Nm - thanks!

[Farrar]

Thanks, y'all. I have some new ideas about how to think ahead about this.

Edited March 3, 2021 by Farrar

[Carol in Cal.]

Can he get a job with better insurance?  That would be the very best option.  

If not, you need to talk with a reliable insurance broker in your state who can really sink his teeth into optimizing this for you. There are too many variables, particularly from state to state, to get good advice this way.

[sgo95]

Sorry if this is a dumb question, is your out-of-pocket maximum basically so high it's useless?

[Lori D.]

From just a very brief look, I don't think he'll be eligible for Medicaid, even if you stop paying for insurance for him at age 18. It looks like the benefits are for those under 18 or over 65, blind, or with other specific disability. It looks like it is a final safety net for the impoverished with critical health care needs.

It sounds like it would be denied in the same way that FAFSA and colleges would deny providing extra financial aid because a parent tried to get a teen declared as emancipated so that parent financials would not be considered in the FAFSA calculations ... 😉 

BUT don't take my quick look opinion as fact! 😉 

Edited March 3, 2021 by Lori D.

[Katy]

No, he won’t be eligible for medicare if he’s eligible for your insurance. 

Check with the community colleges and state universities in your area. They used to offer pretty cheap medical coverage for students, and you only had to sign up for one class to qualify. I don’t know if that’s still an option or still as cheap since the ACA. 

[mom31257]

If your health insurance is that bad, you might want to look into Christian Healthcare Ministries. 

My sister has it and needed a full hysterectomy. Because she actually pays out of pocket first and gets reimbursed, she was able to get the cost of the surgery given to her ahead of time.  I can't remember exact numbers, but it was going to be over 70,000 total and they cut it in half because she was paying out of pocket. They lowered it even further when she received the actual bill (still over 20,000), then she was reimbursed all but $500 from the healthcare ministry. 

She pays everything up to $500 out of pocket regardless of what it is. 

I'm not sure what the policy is concerning pre-existing conditions. 

 

Edited March 3, 2021 by mom31257

[Scarlett]

Is he working?  Once he is 18 he should look into the marketplace plans.  I know several young adults who qualify for great plans with very low deductible.

[J-rap]

Is he still in high school?  Will he be going to college?  I know some colleges used to offer insurance plans.  (Don't know anything about them.)

Or will he be working directly after high school?  (Then he could look for a company with decent health insurance?)  Some companies allow you to be on their health plan even if you're part-time.  (You'd have to pay more than if you were full-time.)

And no, I don't think he's eligible for medicare.  Our dd just went on one of our state's marketplace plans.  It's not as good as we'd hoped it would be, but it will have to do.  (She's planning to have surgery this year as well, so her $5,000 out-of-pocket max will be met immediately.)

 

 

 

[Scarlett]

Here is a pretty good summary of it.  https://www.kff.org/health-reform/fact-sheet/aca-open-enrollment-if-you-are-low-income/

 

[Scarlett]

Dss19 had fantastic medical insurance at Panda Express.  For $100 a month he had 100% coverage on medical and dental.  It was incredible insurance.  

[Ali in OR]

I was also thinking the college/university insurance route, if college/university is in his plans.

[Scarlett]

I think there are so many variables it is  impossible to say exactly.  Depends on your state and his plans and his income etc.  

 

[Pam in CT]

Medicaid proper?  Or ACA subsidies?

When my now-26 year old was briefly between insurance-providing jobs a few years ago, she had a choice between going $$$$$$ COBRA, going $$$ back on to our plan, or going $ onto expanded-Medicaid NY-subsidized ACA. She had no particular medical issues and hadn't already really established doctor relationships, so she chose the subsidized ACA.  She was occasionally grumpy about limited provider lists but the coverage itself was fine.  (There are a LOT more doctors of every type and specialty in NYC though -- limited provider lists could be more of an issue in less provider-dense geography.)

