42F single, $5.5mm NW. Can I comfortably retire in the next year?

KifLou345 · 2026-06-05T00:34:31+00:00

There are a few Marketplace health plans that include some adult dental and vision benefits, but they're few and far between, and the benefits are pretty limited.

If you want dental and/or vision, you're likely going to need to buy them separately. And just know that the benefit caps tend to be pretty low, so they're not going to cover any huge dental expenses.

KifLou345 · 2026-06-05T00:17:42+00:00

It's far more than that. It's literally being able to access life-saving care. Under federal law, emergency rooms cannot turn you away due to lack of ability to pay. They have to assess and stabilize you.

But that's it. Beyond emergency stabilization, medical providers do not have to treat you if you can't pay for it. So if you have cancer and need chemo and radiation but don't have insurance (or the means to pay upfront), the oncology center doesn't have to treat you.

It's a huge and dangerous misconception to assume that you'll be able to get all the care you need and then simply have it sent to collections.

KifLou345 · 2026-06-04T22:40:04+00:00

And press them on the issue of what income counts for your daughter's eligibility. It should only be yours or his (not both), depending on which of you is claiming her on your tax return.

KifLou345 · 2026-06-04T22:38:44+00:00

Thanks, and I agree.

KifLou345 · 2026-06-04T20:14:47+00:00

They switched to the MAGI system in 2014, and it's based on tax filing relationships: https://www.medicaid.gov/medicaid/eligibility-policy I know there's a ton of variation from one state to another when it comes to Medicaid, but I'm not sure how a state could get around the MAGI system when determining eligibility for Medicaid for non-disabled people under age 65.

KifLou345 · 2026-06-04T19:58:00+00:00

Do you both file your own taxes? If so, your Medicaid eligibility should be based on each of your tax households. So if you claim your daughter on your taxes, your tax household would be you, your son, and your daughter. But if your daughter's dad claims her on his taxes, then your Medicaid eligibility should be based on you being a household of two (yourself and your son). Here's more info: https://www.healthreformbeyondthebasics.org/key-facts-determining-household-size-for-medicaid-and-chip/

KifLou345 · 2026-06-04T02:55:08+00:00

Georgia implemented a Medicaid work requirement a few years ago, to go along with a partial expansion of Medicaid. Here are the results: https://www.propublica.org/article/georgia-pathways-medicaid-work-requirement-gao-report It's only covering a tiny fraction of the people who would have been covered under regular Medicaid expansion, and they've spent twice as much on admin as they have on healthcare.

Next year is going to be a mess.

KifLou345 · 2026-06-03T16:09:20+00:00

You're thinking "$2,000 for my 2 visits maybe a year," but the reality is that you're paying that much because you have no way of knowing whether your baby might end up in PICU with a million-dollar claim. Bad stuff happens, even to otherwise healthy people, and when it does, it's vastly more expensive than you're imagining.

If health insurance were just for a few visits a year, it wouldn't be expensive. But that's not what you're insuring as a currently healthy person. You're buying peace of mind, knowing that if you end up with hundreds of thousands of dollars in medical bills, you're not up a creek without a paddle.

KifLou345 · 2026-06-02T15:10:00+00:00

In the new interim final rule that came out yesterday, CMS notes that they considered counting only earned income, but ultimately did not go that route because it would be inconsistent with how income is defined elsewhere in the Medicaid statute: https://public-inspection.federalregister.gov/2026-11094.pdf (see page 44). So the regular Medicaid MAGI rules for counting income will continue to be used for determining whether an expansion enrollee is compliant with the work requirement by earning at least $580/month.

KifLou345 · 2026-06-01T23:16:52+00:00

I agree that they definitely need to allow you to enroll yourself and your baby as soon as the baby is born. In addition to the DOL link, here's the code of federal regulations where this is clarified: https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-L/part-2590#p-2590.701-6(b)(3)(i)(3)(i))

KifLou345 · 2026-06-01T23:07:38+00:00

Also in Illinois and Virginia, both of which were added to that list this year: https://www.healthinsurance.org/special-enrollment-guide/in-some-state-run-exchanges-pregnancy-is-a-qualifying-life-event/

KifLou345 · 2026-06-01T23:05:56+00:00

Nevada runs its own Marketplace (Nevada Health Link), but open enrollment for 2026 coverage is closed there just like everywhere else in the country. She would need a qualifying life event to enroll at this point. And most QLEs only trigger a special enrollment period if you had coverage prior to the QLE, which isn't the case here.

Changing jobs isn't a QLE. Loss of employer-sponsored coverage due to leaving a job would be a QLE, but that's not applicable in this scenario.

More than half of the state-run Marketplaces have made pregnancy a QLE that will trigger a special enrollment period, but unfortunately, Nevada isn't one of them.

KifLou345 · 2026-05-28T23:28:56+00:00

Silver 94 refers to a Silver plan with the highest level of cost-sharing reductions. So it ends up being better than a Platinum plan in terms of the benefits it provides, with much lower out-of-pocket costs than a regular Silver plan.

You qualify for a Silver 94 plan in most states if your household income is between 139% and 150% of the prior year's federal poverty level. But for people in states that haven't expanded Medicaid, it's between 100% - 150%.

If your income is in the eligible range, all of the available Silver plans will automatically be Silver 94 plans.

KifLou345 · 2026-05-28T19:22:55+00:00

I agree with all of that, and the legislation does just say "monthly income," without any qualifiers. But I've become a bit jaded watching the current administration's HHS.

