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Periodic Contributor

Suspending benefits to get Medicaid

I will be soon be turning 62 and receiving Social Security benefits.  Since my benefits will be over $1500 per month I will no longer be eligible for Medicaid.  And I will be too young for Medicare.  My question is can I suspend my Social Security benefits to go back on Medicaid if I need an operation or something?

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@RobertC767060 wrote:

I will be soon be turning 62 and receiving Social Security benefits.  Since my benefits will be over $1500 per month I will no longer be eligible for Medicaid.  And I will be too young for Medicare.  My question is can I suspend my Social Security benefits to go back on Medicaid if I need an operation or something?


Here is the rule from SSA on changing your mind about getting early retirement.

SSA: Benefits Planner - Retirement / If You Change Your Mind

 

You MUST be able to adhere to this schedule and note the highlighted area because you will only be allowed a (1) lifetime withdrawal of application.

If you are going to do this - do it before it starts so that you do not have to payback any of the benefits.

 

If you get a benefit before you WITHDRAW, remember that money will go back to them but before you send it back, make sure they are not reversing it automatically.

 

Terminology is everything when it comes to government, so you would be doing a WITHDRAWAL not a SUSPENSION - the link describes the difference.

 

It also list and kinks the form that you need to submit - I believe it would get into the system faster if you took the form to a local SS office or filled it out with their help.  

 

 

 

 

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Periodic Contributor

Very informative, thank you.  I was not aware that you can withdraw your application even after the benefits start (which I think is nice).  I was not aware that you cannot suspend benefits at all if you are receiving early retirement benefits (I wonder why?).   But no benefits = no income = eligible for Medicaid.  Right?

 

Do you think there is any chance they will come up with a new "Obamacare" that early retirees can afford? 

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@RobertC767060 wrote:

Very informative, thank you.  I was not aware that you can withdraw your application even after the benefits start (which I think is nice).  I was not aware that you cannot suspend benefits at all if you are receiving early retirement benefits (I wonder why?).   But no benefits = no income = eligible for Medicaid.  Right?

 

Do you think there is any chance they will come up with a new "Obamacare" that early retirees can afford? 


Withdrawal / Suspension.  Just different terminology and process for the different age groups - Early vs Full Retirement Age (FRA)

 

I assume you have checked the Obamacare exchange plans based on your income if you did receive early SS benefits.  You could get a premium subsidy so your premiums probably would not be too bad depending upon the plan you pick.  But you would have to go by the plan as to any copays, coinsurance and deductibles, etc.  Those would be your cost within the plan.  However, if this is a real expensive operation - even paying for these things could be a good deal especially if the operation is very expensive and happens within a the annual period - hopefully, finished and done within that time period.  You do also have to stay within the plans network.  

 

Would having a private plan be more advantageous than your state's Medicaid program - Don't know cause that is gonna depend on the availability of provider and specialist within each of the programs and I assume their scheduling.

 

 It is your decision to delay your early SS benefit and stay on Medicaid.  

But also remember that at 62 and early retirement, your SS benefit is reduced - I am assuming that you have taken this into consideration when you gave the benefit number of $1500 - that is your reduced benefit, I assume.

 

Currently Medicare is available at 65 so you could get that and also get your (still EARLY, but not as early) SS benefit at 65 - the reduction to your SS benefit would not be as large as if you decide to get it at 62.

 

 

Sounds like to me, based on what you have said on your income situation, you are doing correct in withdrawing your application for early SS benefits and staying with Medicaid until you know more about your health condition and hopefully, get that fixed.

 

However, if you have not included the SS (early) reduction in that benefit figure - then you need to find out that benefit figure before you decide. 

 

At the face to face with a SS rep - make sure you know

1.  The early $$$$ benefit you will be getting at 62

2.  Your states income maximum for Medicaid

3.  Any other income / assets which your state may count for Medicaid eligibility

 

 Then you can make the best educated decision for yourself and go forward with the withdrawal or acceptance of your early SS benefits at 62.

 

 

 

 

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Periodic Contributor

Thanks for sticking with me.  Please explain what you mean by a "premium subsidy" for Obamacare.

 

I just took a look at healthcare.gov and the cheapest plan that came up was $1076 a month.  (Not doable for me ongoing.)

 

Another wrinkle is that I'm not sure if any of the doctors who perform this actually take Medicaid (more info about the procedure below).

 

Yes, my Social Security is definitely going to be $1566 a month or $18,792 a year.  But for the rest of 2018, if I get 5 months worth of S.S., that would be $7830 (with not much more projected other income).  In West Virginia where I live, the maximum single-person Medicaid income (I am single, no dependants) is $16,134 making me ineligible if it's calculated month-to-month.   I can get 10 months, but not 12.

 

So, I do have 3 questions:

1. What is a "premium subsidy" for Obamacare?

2. Is Medicaid eligibility figured month-to-month or based on the entire year?

3. Could I sign up for Obamacare temporarily, if need be, to get coverage on this condition?  

 

Any other insight is welcome.

