US Medicaid, why avoid it?

[jacob]

There is a lot of focus on dialing in exactly the right income for ACA in order to avoid Medicare? Why is that? What is wrong with Medicare?

[ether]

Medicare is for when you're over 65, I don't know anyone that tries to avoid that program
Medicaid is for low income individuals.

Here is a local example, there are about 30 dentists in a 20 mile radius of my home.
None of them accept Medicaid period, so I would have to travel 50 miles to go to the closest dental office that accepts Medicaid.
So essential everyone in my city that has Medicaid doesn't get dental services. [100k people in my city]

Also there are only 3 general practice doctors offices that accept Medicaid in my city, and two of them are located at Walmart.

Honestly it depends on your location. Take a look at the local places that accept Medicaid and try out the facilities before you sign up.

[sky]

It has been some time since I researched this, but after a certain age (mid 50s), Medicare/aid is no longer an insurance plan, it is a loan. They will try to recover all expenses incurred from your estate when you die.

[workathome]

Alt strategy: move to Canada?

[Chad]

It has been some time since I researched this, but after a certain age (mid 50s), Medicare/aid is no longer an insurance plan, it is a loan. They will try to recover all expenses incurred from your estate when you die.

As ether noted, Medicare and Medicaid are different things. They shouldn't be lumped together. Medicare operates like an insurance plan and covers you up to a point. Most people get supplemental insurance to cover the holes.

I'm unsure about how Medicaid is treated for other instances (younger and poor), but if Medicaid is used for long-term elder care they can recoup money from the person's estate when they die. So, in this instance, it is kind of loan.

[GandK]

It has been some time since I researched this, but after a certain age (mid 50s), Medicare/aid is no longer an insurance plan, it is a loan. They will try to recover all expenses incurred from your estate when you die.

Yes. After age 55, states are supposed to recoup long term care expenses from the estates of those who used Medicaid to pay for that care. More info. Basically if you use federal funding for full-time or nursing home care after 55, they will start seizing assets to pay for it, and they enthusiastically prosecute people who try to hide assets to avoid seizure. Google "medicaid asset recovery" and "medicaid estate planning" for more on this.

Edited to add: More on this from factcheck.org.

[Laura Ingalls]

I was concerned about medicaid as insurance til we actually started using it. When I worked in another state families that I worked with complained about the dental piece.

We see the same family practice doc we did before. We have a great dentist he was 7 miles away (we lived in the county 6 miles from anything). He is now 13 miles away.

So far the scare tactics that it is awful have been completely unfounded in my case.

YLMMV

[George the original one]

Sis is on Medicaid (current age 62). She just got a hip replacement. The level of care was normal and she was not discriminated against for using Medicaid.

However, Medicaid bills she incurred before the ACA went into effect had a cost recovery attached to them, so when she inheirited some money, Medicaid had first claim and she did not get the benefit of the inheiritance. In theory, this type of cost recovery (immediate vs. estate) is no longer in effect now that ACA exists. Since it's at the whim of legislators, I have no confidence that the future will be bright in regard to cost recovery.

[Tyler9000]

Yes. After age 55, states are supposed to recoup long term care expenses from the estates of those who used Medicaid to pay for that care. More info. Basically if you use federal funding for full-time or nursing home care after 55, they will start seizing assets to pay for it, and they enthusiastically prosecute people who try to hide assets to avoid seizure. Google "medicaid asset recovery" and "medicaid estate planning" for more on this.

Edited to add: More on this from factcheck.org.

Good info. Medicaid was originally designed to help those with few monetary assets. Most times there was little to recover so asset seizure didn't really matter and many states didn't bother. As budgets got more tenuous, the federal government made it mandatory. The ACA expanded Medicare beyond its original intended role, but did not amend the old asset seizure rules. I think that was a mistake. Some states are looking to correct that, but at this point I think it's a legal gray area that I'd personally prefer to avoid if possible.

[The Old Man]

Medicaid pays poorly, so many medical/dental practitioners prefer to avoid it where possible. As a consequence the number of practitioners that accept Medicaid is much reduced.

[IlliniDave]

Some states have not bought into the expanded Medicaid facet of ACA. The ACA subsidies actually stop below a certain income level. If you live in a state that does not have the expanded medicaid option, you can find yourself too "poor" to qualify for ACA subsidies, and too "wealthy" to qualify for your state's medicaid program. If you live in an expanded Medicaid state, it's not an issue. If you don't, you can find yourself paying a lot more for an ACA policy than your neighbor with a higher income.

That might be a reason a person might want to keep their income above the dividing line between ACA/Medicaid as spelled out in ACA.

[shade-tree]

Reimbursement to a health care provider is lower than what an insurance company pays. So, some providers won't take NEW medicaid patients. As a result, accessibility to providers for people covered by Medicaid is enough of a problem in some states that this is happening:

http://www.pewtrusts.org/en/research-an ... d-patients

[JL13]

Gonna play devil's advocate here. If we're really comparing ACA versus medicaid, and we're also talking about an ERE-compatible ACA plan which would be a high deductible plan, then the issue with practitioners accepting medicaid is a moot point. With either type of coverage, you are paying out of pocket and everyone accepts cash. At the catastophic level (over $5,000), you're looking at a hospital visit and you will be accepted with medicaid.

