Follow
Share

I’ve purchased two dental policies but need another health policy for at least $88 to lower her countable income. She has Kaiser Senior Advantage so I have nothing to add there. Help? What kind of insurance can I purchase so she can qualify? She is 80 yrs old. We live in California. I’ve searched the internet. What I can’t figure out is every year she had full Medi-Cal, would lose it in January through March and get it back in April. This year it didn’t happen and nothing has changed. The social worker couldn’t explain that, only that she doesn’t qualify now.

Find Care & Housing
Jules, why do you think that losing money in the stock market doesn't reduce countable income? It most definitely does. Like I said, $3000 in losses a year can be used to reduce MAGI. Look below for confirmation.

"MAGI Income Deductions:
Business/Self-employment expenses, include:
farm expenses,
depreciation,
capital losses (limited to $3,000 in a tax year or $1,500 if married and filing separately),"

https://obamacarefacts.com/modified-adjusted-gross-income-magi/

It's actually really simple to reduce MAGI. There are a lot of ways to do it. Another super simple way is for your mom to start a business like a LLC. Business losses also reduce MAGI. Just the $800 a year fee + other expenses in California for a LLC should do the trick. Her business could be selling lemonade on her steps. Trust me, it's really easy to lose money doing that. Make sure you get all local permits and licenses to do so. Which would also cost money and further reduce her MAGI.
Helpful Answer (1)
Reply to needtowashhair
Report
JulesNeedsHelp May 23, 2019
@needtowashhair,
:(
Some individuals are exempt from the MAGI-based income counting rules, including those whose eligibility is based on blindness, disability, or age (65 and older). Medicaid eligibility for individuals 65 and older or who have blindness or a disability is generally determined using the income methodologies of the SSI program administered by the Social Security Administration (some states, known as 209(b) states, use certain more restrictive eligibility criteria than SSI,
(1)
Report
See 1 more reply
What is her annual deductible on that Kaiser advantage plan?
It seems like the monthly amounts far exceed annual caps.

The hard thing is that California is a law unto itself and do things completely different.

If it is costing her so much is it possible to get her on a supplement insurance and go back to standard medicare with a supplemental? I used an insurance broker for my dad and his premiums were less then standard deductibles, made more sense to have the supplemental.

Also, have you tried to negotiate the prices with her doctor's? Have you checked into goodrx for prescription discounts? I thought as long as you used the advantage doctors it was supposed to keep costs to a minimum, could the expense be they are charging based on her recieving Medicaid?

Just throwing ideas out, I believe there is always a solution once we get to the real why.

This is crazy coming from a state that wants to give everyone Medicare, yet people like your mom can't afford to live and they don't want to help. Makes sense to a monkey I guess.
Helpful Answer (2)
Reply to Isthisrealyreal
Report

Your mom lives on her own right? Are you trying to get her on old fashioned medi-cal to put her into a nursing home or other form of community care? If not then it's expanded medi-cal which has no asset requirement. You can have a billion dollars in the bank and still qualify for expanded medi-cal. So having only $2000 in assets is not a thing for that. It's all income based. Is that why you are trying to get her under the income limit?

Have you looked into opening and funding a HSA(Health Savings Account)? That lowers countable income(MAGI) for expanded medi-cal.
Helpful Answer (0)
Reply to needtowashhair
Report
JulesNeedsHelp May 23, 2019
She is living alone in an apartment. She has a lot of doctor appointments, lots of medical expenses and these are adding up, plus Medicare premiums,plus the dental policy and barely has enough to live on. It's not assets that are a problem, it is her monthly Social Security. It is income based Medi-cal which she make $76 a month to much. That $76 is making it so she has to pay Medicare, and all medical bills up to $717 a month before Medi-cal kicks in. I would gladly give them the $76 a month but they won't do that.
(0)
Report
See 1 more reply
Jules, if your moms social worker could not help you then you need to ask for a supervisor. Obviously there is a change or maybe a glitch or maybe an error in data input, I don't know is not an answer. There is an answer, just finding the person that has it might be a pita.

I would get all of her paperwork together and plan on spending the day, if required, to find out what is happening.

Do you know if Miller Trusts (aka qualified income trust) are allowed in California?

