I'm in for.

It seems like the enrollment is much smoother if everyone in a household retires at the end of a tax year. Since DW is planning to retire in mid-2022, this could be an issue for me. I may end up getting a regular marketplace plan for the rest of 2022 and using the EP in 2023.

[jim555]

I'm also planning to use the NY Essential Plan, so this is useful info to read. It sounds like a big bureaucratic headache, but it helps to know what I'm in for.

It seems like the enrollment is much smoother if everyone in a household retires at the end of a tax year. Since DW is planning to retire in mid-2022, this could be an issue for me. I may end up getting a regular marketplace plan for the rest of 2022 and using the EP in 2023.

I have been in NYSOH for 6 years now and it really isn't a problem, at least that is my experience.  I was supposed to leave Medicaid and go to the EP but the pandemic happened and they locked everyone in while we are in a public health emergency, so they keep giving me another year, which is fine by me. 

[American GenX]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

[jim555]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

Nothing in the Biden proposals that I have read make you sign up for Medicare, it would just be another option available.  The ACA and Medicaid expansion remain.  They would need 60 votes to change the ACA, and that isn't happening.

[seattlecyclone]

Even though signing up for Medicare would remain optional, the option of signing up for Medicare would preclude ACA subsidies. One requirement of getting a premium tax credit is that you don't have any other coverage available, including employer coverage, Medicare, and Medicaid.

As for expanded Medicaid, at least in my state an explicit requirement is that you are not entitled to Medicare, though they do have some other stuff available to help low-income folks pay for Medicare, so maybe folks in that Medicaid income range wouldn't be worse off after all.

[jim555]

I don't think we need to do a premature panic since this hasn't even been written yet.  I am sure they will craft it in a way that doesn't give people worse coverage. 

As far as Medicaid it is possible to be a dual eligible with Medicare right now.  What matters is the actual verbiage of the law, but I don't see a Medicare possibility as precluding Medicaid in any way.  Also the Basic Health Plans (NY Essential Plans) are not Medicaid and not ACA subsidies, so they wouldn't be affected.

[American GenX]

Even though signing up for Medicare would remain optional, the option of signing up for Medicare would preclude ACA subsidies. One requirement of getting a premium tax credit is that you don't have any other coverage available, including employer coverage, Medicare, and Medicaid.

As for expanded Medicaid, at least in my state an explicit requirement is that you are not entitled to Medicare, though they do have some other stuff available to help low-income folks pay for Medicare, so maybe folks in that Medicaid income range wouldn't be worse off after all.

Some states may have such programs to help those with low income and hefty assets just like one can qualify for with the Medicaid expansion, which I was comparing to in my post.

In my state, there's a low income AND a very low asset test for the Medicare payment assistance, so it would cut out a lot of people that would otherwise qualify under the current Medicaid expansion.

[American GenX]

I don't think we need to do a premature panic since this hasn't even been written yet.  I am sure they will craft it in a way that doesn't give people worse coverage. 

As far as Medicaid it is possible to be a dual eligible with Medicare right now.  What matters is the actual verbiage of the law, but I don't see a Medicare possibility as precluding Medicaid in any way.  Also the Basic Health Plans (NY Essential Plans) are not Medicaid and not ACA subsidies, so they wouldn't be affected.

I wouldn't make any assumptions about them not being affected/changed based on Medicare changes.  But I never said you should panic.  My first line referenced my hope that it doesn't make it through.  So, there's still hope.  I don't have confidence in it turning out all roses, though.  The government is involved here.

[jim555]

We aren't even in the sausage making part of legislation and being overly concerned is premature, IMO.

[pecunia]

You always have to ask yourself when reading these articles about hypothetical medical legislation as to what would be the best value for the insurance companies.  After all - These are the guys paying for your politicians.

[DaMa]

You always have to ask yourself when reading these articles about hypothetical medical legislation as to what would be the best value for the insurance companies.  After all - These are the guys paying for your politicians.

Sort of thinking out loud here...