 

We put my now-22 year old son on his university's plan. It was way better coverage for way less. I was initially concerned that he'd be out of network when he was home on breaks (his university is in a different state) but the coverage is for 100 miles of EITHER university or home. 

[Bootsie]

My suggestion would be that he focus on getting a job that has good insurance coverage as a young adult, even if it is not where he wants to be long term.  Perhaps working for the state government, a university, or some othe major employer, depending upon your area would provide good insurance coverage.  

Depending upon the type of surgery, considering going out of the country could be very complex.  Remember that you would have to factor in all travel costs, a place to stay for reccuperation, any repeate visits.  

I would also check to see what your maximum out of pocket for your current insurance is.  If you have the option of timing this surgery, you may find that there are number of medically related needs that could be taken care of in the same year, and you would hit your maximum out of pocket.  

[BlsdMama]

If your financial circumstances are relatively not great currently, you could always apply for financial assistance at the hospital to see if your family is eligible. If you are, they will write off a percentage of your costs which could be pretty high. 
 

Also, understand your out of pocket may be high, but your insurance will have contracted limits. You can call your health insurance and ask them an expected amount for this surgery. They may be able to answer that. 
 

For example, Mayo charges a rather lot for my Botox. I looked it up - my last visit billed $10,843.00. However, the amount allowed by my plan due to their contract is $257.40. I was then responsible for 20% of that because we had met our deductible but not our out of pocket. At the beginning of the year, before our deductible is met, we are responsible for 100% of the contracted amount, not for what is billed. These two things are different. Also, hospitals do payment arrangements. There is no reason why he couldn’t contribute to a monthly payment. I feel you on it. The University wants to do an exploratory surgery on our 19yo. Sigh. It is likely she doesn’t have the issue they are looking for. It is likely endometriosis. The catch is IF she has the bacteria they’re looking for, it tends to lead to cancer. Thus, we are doing the procedure. But, as a person who just paid off four years of five figure medical bills (our part, the billed part was well over a million) seriously, couldn’t we just have a year OFF?!?!?!

[catz]

Definitely consider looking at colleges that have health plans available if he is college bound.  The one at my son's university is pretty decent and they have a research hospital on site.  

[cjzimmer1]

1 hour ago, Bootsie said:

My suggestion would be that he focus on getting a job that has good insurance coverage as a young adult, even if it is not where he wants to be long term.  Perhaps working for the state government, a university, or some othe major employer, depending upon your area would provide good insurance coverage.  

Depending upon the type of surgery, considering going out of the country could be very complex.  Remember that you would have to factor in all travel costs, a place to stay for reccuperation, any repeate visits.  

I would also check to see what your maximum out of pocket for your current insurance is.  If you have the option of timing this surgery, you may find that there are number of medically related needs that could be taken care of in the same year, and you would hit your maximum out of pocket.  

Just to add to this, if there are any complications you'd be on the hook for those too.  Even if he was back in the US when the complications occurred, any insurance he has may not cover complications from a procedure done overseas.  

Edited March 3, 2021 by cjzimmer1

[Farrar]

So, he's still under age in high school. I was trying to look ahead a couple of years. So what you're saying is no one can get Medicaid until... when? Until they're 27? By then, I really hope he's not a broke kid anymore, so that would mean he could never get assistance. Plus, I really don't want him to wait a decade. I mean, three years, sure. Whatever. But a decade is not... not a great plan. Unless they can prove parental non-support? Even if they're living independently? What qualifies as independently if so? I feel like that can't be right. I know someone who is under that age who had Medicaid who is not like, estranged from their parents.

Yes, our cap is so high it's useless. As I understand it, there is no real cap. It just pays a percent after the deductible. Like, 50% for most things - more for some things, but less for others. So it's a "lot" but it's not much comfort when you start talking about tens of thousands of dollars. So if the surgery were 50k, then we'd be out 30k. That's... a lot of money. But I have no idea how much it will be. When I tried to discuss this with two different hospitals, they refused to answer me. The doctor's suggestion was to go into the ER so it would become an emergency procedure and they'd have to do it. But realistically, that doesn't work for us, I'm like, that only works if we're broke and don't have any insurance. The problem isn't that weren't uninsured, it's that we might as well be, which is worse for getting something like this done in some ways. If we were actually broke, we could get Medicaid. I'm so envious of the people I know with Medicaid. It's amazing the care they get here.

