Obamacare and early retirement

[Major Tom]

It strikes me as a bit odd that you can actually have a substantial amount of money and still get hefty Obamacare subsides. Anyone using Healthcare.gov for health insurance and getting a hefty subsidy?

I'm on Medi-Cal (the California version of Medicaid). About half of my assets are in taxable accounts, and the dividends and interest from those put me under the required 133% of the FPL for Medi-Cal eligilibility.

My experience with the low income healthcare system in my county has been that it depends very much on which clinic you are signed up with. The first one I went to was in a poorer part of the area, and was not an enjoyable experience at all. Every time I wanted to visit the doctor, I ended up having to wait several hours (this particular clinic did not give appointments - everything was on a first-come first-served basis). To make things worse, the place was very crowded and let's just say that I wasn't exactly sharing the waiting room with a particularly choice segment of society (nice way to put it).

Then I decided to sign up with a clinic a few miles away in Berkeley, and the difference was like night and day. The premises are large, bright, and airy. The clientele represent a much wider cross-section of the community and things are done on an appointment basis, so the wait times are much better. On top of that, after trying a few different doctors, all of whom were pleasant, I have finally found one who welcomes questions, and responds to them in an intelligent, helpful, and unhurried fashion. He's an absolute gem.

While I have found that I do have to wait longer to see a doctor now that I am on Medi-Cal (Medicaid) than I did when signed up with an HMO through AETNA and my former employer, my clinic operates a system of prioritization that is very tolerable. For regular appointments, I typically have to wait a month but if I have a pressing issue, they will make time and see me the same day. About 6 months ago, I had a dull pain in my abdomen which concerned me. While there are a number of possible explanations, at least some of them can be serious. I explained this, and got to see a doctor the same day. I was scheduled for an ultrasound, which I had the next day. The technician gave me a guided tour of my insides as she was performing the ultrasound. She put my mind at rest so that by the time I saw the doctor again, I had already figured there was no cause for worry. My problem was gas, possibly due to my heavy regular intake of Brussels sprouts

It was good to be able to see a doctor swiftly.

So, to make a long story short, yes - the PPACA has indeed helped with my ER a great deal. Many here would not want to go on Medicaid but I think I got lucky and found a good clinic/hospital system.

 

[Jaded salami]

Yeah, as long as you can keep your income under 62,000 you can get subsidies. Unfortunately for me and my wife our pension is over that somewhat and we will be stuck with sky high premiums and deductibles. It is funny how someone with 6 and 7 figure incomes will only have to pay as much as someone who barely makes 62,000.

Yes, I'm keeping our investment income under 50k, so my subsidy (Washington state) is around $4k a year. It was a factor in convincing my wife we were ok to retire, she was very surprised at the amount of the subsidy.

We don't feel guilty at all about it. We are in this financial position because of LBYM, sound investing and making smart money decisions. The ACA afforded us an opportunity to do more of the same.

 

[pb4uski]

...It is funny how someone with 6 and 7 figure incomes will only have to pay as much as someone who barely makes 62,000.

Yeah, because it is well known that it costs twice as much to provide health care to someone who makes $124,000 as it does to someone who makes $62,000. And 4 times as much for someone who makes $248,000.

 

[Snidely Whiplash]

Have you looked into catastrophic plans?

We have them and have been quite happy but we are healthy and really haven't had any claims.

I have looked into the catastrophic plans. Very few practitioners (none I would use) in my area participate with those plans. I hope your experience remains as good if you need to use your insurance.

Given the responses to the original poster, clearly the majority here are winners under the ACA. My opinion of the legislation is significantly lower since I'm one of the losers.

 

[Zathras]

I would have retired with or without the ACA.
I do sleep a lot better knowing it isn't as easy for the insurance company to drop me at any moment and the lifetime limit is gone.
My rates have also gone down a bit which I won't complain about.
No subsidies here, but that is just fine with me.

 

[Looking4Ward]

Yeah, because it is well known that it costs twice as much to provide health care to someone who makes $124,000 as it does to someone who makes $62,000. And 4 times as much for someone who makes $248,000.

+1

 

[FUEGO]

To the OP, yes the ACA makes early retirement a lot easier for us.

Our kids would have been covered under the children's health insurance program (aka medicaid) regardless of the ACA. Now, the adults in the household will be able to get guaranteed issue coverage at a low price (with heavy subsidies).

Without ACA, we would probably have to work a couple extra years to cover the cost (in pure dollar terms and unpredictability) of private market insurance. And if we were denied coverage at some point, one of us would have to go back to work for HI.

 

[Snidely Whiplash]

Yeah, as long as you can keep your income under 62,000 you can get subsidies. Unfortunately for me and my wife our pension is over that somewhat and we will be stuck with sky high premiums and deductibles.

