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Health insurance, Medicaid and permanent residents?

Health insurance, Medicaid and permanent residents?

Old Mar 12th 2014, 2:14 pm
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Default Health insurance, Medicaid and permanent residents?

Hi,

Please can anyone give me some advice?

My wife is an American citizen and I am a green card holder (permanent resident). We are both on a low income right now, and need to sign up for health insurance before the 31st March deadline. I have a few questions:

Are permanent residents eligible to apply for Medicaid? (I think probably not?)
Is it likely that my wife will be able to apply for Medicaid if she is married to someone who will (I guess) have to pay for private health insurance?
Where to begin applying for Medicaid in New York City?

Thank you in advance of any advice.
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Old Mar 12th 2014, 2:24 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by oliverw View Post
Hi,

Please can anyone give me some advice?

My wife is an American citizen and I am a green card holder (permanent resident). We are both on a low income right now, and need to sign up for health insurance before the 31st March deadline. I have a few questions:

Are permanent residents eligible to apply for Medicaid? (I think probably not?)
Is it likely that my wife will be able to apply for Medicaid if she is married to someone who will (I guess) have to pay for private health insurance?
Where to begin applying for Medicaid in New York City?

Thank you in advance of any advice.
Permanent residents aren't eligible for Medicaid until they have been a LPR for 5 years. If your wife is eligible for Medicaid based on combined income, then she can apply.

http://www.health.ny.gov/health_care/medicaid/
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Old Mar 12th 2014, 3:18 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Michael View Post
Permanent residents aren't eligible for Medicaid until they have been a LPR for 5 years. If your wife is eligible for Medicaid based on combined income, then she can apply.

http://www.health.ny.gov/health_care/medicaid/
Depends on the state, some do allow it, for certain things. I doubt NY is one of them mind.
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Old Mar 12th 2014, 3:39 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Hi, thanks for your replies.
I just realised that I kind of knew the answer to my question, but it's different to your reply, Michael. My wife did receive Medicaid for a few months when she was a green card holder (before becoming a citizen). However, our circumstances are different. I came to the US through marriage. Anyway, I will look into this further.
I just read that for a couple, the combined income needs to be lower than about $21,000 to be eligible for Medicaid. Our income is higher than that, but I'm not sure how we're going to find $300+ per month for health insurance. Maybe I'm moving back to England and the NHS.....
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Old Mar 12th 2014, 4:16 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Have you been to the government website and tried to sign up? I was more than pleasantly surprised. With the recession, our income is pretty low as business picks up, around the same as yours, between us, but I ended up with a 'silver' policy for $70 a month, with only a $1,000 deductible. You can go through all the steps on the website without actually committing yourself to the very final stage. We're based in Florida.
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Old Mar 18th 2014, 7:15 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Hi, Paul, thanks for the info. That’s very reassuring. My plan is to get onto this and get it done before the weekend.
Cheers,
Oliver
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Old Mar 19th 2014, 1:28 am
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by paul32x View Post
Have you been to the government website and tried to sign up? I was more than pleasantly surprised. With the recession, our income is pretty low as business picks up, around the same as yours, between us, but I ended up with a 'silver' policy for $70 a month, with only a $1,000 deductible. You can go through all the steps on the website without actually committing yourself to the very final stage. We're based in Florida.
Just out of interest...That kind of super low premium is after applying 'advanced tax credits' on your projected income or something along those lines, right? Because the real premium without those tax credits would likely more be in the $300 to $700 per month range with a deductible in the high thousands.

But what does that mean ... are those tax credits to be paid back to the Government once you pick up on your income?

I found this Forbes article on the topic:
http://www.forbes.com/sites/theapoth...the-subsidies/

So how exactly does this work, i.e. for someone immigrating to the USA for the first time (could be us by the end of the year), with not much of an income to start with, except some modest ongoing capital investment income.

I played a little with the marketplace at healthcare dot gov and came up with all sorts of premiums and plans...what I also figured is that when you actually enter ZERO, i.e. no income, then you will not be given any tax credit and will have to pay full price...so more like $500+ each per month and deductibles like $3000 - $6000+ per annum. How is that going to work for someone?
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Old Mar 19th 2014, 2:32 am
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by whatsnext View Post
Just out of interest...That kind of super low premium is after applying 'advanced tax credits' on your projected income or something along those lines, right? Because the real premium without those tax credits would likely more be in the $300 to $700 per month range with a deductible in the high thousands.

But what does that mean ... are those tax credits to be paid back to the Government once you pick up on your income?

I found this Forbes article on the topic:
http://www.forbes.com/sites/theapoth...the-subsidies/

So how exactly does this work, i.e. for someone immigrating to the USA for the first time (could be us by the end of the year), with not much of an income to start with, except some modest ongoing capital investment income.
"Advanced credits" are based on what you project your income will be for the tax year. When you file a tax return for that year (e.g. by April 2015 for 2014) the credits you were advanced will be reconciled against what your credits should be based on your actual tax-year income: if your actual income is higher than projected, you will owe money; if lower, you will get additional credits.

[
Originally Posted by whatsnext View Post
I played a little with the marketplace at healthcare dot gov and came up with all sorts of premiums and plans...what I also figured is that when you actually enter ZERO, i.e. no income, then you will not be given any tax credit and will have to pay full price...so more like $500+ each per month and deductibles like $3000 - $6000+ per annum. How is that going to work for someone?
For those states that accepted the Medicaid expansion, those up to 133% of the federal poverty level are eligible for Medicaid (government funded heathcare for the poor). The wrinkle is that some - mainly Republican - states refused the expansion, leaving some of their residents worse off than those with incomes too high for Medicaid but low enough to get subsidies.
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Old Mar 19th 2014, 2:48 am
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Giantaxe View Post
"Advanced credits" are based on what you project your income will be for the tax year. When you file a tax return for that year (e.g. by April 2015 for 2014) the credits you were advanced will be reconciled against what your credits should be based on your actual tax-year income: if your actual income is higher than projected, you will owe money; if lower, you will get additional credits.