I've looked into going onto the open market. That might be a better option, but without knowing the cost of the surgery, it's so hard to price out.

It's unrealistic for dh to get a new job based on insurance. We make far too much to him to give up his job, too much to qualify for any assistance, too much for it to be easy for him to slide into another job because he's upper management in a very niche field. But we don't make so much that we can take on a mystery medical bill that no one will tell us how much it will be. Like, will this be 10k? That would SUCK, but we would deal. Or will it be 50k? That would be unsustainable for us. We could lose... I mean, it would be bad. I don't know. And we're not poor enough for anyone to tell us apparently.

This ds is not planning on college so that's not an option.

So... er... idea two then? I do think this would likely be dramatically cheaper abroad. And I might be able to get the price tag, which is the toughest part - not having any clue how much it would be.

[Farrar]

It's a specialist procedure, but doesn't require a long recuperation time and I wouldn't anticipate any real issues. The doctor was pretty blase about it, honestly. Sigh.

[Farrar]

Or, any ideas on how to get a price out of a hospital?

[cjzimmer1]

1 minute ago, Farrar said:

Or, any ideas on how to get a price out of a hospital?

the easiest way I know, is to have the doctors office submit it to insurance for preapproval.  I would assume that would give you some information to start with.  After you have the preapproval, I'd be calling the insurance and hospital till someone coughs up the missing information that you need.

[Farrar]

I guess I just don't understand how, once he's an adult living apart from us, he can't be eligible for totally different insurance. That's nuts.

[Scarlett]

9 minutes ago, Farrar said:

So, he's still under age in high school. I was trying to look ahead a couple of years. So what you're saying is no one can get Medicaid until... when? Until they're 27? By then, I really hope he's not a broke kid anymore, so that would mean he could never get assistance. Plus, I really don't want him to wait a decade. I mean, three years, sure. Whatever. But a decade is not... not a great plan. Unless they can prove parental non-support? Even if they're living independently? What qualifies as independently if so? I feel like that can't be right. I know someone who is under that age who had Medicaid who is not like, estranged from their parents.

Yes, our cap is so high it's useless. As I understand it, there is no real cap. It just pays a percent after the deductible. Like, 50% for most things - more for some things, but less for others. So it's a "lot" but it's not much comfort when you start talking about tens of thousands of dollars. So if the surgery were 50k, then we'd be out 30k. That's... a lot of money. But I have no idea how much it will be. When I tried to discuss this with two different hospitals, they refused to answer me. The doctor's suggestion was to go into the ER so it would become an emergency procedure and they'd have to do it. But realistically, that doesn't work for us, I'm like, that only works if we're broke and don't have any insurance. The problem isn't that weren't uninsured, it's that we might as well be, which is worse for getting something like this done in some ways. If we were actually broke, we could get Medicaid. I'm so envious of the people I know with Medicaid. It's amazing the care they get here.

I've looked into going onto the open market. That might be a better option, but without knowing the cost of the surgery, it's so hard to price out.

It's unrealistic for dh to get a new job based on insurance. We make far too much to him to give up his job, too much to qualify for any assistance, too much for it to be easy for him to slide into another job because he's upper management in a very niche field. But we don't make so much that we can take on a mystery medical bill that no one will tell us how much it will be. Like, will this be 10k? That would SUCK, but we would deal. Or will it be 50k? That would be unsustainable for us. We could lose... I mean, it would be bad. I don't know. And we're not poor enough for anyone to tell us apparently.

This ds is not planning on college so that's not an option.