I don't see a clear advantage for one versus the other.

[sky]

Medicare and ACA are mutually exclusive. If you qualify for Medicare, you don't qualify for ACA.

[almostthere]

A bunch of wonky answers, but no one has stated the obvious.

Why avoid it? Shame. In the culture of the United States, it is associated with poor people, welfare, and handouts. Nobody wants to to appear poor.

[GandK]

I thought this was also pertinent:

What Medicare Doesn't Cover: A Preretiree's Guide (from Forbes magazine)

[FRx]

Medicaid itself isn't really a bad system. I personally think it's good to have affordable (free) access to some minimum health care in a country. The social stigma might be an issue though in some parts of California even the very well off know how to game the system to still take advantage of medicaid (called medical in Cali).
As for "care" being bad in medicaid, that's of course in correct. Medicaid doesn't offer care, the physician does. A shitty doc will give shitty care, a great doc will give great care. A lot of docs don't take medicaid for 2 reasons. The reimbursement is really low. Office visits I believe get somewhere in the $30 reimbursement from medicaid per patient. The 2nd reason ties into the 1st one. The medicaid population is much sicker, out of control diabetes, usually very demanding, cultural barriers, lot's of addiction and mental health issues. So getting $30 for a very demanding patient makes it just not worth it. Then again the docs don't complain when they get $200 for a perfectly healthy patient that's only there for STD testing.

I would say one trend to look for in the next few years is that the good doctors are going after prevention. We know now (well, some of us) that we really can't make a dent in most medical problems. Lots of cancer therapy, antibiotics, cholesterol meds etc fall way short of what they are advertised to do by the pharmaceutical companies. Family history, diet, exercise, stress levels and chemical exposure in the environment is what truly makes a difference. A good doc can identify patients that are at risk and tell them what to do differently. Of course getting them to do it is a whole different battle. Right now I docs will see a patient and quickly do a bp and height and weight and throw on a couple of meds. This will make for a very fast visit. There is plenty of "data" to support this and protects you against law suits. However, to really ask about history, to do a really good exam, to feel the patient out for risk factors and their readiness to adopt a certain strategy is very time consuming. And, if a patient has high cholesterol and I don't start them on meds and I don't give them meds for their high blood pressure I'm putting myself at risk for a law suit. So it takes a special kind of doctor who is willing to practice outside the scope of their medical specialty.

[luxagraf]

Medicare and ACA are mutually exclusive. If you qualify for Medicare, you don't qualify for ACA.

Not sure how universal this is, but in my case in GA I was told I could decline medicaid even if I qualified for it.

When DW was pregnant last year she was somehow automatically moved from our ACA plan to Medicaid (some kind of pregnant mother care thing that happened totally automated). Took few phone calls, but I declined the medicaid program and she was added back to the ACA plan.

Our kids are on medicaid though and the experience in GA has been really great. It can be hard to find providers that take new patients (esp dental, we have to drive 45 minutes to the nearest dentist that would see them), but we haven't had near the problems with that that it sounds like exist in other states. We've changed primary care physicians for the kids three times now without a problem on the medicaid end.

[EdithKeeler]

Medicaid is not an option for everyone (at a qualifying income) because some states are not part of it, notably my state, Tennessee.

TN has "TennCare," which is only available to indigent people who are children, pregnant, "medically needy" meaning they have some kind of qualifying disability or illness. Otherwise, you're screwed. My brother, who is slightly disabled but doesn't qualify as "disabled" because he works, drives a car, etc. makes $8 an hour working in a warehouse. He would have really been helped if this stupid state accepted the expanded Medicare under the ACA, but they didn't. So freakin' short-sighted and stupid because either way, people are paying for it, in terms of higher premiums for those who do have insurance, and in terms of higher costs at the hospital for those who can pay--so hospitals can write off the treatment for those who can't.

There was a great story on NPR just yesterday about TX, which also turned down the expanded Medicaid funds. The same issues exist in TN.

http://www.npr.org/sections/health-shot ... -expansion

I used to live in Dallas, so I'm very familiar with the issues there; very similar in TN. Here in Memphis we have The Regional Medical Center that serves Memphis as well as parts of Arkansas and Mississippi. They treat LOTS of indigent people there, and property taxes go to help pay for that. Basically they stupidly turned down $1 billion in federal funds to expand Medicaid and help a lot of people, and in return, we're probably going to see a property tax hike, in a city that's already dying because the people who can afford it are moving out, leaving the people who can't afford to move--and are likely uninsured and served by that hospital--to stay behind... so we can continue paying for their health needs.

In the words of my congressman, Steve Cohen: "Stupid, stupid, stupid."

Sorry to be political, but this is a real sore subject with me....

[jim234]

It depends on your state whether Medicaid is to be avoided. Fortunately for me all my doctors from my previous work plan are in the UHC Medicaid plan that I am now in. It is excellent coverage and better than a Platinum plan. The biggest difference I see is the drug list is not as complete as the Marketplace plans.

I don't know why so many put it down. I think it is due to the stigma of being associated with a "welfare" health plan. I could care less about that.