 

Indeed, signing up for Obamacare might just solve the whole problem.  I could pay those premiums for a month or two or three.  This is definitely a pre-existing condition. 

 

The medical procedure I am looking at is for a chest wall deformity known as pectus excavatum and involves surgically inserting a bar into the chest.  First they have to evaluate with an MRI, I think, which is expensive in and of itself. In each individual's case the procedure may or may not be medically necessary  The bar will be removed in a couple of years (much simpler operation.)  So the up-front cost is where most of the expense will be.  Based on what I've read, in the U.S. you're talking $50,000+. 

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@RobertC767060

Here is an easy way for you to estimate what your Obamacare insurance cost would have been for 2018 - if you were receiving your early SS benefit for all of 2018.

Kaiser Family Foundation - Obamacare Health Insurance Marketplace ESTIMATOR 2018

 

just fill in the blanks about your geographical area, use the income that you will get from Ss or any other place, answer the other questions about you - age, children, smoker, etc. and hit submit - it will tell you how much it would have costed in 2018 and what type of subsidy you would have gotten.

2019 will be different but comparable.  This estimate will be based on a silver rated plan.

 

 

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Periodic Contributor

Thank you.  Obviously there is a lot to consider and you're right I'll have to speak to some of these doctors about what insurance they take, the ongoing costs, and if I'm medically necessary (that part probably can't be determined over the phone) and I'll have to speak to W. Va. Medicare.  

 

The link you posted doesn't work.  

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OK, Robert, I fixed the link to the 2018 premium estimator -Sorry about that -

just click on it again in my same post - it will literally take you a minute to complete.  You can even fool around with it and put in different incomes to see what happens.  However, below 138% of the Federal Poverty Level, it will refer you to Medicaid.  

 

Or or here it is again -

 

https://www.kff.org/interactive/subsidy-calculator/

 

 

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@RobertC767060 wrote:

Thank you.  Obviously there is a lot to consider and you're right I'll have to speak to some of these doctors about what insurance they take, the ongoing costs, and if I'm medically necessary (that part probably can't be determined over the phone) and I'll have to speak to W. Va. Medicare.  

 

The link you posted doesn't work.  


I'm pretty sure that you meant MEDICAID rather than Medicare - they are so similar sometimes auto correct picks one and it is the wrong one.

 

I will see what I did wron on the KFF - Obamacare plan estimator for 2018 and will repost it.

 

Yep - you have lots going on and it seems it will all affect your decision as to which way to go.

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Periodic Contributor

Yes, I meant Medicaid.

 

The link is working.  Thank you. 

 

Somehow I got the idea that Obamacare is much more expensive that it apparently is. I don't know where I got that idea.  So, assuming I lose Medicaid, I go into healthcare.gov and enter my info and pull up the plans and I see Care Source Low Premium Silver 2 has a deductible of $950, maximum out-of-pocket of $1600 and a monthly premium of $69.99.  Much better than the higher-premium plans!  Am I missing something?  So I need to find out most importantly does it cover surgery?  Clicking on Quick View it says "Inpatient hospital services (like a hospital stay) - $350 copay per stay after deductible".  I don't see surgery.  ?

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For people who make less than 400% of the federal poverty level, their premium cost are subsidized -'the less income, the higher the subsidy - so it is government that is making your premiums much lower.

 

Obamacare plans have to cover the Essential Health Benefits.

Healthcare.gov - Essential Health Benefits

 

Here is the 2018 CareSource Kentucky Health Care Marketplace - Silver Plans

Here is the summary of the Kentucky CareSource plans for 2018 - 

2018 Kentucky CareSource Marketplace Plan Comparison Brochure - pdf

 

Read it and review any footnotes, and any imbedded links - on the brochure there is a number listed for "Questions" - might be a good source for info and specifics.  The brochure for specific plan names and coverage might be available too online, I did not check.

 

in general, the higher the metal rating, the more extensive the network, maybe formulary too.

 

The "cost sharing reductions" are not applicable anymore - the government stopped funding them but the insurer might be providing some benefit - ask them..

 

For the comparison purposes, I think, the plan you are referring to in is on page 9 of the CareSource document.  

 

Since you have mentioned that for this special surgical procedure, there is only a limited number of providers and perhaps facilities which perform it - so it seems to me that making sure that they are "in network" is very important.

 

Making sure that everybody agrees that it is medically necessary and is a covered procedure is also important.

 

If those are your priorities for a plan - make sure of these 1st and then you can find the plan to see if you can afford the subsidized premiums, copays, coinsurance, deductible.

 

Deductibles may have to be met before the plan pays anything - 

Copays may not be counted towards deductible

all these things should be spelled out in the plans you pick for further scrutiny

Remeber plans change for 2019

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Periodic Contributor

Thank you.  Did you mean to post Kentucky?  I live in West Virginia.

