Medical coverage for fulltiming in Texas without expanded Medicaid

[jenalan]

Greetings!

 

I am researching fulltiming in a few years from now. Presently we both work, make good incomes and live in Colorado.

I am stumped when it comes to healthcare. It appears the three most typical states for domicile (Texas, SD and Florida) do not offer expanded Medicaid coverage. This appears to mean, if we are living off savings or are workamping on a very low income, we are "too poor" to qualify for the Affordable Health Care Act subsidizes and are required to pay full price. Even with the BC/BS offered through SKP, this is in excess of $450 a month. We will be in our early 50s when we go.


Any thoughts on this?

[trailertraveler]

The last article I read, only about half the states bought into the expansion of Medicaid under the Affordable Care Act. Since Medicaid is state run you will have to check each to find the elligibility requirements. Consider also that since it is a state run program they may or may not limit coverage to emergencies when out of state. Another thing to check is if there is any requirement for how long you have been a resident of the state before you can apply for public assistance which generally includes Medicaid coverage. States that did not expand Medicaid under the Affordable Care Act may still have asset limits on elligibility. Also keep an eye on the Supreme Court case over subsidies in states that did not create their own exchanges. I believe TX, SD and FL did not. There has also been a lot of discussion on this and other RV forums about the lack of good healthcare coverage in SD for fulltimers that are not elligible for Medicare.

[Kirk W]

Are you sure that Medicaid is what you are looking for? This is taken from the Medicaid.gov site..........

 

Medicaid is a government health insurance program for low-income people in the United States.

It sounds like you are shopping for private health insurance and it is expensive and not getting much better.

[Barbaraok]

Greetings!

 

I am researching fulltiming in a few years from now. Presently we both work, make good incomes and live in Colorado.

 

I am stumped when it comes to healthcare. It appears the three most typical states for domicile (Texas, SD and Florida) do not offer expanded Medicaid coverage. This appears to mean, if we are living off savings or are workamping on a very low income, we are "too poor" to qualify for the Affordable Health Care Act subsidizes and are required to pay full price. Even with the BC/BS offered through SKP, this is in excess of $450 a month. We will be in our early 50s when we go.

 

 

Any thoughts on this?

Are you saying you all have zero income - if so, you would qualify for Medicaid, but that isn't what you want to have if you fulltime because Medicaid will have limited options (usually zero) for being outside the state. Sounds like you are looking at whether or not you will qualify for subsidized private insurance via a health exchange (currently Federal for Texas) - there are several plans available under the Federal exchange in Texas (most are Blue Cross/Blue Shield) and premiums are dependent upon your total income and the plan you choose. And if you are several years away, there really is no way to speculate on what will be available when you retire.

When you talk about savings are you talking about money in a savings account or money in an IRA/401k? Makes a big difference in terms of what you will qualify for - because IRA/401ks will be taxed as if they are current income when withdrawn, with post-tax savings then only the interest/dividends will be tax.

 

Barb

[trailertraveler]

Since this is your first post, Welcome to the Escapees Forum!!

 

I suspect that, you are not getting the kind of answers that you wanted to hear.

Are you saying you all have zero income - if so, you would qualify for Medicaid

Not sure that this is exactly correct in regard to qualifing for Medicaid. Taking a quick look at the Texas Medicaid Eligibility short form used to see if you are eligible; there are questions about earnings, savings, investments, etc. So it appears that Texas does means test for Medicaid eligibility. There is also a question about whether one needs assistance finding employment, so Texas may be one of the states that still requires those on public assistance to look for work. In the past, some states would not pay unemployment or other public assistance to those that voluntarily left their jobs. Don't know if that is still true or not.

 

If you choose to domicile in a state that expanded Medicaid under the Affordable Care Act, if it has a State Income Tax, savings or investments in other than tax sheltered accounts will most likely be subject to tax. If you take withdrawls from IRAs or other retirement accounts instead of savings, it appears that it counts as income when calculating eligibility for ACA subsidies and may give you enough income to qualify for a subsidy in Texas. However, if you start withdrawls before age 59.5, you may have to pay a penalty on those withdrawls if you do not meet one of the exceptions. You can read a brief description of the equal payments exception here.

 

So my thinking is that if your equal payments from IRAs or other retirement accounts, plus workamping income is high enough, you could get an ACA subsidy as a Texas resident depending of course on the outcome of the Supreme Court case about subsidies in states that did not setup their own exchanges.

[jenalan]

Yes, we are new Escapees!

We will have savings, as well as a 401k. We plan to fulltime in our early 50s, so we wouldn't be drawing on our 401k for at least 10 years after that.

 

The issue is that Texas does not have expanded Medicaid. Workamping will likely not bring us close to the 20K that is required to be at the low end to quality for the Health Exchange. From what I can find, since Texas has not expanded Medicaid, if we are "too poor" (I.E. workampers) we will not qualify for Medicaid. The BC/BS group plan I see through Escapees lists the monthly payment to be approximately $475, which is still more than we really want to pay. For those that are not old enough for Medicare, are you really paying at least that much?