Having to generate more debt to get assistance is just insane.

You state that mom has roughly 1500.00 in a funeral account, is she able to increase that amount? I am guessing that amount will only pay for cremation. Maybe she can increase that amount so she leaves enough for a small service and luncheon, maybe Medicaid gets it after she's gone, doesn't matter as long as she gets the needed assistance while she needs it.

I am sorry that you are being led on a merry chase, but time to buck up and head down to Medicaid with the idea that you are not leaving without an answer.

Best of luck and let us know.
Helpful Answer (1)
Reply to Isthisrealyreal
Report
JulesNeedsHelp May 22, 2019
The 1500 is allowed nothing more or it counts as an asset.
The Miller Trust can be used in CA. But it is primarily used for those in LTC or nursing home as I read it. I wasn't really clear on how it works, but unless I can just put the $78 into it, I am not sure it would work for this because she still needs all her money to live on. I further read it is about 800-1600 to get this trust. I need to do more reading on it.
(0)
Report
How about a vision plan?
A friend had to do that for her mom.
I agree they should be able to explain why she lost coverage. I have called back later to get someone different. And hopefully this time someone who knows what they are doing/talking about!
Hope this helps.
Sparkles
Helpful Answer (1)
Reply to sparkles87
Report
JulesNeedsHelp May 22, 2019
Thank you! I looked at vision and they are only $20 month, couldn't find anything else for the other $60.
The lady did explain she lost coverage because she makes to much, but she couldn't explain why she qualified in past years . I was afraid to press further because what if the past years were calculated incorrectly and then they made her have to pay back years of medi-cal. I did ask to speak to a supervisor but that didn't happen.
I could swear they deducted 135 Medicare premiums in the past to lower countable income but she said no . If they did she would more then qualify!
(0)
Report
See 1 more reply
The eligibility worker should have been able to explain why she no longer qualifies. I would push the issue—ask to speak to her supervisor. If her income is taxable, all I can think is that perhaps her countable income increased as a result of all the tax changes, we are all supposed to be taking home more $ every month. But again, the eligibility worker should have been able to determine why she doesn’t qualify.

Is she over the limit by $88 a month? And this is for health insurance, not long term care right? Look in to a term life insurance policy to pay for her funeral. term life insurance is not considered an asset.
Helpful Answer (1)
Reply to worriedinCali
Report
JulesNeedsHelp May 22, 2019
She only has $1447 in social security a month. She still lives in an apartment etc. not in a nursing home. She has less then $2000 in assets. I was told countable income was calculated as follows:
$1447-20 allowance - 20 dental insurance - 60 dental insurance= 1347 countable income - 1271 Medi-cal income limit= $76 over. She pays Medicare premium of $135 but was told I can't use that in countable income calculation. I thought it could, which would bring her to $1212. So now I need to find a policy that costs $76 a month that would be counted towards lowering income. But I can't find anything. She has Kaiser Senior Advantage so I can't add anything to that.
She has $1495, in a designated burial expense account. Any ideas on what I can do. As I stated in prior post other then SS increase, and a $60 dental policy, nothing has changed .
(0)
Report
See 1 more reply
Worriedincali, here is your area of expertise. Help this woman out with your wide knowledge of how to get this dealt with.
Helpful Answer (2)
Reply to Isthisrealyreal
Report
JulesNeedsHelp May 22, 2019
Thank you. I hope they can help. I am desperate.
(0)
Report
See 1 more reply
Have you researched the possibility of a Medicaid Waiver with a Qualified Income Trust? Call your local Medicaid Office and ask them what they think.
Helpful Answer (1)
Reply to Ahmijoy
Report
JulesNeedsHelp May 22, 2019
I have not. I will look for info on this. It has taken 4 messages, 10 calls to and a letter to finally have Medicaid social worker call me back. Only to tell me , she doesn't know how she qualified in prior years, she only knows that now she needed to find a way to reduce her income ( only SS) .
Additionally, I thought she could reduce her income by the $135 she pays for Medicare but was told no. So now she has to pay $135 and 717 SOC before Medi-cal helps, she only makes a bit over $1400 .
(0)
Report

Ask a Question

Subscribe to
Our Newsletter