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@RobertC767060 wrote:

Thank you.  Did you mean to post Kentucky?  I live in West Virginia.


Yes, I am sorry, Robert - let me see what I can find on West Virginia cause it does go by state.

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Here ya go - Robert

I want from here:  West Virginia Health Care Marketplace - Silver

 

To Here - which is the actual contract for 2018 Silver plans

West Virginia - Narketplace plans 2018 - Care Source - Evidence of Coverage And Health Insurance Con...

 

Appears to be very complete and detailed, seems easy to read too, long but well sectioned - the only thing that is missing is the specifics of the various CareSource plans (see page 131 - Section 14) which would be inserted once you know your plan pick.

 

There is a link provided within the document where hopefully you can check in-network providers and facilities.   I believe there is also a Questions phone contact.

 

Glad I could help but only you know all the details and logistics and the order in which you need to do all these things -Decisions, Decisions . . . . .

  • SS early benefit begin (yes or no),
  • drop Medicaid in 2018 or 2019 or not at all if you decide not to get your SS benefit early
  • get SS early benefit in 2018 - stay on Medicaid for 2018
  • get SS early benefit in 2019 - pick up a Marketplace plan ( choose in the fall of 2018) after checking the 2019 plan

Make sure the procedure is covered at an in-network facility and done by an in-network surgeon - make sure any other providers are also in-network like the MRI facility, radiologist who reads it, anesthesilogist for the procedure -

Good Luck

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Periodic Contributor

Very good.  Thank you.

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@RobertC767060

 

I don't know how West Va. calculates their prorate income for Medicaid - it should be on their website or call and ask.

 

Yes you would be able to get an Obamacare plan if you decide to go ahead and get the early SS benefit this year. I think you should be able to qualify for the Special Enrollment Period.

 

Go ahead and check out the Obamacare plans and what your premium subsidy would be for 2018.  West Virginia is on the Federal Exchange so go to Healthcare.gov -

Healthcare.gov

 

Do some reading, look at the plans and fill out an application just to get an idea of what your (subsidized) premiums would be for 2018, but DO NOT submit the application - do this just to get an idea of what your premiums would be if you have that $18,000+ early SS benefit, add in any other countable income.  It is not gonna take the 2018 ($ 7830) income - that's too low and it will refer you to Medicaid.

 

OR  on that Healthcare.gov page under "Get Answers" at the top of the page - it takes you to another page with FAQs but on the right side of the page it there is a place,where you can get a local contact - either a broker, insurance agent or a healthcare.gov navigator.  They might be able to give you the amount without filling out an application.

 

Open enrollment for 2019 Exchange plans does not start until sometimes in November 2018.  The plan offerings and the premiums will be different than this year.  So to know exactly your subsidized premiums and the plan  for 2019, you would have to wait and apply at that time, effective for 2019.

 

Based on your reasoning for 2018, most likely you would be able to buy a plan under the special enrollment option - your income is increasing (if you do get your early SS benefit) and you would have to come off of Medicaid.  But do you really want to do that since it seems that you should be able to  stay on Medicaid for 2018 - your SS benefit would only be for half a year.   But like I said,nI don't know how W.Va prorated that income - ask them.

 

On the other hand - would you be able to get the procedure sooner or better under a private plan than Medicaid in 2018 - I don't know.  Why wouldn't Medicaid approve and pay for the procedure in 2018????  I Assume it is medically necessary.  If only a select number of doctors do this procedure - call them and see if they accept Medicaid.  You could also ask their insurance person which Obamacare plans they might take too.

 

If you want to chose a good Obamacare plan, you need to also check out what your out of pocket cost would be and the providers in the network of the plan.  Any medicine which you might need now or after the procedure also needs to be on their formulary.  So check type of Specialist in the plan, hospitals, other docs, etc.  But like I said, this is for 2018.   2019 might be different, you would have to do it again in the fall at open enrollment.

 

So the way, I see this, you could just do what you are doing now - get the procedure in 2018 under Medicaid or plan that way.  Then review the 2019 Obamacare West Va plans in the fall for 2019 - sign up for one that you might like  including providers and start your early SS benefits for 2019.

 

You have to do what is best for you, your health, your pocketbook - so you are just gonna have to decide when to take early SS benefit - now  or hold off until later.

 

All I am doing is giving you some things to add into that determination.

 

 

 

 

 

 

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@RobertC767060  First, have you visited the Social Security web site and created an account? Be sure to check out the FAQs too.

https://www.ssa.gov/

 

Second, why are you going to start receiving benefits at 62 if you don't want them? Have you already applied?

Periodic Contributor

Thank you.  Yes, I have already applied.  I have an in-person appointment scheduled for next week.  I'm living off of savings which are limited.  I just discovered that I may need major surgery (that I cannot afford to pay for myself).  The medical situation, including how long it will take to get necessary appointments, is very much up in the air right now.  I see that I can withdraw the application even after the benefits start if I pay the benefits back, so that may be an option.    

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