What do you pay for healthcare premiums

[nun]

I get a plan from my ex-state employer. Medical and dental premiums are $463 per month for me as single 53 year old deferred retiree. The plan has no-deductible except the first $250 of tests. As I am not yet retired in the eyes of the state I have to pay the full premium, when I get official retiree status at 55 my premiums will be reduced to $115/month.

[pb4uski]

Quote:

Originally Posted by ripper1 Maybe lower rates with ACA but deductibles are like 5000 or 6000 an individual and co-pays and other expensives are sky high.

But.... the deductibles and co-pays only come into play if you need to go to the doctor, hospital or whatever - if you don't have any health issues and just go in for a routine physical there is no cost other than the premiums. For those with chronic medical issues, at the end of the day it is a trade-off between paying higher premiums or paying health care costs.

[nun]

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Originally Posted by pb4uski But.... the deductibles and co-pays only come into play if you need to go to the doctor, hospital or whatever - if you don't have any health issues and just go in for a routine physical there is no cost other than the premiums. For those with chronic medical issues, at the end of the day it is a trade-off between paying higher premiums or paying health care costs.

My options when I stopped working at a state university at 53 were to go on ACA and pay $200/month for a high deductible plan or stay with my cadillac state plan and pay the full premium of $463/month until I reach 55 when my premium will go down to $115/month. I chose to stay in the state plan because of the high benefit level and to maintain continuity of my insurance. I would have changed plans right at the time the ACA was having its website difficulties and given that it will probably continue to undergo changes and attempts to phase it out I thought it best to go with a plan that I can rely on.

[pb4uski]

I would have taken the $263/month savings, but i'm just cheap I guess. That $3,156 would more than cover our typical health care costs in a year.

I had HSA-eligible HDHI when I was working and we had already had BCBS HDHI HSA-eligible insurance for 2012 and 2013 so the transition to a BCBS ACA HDHI HSA-eligible bronze plan was pretty easy even though the exchange website was a POS.

On July 1 we changed to a catastrophic plan and that was a huge hassle, but now that we are on it things are going smoothly and actually even better than the bronze plan in that we can now pay the insurer directly and they have auto-pay capability whereas I had to write out and mail a check each month to the exchange for the bronze plan since they could not do auto-pay or even electronic payments.

[nun]

Quote:

Originally Posted by pb4uski I would have taken the $263/month savings, but i'm just cheap I guess. That $3,156 would more than cover our typical health care costs in a year. .

I went back and forth over the choice. I'm healthy and my healthcare costs are just my premiums...... apart from the dentist where the insurance just paid for 50% of a crown I needed. If I wasn't going to have my premium reduced to $115 a month in 2 years time I would have gone with ACA, but I figured $6k was worth it to avoid the hassle of changing insurance right at the time when the ACA was at its craziest. Also to get similar coverage with the ACA would have been significantly more expensive and that makes me feel like I'm getting a good deal, even if I'm not going to the doctor. If something nasty does occur I don't have to worry about any big deductibles or out of pocket charges before the insurance starts paying.

[LarryG]

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Originally Posted by utrecht DW and I are retiring in Jan and our retiree rates are very high as yours are. Here's my question to you because we are in the same boat. Why are you staying with your retiree insurance when you can clearly see that rates are cheaper on the open market? What benefit do you get for "buying thru their group plan"?

utrecht, there are a few reasons. First, there is a small financial account at megacorp that I am using up that (modestly) helps defray a bit of this cost. Second, if I leave the plan, I can't go back in later. Third, when I looked at ACA plans in my state when I went off COBRA in June of this year, the costs were about the same for the same level of coverage (PPO plan with BCBS with a very wide network). It is a false assumption that the open market is cheaper, for the same level of coverage AND network. Also note that I am not eligible for any ACA subsides. And fourth, my wife is extremely persnickety about what doctors and hospitals are considered in-network, compared to the ACA plans. She has several medical issues whereas I have relatively few.

