Medicaid for the voluntarily "poor".

[Tanglefoot]

Hi all,

I've been going back and forth about this several times. I think I know what I will choose but I wanted to hear from others in a similar situation, what they decided and how they rationalized it.

I've enjoyed a commercially-minimal lifestyle with sub-poverty-level income for several years now. I've been paying for an individual health insurance plan (which is going up in premium in January) but went through the steps on the state marketplace just to see what my options were. With my very low income, the marketplace directed me to the Medicaid application, and I was approved for premium-free Medicaid and sent a ID card (I didn't plan to go this far...the website sure doesn't hesitate!).

I'm very conflicted with receiving aid. I don't like to draw from the system. I've never applied for or received any kind of benefit or subsidy before now. I also don't plan on making much more money than I do now, and I'm 33, so if I chose Medicaid, I would likely be on it for much of my life.

Health insurance is certainly a financial burden for me (it's already my second-largest expense after housing), but I feel that before I accept aid, I should cut my few, other expenses. Although I know many with much higher incomes are receiving aid for health care, I still don't feel comfortable with it. I'm inclined to cancel the Medicaid and just scrape together enough for the premium on my current plan (which is lower than the most inexpensive plan in the marketplace, for the time being).

I came across an article (that I can't find now) that said my state's Medicaid expansion costs may come close to the pre-expansion numbers. It cited factors such as increased jobs. It complicated my choice, but I'm still pretty sure that each person on Medicaid is a definite draw on the economy.

I was hoping (and continue to hope) that the increased participation in health care would bring the costs down more. I believe that reducing both the premiums and the subsidies with be more sustainable than high premiums and widespread, substantial subsidies. We'll have to see what happens.

Are there any others in voluntary "poverty" who are fretting over health care?

Thanks!

[Teacher Terry]

I think that this is a really tough decision. If your poverty was not voluntary it would be a no brainier but since it is I think that is another matter. You are going to have to search your conscience and decide what is the best course of action. I really love that this is a dilemma for you which shows you have true integrity. Since you are so young did you save up a pile of money to live off the income from it and did any books inspire you? I would love to hear how you arrived at your place in life at such a young age. Take care.

[gimmethesimplelife]

I am absolutely amazed at a country in which people would have a moral quandary about signing up for insurance that happens to be free. Seriously. In any other country in the developed world this would not be an issue whatsoever as there would be framework in place for health insurance coverage of some kind. Shoot - even Mexico has socialized medicine for those in the formal economy (those hawking merchandise in the streets don't qualify as they are part of the underground economy). I don't mean to bash the OP in any way shape or form. My issue is that a country could so ingrain such a thought process into people that being covered by insurance - even if qualifying for Medicaid in the US - could be a bad thing. For myself, I divorced myself from this line of thinking while I was very young. Personally I'd rather be on the exchanges due to having a higher income, and this is not guilt of getting insurance for free either - this is realizing that I may get quicker appointments and better service out of an insurance plan on the exchanges. I would say to the OP - take the Medicaid and then if it's a burden on you for whatever reason - then formulate a plan for a higher income if possible. No judgment towards the OP in this - there's nothing wrong with accepting insurance that you qualify for. I sure would not like to think that society would have such an influence over someone that they'd pass on the Medicaid. But, that's me personally. Your mileage may vary. Rob

[bae]

I am absolutely amazed at a country in which people would have a moral quandary about signing up for insurance that happens to be free.

Free?

http://i1.wp.com/kathleencaron.com/wp-content/uploads/2013/04/Princess-bride-image.jpg?resize=300%2C300

[gimmethesimplelife]

Free?

http://i1.wp.com/kathleencaron.com/wp-content/uploads/2013/04/Princess-bride-image.jpg?resize=300%2C300Free in the sense that it doesn't cost monetary sums to the one covered by the insurance, though I can say that now in Arizona, there are small copays for some services and I am fine with that. It absolutely amazes me that in America money means more than human life with so many people and this is actually acceptable in society. Given what I have posted, am I in the wrong country or what? Rob

[redfox]

I'm happy to pay taxes so that we all have decent, single payer coverage. Free is indeed relative, and I'm all for supporting the well being of our overall society with health care that all can utilize.

[bae]

I'm happy to pay taxes so that we all have decent, single payer coverage.

Wouldn't that be so simple and easy? Where do I sign?

[redfox]

Wouldn't that be so simple and easy? Where do I sign?

Hah! In Canada or England, I suspect. Howevah.... The day will come. I just hope it 's before I shrivel up n perish...

[iris lilies]

Hah! In Canada or England, I suspect. Howevah.... The day will come. I just hope it 's before I shrivel up n perish...