I'm in the same boat as you ripper1. I need to draw about 65-70K from IRA's to live on. I am paying $500/mo for a non-aca 10K ded plan for my wife and I. We moved to Fl and will loose our policy the end of this year. The ACA comparable plan will cost $1474/mo(Florida Blue Options 1419) with a $12500 ded. That is nearly triple my current cost for less coverage and the ACA plan is up 22.1% from last year.

Well, in a misery loves company kinda way, at least I'm not feeling like the only loser in this whole deal.

And I'm not impressed with those who argue that my increased premiums would have happened with or without Obamacare. What happened to the savings we were all told would accompany the passage of Obamacare?

We don't feel guilty at all about it. We are in this financial position because of LBYM, sound investing and making smart money decisions. The ACA afforded us an opportunity to do more of the same.

Im not following your thinking here. Are you equating the lack of guilt ref: the subsidy with your lifestyle and smart money decisions? How's that work?

For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?

 

[Chuckanut]

I do sleep a lot better knowing it isn't as easy for the insurance company to drop me at any moment and the lifetime limit is gone.

+1

The fear of losing health insurance or not being able to get it, or get it with to many exclusions is gone. The medical establishment could have done themselves a huge favor if they had changed this before the ACA.

IMHO, will help open some jobs for younger people as we older people retire. It would open more and better jobs is they get rid of the stupid 30 hour rule. Or better yet find a way to divorce health insurance from employment.

 

[rodi]

So, to make a long story short, yes - the PPACA has indeed helped with my ER a great deal. Many here would not want to go on Medicaid but I think I got lucky and found a good clinic/hospital system.

Friends of ours were on "healthy families" here in CA which was an insurance program for folks higher then the federal medicaid income - but still low income... that got rolled into Medi-Cal with ACA and coveredCA. They didn't like the new label (stigma) -but their son just spent 2 weeks in/out of Childrens hospital with a really nasty case of lyme disease. He got excellent care and specialists tripping over themselves to look at his case. I was impressed with the coverage and care (not to mention the private room.) I think their concerns about being moved to Medi-Cal were alleviated by this incident.

 

[FUEGO]

Friends of ours were on "healthy families" here in CA which was an insurance program for folks higher then the federal medicaid income - but still low income... that got rolled into Medi-Cal with ACA and coveredCA. They didn't like the new label (stigma) -but their son just spent 2 weeks in/out of Childrens hospital with a really nasty case of lyme disease. He got excellent care and specialists tripping over themselves to look at his case. I was impressed with the coverage and care (not to mention the private room.) I think their concerns about being moved to Medi-Cal were alleviated by this incident.

+1 on medicaid (or whatever nice name they use for it) for kids. Never heard anyone I know complain*, and many I know have kids on it.

It's looking like my kids will end up on the medicaid for kids plan since I think that's how low to moderate AGI households get Exchange insurance when you have kids. I'm not sure if paying extra to have them on our silver plated silver plan (at AGI of 133% of FPL) is an option or what the cost increment would be, or whether there would be any real benefit/detriment for our perfectly healthy children. The OOP costs will be way lower than our current HDHP, not that we'll overconsume medical services just for fun.

* Well, there was one mom who complained that her three kids couldn't get free braces for cosmetic reasons. Then after some wrangling she got 2 of them braces for free after some dentist somewhere found some medical reason to recommend braces. And one mom complained about having to attend a 1 hr prenatal class in exchange for getting five figures of free medical care.

 

[pb4uski]

I have looked into the catastrophic plans. Very few practitioners (none I would use) in my area participate with those plans. I hope your experience remains as good if you need to use your insurance....

We were fortunate that our cat plan has the exact same network as our bronze plan (same carrier and according to them, same network for any skeptics).

 

[Major Tom]

We were fortunate that our cat plan has the exact same network as our bronze plan

My brain wasn't in full gear when reading this and for a couple of seconds, I was wondering what possible connection a pet insurance plan could have to the PPACA

 

[pb4uski]

My brain wasn't in full gear when reading this and for a couple of seconds, I was wondering what possible connection a pet insurance plan could have to the PPACA

OK, I'm too lazy to type out catastrophic... I'm retired!!!

 

[Fermion]

For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?

The money comes from that vast pile that bails out banks, underwater homeowners, and underfunded public pensions.

 

[joe8012]

The money comes from that vast pile that bails out banks, underwater homeowners, and underfunded public pensions.

I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.

 

[Fermion]

I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.

One reason your premium tripled is because you have to cover pregnancy as a 60 year old eunuch and someone can enroll for a reasonable premium who uses $100,000 a year in medicine for a pre-existing condition. Your premium didn't triple because a few of us have figured out how to manage our wealth to qualify for a bit of subsidy.

My comment was also pointing out that there are plenty of other "unfair" examples in our government and the way it transfers wealth.

 

[pb4uski]

I don't understand your comment. The money would have to come from higher premiums and new younger enrollees. I know for a fact my premium tripled with less coverage.

