Figuring Health Care Costs after Medicaid

April 27, 2023 4:22 PM

I have some health issues that have kept me from working on and off. As of right now, they are well managed so I want to go back to work. However, some of that management requires regular medical and medication. That care gets me to the point where I can work, and I'm trying to figure out the threshold salary I'd need to make to actually work again. I'm stuck on figuring out the healthcare costs because its been so long and I've had so many changes since I last had either employer or marketplace insurance.

I'm concerned if I take a job that knocks me out of medicaid I won't be able to afford my medical care and then I will become too disabled to work again. But I have NO idea how to determine those costs now. I have a few doctors I see 1 or more times a year, I have medications, I probably have a surgery at some point, and I've done pt a few times, which I have to do again before determining if I need surgery.

But my health is so much better, that like as long as I have the same care and things keep working, I can work again. HoooRay. I just don't want to get stuck in the middle with not enough insurance and fall apart. How do I get an idea of budgeting for the medical needs I have now.

posted by [insert clever name here] to Work & Money (8 answers total)

This really tricky because because out of pocket care costs can be so so so so variable between plans is likely to be employer specific in the US.

You can however look at some market place plans in particular price ranges with guesstimate salaries and get some idea of cost.

You might want to look into if any of your care providers are associated with a charity care program of some kind which may assist with some parts of your care. Also if any of your medication has prescription drug programs you can use. Generally these programs are happy to answer questions. Some will discount for people with insurance, some will not. It's going to be hospital specific.

Sometimes you can access prescription formulary online for insurance plans to look if particular meds are covered.

If you are recieving disability currently, the ticket to work program can help you keep your insurance for awhile as you figure this stuff out. If you are not, note medicaid rules are changing back to what they were before the pandemic, which may mean changes in how to maintain or keep your medicaid, including work requirements depending on the state.
posted by AlexiaSky at 4:35 PM on April 27, 2023 [1 favorite]

Have you considered just working part-time so you could maybe keep the medicaid? Every state has different rules about income caps, check to see what yours is.
posted by mareli at 4:44 PM on April 27, 2023

Are you on SSI disability? If so, the Ticket to Work program might be helpful.
posted by lapis at 4:57 PM on April 27, 2023

Response by poster: Have you considered just working part-time so you could maybe keep the medicaid?

Considered, but I'm tired of living in poverty and I'm not sure I need to. Thus the mathing.

As for SSI and SSDI, nope, I have started the process, but wasn't approved, Appealed once, forgot the second time, scramble, didn't appeal. I've been existing on student loans. I am supposed to be going through DVR for retraining, but that's been a bit of a mess (some mine, a lot theirs). But as my hand mobility and a few other medical conditions have improved with treatment, I'm feeling strongly I need to take a step back and get myself out of this poverty cycle (if I can) to work and then reevaluate how I want to finish my degree. (I am having an existential crisis about that, and I don't think I'll see clearly until I take a step back and I'm not strugglebussing financially so hard.

I don't have to leave school, and if I understand correctly, I should be able to stay on medicaid because they aren't as strict as the disability requirement for medicaid, they just need a letter from my doctor stating I'm disabled. I have an appointment next month to get that, and I don't have to worry about medicaid renewal until march 31, 2024.

I used to work in UX design, know my way around design and front end dev and some other misc tech skills. I know my skills have atrophied so part of my thinking is to look for jobs that might be closer to entry level to ease back into it. (or the right part time gig/contract). (and yes, I know the tech job market is sucking right now, but IDK, my hands are working and its time.)

I do have other medical besides the mobility problems and it may come back or get worse, but for now I'm not going to let that hold me back (I also NOW know all sorts of handsfree tools I didn't so god for freaking bid I start having the same limitations, I have other tools.)

I'm also speaking with a benefits specialist next week through my state's department of vocational rehab, but I don't know exactly what she's going to be doing, and I'd like to have some of my own research before I do.

Anyway, I don't mean to thread sit, I just want to clear up those things.
posted by [insert clever name here] at 7:07 PM on April 27, 2023 [1 favorite]

I would sit down and make a list of all of your medical stuff from last year - doctor's appointments, meds, lab work etc. Then look at the ACA marketplace plan. Match your expenses to the different categories (office visit, specialist visits), medications. You can then do an estimate of your out of pocket costs plus monthly fees. If your income is low enough, you might be eligible for a subsidized plan - at least on the California website, it shows the income range for each plan. This gives you a rough idea of how much extra medical expense you would be facing. If you are employed, the cost will be probably be subsidized by your employer but knowing how much medical care you need will help you evaluate the cost of the different options that your employer offers. Also, if you are paying the full cost yourself, you might be able to find cheaper plans using an insurance broker so that should be an outside number.
posted by metahawk at 9:12 PM on April 27, 2023 [2 favorites]

Some states have programs where you can buy into Medicaid if you have certain disabilities and are working. I learned about it because of PA’s program, called MAWD. If your location listed is correct, I think this WI program is similar:
https://www.dhs.wisconsin.gov/medicaid/disabilities.htm
posted by needs more cowbell at 9:39 PM on April 27, 2023 [1 favorite]

Sorry, I meant to link more specifically to this:
https://www.dhs.wisconsin.gov/medicaid/medicaid-purchase-plan.htm
posted by needs more cowbell at 9:42 PM on April 27, 2023

If you start working for an employer that offers health insurance, that insurance will have an out-of-pocket maximum for in-network coverage. Once you hit that maximum, you shouldn't have to pay anything more for the rest of the year. According to Kaiser Health News, 13% of employees had OOP maximums of less than $2,000, while 27% had an OOP Maximum of $6,000 or more. That cost doesn't include any monthly premiums you pay. Say that you have a monthly premium of $200/month; if you use a lot of medical services and get to that out-of-pocket maximum, your total yearly spending on health care could be between $4500 and $9000.

However, that's the "catastrophic" cost. Once you meet an insurance plan's deductible, the insurance should start picking up the majority of your costs -- often between 75%-95% of medical services, and 60%-95% of prescription drugs. Plan for the premium cost and deductible (say, $500-$2,000), and then make an estimate of how often you might see a doctor of have recurring prescription costs to make some estimates.
posted by Theiform at 2:05 PM on April 28, 2023 [1 favorite]