As long as they allow me to write a checkt o get to the head of the line, or to visit Harley Street eqivilant docs, ok, whatever. The country can't afford it but no one really cares about fiscal responsibility at this point. Free guberment everything, bring it on!

[boss mare]

Here is my take on this as someone who has worked in the dental field for 30 + years... I currently work at a dental office that caters only to children of low income families... the schedule is jammed packed and there is only one dental office here where I live that accepts Medicaid for adults.... In 2011 Medicare in Washington quit covering adults for dental care.. Except to make the patient "comfortable" ( pulling the tooth reguardless if it is a front tooth) No coverage for dentures or partial dentures either to replace the missing tooth... And then just to find a dental office that will take Medicaid for adults (or children ) is a huge problem. I would be really leery of this "free medical insurance" because some offices might not take it and those that do will be on overload and it maybe be awhile before you could get in

[Spartana]

Tanglefoot I am in a similar situation. I voluntarily retired young (at 42) once I saved enough money to cover all my very low expenses for (hopefully) life. I funded my own medical insurance thru Blue Cross with a low cost/high deductible catastropic plan for years. I also have a service-connected injury/disability from the military so can use the VA hospital for free or low cost and they would just bill my insurance company. My Blue Cross plan was recently cancelled and to buy a similar policy would cost approx. 3 times more in monthly premiums and have a $3000/year increase in my deducible (up from $4000/year to $7000) plus a 40% co-insurance as well as co-payments. I do not qualify for any subsidies, only Medicaid, because my taxable income is below the amount needed to get subsidies. Also you can't get subsidies if you use the VA since that is provides "basic" level of healthcare to meet the ACA standards.

I am very reluctant to get Medicaid. I feel that as it is now, without universal healthcare for all, it is ethically wrong for me to accept free medical care from the taxpayers who don't have that same option when I am capable of either paying for my own care out of my savings or going back to work. I don't think it's right that I should be receiving Medicaid for many, many years so I can go out and play beach volleyball everyday :-). I also feel that way about getting any non-service connected medical care from the VA (which charges a small co-pay and bills any other insurance you may have - including Medicaid - to reimburse the costs of any non-service connected care I receive at a VA hospital) but am less ambivalent about that since it was a contractual agreement when I joined the military. I also have a worry about using the VA solely for all my medical care as they have a reputation for long waits (months!) and shoddy service - although I have always been treated very well there. So I have been looking for a more affordable plan rather than going on Medicaid. I know others here struggle with this same choice about Medicaid and subsidies - retire early and live on a small amount of money like you and I are doing but have the working taxpayers (Alan!) subsidize or pay for our medical care for decades while we "play" or fund our insurance ourselves by working or out of savings/cutbacks. I am choosing the latter as I've done since I quit work - with the VA as a backup...just in case :-)! No moral judgement on you or anyone else but this is the path I am comfortable with.

ETA: Tangle foot - I just reread your post and realized you didn't say you were retired, just low income. If that is working low income then that would make a difference to me as to whether or not to use Medicaid. Some jobs, just by their nature, don't pay much and with rising healthcare costs it's hard to keep pace and still have even a poverty level existence. I am actually retired and work-free (with no intentions to go back to work anytime soon) so feel I should work or use savings to fund my own medical care.

[Teacher Terry]

Rob, please quit using the word "free." Nothing is free-someone is paying for it. In Europe healthcare is not free-heavy taxes are paying for it. My DIL is from Poland and there even if you are college educated & have a good job you must chose between living with your parents as an adult so you can own a car & maybe have some $ & not a ton of other luxuries or you can rent a place, walk and struggle. There is no easy answer. There are no utopias. I am for single payer care but we would need to come up with a way to stop wasting $ as a country in order to pay for it. I am not optimistic that this will happen.

[redfox]

In the single payer scenario, everyone is covered the same. What you describe, boss mare, would not occur.

Terry, defense spending and tax code reform.

[bae]

Terry, defense spending and tax code reform.

Cut defense spending 75%, use the savings to fund healthcare and infrastructure improvements and tax cuts for Alan.

[redfox]

Cut defense spending 75%, use the savings to fund healthcare and infrastructure improvements and tax cuts for Alan.

I'm down with this.

[Teacher Terry]

Bae & Redfox, we have solved the problem:cool: You guys are so right that our priorities are wrong & it does not take a rocket scientist to see that if we as a country spent our money more wisely we could all have healthcare & a better infrastructure. I think that Socialism has failed because without an incentive to work and better ourselves why would anyone work? However, I think that balance is key-help the truly less fortunate, help people to get a hand up and allow the truly motivated to become what they truly can be. I also have to tell you from personal experience as well as observing my clients there is truly nothing better then being able to support yourself/family. Programs that give a hand up for those willing to do the work do wonders for people's self-esteem.

