Medicaid for dummies
December 1, 2018 12:32 PM   Subscribe

Should I enroll in Medicaid or try to stay on an Obamacare plan?

I live in New York City. I got a letter from the NY State of Health (the "obamacare" exchange for NY State) saying that because of my income, I no longer qualify for the exchange and will be enrolled in Medicaid in January. I don't understand Medicaid well enough to figure out if I should go with it or try to keep my current insurance.

I'm a freelancer, and my annual income usually varies between about 30K and 80K. It must have dropped low enough (after deductions) last year to trigger Medicaid. I have no idea what I will earn in 2019, but it's very unlikely to be low enough to qualify for Medicaid.

My first worry is that if I accept Medicaid coverage, I may be dropped during 2019 because my income is too high, perhaps even retroactively. The risk of tax audits is particularly high for freelancers, and my past as well as my current income could be reassessed.

My second is that I will lose access to the medical practice I've been at for the last few years, though to be honest I could probably afford to pay out of pocket to see the same doctor if I'm not paying $500-600/month in insurance premiums.

I'm also worried about learning to deal with a whole new and different health bureaucracy.

I have the usual chronic issues of a middle-aged person (high blood pressure, etc), that I'm sure Medicaid handles just fine; plus others (chronic fatigue, possible ADHD) that I'm not sure about.

I don't know if I can convince the state to allow me back on the exchange, since my tax return for last year will indeed show that I didn't make much money in 2017.

I'm not concerned about minimizing my expected costs for 2019; more with minimizing risk and discontinuity. I don't want to open myself up to possible catastrophic expenses or loss of coverage with one choice or another. What should I take into consideration when deciding how to proceed?
posted by anonymous to Health & Fitness (6 answers total) 4 users marked this as a favorite
First check to see if your current insurer also provides Medicaid as a managed care organization. If it does, you might be able to keep your provider.
posted by metasarah at 12:55 PM on December 1, 2018

You may want to find a community health advocate to help answer your questions:
To learn more about coverage options for which you may qualify, visit New York’s online health insurance marketplace,, or call its toll-free customer service line (Monday-Friday, 8:00 a.m. – 5:00 p.m.): 855-355-5777.

For more help finding the right coverage for you, contact Community Health Advocates at or (888) 614-5400.
posted by Little Dawn at 12:57 PM on December 1, 2018 [2 favorites]

(This answer is predicated on the assumption that you're not committing tax or benefits fraud. If you are, yes, you're stuck with the risk of an audit, can't really help you with that.)

So, I'd need to see the letter, but I think it's not that you can't be on a marketplace plan. It's that your income was calculated as so low that it is below the floor for premium assistance for a marketplace plan and into eligibility for Medicaid. If you try to stay on the marketplace plan, I believe (not 100% sure, you should definitely confirm) that they won't give you the subsidies, so the cost may be significantly higher per month than you think.

Your income must have been quite low indeed. The qualifying MAGI for a single individual below retirement age and not disabled is about $16,500. Are you sure that's accurate? If it is, you only have to recertify yearly. If your income jumps up this year, then you can go back on a marketplace plan.

The discontinuity concern is reasonable, but isn't there a simple way to address it? Call your current doctors and see if they'll accept it for a current patient.

Speaking generally, I have a friend on Medicaid in NYC who is reasonably content with it.
posted by praemunire at 12:58 PM on December 1, 2018

All solid advice. I’d add that NY almost certainly has a thing called a special enrollment period that’s specifically to let people who lose their Medicaid eligibility mid-year enroll in an Obamacare plan, and make it so you roll right from one to the other without a gap in coverage. The community health advocate should be able to tell you more and how to do it, but you want to know about a special enrollment period for a loss of minimum essential coverage/loss of health insurance. Good luck.
posted by jameaterblues at 2:01 PM on December 1, 2018 [1 favorite]

You can move back and forth between Medicaid and a subsidized ACA private plan as your income changes during the year. The tricky part is the documentation required to verify your income, especially if you are a contractor. For that you should probably go through an ACA navigator to help you figure it out.

When you fill out your application, they ask you to estimate your annual income, but then they will require documentation to support your estimate. In the absence of anything better, they will use your most recent tax return which would be for 2017. But they may allow you to use business invoices, receipts or copies of checks you received in 2018 as more recent data to show increased income. A navigator should be able to help you. This is assuming that your 2018 income is in the subsidy range.

If 2018 income is too low, you will have to start 2019 on Medicaid, but could transition to a subsidized plan on the exchange if your first quarter income is high enough. Your April 2019 first quarter estimated tax statement would be excellent verification of increased income. Losing Medicaid eligibility because of increased income is a qualifying event for enrolling in an exchange plan mid-year.

Also, if you have the cash available, you could just pay for the ACA plan out of pocket for 2019. If your income falls in the subsidy range by the end of 2019, then you can get a refund of the full subsidized amount when you file your 2019 return in April 2020. But that requires a lot of out of pocket investment up front. Just make sure that you buy an ACA on the exchange or you won't be eligible for subsidy.
posted by JackFlash at 4:37 PM on December 1, 2018 [3 favorites]

I'm a freelancer in New York State and this has happened several times for me. Some years we qualify for Medicaid, or for the NY essential plan (medicaid-ish plan for people making a mediumish income) and some years we don't. This was a pain when the ACA first came out but now they've been auto-calculating our income and it's fine.

Once you qualify for medicaid or an essential plan, you are allowed to be on it for one year. They won't take it away mid year. The big problem is finding doctors, which I found difficult for some specialists. However, if you qualify for medicaid, then you don't get any subsidies and you cannot apply any subsidies to a different metal-level plan; you have to pay the full price.

Other than the uunavailability of some doctors, I really like having medicaid/essential plans, when they're available. Everything is very very affordable, often free, and relatively easy. I'd encourage you to go for it, personally.
posted by PhoBWanKenobi at 5:35 AM on December 2, 2018 [4 favorites]

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