Anyone on Medicaid?

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cmonkey
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Anyone on Medicaid?

Post by cmonkey »

I've reached the point where my family will either be on Minnesota's Medicaid program or MinnesotaCare and need to make the decision in about 1 month. We live comfortably on about 2/3's the poverty level for a family of 3 which means we can withdraw enough from our IRA to stay just below the standard deduction and pay zero income tax. So monetarily it makes sense go on Medicaid, however, I'm not sure it's the best decision for other reasons.

To be on MinnesotaCare, one needs income above 29K which would leave about 4K in taxable income. It has the same zero premiums as Medicaid at our income level, but the copays are higher - $250 for an ER visit for instance.

I'm not sure if Medicaid comes with any drawbacks? I've heard in the past that not every provider will take Medicaid.

I've also seen that, in Minnesota, asset forfeiture seems to be limited to 55+ people who use Medicaid to pay for long term care facilities. I'm not sure that I trust politicians not to come after the small percentage of people with assets who are smart enough to find free healthcare. That's really what it comes down to. Stupid worry or no?

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unemployable
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Re: Anyone on Medicaid?

Post by unemployable »

cmonkey wrote:
Wed Nov 03, 2021 4:20 pm
I've also seen that, in Minnesota, asset forfeiture seems to be limited to 55+ people who use Medicaid to pay for long term care facilities. I'm not sure that I trust politicians not to come after the small percentage of people with assets who are smart enough to find free healthcare. That's really what it comes down to. Stupid worry or no?
I think it's more likely they'll add an assets test (rather than just an income test) to the various government healthcare programs, so you'll end up not having free healthcare to begin with.

cmonkey
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Re: Anyone on Medicaid?

Post by cmonkey »

Good point.

I've been making some calls and clinic/hospital services are fully covered around here. Same with our current eye clinic. Dentists are another story thought. It's like pulling teeth (ha!) trying to find anyone who even accepts state programs, let alone is accepting new patients. After about a dozen calls I've found no one.

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unemployable
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Re: Anyone on Medicaid?

Post by unemployable »

Routine dental care should be cheap enough to pay cash for, to the extent that I feel like dental insurance is somewhat of a scam. Even yeeting two wisdom teeth (you have to do two) should be well under a grand.

I'd call around and ask what their cash rates are. Pretty sure they'll fit cash payers into their schedule.

WFJ
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Re: Anyone on Medicaid?

Post by WFJ »

I'm in the same boat, planning to use ACA soon and appears that every state is quite different and plans change every year. I have a condition and will hopefully be able to remain in the current treatment facility but this appears to be unknown until the plans are published each year. The condition is quite new and complicating prior ERE plans.

chenda
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Re: Anyone on Medicaid?

Post by chenda »

unemployable wrote:
Thu Nov 04, 2021 10:43 am
Routine dental care should be cheap enough to pay cash for, to the extent that I feel like dental insurance is somewhat of a scam.
I'd consider insurance for dental trauma to cover implants, that's usually very cheap and worthwhile (implants cost 1000s)

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unemployable
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Re: Anyone on Medicaid?

Post by unemployable »

I have an implant in fact, from when I chipped a tooth falling down an escalator at O'Hare. Paid for it out of my HSA. This was 2008, so it was under whatever the HSA limit was back then.

I don't fly anymore, although that's not why.

Laura Ingalls
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Re: Anyone on Medicaid?

Post by Laura Ingalls »

chenda wrote:
Fri Nov 05, 2021 12:56 pm
I'd consider insurance for dental trauma to cover implants, that's usually very cheap and worthwhile (implants cost 1000s)
Insurance that covers implants? Tell me more.

I have an implant and need another one. They were not cause by trauma, decay, or bone loss but according to the oral surgeon that pulled the second one a odd situation where tendons around the teeth the had an excessively tight grip and didn’t cushion the teeth the way they are supposed to.

Anyway despite having dental insurance I have never gotten anyone to cover it. :(

chenda
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Re: Anyone on Medicaid?

Post by chenda »

Laura Ingalls wrote:
Fri Nov 05, 2021 2:43 pm
Insurance that covers implants? Tell me more.
This is the one I use, you can scroll down to the implant bit.

https://www.denplan.co.uk/patients/payment-plans/extras

I think a lot of extractions which are done are not clinically necessary.

Laura Ingalls
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Re: Anyone on Medicaid?

Post by Laura Ingalls »

chenda wrote:
Fri Nov 05, 2021 3:40 pm
This is the one I use, you can scroll down to the implant bit.

https://www.denplan.co.uk/patients/payment-plans/extras

I think a lot of extractions which are done are not clinically necessary.
You are UK based, two radically different systems.

chenda
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Re: Anyone on Medicaid?

Post by chenda »

Laura Ingalls wrote:
Fri Nov 05, 2021 5:02 pm
You are UK based, two radically different systems.
Yes but dental care here is often privately funded, I'd be surprised if you couldn't find a similar policy.

Edit: speaking of dentistry, if you have children consider this: https://www.bioeden.com/us/

Married2aSwabian
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Re: Anyone on Medicaid?

Post by Married2aSwabian »

cmonkey wrote:
Wed Nov 03, 2021 4:20 pm
I've reached the point where my family will either be on Minnesota's Medicaid program or MinnesotaCare and need to make the decision in about 1 month. We live comfortably on about 2/3's the poverty level for a family of 3 which means we can withdraw enough from our IRA to stay just below the standard deduction and pay zero income tax. So monetarily it makes sense go on Medicaid, however, I'm not sure it's the best decision for other reasons.

To be on MinnesotaCare, one needs income above 29K which would leave about 4K in taxable income. It has the same zero premiums as Medicaid at our income level, but the copays are higher - $250 for an ER visit for instance.