[redfox]

For me, incentive to work is to make my community a better place for all of us. In my experience, most people are happy to jump in and help out. I think it's a myth that money is the only incentive to work. I will dance on the grave of capitalism when it dies.

[iris lilies]

In the single payer scenario, everyone is covered the same. What you describe, boss mare, would not occur.

So, if I am a dentist, I am required to accept you as a patient even though I do not like the amounts that you will pay me. I'm not able to set my fees. Or, may I cater to those who will privately pay and forgetabout you as a patient?

I really want to know in your imaginary utopia how this works.

[try2bfrugal]

Are there any others in voluntary "poverty" who are fretting over health care?

Thanks!

Judge Learned Hand wrote, "Any one may so arrange his affairs that his taxes shall be as low as possible; he is not bound to choose that pattern which will best pay the Treasury; there is not even a patriotic duty to increase one's taxes."

I suggest you substitute the tax part for "arrange his affairs that his subsidies shall be as high as possible" and sleep well at night. I know I do. :)

[Teacher Terry]

People are willing to jump in & help out but that is called volunteer work. I do alot of it and i am sure many of you do too. However, many people need pay to actually work. I would venture to guess that many on this site are not your average "bears."

[ApatheticNoMore]

People are willing to jump in & help out but that is called volunteer work. I do alot of it and i am sure many of you do too. However, many people need pay to actually work. I would venture to guess that many on this site are not your average "bears."

well volunteering can be rewarding, most paid work isn't. Volunteering can give one a deep right feeling, not found elsewhere, of doing work and not hating it (I can burn out on volunteering too, but I have felt this). Anyway this really should be another thread since I'm not helping the OP at all here :).

[catherine]

For me, incentive to work is to make my community a better place for all of us. In my experience, most people are happy to jump in and help out. I think it's a myth that money is the only incentive to work.

+1

As for the OP, this is the frustrating part of Obamacare, because you really have crummy choices, don't you? You choose to live in voluntary poverty, which I think is a wonderful calling if it's for you. So you either are forced to abandon that to make more money to get coverage that you feel is morally unambiguous, or you take the choice that you feel is perhaps not "right," or you go without insurance, and pay a penalty. None of those options are satisfactory. A person like you who is happily earning little without "drawing from the system," should have that right.

I do think that Obamacare really changes the meaning of Medicaid though. Now that Medicaid is expanded in certain states to accommodate the low-wage earner's ability to get insurance, it's really not the "old Medicaid," -- it's more like a repurposing of a current structure to accommodate the new healthcare mandates. That's the way I see it.

This is what your country offers you, and so I would take it unapologetically.

[Tammy]

Tanglefoot-

My husband chooses low paid self employment gigs cause I have the more demanding but high paid career at this point in our 32 years together. He keeps our life running while I keep the money coming in. As a result, we are in a lowrr tax bracket than if we both did what I do. But I never feel that somehow we are immoral for paying less taxes.

In the same way, you choose less income. As a side benefit, your insurance is less costly or free to you. Don't sweat it. Get the Medicaid.

[razz]

Just to clarify from a Canadian perspective, our health coverage does not cover dental, hearing, vision etc beyond emergency hospital services. I have paid for extended health insurance coverage or upon service for these as do most Canadians who need these.

As more and more technology makes more diagnoses and corresponding treatments and prevention care become available, the public expects that their public health insurance is going to cover them. It is simply not sustainable.

Hospitals now have to work within a budget preset and cut services to meet that budget.

The ideal, IMO, is a publicly funded base level of care universally available and then anything above that is privately funded. Not every problem can be solved medically and not every person can be saved forever. We all have to become realistic about what is affordable.

A friend has had three triple heart bypass operations, extensive and the very expensive treatment for a rare cancer the past two years every week until the medical team decided that it was of no benefit and now he is receiving blood transfusions every week. Why?

Another very fragile case - the individual decided that he would not agree to the DNR despite advanced diabetes, several heart surgeries after a number of heart attacks and lack of mobility. He publicly stated that, if he was unable to speak for himself, both his wife and children had to first agree to stop treatment at the end which was an impossible situation for the family. He was so frightened of dying it was truly sad to see.

Just as in our finances, we have to ask, "When is it enough?"

This is not about public funding, capitalism but what is reasonable to expect of healthcare and provision for "sick care" which is what you, in fact, are really talking about. We need a reasonable discussion about death and what it means as this seems to be the big issue and what is life and reasonable life support. Is it going to happen soon, probably not as there are too many belief systems that will block the discussion.