[

For those states that accepted the Medicaid expansion, those up to 133% of the federal poverty level are eligible for Medicaid (government funded heathcare for the poor). The wrinkle is that some - mainly Republican - states refused the expansion, leaving some of their residents worse off than those with incomes too high for Medicaid but low enough to get subsidies.

Thanks for your reply, much appreciated. BTW...I think new immigrants will not be eligible for Medicaid, anyway from what I read.
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Old Mar 19th 2014, 3:27 am
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Default Re: Health insurance, Medicaid and permanent residents?

It is as you might expect more complicated than the posts above imply, good luck finding someone who knows all the issues.

You can have split households, a USC who is eligible for Medicaid and a Spouse LPR who is not.

The 5 year thing is more complicated as of course there would be a I 864 to consider.

Also it appears that at least 10 of those States with 'enhanced' Medicaid also have introduced rules to reclaim the cost from your Estate.

Tax rebates require there to be tax paid, so quite how that is supposed to work is beyond me.

It is a massive cock up basically, good luck.
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Old Mar 19th 2014, 3:46 am
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Boiler View Post
Tax rebates require there to be tax paid, so quite how that is supposed to work is beyond me.
Not true.

If the amount of advance credit payments you get for the year is less than the tax credit you're due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.

https://www.healthcare.gov/glossary/premium-tax-credit/

Some tax credits are refundable such as the Earned Income Tax Credit and others are non-refundable. ACA tax credits are refundable which means that even if you paid no income taxes for the year, you will get a refund if the advanced subsidy was too small.
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Old Mar 19th 2014, 3:43 pm
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Default Re: Health insurance, Medicaid and permanent residents?

I had to read that several times. Then I fell asleep.

So going back to the OP.

USC ends up on Medicaid and may well have a recovery obligation attached to any Estate. Depends on which State they live in. In some States who have not extended Medicaid may not qualify due to assets.

LPR, not eligible for Medicaid but does get a payment through the Tax system to pay for premiums.

LPR could be the better bet in States that have extended Medicaid and do recoveries!

Does go back to my comment that it is a gigantic cock up.

Last edited by Boiler; Mar 19th 2014 at 3:46 pm.
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Old Mar 19th 2014, 4:30 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Boiler View Post
USC ends up on Medicaid and may well have a recovery obligation attached to any Estate. Depends on which State they live in. In some States who have not extended Medicaid may not qualify due to assets.
Or lack of children. Pre-ACA only a handful of states covered childless adults regardless of how low income was. And contrary to the impression you left in a previous post, Medicaid's recovery rules pre-date the ACA by a decade or three. And, of course, some states have chosen to modify those rules post-ACA.

USC also has the option of declining Medicaid.

Originally Posted by Boiler View Post
LPR, not eligible for Medicaid but does get a payment through the Tax system to pay for premiums.

LPR could be the better bet in States that have extended Medicaid and do recoveries!

Does go back to my comment that it is a gigantic cock up.
I think you're incorrect. LPR will only get a payment through the tax system if their income is greater than 133% of the federal poverty level.
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Old Mar 19th 2014, 6:15 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Giantaxe View Post
Or lack of children. Pre-ACA only a handful of states covered childless adults regardless of how low income was. And contrary to the impression you left in a previous post, Medicaid's recovery rules pre-date the ACA by a decade or three. And, of course, some states have chosen to modify those rules post-ACA.

USC also has the option of declining Medicaid.

I think you're incorrect. LPR will only get a payment through the tax system if their income is greater than 133% of the federal poverty level.
You have added some complications.

Can the States modify the rules? I was under the impression that they could choose to opt in or out of certain measures but not change them?

So in the case above, the USC could decline Medicaid and even with nominal income still max out on the Obamacare tax subsidy by buying through the exchnage? Which may be a better bet if you are in a State with extended Medicaid but a recovery rule?

On the LPR issue I am not saying you are incorrect, the link Michael provided to makes no mention, do you have anything?
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Old Mar 19th 2014, 6:57 pm
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Default Re: Health insurance, Medicaid and permanent residents?

Originally Posted by Boiler View Post
You have added some complications.
If by "added some complications" you mean "corrected your errorneous information" then yes I did

Originally Posted by Boiler View Post
Can the States modify the rules? I was under the impression that they could choose to opt in or out of certain measures but not change them?
They have to adhere to certain standards. Beyond that, they can make changes. Here's a Seattle Times article on the subject that indicates that both Oregon and Washington have made such changes:

http://seattletimes.com/html/localne...coveryxml.html

Edit: some fact checking info on this:

http://www.factcheck.org/2014/01/med...overy-program/

Originally Posted by Boiler View Post
So in the case above, the USC could decline Medicaid and even with nominal income still max out on the Obamacare tax subsidy by buying through the exchnage? Which may be a better bet if you are in a State with extended Medicaid but a recovery rule?
You're mssing the point. If your income is below 138% of the fpl, you are eligible for Medicaid but not for subsidies. You do have the option of declining Medicaid and buying an unsubsized policy on an exchange.

Originally Posted by Boiler View Post
On the LPR issue I am not saying you are incorrect, the link Michael provided to makes no mention, do you have anything?
Try this:

http://insuremekevin.com/2013/09/15/...um-assistance/

Essentially people immigrants of less than five years standing whose income is less than 138% of the fpl are screwed as far as subsidies go.

Last edited by Giantaxe; Mar 19th 2014 at 7:18 pm.
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