 

One option I am looking at is leasing a lot at one of the SKP co-ops in Arizona and domiciling there. They have expanded Medicaid which would apply to "poor" people (i.e. living off our savings and workamping).

[skp51443]

Keep a careful eye on Arizona news, the expanded Medicaid is being fought over, may stay may go.

 

Here are a couple searches on local papers that are covering it. Neither as bad as The New Times but you have to read carefully to discern reported fact from opinion.

 

http://www.azcentral.com/search/Medicaid/

 

http://www.eastvalleytribune.com/search/?t=article&d1=1+year+ago&q=Medicaid

[Kirk W]

Keep a careful eye on Arizona news, the expanded Medicaid is being fought over, may stay may go.

And also consider the impact that the AZ state income tax and other fees could have on your budget.

[trailertraveler]

...From what I can find, since Texas has not expanded Medicaid, if we are "too poor" (I.E. workampers) we will not qualify for Medicaid...

Is it really that you are "Too Poor" for Medicaid. I didn't think that was possible. Or, is it that you have too many assets in savings, 401K, etc. that you do not want to spend down to meet the Texas Medicaid requirements?

 

I believe the states that expanded Medicaid under the ACA eliminated means testing which opens the door for what you want to do if you domicile in one of those states. Not sure, but you might want to check out WA, NV and NH as states with no income tax that have/had a state exchange and may or may not have expanded Medicaid.

 

Before the ACA, one of the time tested ways to do what you want to do was to figure out a way to qualify for Social Security Disability and thus Medicare.

[Barbaraok]

You really can't travel and expect to get coverage that will go with you under Medicaid. Medicaid coverage will be contracted with providers within the state and not throughout the country. And even in states with expanded Medicaid coverage, the coverage is limited to those in the state through state contracted providers.

 

As to the costs - as was said, if you are trying to compare what you, as an employee, paid for employer provided health coverage, then you undoubtedly have no idea of the true costs of health insurance as it applies to an individual.

 

Barb

[LindaH]

 

One option I am looking at is leasing a lot at one of the SKP co-ops in Arizona and domiciling there.

 

Check the Co-ops to see what kind of waiting list they have. Sometimes it can take years for your name to make its way to the top of the list to get a lot. Some of the Co-ops have been seeing shrinking wait lists, but I don't have any idea about the Co-ops in Arizona.

[RV_]

If you are not going to have much or any earned income, going to another state for domicile that would

 

A. Would allow you to be a full time RVr and be a state resident via an forwarding service and will not tax the monies you do have.

 

B. Have laws that you find favorable for laws regarding succession and death if you are handling a sizeable estate that will go forward. I am spending my kid's inheritance but still have all the paperwork done if we both suffer an accident and my executor, now my youngest son, will be receiving copies of our last will and testament and living will.

 

Rather than take a political view check the costs with several states that did join in, and those that did not create their own exchanges. This website may help you make your decision about your new coverage in 2015, and what it will cost:

https://www.healthcare.gov/keep-or-change-plan/choices/

 

Hope that helps.

[Phil and Micky]

FYI:

 

I live in different states during the year. My summer home is in a northern state; my winter home is in a southern state. Where do I sign up for health coverage? And if I sign up for a plan in one state, how do I find in-network health providers in the other state?

You should buy coverage in the state where you officially reside. Most states consider you a resident if you intend to make that state your permanent home. So-called “snowbirds” may own a second home and live part of the year in another state, but their official state of residence is where they spend most of the year, where they pay taxes, where they register their cars, or are registered to vote.

If you are buying coverage in your state of residency but spend a significant amount of time in a different state, you may want to explore plans offered by insurers that use a national provider network so that you could find participating providers in more than one state. You could also explore insurers that arrange to cover as in-network other insurers’ network providers. (For example, some, though not all "multi-state" plans, and some, though not all "multi-state" plans have such agreements.) You could also evaluate what out-of-network coverage, if any, your plan offers.

http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/#question-i-live-in-different-states-during-the-year-my-summer-home-is-in-a-northern-state-my-winter-home-is-in-a-southern-state-where-do-i-sign-up-for-health-coverage-and-if-i-sign-up-for-a-plan-in-on

 

[whj469]

To answer their question, $475 per month each will only buy

a high deductible health care policy if you are to young for Medicare.

It is my understanding that Texas does not have Medicaid for people

who are not disabled or over 65 years old?

My employer pays $870 per month for my very good health insurance, $500 deductible, 90% 10%,

doctor visits $15, any doctor in the plan and total out of pocket of $3,000 then they pay 100%.

It includes drug plan with co-pays of $10, $25 and $50, all of my meds are $17 for 90 day supply and

a vision and dental plan. My cost to enroll my better half in this plan is a little more then $1,000 per month.

When I asked why my better half cost was $150 more then mine, they told me that if someone was willing to pay that much

they would use it! Good Luck