Joe, Fermion's comment was referring to subsidies (aka advance premium credits) paid by the federal government to insurers, not to premiums.

 

[EastWest Gal]

Your premium tripled over what period of time? Premiums do go up with age.

For 3 years I worked in a very small office. My insurance was covered but my DH and DS were not. I had to pay $500/ for the 2 of them. For all 3 it would have been $800/mo. This was 10 years ago. To pay COBRA next year it will be $1500/mo for my high deductible HSA plan, which is the cheapest one offered. New ACA plans have been posted on healthcare.gov and the silver plan I'm thinking of enrolling in next month is $880/mo + $120/mo for a catastrophic plan for DS. This is less than when I looked 4 months ago. So 10 years later I'll be paying not much more for better coverage.

The money for subsidies theoretically will come from decreased need for government support of hospitals for charity care and decreased costs from better preventive care and better chronic disease management. The insurance companies will get more income from previously uninsured healthy young people now paying cheap premiums for insurance that they will use infrequently.

Cost controls are part of the ACA, such as controlling runaway insurance company profits and quality controls. For example, readmissions within 30 days for certain medical conditions and treatment for UTIs due to unnecessary in dwelling urinary catheters are totally in reimbursed by insurance--the hospital has to eat the cost.

I still see the insurance companies trying not to pay the bills-my son had surgery in July and we 're still hassling with the company. First they said DS had other primary insurance which was ridiculous, then they waited another month to send us a 4 page form to fill out stating that the surgery wasn't due to an auto accident, which given the surgery obviously it was not.

It's a complicated system and all the insurance companies, hospitals and office practices have not fully adjusted to the changes.

Look at the healthcare systems in France and Germany, which are both private/public partnerships. They have their drawbacks but they are providing similar and in many ways better care at much less cost than ours.

A lot of reasonable people want to make the ACA work.



Sent from my iPhone using Early Retirement Forum

 

[Jaded salami]

Im not following your thinking here. Are you equating the lack of guilt ref: the subsidy with your lifestyle and smart money decisions? How's that work?

For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?

I was referring to the OP saying that it's odd that we are getting a subsidy even though with our financial position we could easily afford HI without it.

 

[MooreBonds]

Your premium tripled over what period of time? Premiums do go up with age.

In some sense, I'm glad that some form of health insurance reform was passed to at least have a starting point for future refinement.

However, you have to realize that there were some MAJOR increases caused solely by the changes in requirements of the ACA. It's not due to age. People aren't looking at rates from 1995 and comparing it to now.

I'm still on my old grandfathered plan (37 years old, male, Missouri) that doesn't qualify for ACA. I pay $64.55/month for a $5,100 deductible, HSA policy from Anthem.

When my plan expires this year, I'll have to get an ACA-compliant individual policy. The current prices for MO for a Bronze ACA plan are the following:

Choice of just 3 insurers. The cheapest:

$6,300 deductible = $176.47, or 273% higher premiums, PLUS a 23% higher deductible. AND....that doesn't even include comparing the hospital or doctor networks, as many people have commented how there have been some network changes (smaller networks) with the many new ACA plans.

 

[pb4uski]

The percentage increase is only because you're getting a screaming deal now at $65/month. Even $177/month is a good deal.

 

[photoguy]

When I first started working in CA in late 2001 I had to buy my own health insurance on the individual market (I was at a very small company but was reimbursed). This cost me $100/month and after a year or two increased to about $200/month. My plan was through Health.net and unfortunately I don't remember any details other than it was a PPO.

Currently my bronze plan through ACA costs $214/month (no subsidy).

 

[donheff]

For those who support the subsidy, I'm curious where you think that money comes from? I mean, philosophically you must view it as your right to get your healthcare subsidized, so the subsidy coming from the US "general fund" is OK?

I have much too high a taxable income to qualify for a subsidy and get my insurance from a retirement plan anyway but I strongly support the subsidy concept and would prefer a single payer system like Medicare for all (with a good faith bipartisan effort to implement improvements). I also understand that I have been and am currently paying a lot more in than I get out since I am in very good health and have a relatively large income. But I also recognize that good health is a bit of a crap shoot and I could be wiped out in a skipped heartbeat if I was responsible for all my costs. I like that little bit of socialism that takes a huge chunk of financial uncertainty out of the equation.

 

[tomz]

I have much too high a taxable income to qualify for a subsidy and get my insurance from a retirement plan anyway but I strongly support the subsidy concept and would prefer a single payer system like Medicare for all (with a good faith bipartisan effort to implement improvements). I also understand that I have been and am currently paying a lot more in than I get out since I am in very good health and have a relatively large income. But I also recognize that good health is a bit of a crap shoot and I could be wiped out in a skipped heartbeat if I was responsible for all my costs. I like that little bit of socialism that takes a huge chunk of financial uncertainty out of the equation.

+1. Well said.