[catherine]

Great points, razz... so true. I remember when my MIL died, it was after a very brief, very unexpected illness while we were on vacation in Vermont. The surgeon offered us the option of very invasive surgery, or just let nature take its course. She was 85. The surgeon really steered us to "let nature take its course," and that's what we did.

That was in a community hospital in Vermont. I've often wondered if we had been home in NJ instead of VT, what would we have done? Would the surgeon at the large academic hospital here have advised us to do the surgery? And at what expense, both cost-wise, but also in terms of quality of life for my MIL, who had increasing grown bored with life as it was.

Good questions you raise.

[Florence]

I had a similar quandary. I qualified for SSDI when I could no longer work because of a progressive neuromuscular condition. However, I really didn't need the money so I didn't apply for it.
I am going to take my Social Security when I turn 66 and will have Medicare when DH retires and we no longer have health insurance through his employer.

[iris lilies]

...As more and more technology makes more diagnoses and corresponding treatments and prevention care become available, the public expects that their public health insurance is going to cover them. It is simply not sustainable. ..


...The ideal, IMO, is a publicly funded base level of care universally available and then anything above that is privately funded. Not every problem can be solved medically and not every person can be saved forever. We all have to become realistic about what is affordable.

.
This in a nutshell, I completely agree.

But us Americans, we expect bigger, better, more expansive care than y'all up north. For everyone! Because we deserve it. :) And there are no politicians here who will put the brakes on coverage in socialized medicine because they are spineless weenies. So we are completely f*cked before it even starts.

I am a Republican who insists on Death Panels. There MUST BE DEATH PANELS, dammit! :)

[rodeosweetheart]

I would say take the Medicaid for now and see how that plays out. It seems the least difficult path to making adjustments for the major changes that have been made to healthcare in this country.

[gimmethesimplelife]

I'm happy to pay taxes so that we all have decent, single payer coverage. Free is indeed relative, and I'm all for supporting the well being of our overall society with health care that all can utilize.Agreed 100% and very well put. Rob

[gimmethesimplelife]

Cut defense spending 75%, use the savings to fund healthcare and infrastructure improvements and tax cuts for Alan.I don't know about the tax cuts but the rest of your post I completely agree with. Rob

[gimmethesimplelife]

For me, incentive to work is to make my community a better place for all of us. In my experience, most people are happy to jump in and help out. I think it's a myth that money is the only incentive to work. I will dance on the grave of capitalism when it dies.About the dancing on the grave of capitalism when it dies - count me in, too. Rob

[gimmethesimplelife]

Tanglefoot-

My husband chooses low paid self employment gigs cause I have the more demanding but high paid career at this point in our 32 years together. He keeps our life running while I keep the money coming in. As a result, we are in a lowrr tax bracket than if we both did what I do. But I never feel that somehow we are immoral for paying less taxes.

In the same way, you choose less income. As a side benefit, your insurance is less costly or free to you. Don't sweat it. Get the Medicaid.+1 on your advice Tammy. Rob

[enota]

Hi all,

I've been going back and forth about this several times. I think I know what I will choose but I wanted to hear from others in a similar situation, what they decided and how they rationalized it.

I've enjoyed a commercially-minimal lifestyle with sub-poverty-level income for several years now. I've been paying for an individual health insurance plan (which is going up in premium in January) but went through the steps on the state marketplace just to see what my options were. With my very low income, the marketplace directed me to the Medicaid application, and I was approved for premium-free Medicaid and sent a ID card (I didn't plan to go this far...the website sure doesn't hesitate!).

I'm very conflicted with receiving aid. I don't like to draw from the system. I've never applied for or received any kind of benefit or subsidy before now. I also don't plan on making much more money than I do now, and I'm 33, so if I chose Medicaid, I would likely be on it for much of my life.

Health insurance is certainly a financial burden for me (it's already my second-largest expense after housing), but I feel that before I accept aid, I should cut my few, other expenses. Although I know many with much higher incomes are receiving aid for health care, I still don't feel comfortable with it. I'm inclined to cancel the Medicaid and just scrape together enough for the premium on my current plan (which is lower than the most inexpensive plan in the marketplace, for the time being).

I came across an article (that I can't find now) that said my state's Medicaid expansion costs may come close to the pre-expansion numbers. It cited factors such as increased jobs. It complicated my choice, but I'm still pretty sure that each person on Medicaid is a definite draw on the economy.