The 60-64 group is the most expensive for insurance companies today.  Putting that risk on the government would not only improve profitability, but also allow premium reductions for other groups.  Taking them out of the ACA pool would be really good, since they are probably losing on them in general.  (Aren't there limits on how high the age rating differences can be?)  So the insurance companies would be basically giving the government their losses.   If they can also get them into Medicare Advantage plans, where the government is essentially paying the bill, it's a win-win.

They are going to support it.   They probably wrote it. 

It won't work as an option, Medicare or ACA, if Medicare charges an actual rate (experience rated).  Medicare will cost more, especially initially -- the people already in it are disabled, so high cost.  With the ACA age rating limits, ACA is still going to be cheaper.  So they are going to want to keep the you can't be in ACA plan if your eligible for Medicare rule.

If they don't charge an actual rate, they'll have to raise taxes.  Medicare Part A is fully subsidized and Part B is 80% subsidized (paid by the 2.9% payroll tax).

Wow, I really wish I hadn't gone down this rabbit hole today.

[seattlecyclone]

Taking them out of the ACA pool would be really good, since they are probably losing on them in general.  (Aren't there limits on how high the age rating differences can be?)

Yes. There's a 3:1 difference in premiums on ACA plans between 21-year-olds and 64-year-olds. I read somewhere that a 5:1 ratio would better reflect the actual cost difference between these age groups. The young are forced to subsidize the old through artificially high insurance premiums and we wonder why so many people decide to forego coverage.

[jim555]

NY and VT don't recognize age in setting rates for the ACA.  So losing the 60-64 group would lower rates for everyone.

[American GenX]

NY and VT don't recognize age in setting rates for the ACA.  So losing the 60-64 group would lower rates for everyone.

Actually, it wouldn't.  See the link I provided earlier.  It will be many times more expensive for a lot of those 60 to 64 year olds.

Also remember, the healthy subsidize the unhealthy, and a lot of young people have health problems, and not all older people have health issues   Also remember, too, that everyone hopes to be old eventually, so it all balances out in the end.  I don't mind paying more now to help keep costs down for older people including my future self and most of the rest of you here that will be old someday.

Anyway, the dems want to rush this through using reconciliation, so hopefully this part of plan doesn't make it through.  Actually, I oppose most of the massive spending plan, so I would be happy to see it go down in flames.

[jim555]

NY and VT don't recognize age in setting rates for the ACA.  So losing the 60-64 group would lower rates for everyone.

Actually, it wouldn't.  See the link I provided earlier.  It will be many times more expensive for a lot of those 60 to 64 year olds.

For the 18 through 59 year olds in NY the rates would go down because the more expensive 60-64 group has been removed from the pool, that is all I'm saying.

[friedmmj]

NY and VT don't recognize age in setting rates for the ACA.  So losing the 60-64 group would lower rates for everyone.

Actually, it wouldn't.  See the link I provided earlier.  It will be many times more expensive for a lot of those 60 to 64 year olds.

For the 18 through 59 year olds in NY the rates would go down because the more expensive 60-64 group has been removed from the pool, that is all I'm saying.

You used the term everyone.  I think was a poor word choice.

[dblaace]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

What are the odds of this passing by the end of the year?

I am retiring and will be 60 so I'll be making decisions about insurance in December. Medicare would cost me a little more probably but be more portable and I would not have to worry about AGI.

[Exflyboy]

Yes I am 'forced" to minimise my MAGI on the ACA.

Under Medicare I can earn a lot more before it starts to hurt.

[Mr. Green]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

What are the odds of this passing by the end of the year?

I am retiring and will be 60 so I'll be making decisions about insurance in December. Medicare would cost me a little more probably but be more portable and I would not have to worry about AGI.

I'm curious if the Medicare expansion would actually save money for those that want a higher income. At that young age, a Medicare plan with supplemental probably is 7k or less per person, which is probably less than ACA premiums + max out-of-pocket. That does not help low earners, but if the option remains to select either....

[American GenX]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

What are the odds of this passing by the end of the year?

I am retiring and will be 60 so I'll be making decisions about insurance in December. Medicare would cost me a little more probably but be more portable and I would not have to worry about AGI.

