Healthcare in Texas , Florida and South dakota and Medicaid... - RV-Dreams Community Forum

The Junkman · RV-Dreams Family Member

Healthcare in Texas , Florida and South dakota and Medicaid...

Howard · Host

Junkman,

Thank you for opening a new topic on this. Healthcare for RVers is indeed very important, and though there are certainly political aspects of healthcare in the U.S. right now, we can discuss it without the discussion sinking to sniping and snarkiness. With that said, the reason I closed the other thread was because the discussion of healthcare was not part of the original poster's questions and we've asked over and over and over and over that people keep their posts 1) on the topic in the title of the thread and 2) relevant to the original poster's questions/comments. It just makes for a better Forum experience for those that start topics and for those searching for information based on topic titles.

Glenn West · RV-Dreams Family Member

I do think you are seeing more in this than there is. I know of several people here in Texas that are struggling financially. They get a lot of help from various sources. Medicaid, churches, families, neighbors, etc. Texans have big hearts. Now I know there are exception to this but this is the norm. There is so much opportunity here for good paying jobs. If you are trying here, help is here. If you want to live on welfare Texas, for the most part, will not help. Now anyone retired and eligible for Medicaid get it where ever you are. RVs are not cheaper to live in. Now to buy a junker and live in it and never move it may be "cheap" for a time but it will rot down around you. No economics in that. We that live full time in RVs are not poor. It cost money to pull our homes. Costs to keep them up, tires, etc. We were in a grocery store recently. Young woman with kids trying to buy Simelac milk and problem at register. We bought a case for her. Not tooting our horns but this in the norm here. We see lots of people paying for someone else groceries. Never seen an elderly woman or young woman with kids go away in a grocery store without getting what they need. Someone will pay it for them. We are from NC and we can't say this about them. But NC is generous with state and government help. Taxes are also very high to pay for this. That is why we are Texans now.

-- Edited by Glenn West on Tuesday 18th of November 2014 10:39:33 AM

Howard · Host

Yes, this subject is very, very complicated and though people can figure it out, there are so many factors in play and so many pending legal issues and uncertainty right now, that even the most competent researchers can struggle making sense of it all.

You are correct that "expanded Medicaid" under the Affordable Care Act (ACA) increases the numbers of individuals and families eligible for Medicaid. "Expanded Medicaid" makes Medicaid available to people without children dependents whereas basic Medicaid is often not available for childless, non-senior individuals and couples. The states that have rejected the "Expanded Medicaid" under the ACA, therefore, have stricter requirements and fewer groups of people at lower income levels aren't eligible for Medicaid. But Medicaid is still available in all states for those that need it most. Also, those that would fall into the gap of those eligible under "Expanded Medicaid" also have the ability to purchase health insurance under the ACA with significant subsidies.

Now, the subsidy issue leads to a whole other set of problems. There are lawsuits pending that say the ACA language doesn't allow subsidies for policies purchased through the federal exchange, only for policies purchased through individual state exchanges. If those lawsuits succeed, subsidies won't be available for the states that are using the federal exchange (i.e. Texas, South Dakota, Florida, etc. etc.) and that could completely unwind the ACA.

There are several other issues with purchasing health insurance on the exchanges and off the exchanges. There are issues with whether coverages are national or just local/regional. Most traveling RVers will want national, in-network coverage, and choice of state of domicile has been affected by the ACA.

So, regarding Medicaid, under "Expanded Medicaid", individuals with income of around $15,500 would be eligible for Medicaid and couples with income of about $21,000 would be eligible for Medicaid. Folks in those ranges that need Medicaid may very well want to stay domiciled in states that have accepted "Expanded Medicare". Now the portability of that coverage from state to state is a completely different issue.

Again, it's all very, very, very complicated based on needs, budgets, income levels, age, travel plans, and much more.

So, the domicile issue for Full-time RVers where the major factor is health insurance, is more difficult than it was a year or two ago. And the landscape is constantly changing. What looks like a good decision today may not be a good decision in six months, and many people we know have personal experience with that.

SnowGypsy · RV-Dreams Family Member

Our adult son with DS gets Medicaid. In KS, as well as a few other states, the state has turned Medicaid over to for-profit insurance companies. They are slashing and looking for new ways to slash benefits. We are lucky that our son is healthy and we depend 99.9% of the time on homeopathic/natural medicine (health services made him worse, not better). I would be careful of states that have turned Medicaid over to for-profit and it is easy enough to google for the states doing this. Others may follow. The for-profits are denying and delaying services and treatments and for the population with developmental disabilities that can equal a death sentence and also for the frail elderly. We hope to be able to access care in Mexico by RVing in the future. Know that a lot of people look down on us when we use our son's Medicaid card, especially at the pharmacy, but until he became an adult, we covered all of his expenses to the point that we will have a very slim retirement if any at all.