So... er... idea two then? I do think this would likely be dramatically cheaper abroad. And I might be able to get the price tag, which is the toughest part - not having any clue how much it would be.

Are you in a state where Medicaid was expanded?  I think he could qualify in expanded states after he is 18.  Regardless once he is working and makes at least just under 13K he will qualify for a ACA plan which will probably be very affordable and with good coverage.

Did you see  my post about Panda Express?  Not sure if they have those where you live, but seriously the insurance is amazing.  

One more thing....have you looked into your entire family qualifying for a ACA plan since you pay a lot for your current plan?  I remember there was some way out for people stuck with horrible group plans.

[Scarlett]

3 minutes ago, Farrar said:

I guess I just don't understand how, once he's an adult living apart from us, he can't be eligible for totally different insurance. That's nuts.

What do you mean?  He will be.....

[Katy]

Here’s an article a year old on the same dilemma: https://www.google.com/amp/s/thecollegeinvestor.com/32181/cheapest-health-insurance/%3famp

[Scarlett]

12 minutes ago, Farrar said:

Or, any ideas on how to get a price out of a hospital?

 

6 minutes ago, cjzimmer1 said:

the easiest way I know, is to have the doctors office submit it to insurance for preapproval.  I would assume that would give you some information to start with.  After you have the preapproval, I'd be calling the insurance and hospital till someone coughs up the missing information that you need.

Hospitals are notorious for not being able to price a procedure ahead of time.  It is ridiculous.  

[Farrar]

Just now, Scarlett said:

Are you in a state where Medicaid was expanded?  I think he could qualify in expanded states after he is 18.  Regardless once he is working and makes at least just under 13K he will qualify for a ACA plan which will probably be very affordable and with good coverage.

Did you see  my post about Panda Express?  Not sure if they have those where you live, but seriously the insurance is amazing.  

One more thing....have you looked into your entire family qualifying for a ACA plan since you pay a lot for your current plan?  I remember there was some way out for people stuck with horrible group plans.

Yes, Medicaid was expanded here. I don't know where he'll be living in two years or three, but if he's here, I would think? I guess that's what I'm confused about. Like, people were saying up thread that no, he couldn't get Medicaid. But I was thinking, but if he's making very little and is an adult, why not? If he lives at home, then do we have to kick him out for him to get it? Which, okay. That could be worth it. I get that he would still be eligible for our insurance, but it's junk. Under what circumstances are we required or not required to leave him on it?

I looked into opting out of dh's insurance. And I tried to convince him to. It was going to be a lot more, but at least there would be a cap, so I think it may make sense. Honestly, I mostly just tried to convince dh to drop the insurance altogether at one point. I was like, we're literally only using this for meds at this point. We don't qualify for any assistance. We make too much.

[Farrar]

4 minutes ago, Scarlett said:

What do you mean?  He will be.....

Two people at the start of the thread said the opposite. That as long as he's eligible for our insurance, he cannot go on Medicaid as an adult.

[Ottakee]

Adults on their own can get medicaid.  The income depends on if your state expanded medicaid or not.  He might also qualify for a market place insurance plan.

[Scarlett]

1 minute ago, Farrar said:

Yes, Medicaid was expanded here. I don't know where he'll be living in two years or three, but if he's here, I would think? I guess that's what I'm confused about. Like, people were saying up thread that no, he couldn't get Medicaid. But I was thinking, but if he's making very little and is an adult, why not? If he lives at home, then do we have to kick him out for him to get it? Which, okay. That could be worth it. I get that he would still be eligible for our insurance, but it's junk. Under what circumstances are we required or not required to leave him on it?

I looked into opting out of dh's insurance. And I tried to convince him to. It was going to be a lot more, but at least there would be a cap, so I think it may make sense. Honestly, I mostly just tried to convince dh to drop the insurance altogether at one point. I was like, we're literally only using this for meds at this point. We don't qualify for any assistance. We make too much.