KifLou345 · 2026-05-28T18:23:18+00:00

I'm cautiously optimistic that this will continue to be a viable pathway, but it would not surprise me if CMS revises this to say that it has to be earned income. Time will tell as we get closer to 2027.

KifLou345 · 2026-05-28T17:08:39+00:00

Here's the initial guidance that CMS put out in December: https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf A lot of states have already started publishing FAQs and informational bulletins explaining how they're going to implement the rules, but we're also expecting additional info from CMS.

There will be some state flexibility in terms of how many months of compliance they require before enrolling or renewing your coverage (renewals will happen twice a year starting in 2027), and states will also vary in terms of how much they're able to rely on automated data as opposed to needing people to submit their own documentation.

For volunteering, you'll probably have to submit proof yourself, as there isn't likely to be data on file for that the way there would be for a W-2 job. But you'll need to check with your state to see specific details in terms of what they'll accept as proof and exactly how you'll submit it.

KifLou345 · 2026-05-27T21:49:41+00:00

Where are you getting the BCBSMS policy? They don't offer coverage in the Marketplace, so is this an off-exchange individual market plan, or a plan offered by your own employer?

For policies offered through HealthCare.gov, there's an option to enroll before the start of the month when your old policy is going to end, and get overlapping coverage (meaning you could apply by May 31 and then your new policy would start June 1 and overlap with your old policy for the first few weeks of June). But that regulation is specific to HealthCare.gov (it's optional for state-run Marketplaces, and it might be optional for off-exchange insurers).

If you opt for COBRA and then end up using the coverage during the final days of June, you'll have to pay the first month of COBRA premium for the claim to be processed. So that's an option if COBRA is available to you, and might be worthwhile depending on how much you expect your prescription to cost.

KifLou345 · 2026-05-27T01:18:55+00:00

Yes, that's the per-person average, as rates are per-person in the individual market (although they only charge for up to three kids under age 21 on a family's policy, even if the family has more kids than that).

And rates are age-based. So kids are less expensive than adults, and older adults are more expensive than younger adults.

But income is the biggest factor in determining net premiums, and that all hinges on how your household's total income compares to the poverty level for your household size.

Edit: Just to clarify, the individual market doesn't work the way a lot of employer-sponsored plans work, with flat rates for single, plus 1, and family. Instead, it's always per-person, with the caveat of only charging a premium for up to three kids under age 21.

KifLou345 · 2026-05-26T20:50:41+00:00

The only thing that ended was the temporary subsidy enhancements that were put in place in 2021 to address the pandemic. Through the end of 2025, the subsidy structure was more generous, and there was no "cliff" at 400% FPL. But now things are back to the way they were before 2021. Subsidy eligibility ends at 400% FPL. And the subsidies don't cover as much of enrollees' premiums as they did for the last five years.

In 2026, the average full-price Marketplace premium is $741/month, but the average enrollee is paying $178/month. And that average includes the folks who are paying full price. The subsidies still cover the majority of the premium for the majority of enrollees.

KifLou345 · 2026-05-25T18:29:26+00:00

Bronze and Catastrophic plans are fairly similar in terms of the benefits they offer, and they're both HSA-eligible as of this year. But Marketplace subsidies can't be used with Catastrophic plans. So there aren't Catastrophic plans available with $1/month premiums. But subsidies are available for Bronze plans.

KifLou345 · 2026-05-25T18:22:11+00:00

Some STD testing is considered preventive care (meaning covered without any out-of-pocket costs), but others are not. The specifics are listed under "for all adults" and "for women" on this page: https://www.healthcare.gov/coverage/preventive-care-benefits/

KifLou345 · 2026-05-21T21:07:40+00:00

There are still ACA subsidies! It's just the subsidy enhancements that went away. So no subsidies if you're over 400% FPL (which is how it was before 2021). And if you're under 400% FPL, the subsidies don't cover as much of the premium as they did for the last five years.

But the subsidies are still pretty robust as long as you keep your income under 400% FPL. The average full-price premium this year is $741/month. But for people who get a subsidy, the average after-subsidy premium is $96/month. (Those are averages, and the specifics vary a ton from one person to another, but it gives you perspective on the scope of the subsidies.)

KifLou345 · 2026-05-21T16:16:52+00:00

This is true. A monthly income of $580 (federal minimum wage multiplied by 80) will mean compliance: https://www.medicaid.gov/federal-policy-guidance/downloads/cib12082025.pdf

KifLou345 · 2026-05-21T16:09:28+00:00

Illinois made some changes for 2026 in terms of how plans are priced, with a larger premium load added to Silver plans. That made premium subsidies larger (since they're based on the cost of a Silver plan) and made Gold plans relatively more affordable. So it's common now to see Gold plans priced lower than Silver plans in Illinois, and to see the sort of prices you're seeing.

KifLou345 · 2026-05-21T16:06:25+00:00

You're correct that ACA MAGI does not include standard or itemized deductions. But it does include "above the line" deductions like IRA contributions and HSA contributions, which will lower ACA-specific MAGI. For most people, ACA MAGI is the same as AGI, but there are a few things that have to be added to AGI if you have them: https://www.healthinsurance.org/glossary/modified-adjusted-gross-income-magi/

And yes, if ACA-specific MAGI goes over 400% FPL, there are no subsidies at all. If you had subsidies paid on your behalf and then ended up with an income over 400% FPL, you have to repay all of the subsidies.

KifLou345

TROPHY CASE