I was hoping (and continue to hope) that the increased participation in health care would bring the costs down more. I believe that reducing both the premiums and the subsidies with be more sustainable than high premiums and widespread, substantial subsidies. We'll have to see what happens.

Are there any others in voluntary "poverty" who are fretting over health care?

Thanks!

It is very important to me to be in 100 percent control over my health care choices at all times. You cannot do that if you accept government money. They can threaten to "cut you off" if you do not comply with their demands (such as having an RIF chip implant, if they decree it so). Then you have NO health care unless you allow them to do whatever they wish with you. Nope, not my cup of tea.

[Tanglefoot]

Wow--thanks for all the feedback! (I just saw your post, enota. That's a scary thought)

I know everyone's specific situation is different and it's great to see how others decided.

My conscience is probably the largest contributor to my happiness and I think that collecting benefits for such a long term will overturn my zen, if you will, to the degree that I will be happier just paying for health insurance. A chart I found (which I also can't find again--I really need to bookmark more) put the per-person government expense of Medicaid for my age group at more than double the premium I'm paying. I can't justify being that much of a burden.

I'm very reluctant to cancel my current individual plan as an experiment, because it's grandfathered and I likely couldn't sign up for it again in the future if I changed my mind.

I've noticed that worrying about the health insurance decision has been more detrimental (to my health!) than paying the premium, at this point. I think I'm going to cancel the Medicaid (if I can ever get through the phone maze) and just put the issue behind me.

Thanks everyone!

[Alan]

Well done Tanglefoot!

Independence of thought, independence of action and a well reasoned concern for your impact on society. Welcome to our humble forum.

[Yossarian]

Judge Learned Hand wrote, "Any one may so arrange his affairs that his taxes shall be as low as possible; he is not bound to choose that pattern which will best pay the Treasury; there is not even a patriotic duty to increase one's taxes."



Just some tax trivia for you- the taxpayer lost that case.

[try2bfrugal]

Wow--thanks for all the feedback! (I just saw your post, enota. That's a scary thought)

I know everyone's specific situation is different and it's great to see how others decided.

My conscience is probably the largest contributor to my happiness and I think that collecting benefits for such a long term will overturn my zen, if you will, to the degree that I will be happier just paying for health insurance. A chart I found (which I also can't find again--I really need to bookmark more) put the per-person government expense of Medicaid for my age group at more than double the premium I'm paying. I can't justify being that much of a burden.

I'm very reluctant to cancel my current individual plan as an experiment, because it's grandfathered and I likely couldn't sign up for it again in the future if I changed my mind.

I've noticed that worrying about the health insurance decision has been more detrimental (to my health!) than paying the premium, at this point. I think I'm going to cancel the Medicaid (if I can ever get through the phone maze) and just put the issue behind me.

Thanks everyone!

Just a thought, but before you cancel Medicaid, you might want to look beyond your premiums to your out of pocket maximums and potential out of net work costs not covered by insurance. Under our pre-ACA insurance policy, between out of network costs, some occurred during a hospital stay where we had no control over the provider, co-pays, and out of pocket maximums, with one surgery in the family this past year our portion of surgery alone was over $16K, and that is with insurance. Plus other family members had more routine check ups and offices visits which added to the total medical costs for the year.

I am not sure how Medicaid works, but you might want to compare your potential out of pockets, worst case maximums between the two policies and not just the premium costs.

[gimmethesimplelife]

It is very important to me to be in 100 percent control over my health care choices at all times. You cannot do that if you accept government money. They can threaten to "cut you off" if you do not comply with their demands (such as having an RIF chip implant, if they decree it so). Then you have NO health care unless you allow them to do whatever they wish with you. Nope, not my cup of tea.Interesting take on this issue, thanks for posting. Now that I think of it, this is incentive for me to continue going to Mexico - to remain in control of my health care choices. Rob

[iris lilies]

Interesting take on this issue, thanks for posting. Now that I think of it, this is incentive for me to continue going to Mexico - to remain in control of my health care choices. Rob
Rob,I think the Mexico option makes sense for a lot of people because it DOES allow you to keep in control.

[redfox]

About the dancing on the grave of capitalism when it dies - count me in, too. Rob

I'd love a dance with you, Rob!

[ToomuchStuff]

My conscience is probably the largest contributor to my happiness and I think that collecting benefits for such a long term will overturn my zen, if you will, to the degree that I will be happier just paying for health insurance. A chart I found (which I also can't find again--I really need to bookmark more) put the per-person government expense of Medicaid for my age group at more than double the premium I'm paying. I can't justify being that much of a burden.

I'm very reluctant to cancel my current individual plan as an experiment, because it's grandfathered and I likely couldn't sign up for it again in the future if I changed my mind.