Beware that as companies pay providers less money, those providers either end up out of business because the reimbursement is too low, they limit how many they will take (Medicaid providers do this), etc. This is becoming an even bigger problem here with Medicaid going for-profit. For our son, benefits outside the state are very limited and I believe it only amounts to emergency care.

KS along with 6 or 8 other states is trying to get the Federal Government to give them block grants and allow the states to administer Medicare in what appears to be the same manner that Medicaid is being handled, for-profit insurance companies. It pays to do your research and keep updated because things change quickly. Supposedly the states won't be able to snag Medicare but I would not have thought they would have farmed out Medicaid to for-profits.

The Junkman · RV-Dreams Family Member

In florida .a non-expanded state... to receive medicaid

DCF determines Medicaid eligibility for:

Parents and caretakers relatives of children
Children
Pregnant women
Former Foster Care Individuals
Non-citizens with medical emergencies
Aged or disabled individuals not currently receiving Supplemental Security Income (SSI)

you must be declared disabled by social security to be concidered disabled in fl.
Most people cannot qualify for medicaid.Even with $0 income...unlike the expanded medicaid programs..

And as to subsidies.. as in florida.. they amount to only tax breaks? right? I'm not seeing a couple living on 15k, needing a tax break. So arent they useless to low income?

I'm not seeing this so complicated..really.. If you are under that dollar amount, and your state has "expanded medicaid" .. now is the the time to apply and get covered. Other wise start shopping and paying full price.

I think there is a time limit for enrollment .. so get a move on!. and if moving.. and on or thinking about medicaid.. do your homework.

Glen.. Sounds like you have some great people around you.Now if we could just find away to get the other 6.3 million texans insured in tx..t
"Texas is the uninsured capital of the United States. More than 6.3 million Texans - including 1.2 million children - lack health insurance. Texas' uninsurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts. "

www.texmed.org/Uninsured_in_Texas/

-- Edited by The Junkman on Tuesday 18th of November 2014 06:06:36 PM

-- Edited by The Junkman on Tuesday 18th of November 2014 06:07:59 PM

bjoyce · RV-Dreams Family Member

Technomadia and WheelingIt.Us are doing a video chat at 7:30PM EST tonight, November 18, 2014 on health insurance for pre-Medicare fulltimers- http://www.technomadia.com/video/. Even if you do not watch it live where you can ask questions via chat, if this subject interests you, it will be available to watch later.

The Junkman · RV-Dreams Family Member

Different ball game for medicaid . But thanks

-- Edited by The Junkman on Tuesday 18th of November 2014 06:46:40 PM

Glenn West · RV-Dreams Family Member

Steve percentage wise Texas in good shape. It is the largest state and heavily populated. It is a great place to be.

The Junkman · RV-Dreams Family Member

Glenn West wrote:
Steve percentage wise Texas in good shape. It is the largest state and heavily populated. It is a great place to be.

??? they are the worst in the country.. percentage wise .. Click the link..

Glenn West · RV-Dreams Family Member

Most people hear don't have insurance by choice. I never had until this year. There is millions of construction workers here. Our companies don't provide coverage. We are seasonal workers. We make lots of money. We are mostly self paid. I repeat, Texas is a great place.

The Junkman · RV-Dreams Family Member

Glenn West wrote:
Most people hear don't have insurance by choice. I never had until this year. There is millions of construction workers here. Our companies don't provide coverage. We are seasonal workers. We make lots of money. We are mostly self paid. I repeat, Texas is a great place.

yes, it is..

Howard · Host

Subsidies can be either taken as a tax credit or used to reduce premium payments. From the healthcare.gov website:

You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month. This is called “advance payment of the premium tax credit.”

And the reduction of premium can make the payments close to zero for the lowest income folks that are not eligible for Medicaid, so they are not "useless".

It's not complicated if we are simply talking about people living in an RV in a permanent location with no plans of ever moving it. It gets more complicated when you live in an RV and travel state to state and need healthcare beyond the borders of your state of domicile.

The Junkman wrote:
And as to subsidies.. as in florida.. they amount to only tax breaks? right? I'm not seeing a couple living on 15k, needing a tax break. So arent they useless to low income?

I'm not seeing this so complicated..really.. If you are under that dollar amount, and your state has "expanded medicaid" .. now is the the time to apply and get covered. Other wise start shopping and paying full price.

Barbaraok · RV-Dreams Family Member

Some of the confusion might be because most people think tax deduction, where you need a considerable amount of deductions before it is usable, instead of tax CREDIT which can be used without the need to fill out Schedule A and itemize deductions.

