Question re Obamacare & upcoming Calif Health Ins Exchange
June 14, 2013 12:27 PM   Subscribe

Is my income too low to qualify for Obamacare health insurance subsidies?

I own my home and other real estate free and clear and am retired with my only income (until I'm eligible for Social Security) is $1200/month in rental income. I'm 59 years old and pay $364/month for Kaiser Permanente health insurance. It's a squeeze for me but it's the insurance I want so I pay it. Everything I've read says Kaiser premiums will increase substantially next year and I won't be able to pay the expected increase. From what I've read, I don't earn enough to qualify for the insurance subsidies under Obamacare and will have to sign up for Medi-Cal/Medicaid.

Is it true I won't be eligible for subsidy?

If I get seriously ill with Medi-Cal/Medicaid, will the governent go after my estate to recover their outlay?
posted by buggzzee23 to Law & Government (9 answers total)
$1200/mo is an income of $14,400/yr. You definitely qualify for federal subsidy for the Covered California insurance exchange (California's Obamacare implementation), and you'll be paying far less a month for insurance than you're currently paying.

Subsidies are for people who don't make very much money. You are one of those people. There is no such thing as a "too low" income for subsidy.
posted by erst at 12:44 PM on June 14, 2013 [2 favorites]

erst, your link goes to this thread.

There's a subsidy calculator here. Caveats: I work for the place that created this but had nothing to do with its creation; it depends a lot on where you are - the calculator is meant to be a ballparking kind of thing, not a "this is exactly how much you will pay" kind of thing.
posted by rtha at 12:50 PM on June 14, 2013

More California-specific info here.
posted by rtha at 12:54 PM on June 14, 2013

Awww crap. Actual Covered California link with subsidy and plan info. Sorry about that.
posted by erst at 12:56 PM on June 14, 2013 [1 favorite]

Response by poster: From the link posted by rtha:
"If your state does not expand Medicaid
If your state does not expand Medicaid, you will be eligible to purchase subsidized coverage through the exchanges."

I live in California and California is expanding MediCaid. From what I've seen so far, it looks like people making under $16,000 will not qualify for the subsidy.

According to the Covered California link posted by erst, it looks like the minimum income for subsidy is $15,856. When I enter my info into this calculator , MEDI-CAL pops up as the answer.

This really sucks if it's the case.
posted by buggzzee23 at 1:11 PM on June 14, 2013

Is it true I won't be eligible for subsidy?

Yes, unfortunately (for your particular income level) it looks like you'll be eligible for Medi-Cal, so if you apply for a premium subsidy through the Exchange you'll be moved over to Medi-Cal and probably determined eligible for that program, which would make you ineligible for federal premium subsidies.

Worth noting that Medi-Cal is primarily administered through managed care plans in California, and Kaiser is one of the participating insurers. It's county-by-county in terms of which plans are available, but I know my grandparents were insured through Kaiser (paid by Medi-Cal) when they lived right outside San Diego a few years back.

If I get seriously ill with Medi-Cal/Medicaid, will the governent go after my estate to recover their outlay?

I don't think this is very likely at all, although I'm not a definitive expert on this. To the extent states go after estates to recover costs, it's almost entirely for people who are applying to Medi-Cal upon entering a nursing home and have assets like a house that they had transferred to kids or a spouse in the recent past in order to qualify for Medi-Cal. However, the current eligibility rules for Medicaid-expansion adults (which is very likely how you'd be qualifying) under the ACA do not allow asset tests, so I would have a hard time seeing how they would have any standing to go after your estate. Asset tests do exist for the elderly, but by that time you should qualify for Medicare as your primary coverage and the whole issue would be moot.

I'm hoping someone can come in after me with a more definitive link, but if it were me, I wouldn't be worried about the state coming after your assets if you sign up for Medi-Cal in 2014.
posted by iminurmefi at 1:26 PM on June 14, 2013

A little bit more information on "estate recovery", which is when a state would try to recover the money it spent on your medical care after your death by taking part of your estate, can be found here:
State Medicaid programs must recover certain Medicaid benefits paid on behalf of a Medicaid enrollee. For individuals age 55 or older, states are required to seek recovery of payments from the individual's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States have the option to recover payments for all other Medicaid services provided to these individuals, except Medicare cost-sharing paid on behalf of Medicare Savings Program beneficiaries.

Under certain conditions, money remaining in a trust after a Medicaid enrollee has passed away may be used to reimburse Medicaid. States may not recover from the estate of a deceased Medicaid enrollee who is survived by a spouse, child under age 21, or blind or disabled child of any age. States are also required to establish procedures for waiving estate recovery when recovery would cause an undue hardship.

States may impose liens for Medicaid benefits incorrectly paid pursuant to a court judgment. States may also impose liens on real property during the lifetime of a Medicaid enrollee who is permanently institutionalized, except when one of the following individuals resides in the home: the spouse, child under age 21, blind or disabled child of any age, or sibling who has an equity interest in the home. The states must remove the lien when the Medicaid enrollee is discharged from the facility and returns home.
So, it looks like it's technically possible that the state would go after your estate after your death, but that really is for people who end up in nursing homes or using other long-term care services. Of course, current private health insurance (like your Kaiser plan) don't cover long-term care services like nursing homes, so the likelihood is that no matter what type of coverage you had, if you became disabled enough to need a nursing home you'd likely end up on Medi-Cal anyway.

In any case, if you're just using Medi-Cal as regular health benefits for the next 6 years, and not for long-term care, my personal sense (which is worth what you pay for it!) is that it's very unlikely that state would go after your estate when you die even if you became ill with a high-cost disease like cancer. That's because the managed care plan you'd be likely to enroll in through Medi-Cal would be the entity taking the financial hit, not the state--the state is really just paying the premiums to the plan.

Sorry that you might not be able to stay on your current plan, that's a bummer. I hope premiums don't increase by as much as you fear.
posted by iminurmefi at 1:55 PM on June 14, 2013

Surely there is some way that you can increase your rental income level by the 1500 (or about $125 a month) needed to get out of Medicaid. What if you raised the renter's income by $125 a month and then rebated back the renter under the table - or some arrangement like that?
posted by Podkayne of Pasadena at 3:10 PM on June 14, 2013 [1 favorite]

On a more legitimate note: become an ebay seller. Once a month you make a trip to the thrift store and buy enough crap that you can sell for $125 each month. Again, problem solved.
posted by Podkayne of Pasadena at 4:04 PM on June 14, 2013 [1 favorite]

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