I'm not sure if Medicaid comes with any drawbacks? I've heard in the past that not every provider will take Medicaid.

I've also seen that, in Minnesota, asset forfeiture seems to be limited to 55+ people who use Medicaid to pay for long term care facilities. I'm not sure that I trust politicians not to come after the small percentage of people with assets who are smart enough to find free healthcare. That's really what it comes down to. Stupid worry or no?
Just saw this post and am also digging into ACA premium rates, plans and subsidies here in MI, as we want to pull the plug this spring on FT work. Here, if you’re under 133% FPL for family, you go on Medicaid and not ACA. Medicaid does have estate recovery here based on benefits received and may not always be accepted as you noted. It occurred to me that doing Roth conversions would be a good way to optimize taxes, while taking the minimum tax hit during low income year(s). It turns out it may also assist in qualifying for ACA subsidies.

I found this article with spreadsheet (from MMM forum member) just now:

https://thefinancebuff.com/tax-calculat ... bsidy.html

I haven’t had a chance to try it out yet.

Maybe it will be helpful to you as well?

Married2aSwabian
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Re: Anyone on Medicaid?

Post by Married2aSwabian »

Also just read through this thread:

viewtopic.php?t=12043

A friend of mine in IL who happens to have had high-level management positions throughout his 30 plus year career also was on Medicaid for a while (year or 2?). They just had v low income for that time period.

I plan to check with our Docs if they’ll keep us on as patients were we to switch. I have no problem with the concept of asset clawback assuming it’s fair. I just don’t understand exactly how it works, other than the state is obligated to seek “recovery” of $ after both you and spouse have passed, based on benefits provided. If we used say $50k of healthcare over a multi year period, I suppose they should be entitled to that.

cmonkey
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Re: Anyone on Medicaid?

Post by cmonkey »

Asset clawback depends on the state you live in. Where I live (MN) they only try to recover assets if the funds are used for long term care once you are over a certain age.

Of course I will be keeping an eye out for any changes that might be made and make adjustments.

Married2aSwabian
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Re: Anyone on Medicaid?

Post by Married2aSwabian »

cmonkey wrote:
Wed Nov 03, 2021 4:20 pm
I've reached the point where my family will either be on Minnesota's Medicaid program or MinnesotaCare and need to make the decision in about 1 m…

Did you make the switch already and if so, how has that gone?

I reached out to docs that DW and I use now and so far only my therapist has said she doesn’t take Medicaid insurance. Apparently, all plans work like an HMO, with a PCP to manage. In MI, there is also an intermediate plan called Healthy Michigan or something like that that has small premiums and copays, but better coverage and dental included apparently. Our dentist also told us that Dentemax is a good one for independent dental insurance for about $10/mo per person. I’ve not yet looked into details.

I also put a call in to attorney that we used in past to put all our wills, powers of attorney, etc. together. Want to ask him about asset clawback here in MI. I know he has a lot of experience with issues involving Medicare and Medicaid, asset recovery and nursing home stays, as you mentioned is the practice in MN. I guess that’s where large amounts of $$$ are involved. We’ll see what we hear back…

I’m kinda surprised there isn’t more participation in this thread on this forum. I know many are in their 20s and 30s here, but don’t people still need healthcare?? Many flying without a parachute, I guess.

cmonkey
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Re: Anyone on Medicaid?

Post by cmonkey »

Still in process, they require proof of income prior to processing so I am waiting for January financial statements. I should be able to report back by mid February.

Made my first Roth conversion today!

cmonkey
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Re: Anyone on Medicaid?

Post by cmonkey »

Married2aSwabian wrote:
Tue Jan 11, 2022 8:12 pm
I’m kinda surprised there isn’t more participation in this thread on this forum. I know many are in their 20s and 30s here, but don’t people still need healthcare?? Many flying without a parachute, I guess.
Agreed, I was surprised to not find many anecdotes when I searched. I think many don't like the stigma of it and so maybe don't talk about it? I couldn't care less. I have put tens of thousands into the healthcare system via 10 years of premiums and high deductibles and I'm sure many can say the same. We shouldn't feel bad about it.

Irishmam
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Re: Anyone on Medicaid?

Post by Irishmam »

I was speaking with a Case Manager today about a client. They will have to pay $568 day for a nursing home until their assets are spent down and they qualify for Medicare. This certainly makes a case for Revocable Family Trust...

Scott 2
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Re: Anyone on Medicaid?

Post by Scott 2 »

Married2aSwabian wrote:
Tue Jan 11, 2022 8:12 pm
Our dentist also told us that Dentemax is a good one for independent dental insurance for about $10/mo per person.
I think Dentemax is a network of dentists, leased to dental insurance providers. The $10 option I could find is a dental savings plan:

https://consumerbenefits.net/dentemax-dental-plan.htm

I ended up on a Cigna plan, which includes preventative care and $1000 of coverage - for about $30 a month. From what I could tell, if you use the preventative care (2 cleanings / exams, 1 x-rays) - you come out even on costs compared to a dental savings plan. But you get the $1000 of insurance too. There may be a 6-12 month waiting period before the $1000 kicks in, unless you can provide proof of prior coverage.


IMO for most FIRE folks - hitting the Medicaid income cutoff is rare. An ACA plan optimized for subsidies and cost sharing provides more opportunity to tax optimize. There's also less stigma, which is important to some.

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Re: Anyone on Medicaid?

Post by theanimal »

Some states also have asset limits that disqualify you from Medicaid. For example, in Alaska the asset limit is $2,000 for non-seniors. This includes stocks, bonds, checking accounts etc etc.

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