Barb

The Junkman · RV-Dreams Family Member

Howard wrote:
Subsidies can be either taken as a tax credit or used to reduce premium payments. From the healthcare.gov website:
You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month. This is called “advance payment of the premium tax credit.”
And the reduction of premium can make the payments close to zero for the lowest income folks that are not eligible for Medicaid, so they are not "useless".
It's not complicated if we are simply talking about people living in an RV in a permanent location with no plans of ever moving it. It gets more complicated when you live in an RV and travel state to state and need healthcare beyond the borders of your state of domicile.

The Junkman wrote:
And as to subsidies.. as in florida.. they amount to only tax breaks? right? I'm not seeing a couple living on 15k, needing a tax break. So arent they useless to low income?

I'm not seeing this so complicated..really.. If you are under that dollar amount, and your state has "expanded medicaid" .. now is the the time to apply and get covered. Other wise start shopping and paying full price.

Awesome.. I did not know people can take advantage of that each month..That can help.. thx!

yea the moving thing .. I think you need a ppo for that.. we are getting exactly that..

for anyone..Is there other options for low income healthcare for people that travels state to state that reside in or domicile in TX, FL OR SD?

I realize the average full timer age is 68.. and most would be in medicare.. but for the folks that do not qualify.. has anyone found a effective solution?

The Junkman · RV-Dreams Family Member

Barbaraok wrote:
Some of the confusion might be because most people think tax deduction, where you need a considerable amount of deductions before it is usable, instead of tax CREDIT which can be used without the need to fill out Schedule A and itemize deductions.

Barb

Yea, I need to look more into that for sure.. I need to learn how this works.

The Junkman · RV-Dreams Family Member

Man, Thankfully the federal goverment did instill these subsidies in the healthcar program.. and they left it federal.. and not let the states do it.. cause if they let Florida handles, I'm afraid you need to be rich or have kids to get health care coverage in this state..

After reading a bit on the subsidies.. a couple making apx 17k a year.. can be subisitize at over $700 per month.. so you can efectivivly get free health car, or pay a little, and get decent health care.. Including a gold or platinum PPO, that rver's can use nationally. No thanks to the state of florida.. they really need to expand medicaid..as many who make less than like 11k.. cannot qualify for ANY assistance at all.. I know , make no sense.. make less, and get not help.. make more, and they give you help.. but thanks to the feds.. you have at least that.. if you are low income.

Just wanted to post this up..
Been talking with the health insurance guy who advertises on this fourm here,pretty sure we are close to signing on with him..

Is it all rich folk here? Or maybe everyone is of age and on Medicare or disability? I read the average age of a fulltimer is 68 years old.. so maybe.

-- Edited by The Junkman on Sunday 23rd of November 2014 02:34:15 PM

-- Edited by The Junkman on Sunday 23rd of November 2014 02:34:54 PM

bigboomer · RV-Dreams Family Member

bjoyce wrote:
Technomadia and WheelingIt.Us are doing a video chat at 7:30PM EST tonight, November 18, 2014 on health insurance for pre-Medicare fulltimers- http://www.technomadia.com/video/. Even if you do not watch it live where you can ask questions via chat, if this subject interests you, it will be available to watch later.

Nina and Cherie did a great job on this. We will be caught in this mess come the end of December when I "officially" retire from my full time career. We also spoke with Kyle Henson and it looks like we will be getting short term insurance so that we have coverage from Jan. 1. This gives us time to start the process of switching to become a Texan, especially since we have to switch all of our addresses, etc. before June which is due to Dakota Post (Alternative Resources) in Sioux Falls has switch to a new facility.

As Nina pointed out, anyone younger than 65 and looking to become full time RVers, do not even consider SD, go straight for Texas or Florida. As we have come to find out, none of the mail forwarding services are doing any advocacy for RVer's on this issues nor do any of the politicos care as they have basically stated they have left it up to the insurance companies to work it out.

Here is a link to Nina's blog on the subject:

http://www.wheelingit.us/2014/11/25/health-insurance-sd-domicile-are-there-any-options-left-for-younger-fulltime-rvers/

Frustrating but we have learned to deal with it!

Technomadia · RV-Dreams Family Member

bigboomer wrote:
Nina and Cherie did a great job on this.

Thank you.. it's a tough, and important topic, for those of us under 65.

Nina now has the video integrated into her blog post, and we have it also in our Healthcare article at:

http://www.technomadia.com/healthcare

Nina's post has generated a lot of great comments, so worth reading through the whole thing. Neither she or I have any experience with the Medicaid issue however.

The Junkman · RV-Dreams Family Member

We signed up with kyle , today as a matter of fact..

Note .. that none of these states has expanded the medicaid program..So if you qualify for medicaid.. look close . It's very difficult to get medicaid in all of them ..

Not sure if the link addresses medicaid.. the video did not.