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Looking for people in states where Medicaid expansion wasn't adopted but would've qualified

I am a reported and am looking for people who live in states where Medicaid expansion was not adopted--this includes childless adults making an adjusted gross income under $16,500/yr (most states that didn't expand Medicaid don't allow childless adult to apply/qualify for Medicaid at all, or an annual income of $27,724 for a family of three. I am interested in how you afford/access health care in the absence of Medicaid and what insurance you have--if any--and it's costs to you. Please feel free to reply here or email lakiesel@gmail.com. 


  • Posts: 56
    I am an early-retired (or unemployed, but with enough assets to survive without working some low-paid job, LOL) early middle-aged bachelor.  Non-expansion Medicaid was unavailable to me.  I also have a history of cancer, so purchasing insurance before the ACA was impossible.  I had contracted the cancer and had the initial diseased organ removal and about a year of surveillance tests while on COBRA.  After the COBRA coverage ended, I was able to use the state public hospital (at no cost) to continue the surveillance (tumor marker blood test, X-ray, CT exam) for the few years remaining on the surveillance protocol.  I had regular medical care done at medical clinics that were some sort of federal program, with the cost typically about $20-45 per visit.  For a while I was paying the full cost of Rx, which because one of the Rx was pre-generic Ambien, made the costs approach $2K per year until I was able to get on a program by Rx Outreach, which lowered by cost to about $200/year.  I had an issue which involved needing to get a sigmoidoscope, and that was also done at the state public hospital for free, and it seemed to be done by a medical student with a mentor physician (i.e., I was a guinea pig or the student, LOL).

    My state used to be a non-expansion state, but has recently expanded.  My income for 2012 (which is what was used to determine eligibility for 2014) was slightly less than the poverty level (it was completely generated by pre-age-59-1/2 distributions or Roth IRA conversions); thus, because using that income would have left me without the premium tax credit, I decided to be "optimistic" that my income would come in at exactly the poverty level, and hence proposed that amount, and thus got the premium tax credit.  (NOTE: It did not matter whether or not that income ended up getting reached as the tax rules specify that so long as the Exchange determined the income, which for the case of folks like me, it basically takes the individual's guess, the premium tax credit does not have to paid back if the income is less than poverty level.)

    For all years, I chose the lowest-cost Silver plan, all of which have a net 94%
    actuarial payout.  For 2014 & 2015, this plan was a co-op
    plan (discontinued after 2015), and the difference between this and the corresponding 2nd lowest-cost Silver plan (SLCSP) was more than the 2
    % of income, which is the expected premium cost at this income level, so the net premium was $0.  Rx all cost no more than $5 (at least for generic, which is all that I got), and by the time 2014 ran out, I had reached the maximum out-of-pocket maximum of $700, although I didn't make it that far for 2015.  For 2016 I got the lowest-cost Silver plan, offered by regular insurer that only had a $200 deduction & out-of-pocket maximum, which was easily reached early on; however, since the SLCSP was very close to the lowest-cost one, I had a payment of about $19/mo.  When the Medicaid expansion was operational, I quit that plan.

    I should say that because I am asset-wealthy (relatively speaking, LOL) but income-poor, making the premium payments or co-pay/insurance was not an issue.  Currently, care from Medicaid is completely free, and fortunately, the medical institution in which I get visits & tests (a major one in my area, a philanthropic non-profit started by a famous physician) and my regular physician takes the particular Medicaid plan I am enrolled in; interestingly, many of the other Medicaid plans are not taken by this institution, and the only reason why I was taken was because I was an existing patient under the ACA plan.

  • Posts: 56
    I should also state that the full cost (i.e., before the premium tax credit) of my (Silver plan) coverage for 2014-2016 was $364, $411 & $521 per month, respectively.
  • Posts: 70
    Well I am not too sure, but just given the amount of Medicaid cases and claims that I am seeing at my work lately, I am going to go ahead and assume that we have the Medicaid expansion here.  It also makes me wonder, though, what would happen if we did not have it.  I am sure some of the people would be okay, but I cannot help but think some people would certainly fall through the cracks.
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