I think someone was saying you can't ditch current coverage and get medicaid. But once he is 18 certainly you can drop him from your group plan and then he can apply to wherever for coverage of his own.  Some coverages may ask for household income.  Read the link I posted above from the Kaiser foundation.  They have a lot of good info on it. 

It is good you are thinking ahead so you have a plan for him....that would be a good idea with or with the surgery he needs.

[Scarlett]

3 minutes ago, Farrar said:

Two people at the start of the thread said the opposite. That as long as he's eligible for our insurance, he cannot go on Medicaid as an adult.

I don't think that is correct.  

[Farrar]

Sigh. American healthcare is so crazy, y'all. Like, dh makes a really good living. We have a house that we "bought at the right time" so it's got an absurd amount of equity, even though it's not like we can tap it easily, it's there. We have some savings. Like, no one should be in a situation where they have to figure this out like this in the first place. But the myth of America says that people like us won't be. People who are fine on paper. And I feel like a dummy having to be like, well, we don't qualify for anything... but who can just absorb a mystery high dollar medical bill? It's almost worse that we have to plan it. Like, if he got in a car accident, there'd be no choices. We'd just have to get him care.

[Spryte]

It is indeed crazy.

We are in the process of getting an elder on Medicaid (well, three of them, actually), and I’ve come to think that the system is designed to keep people out.  Ugh. 

One thing we we have learned though, which may or may not apply to a young adult living at home, in your area, is that the elder who lives with us has to be her own “entity.”  Meaning, I think, that our finances cannot be mixed or our income will be factored into whether or not she receives Medicaid.  So she needs to be supporting herself (though Medicaid frowns on family accepting anything that looks like rent, so how this works, I just don’t know). It may not be the same, but if your kid does live at home and you are helping him get onto Medicaid, how your household resources are shared may be a factor.  
 

 

[Bootsie]

For 2021, the marketplace plans have an out-of-pocket limit of $8550 for an individual (and $17,100 for a family).  Is your out-of-pocket limit really that much more?  

I don't know where you would consider looking abroad, but by the time you found a doctor, travelled to that location (post-pandemic I am assuming), and paid for any lodging, I would think it might be difficult to come out ahead financially.  

[mom2scouts]

It's unlikely he'll be able to get Medicaid if he still lives with you or you can add him to existing insurance, but you should also be aware that in many areas it's very, very hard to find medical providers who accept Medicaid for adults. Also, they will make it nearly impossible to get a surgery that's not required.

[Pawz4me]

59 minutes ago, Farrar said:

I guess I just don't understand how, once he's an adult living apart from us, he can't be eligible for totally different insurance. That's nuts.

He can be. DS22 lives here but works. He has a silver plan through the ACA. The subsidy he qualifies for covers most of the premium. It's certainly not fabulous coverage, but it's decent. At least considering what passes for decent insurance coverage nowadays (sigh).

Edited March 3, 2021 by Pawz4me

[Lori D.]

1 hour ago, Farrar said:

So, he's still under age in high school. I was trying to look ahead a couple of years. So what you're saying is no one can get Medicaid until... when? Until they're 27? ... Unless they can prove parental non-support? Even if they're living independently? What qualifies as independently if so? I feel like that can't be right. I know someone who is under that age who had Medicaid who is not like, estranged from their parents...

PLEASE do NOT rely on my post upthread -- that was just a very quick opinion based on what I was seeing from the Medicaid website. Absolutely I would start doing some digging for information. And get on the phone and talk with someone who really understands who is eligible for Medicaid, and when, and for how much.

Health insurance is such a murky and variable area that this is definitely NOT a situation to rely on the Hive, because
1.) we all are in different areas with different situations, and
2.) none of us are health insurance experts, esp. when it comes to Gov't. insurance programs. 😉

BEST of luck!

[Farrar]

11 minutes ago, mom2scouts said:

It's unlikely he'll be able to get Medicaid if he still lives with you or you can add him to existing insurance, but you should also be aware that in many areas it's very, very hard to find medical providers who accept Medicaid for adults. Also, they will make it nearly impossible to get a surgery that's not required.