I've noticed that worrying about the health insurance decision has been more detrimental (to my health!) than paying the premium, at this point. I think I'm going to cancel the Medicaid (if I can ever get through the phone maze) and just put the issue behind me.

Thanks everyone!


Well done Tanglefoot!

Independence of thought, independence of action and a well reasoned concern for your impact on society. Welcome to our humble forum.


Before anyone else, maybe prematurely, says well done, I have a question I expected to read about in this thread. Tanglefoot, are you going to lie on your taxes?
The reason I ask that, is because, if you "qualify" and don't sign up and pay it yourself, you might still end up with the money back, in the form of tax deductions or something like the earned income credit. (haven't seen the forms to see how it will actually be done, yet)

Morally, no one can choose for you, but you.

[Tanglefoot]

I don't plan to lie on taxes. I've sent my state Medicaid customer service center an e-mail (because I still haven't been able to get through on the phone) to cancel. If the Medicaid is cancelled, hopefully there won't still be additional deductions on my file but I'll see when I get there.

[ToomuchStuff]

I don't plan to lie on taxes. I've sent my state Medicaid customer service center an e-mail (because I still haven't been able to get through on the phone) to cancel. If the Medicaid is cancelled, hopefully there won't still be additional deductions on my file but I'll see when I get there.

So until we see a final tax form and instructions on this, you still might be getting your health care paid for via a tax rebate at the end of the year. (isn't just a state tax thing, but also a federal tax thing)

[Gardenarian]

Tanglefoot,

You could consider taking the Medicaid and donating the money you would have paid to a cause that is in alignment with your beliefs.
Just a thought.

[Spartana]

So until we see a final tax form and instructions on this, you still might be getting your health care paid for via a tax rebate at the end of the year. (isn't just a state tax thing, but also a federal tax thing)Tax rebates only work if one is getting subsidies not for Medicaid. It's basicly "free" with no out of pocket or premiums to get tax rebates for at the end of the year. Because the amount of income needed to qualify for Medicaid (below $16K/year for a single person or $35K for a family of 4) is below the federal taxable amount after exemptions and standard deductions, you are already in the zero percent tax bracket. So basicly you either qualify or you don't.

Tanglefoot - while I also send kudos your way for deciding not to go on Medicaid if you have the means or ability to pay your own insurance, before you drop it I would first investigate exactly how much "total" out-of-pocket expenses your insurance coverage will cost you under the new requirements of the ACA. Don't just look at the monthly premiums but the whole plan. The plans have changed and now have much higher out of pocket expenses than they previously did for many people. Some of the bronze level plans only cover 60% of your medical costs AFTER you paid your full deductible - which could be as much as $7K/year. That means if you have medical treatment for something costing $100K, you'll be on the hook for the $7K deductible as well as 40% ($40K) in co-insurance as well as whatever co-payments you must pay. For anyone who is in the "working poor" category those expenses are not doable. Heck they aren't doable for anyone!! So if you can't afford that "potential" expense on your own insurance plan, then stay on Medicaid while you look for something affordable with better coverage or until you decide to either increase your income (if possible) or just take the chance. You can also choose to keep Medicaid and just not use it except in a costly emergency or medical need. Self-fund any regular medical care or basic testing and just use Medicaid the same way as you would car insurance - you pay for your tune ups and oil changes and car insurance covers the BIG stuff. One thing that I like about Medicaid better than subsidies is that it doesn't cost taxpayers anything until someone actually uses it. With subsidies, the taxpayers (Alan!) are paying the big insurance companies a percent of the monthly premium costs each and every month for all those people getting subsidies - whether those people use their medical insurance or not.

[Teacher Terry]

Spartana, you make some excellent points! It sounds like a good plan to have it for unexpected huge bills/illnesses. You never know what the future holds.

[try2bfrugal]

Medical costs are the largest cause of bankruptcy in the U.S., with the majority of the medical bankruptcy households having insurance -

"62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance."

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

Notice people are not going bankrupt over their premiums, they are going bankrupt over their co-pays, deductibles, and out of network charges. We still have some insurance payments under appeal, but if the insurance company doesn't up their payment portions, our medical expenses for a family of 4 with some random illnesses and one surgery, will be $24K, not including premiums.

[gimmethesimplelife]

Medical costs are the largest cause of bankruptcy in the U.S., with the majority of the medical bankruptcy households having insurance -

"62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance."