Even if it happened to pass with this included by the end of the year, I can't see it actually taking effect for 2022.  There's a lot of work that will need to be done on the administrative / implementation side of things.  The progressives were pushing for it, but a couple of the moderate democrats have stated that they are not in favor of a $3.5 Trillion spending bill, and they can't afford to lose any of their party votes, so I'm hopeful this is something that gets cut in any final legislation that has a chance of passing.  I would like to see the improvements to Medicare coverage, though.

If it passed and people were given the choice between Medicare and ACA, that would be different, but as shown in a previous link, you aren't eligible to the ACA PCT tax credit if you are eligible for Medicare.

[friedmmj]

Bad News! Hopefully, this won't make it through.

Lowering the Medicare eligibility age is included in Democrats’ $3.5 TRILLION big spending plan:

https://www.cnbc.com/2021/08/09/democrats-budget-plan-calls-for-major-medicare-expansion.html

This would actually increase health care coverage costs for many of the lowest income Americans 60 to 64.

https://apnews.com/article/medicare-business-health-government-and-politics-2d2604b87a3fd87e34523e72ce50238e

And it would be even worse than that shows because many today would be eligible for the Medicaid expansion under the ACA despite having hefty assets, but Medicare will be much more costly, even more so for those who don't have enough years in to get free part A.

What are the odds of this passing by the end of the year?

I am retiring and will be 60 so I'll be making decisions about insurance in December. Medicare would cost me a little more probably but be more portable and I would not have to worry about AGI.

Even if it happened to pass with this included by the end of the year, I can't see it actually taking effect for 2022.  There's a lot of work that will need to be done on the administrative / implementation side of things.  The progressives were pushing for it, but a couple of the moderate democrats have stated that they are not in favor of a $3.5 Trillion spending bill, and they can't afford to lose any of their party votes, so I'm hopeful this is something that gets cut in any final legislation that has a chance of passing.  I would like to see the improvements to Medicare coverage, though.

If it passed and people were given the choice between Medicare and ACA, that would be different, but as shown in a previous link, you aren't eligible to the ACA PCT tax credit if you are eligible for Medicare.

Agree on the slim odds of this taking effect in the near term.  I doubt the age 60 part makes it into any bill that eventually passes.  I think it's more likely that some incremental benefits will be added like dental care, hearing aids, etc. 

[secondcor521]

Question. The last stimulus package included ACA cost sharing subsidy increase for people who received unemployment at any point in 2021, reducing their insurance premiums to almost zero. When does this change expire?

This is what I'm referring to:

https://www.kff.org/health-reform/issue-brief/impact-of-key-provisions-of-the-american-rescue-plan-act-of-2021-covid-19-relief-on-marketplace-premiums/

People Receiving Unemployment Insurance
The COVID-19 relief law makes special considerations for people approved to receive or receiving unemployment compensation at any point in 2021. Under the COVID-19 relief law, if a person is receiving unemployment compensation and she qualifies to purchase insurance on the Marketplace, she and any eligible dependents can get a silver plan with a $0 premium. That is because, under the proposal, any household income above 133% of poverty is not considered in the calculation of her premium tax credit if she receives unemployment insurance.

For people receiving unemployment compensation at any point in 2021, their income up to 133% of poverty is counted in determining eligibility for a cost-sharing reduction, which is only available to people with incomes between 100% and 250% of poverty. That is, a person with income, including unemployment compensation, of 260% of poverty would receive a premium and cost-sharing reduction subsidy as if her income is 133% of poverty. A person receiving unemployment income would still need to attest that they do not have an affordable offer of employer-sponsored insurance from their spouse or other family member. As the COVID-19 relief law does not change the so-call “family glitch” in the ACA, if an employer offer is deemed affordable (9.83% of household income for 2021 for self-only coverage), this may disqualify people receiving unemployment income from receiving ACA subsidies if they still have a working family member with an employer offer.

Currently (i.e., until/unless the law is changed again) it expires at the end of 2021.  In other words, it's a change for this year only.