This is definitely being "required." It's just not urgent. The doctor was like, so we should just go ahead and get it done. And I was like, um... how much? When he couldn't say, I was like, I think we're going to wait. He was like, that's fine too.

[Farrar]

Okay... thanks. I'll think it through. It may make sense for us to wait for open enrollment, drop dh's insurance, start a new plan for a year, get this done (and hey, maybe other things too... though I have no clue what that could be) where we understand what the cap will be so we can control the costs at least. It will definitely cost us a lot more, but might make some sense so we can at least understand what the upper limits are.

[Terabith]

5 minutes ago, Farrar said:

Okay... thanks. I'll think it through. It may make sense for us to wait for open enrollment, drop dh's insurance, start a new plan for a year, get this done (and hey, maybe other things too... though I have no clue what that could be) where we understand what the cap will be so we can control the costs at least. It will definitely cost us a lot more, but might make some sense so we can at least understand what the upper limits are.

I think they've re-opened open enrollments right now because of the pandemic.  

[Corraleno]

12 minutes ago, Farrar said:

Okay... thanks. I'll think it through. It may make sense for us to wait for open enrollment, drop dh's insurance, start a new plan for a year, get this done (and hey, maybe other things too... though I have no clue what that could be) where we understand what the cap will be so we can control the costs at least. It will definitely cost us a lot more, but might make some sense so we can at least understand what the upper limits are.

I'm assuming from what you've said about your DH's salary that you likely wont qualify for any ACA subsidy, so it may make the most sense to wait until your DS turns 18, let him get a job, and then have him go through the ACA Marketplace based on his own (presumably very low) income. I don't know what you're paying for the insurance you currently have, but if an unsubsidized plan to cover your whole family was, say, $2000/mo, that plus a large OOP maximum could have you over $30K for the year anyway.

[JumpyTheFrog]

I haven't read the replies yet. Have you looked into any of the all-in-one price surgical centers? They post their pricing on the website.

https://surgerycenterok.com (in Oklahoma)

https://osshealth.com/ambulatory-surgical-center/ (in York, PA)

I can't find the price list on the OSS Health website anymore, but I know they used to have one.

Edited March 3, 2021 by JumpyTheFrog

[Farrar]

41 minutes ago, JumpyTheFrog said:

I haven't read the replies yet. Have you looked into any of the all-in-one price surgical centers? They post their pricing on the website.

https://surgerycenterok.com (in Oklahoma)

https://osshealth.com/ambulatory-surgical-center/ (in York, PA)

I can't find the price list on the OSS Health website anymore, but I know they used to have one.

Not on there. But thank you. I had no idea this was a thing. 

[Farrar]

So, once he's 18, can we remove him from our insurance and buy an individual plan for him on the marketplace... regardless of other things? Like, I anticipate he won't be making much, if any, money. He will be taking a couple of CC classes and dancing.

[Scarlett]

6 minutes ago, Farrar said:

So, once he's 18, can we remove him from our insurance and buy an individual plan for him on the marketplace... regardless of other things? Like, I anticipate he won't be making much, if any, money. He will be taking a couple of CC classes and dancing.

Well, the tricky part about that is that he will have to make at least the minimum to qualify for subsidy on the ACA.  It is in that link I posted at the beginning of this thread.  

In our state there is an insurance for low income working adults.  Many states have some version of it.

[Farrar]

Our appointment to deal with this and find out he needed this done was literally the last thing we did before shutdown last year, by the way. It seemed beyond obvious that during the pandemic was not the time to deal with it. It seems like we may... or may not... have more options in another year plus when he technically becomes an adult. So I guess the thing is to keep researching. I realized that we do have a city office that apparently is made to try to help you figure out what's your best option, so they may be able to help. Our bureaucracy is... infuriating... but my experience is usually that if you can get a human, they're super helpful.