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

Notice people are not going bankrupt over their premiums, they are going bankrupt over their co-pays, deductibles, and out of network charges. We still have some insurance payments under appeal, but if the insurance company doesn't up their payment portions, our medical expenses for a family of 4 with some random illnesses and one surgery, will be $24K, not including premiums.24K? This is about what I make in two years since the economy tanked. Ouch and wow! I hear stories like this and I am so so so so so ETERNALLY jgrateful that I live near the Mexican border and have access to high quality low cost medical care. Why I'd think about moving to Pittsburgh I don't know.....Pittsburgh doesn't have this access that Phoenix allows me. Unfortunately, we live in a country where health care decisions can rob of us of creativity and initiative and joy.....I still don't know how to process/forgive this one. For me it's a BIG deal. Rob

[try2bfrugal]

24K? This is about what I make in two years since the economy tanked. Ouch and wow! I hear stories like this and I am so so so so so ETERNALLY jgrateful that I live near the Mexican border and have access to high quality low cost medical care. Why I'd think about moving to Pittsburgh I don't know.....Pittsburgh doesn't have this access that Phoenix allows me. Unfortunately, we live in a country where health care decisions can rob of us of creativity and initiative and joy.....I still don't know how to process/forgive this one. For me it's a BIG deal. Rob

This was on top of our post COBRA premiums of $27K. Our medical expenses including premiums for one year (so far) have been over $50K. We shopped around. At our ages with pre-existing conditions and no group coverage, before the ACA our insurance choices were very limited.

Too bad Yahoo news never puts stories like mine on their front page with along with all their ACA disinformation campaign stories.

[bae]

Rob,

Elsewhere you offered to pay 50% more in taxes, if it could be used to provide healthcare for all.

At $12k/year of income, which is below full-time minimum wage in your state, this is a bit of a painless offer, isn't it? I mean, how much tax do you end up paying on that amount.... Heck, since you mentioned you own a house, you may be able to lay your cards right and get an EITC tax check written *to* you..... from Alan, as usual.

[ApatheticNoMore]

I did do the math on that 50% more. So I pay about 20- 25% of my income in tax (including social security and medicare), and that's not marginal, so that would be about 37.5%, yes I do believe that for that much there would not just be universal coverage but long term care etc. - you could do the full European model in lots of things, because it sounds about right. That doesn't include sales taxes though of course (nor taxes on utlity bills, gas, etc.).

I think it's only fair for non-standard deductions to be eliminated as part of the bill to raise taxes 50% (end itemization). Hey you can't expect renters to pay all the taxes in this country, time for homebuyers to pony up a little.

[gimmethesimplelife]

Rob,

Elsewhere you offered to pay 50% more in taxes, if it could be used to provide healthcare for all.

At $12k/year of income, which is below full-time minimum wage in your state, this is a bit of a painless offer, isn't it? I mean, how much tax do you end up paying on that amount.... Heck, since you mentioned you own a house, you may be able to lay your cards right and get an EITC tax check written *to* you..... from Alan, as usual.Bae, if you look back at my post, you will see that I prefaced it with the following - I realize my taxes are very low.....I do realize this. I still pay city tax on food in Phoenix, I still pay sales tax (though I do avoid it quite often via yard sales and thrift shops) and I still pay property tax, half of it on the house I own half of in Phoenix. I pay taxes on the shuttle I take down to Yuma to get to Los Algodones, Mexico. and I am sure scattered here and there are other taxes I pay. But yes, my overall total and percentage is not very high, a fact of which I admitted in my prior post. I would still be willing to pay 1/2 more if it meant others could access health care - the point is there are a lot of people in my shoes these days and our small 50% increase could make a big difference because there are so many of us now.

About being below the full time minimum wage in my state - I have been unable to find F/T work since being layed off my last job. I now work on call for a catering temp agency, list items on ebay I am able to find secondhand cheaply elsewhere, donate plasma, and work on gpt sites for cash. It all balances out to 12K a year and I am only one of many in this boat. I often feel that this is something US society in general is not willing to face - how many people out there know my reality and how many people in this reality realize remaining in the US is perhaps not viable going forward. This society is built on so much denial of the realities others face.....I often wonder when this will lead to major instability from the inside, not from outside. Rob

[iris lilies]

Bae, if you look back at my post, you will see that I prefaced it with the following - I realize my taxes are very low.....I do realize this. I still pay city tax on food in Phoenix, I still pay sales tax (though I do avoid it quite often via yard sales and thrift shops) and I still pay property tax, half of it on the house I own half of in Phoenix. I pay taxes on the shuttle I take down to Yuma to get to Los Algodones, Mexico. and I am sure scattered here and there are other taxes I pay. But yes, my overall total and percentage is not very high, a fact of which I admitted in my prior post. I would still be willing to pay 1/2 more if it meant others could access health care...