[Pam in CT]

re "Medicaid" vs "Medicaid expansion for ACA subsidies"

3 hours ago, Scarlett said:

Are you in a state where Medicaid was expanded?  I think he could qualify in expanded states after he is 18.  Regardless once he is working and makes at least just under 13K he will qualify for a ACA plan which will probably be very affordable and with good coverage....

 

3 hours ago, Farrar said:

Yes, Medicaid was expanded here. I don't know where he'll be living in two years or three, but if he's here, I would think? I guess that's what I'm confused about. Like, people were saying up thread that no, he couldn't get Medicaid. But I was thinking, but if he's making very little and is an adult, why not? If he lives at home, then do we have to kick him out for him to get it? Which, okay. That could be worth it. I get that he would still be eligible for our insurance, but it's junk. Under what circumstances are we required or not required to leave him on it?

Once he's 18, he is eligible for ACA on his own account. If he makes enough money to pay the premiums and not so much money that it's too much for qualify for the subsidies, he could (like my daughter when she was ~23-24) be eligible for an ACA plan with Medicaid expansion subsidies.

Not "Medicaid" proper.

3 hours ago, Farrar said:

Two people at the start of the thread said the opposite. That as long as he's eligible for our insurance, he cannot go on Medicaid as an adult.

She was between proper jobs, and we helped her out with rent through the transition.  But she was making enough through temping / contract work to be able to demonstrate a sufficient degree of independence.  (Your son might have to make some kind of token rent payment if he were living at home, for instance?  I don't know.)

 

2 hours ago, Corraleno said:

I'm assuming from what you've said about your DH's salary that you likely wont qualify for any ACA subsidy, so it may make the most sense to wait until your DS turns 18, let him get a job, and then have him go through the ACA Marketplace based on his own (presumably very low) income. I don't know what you're paying for the insurance you currently have, but if an unsubsidized plan to cover your whole family was, say, $2000/mo, that plus a large OOP maximum could have you over $30K for the year anyway.

 

37 minutes ago, Farrar said:

So, once he's 18, can we remove him from our insurance and buy an individual plan for him on the marketplace... regardless of other things? Like, I anticipate he won't be making much, if any, money. He will be taking a couple of CC classes and dancing.

Yes -- once he's 18 he can get an individual plan.

And so long as he makes "some" income but not "too much" income, he should be able to get a plan subsidized through Medicaid expansion.

[Corraleno]

51 minutes ago, Farrar said:

So, once he's 18, can we remove him from our insurance and buy an individual plan for him on the marketplace... regardless of other things? Like, I anticipate he won't be making much, if any, money. He will be taking a couple of CC classes and dancing.

If he's taking CC classes, he may be able to get student insurance through the CC. In order to buy a plan through the ACA Marketplace, he will need to have a certain level of taxable income.

 

[Katy]

It's probably cheaper to pay for a good insurance plan for an 18 year old male than it is to drop him as a dependent.

This reminds me of a story I heard on NPR about rabies shots and hospitals being required to post prices online now because one officer went to the ER in Key West and another went to a health department in Miami and the shot was (totally making these numbers up) something shocking like $35 in the health department and $12,000 in the Emergency Room. I cannot remember if the "new law" that prices be posted online was a local thing or a federal thing.

Hmmm...  CNBC says it's national:  https://www.cnbc.com/2021/01/05/hospitals-must-now-post-their-prices-online-how-consumers-may-benefit.html

[Corraleno]

I looked around to see if I could find the minimum income requirement for ACA subsidy, and I found this:

"Subsidy eligibility is based on income (ACA-specific MAGI ) You have to earn at least 100 percent of the federal poverty level (139 percent of the federal poverty level in states that have expanded Medicaid), but not more than 400 percent of the poverty level."

The current FPL for 1 person is $12,880, x 1.39 if your state expanded medicaid = $17,900 in annual income to qualify. 

Edited March 3, 2021 by Corraleno