None of this pays anything toward the Federal bill of income tax to fund healthcare for the masses, surely you realize that. Your 50% increase is 0.

But that's ok, from each according to his ability, to each according to his need doncha know.

[ToomuchStuff]

Tax rebates only work if one is getting subsidies not for Medicaid. It's basicly "free" with no out of pocket or premiums to get tax rebates for at the end of the year. Because the amount of income needed to qualify for Medicaid (below $16K/year for a single person or $35K for a family of 4) is below the federal taxable amount after exemptions and standard deductions, you are already in the zero percent tax bracket. So basicly you either qualify or you don't.


And if he doesn't accept the medicaid, then he may qualify for those subsidies, which would be other peoples money (what it sounds like he is trying to avoid). Having talked to some of the IRS people I know, their orders are still fluid and changing (heck the 2013 tax instructions aren't done yet, or I would already have my tax form, pretty much done). The current way, is to pay directly to your chosen insurance provider, or via the "rebate" at the end of the year.
For your medicaid amount, I believe that is different from state to state. (state program, state poverty levels) Here, it would be lower then that.

[Spartana]

And if he doesn't accept the medicaid, then he may qualify for those subsidies, which would be other peoples money (what it sounds like he is trying to avoid). Having talked to some of the IRS people I know, their orders are still fluid and changing (heck the 2013 tax instructions aren't done yet, or I would already have my tax form, pretty much done). The current way, is to pay directly to your chosen insurance provider, or via the "rebate" at the end of the year.
For your medicaid amount, I believe that is different from state to state. (state program, state poverty levels) Here, it would be lower then that.You may be right if his/her taxable income at the end of 2014 ends up being much higher than expected. Otherwise my understanding is that if he/she tried to buy a plan on the exchanges (his state or the fed site) and was put into the Medicaid bracket because of his low taxable income levels then they can't actually even sign up for a plan on the website or apply for any subsidies - just Medicaid. This is what happened to me when I tried to use the Calif ACA website - wouldn't even let me look at or buy any plans, just Medicaid. Again this was my personal experience. I didn't follow thru with the application so don't know the end result but it just wouldn't let me even buy a plan thru the website, I have to go thru the insurance company directly or use something like www.ehealthinsurance.com to look at and buy coverage at full cost and can't get any subsidies at my low income level. Now maybe at the end of 2014, if his income is higher than expected and he bought his own ACA-approved insurance plan and had paid the full amount for his premiums each month he can then get the rebate. But I think you have to buy your plan directly from the exchanges and he can't do that unless he lies about his income and makes it higher (tax fraud!). But I could be wrong about that.

[Spartana]

Spartana, you make some excellent points! It sounds like a good plan to have it for unexpected huge bills/illnesses. You never know what the future holds.

Well I'll probably be taking my own (good???) advice for now. I won't sign up for Medicaid but will use the VA instead of buying a new plan after my is cancelled at the end of the year - at least until I can find a new one that doesn't have such high out-of-pocket costs. Yesterday I had my annual physical and got all my "brain, head, hearing and neck stuff" done at the VA (which I get done for free as part of my service-connected disability) so barring any kind of big emergency, I won't need to go to a doctor for at least a year or two. The VA is ACA-approved so I won't have to pay a penalty either and the co-payment for people at my income level are low. Don't really like doing it this way and would rather have my old catastrophic plan back but as other's have said, that's the way they wrote the ACA so use it. It'll give me time to see how things pan out and find a more affordable plan. It's not so much the increased cost of the monthly premium, as I can bear that additional expense, but it's as try2befrugal says - it's not the premiums that get you, it's all the other expenses like co-insurance, deductible and co-payments that can lead to huge medical bills. I don't know if these increased co-insurances and deductibles are a new thing because of the ACA, but I don't remember insurance plans ever having such high co-insurances and deductibles except for people with pre-existing conditions (something the ACA did right by eliminating that clause). It seems that there were either PPOs or HMOs for the most part. The first usually having no more than a 20% co-insurance and the later have no co-insurance and both having lower deductibles. But maybe I'm wrong about that.

[boss mare]

It is very important to me to be in 100 percent control over my health care choices at all times. You cannot do that if you accept government money. They can threaten to "cut you off" if you do not comply with their demands (such as having an RIF chip implant, if they decree it so). Then you have NO health care unless you allow them to do whatever they wish with you. Nope, not my cup of tea.
Thank You This was what I was trying to say in my post with the dental... Here in WA Medicare will only cover adults to have the tooth extracted... And that is IF you can find an office that accepts Medicaid and no coverage for dentures, partial dentures or bridges to replace the miss tooth . Even if it is a front tooth