[Cat-tirement]

After retiring earlier this month, I just received my my Megacorp notice on retiree health benefits today (such as they are). Age has no effect, other than the requirement to be between 55 and 65. My top choices are:

1. COBRA continuation of my HDHP, which though it qualifies me for a HSA, I have to manage that myself. Monthly cost is $1055 for DW & I.
2. A fairly traditional $400 deductible/20% copay PPO plan. Monthly cost is $878 for both of us.

Megacorp provides no subsidy at all. Dental is only available through COBRA.

[nun]

Quote:

Originally Posted by LarryG Third, when I looked at ACA plans in my state when I went off COBRA in June of this year, the costs were about the same for the same level of coverage (PPO plan with BCBS with a very wide network).

That's what I found too. My employers plan is pretty rich....no deductibles etc and to get that level of coverage on the ACA I would have been paying a $800/month and even with the ACA subsidy I would be paying more than for my old employer's plan. The only way to save money would be to take a high deductible plan with a new insurer. So I'm paying more for far better coverage. Of course I might not use that coverage......I suppose those that go for low deductibles are optimists and those that go for cadillac cover are pessimists.

[rodi]

Late to the party.
Rates are for a family of 4. DH = 62, me = 53, 2 minor age kids.

Since I retired in June at age 52 we're paying 1127/month for medical (Kaiser Permanente, no deductable, $20 copays.... so a high metal plan). We're also paying 135 for dental.

My income was too high, this year, to qualify for ACA subsidies... and the group rates I get through cobra are about $500 less/month than I could get, unsubsidized... so I pay cobra.

Next year we'll qualify for ACA subsidies and our medical should be about $750/month.

From playing around with calculators/coveredca/healthsherpa/KP's website... my husband's age is a big factor in our price. He accounts for 45% of our total premium. Life will be good when he goes on medicare.

[aaronc879]

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Originally Posted by ripper1 Just got notice from the city of chicago that my retiree healthcare premium is going up to 1375 a month. This essentially doubling from 750 only two years ago. Of course I am one of those hated public employees!

I pay $31/mo for a subsidized silver plan with a max OOP of $500/yr. If your pension is over $1500/mo then i'd trade with you any time. Still, if I planned for a healthcare cost of $750/mo I wouldn't expect it to go up more than 10%/yr.

[flyingaway]

I am shocked by the numbers posted here. I was budgeting $4,000 per year for health insurance in retirement for a couple. It seems that I have to go back to the drawing table to work out a new budget.

[W2R]

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Originally Posted by aaronc879 I pay $31/mo for a subsidized silver plan with a max OOP of $500/yr.

Aaron, that is terrific! I am truly happy to read that you are getting such a great deal on health insurance.

As you grow older, of course it could increase dramatically due to the marked effect of age on insurance rates, but hopefully the subsidies would keep up with it.

[aaronc879]

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Originally Posted by W2R Aaron, that is terrific! I am truly happy to read that you are getting such a great deal on health insurance. As you grow older, of course it could increase dramatically due to the marked effect of age on insurance rates, but hopefully the subsidies would keep up with it.

According to this subsidy calculator i'd pay the same premium at age 55 as I do at age 35.
Subsidy Calculator | The Henry J. Kaiser Family Foundation

[pb4uski]

Quote:

Originally Posted by aaronc879 According to this subsidy calculator i'd pay the same premium at age 55 as I do at age 35. Subsidy Calculator | The Henry J. Kaiser Family Foundation

Doesn't work that way in most states. Go to healthsherpa.com

[sheehs1]

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Originally Posted by nun That's what I found too. My employers plan is pretty rich....no deductibles etc and to get that level of coverage on the ACA I would have been paying a $800/month and even with the ACA subsidy I would be paying more than for my old employer's plan. The only way to save money would be to take a high deductible plan with a new insurer. So I'm paying more for far better coverage. Of course I might not use that coverage......I suppose those that go for low deductibles are optimists and those that go for cadillac cover are pessimists.

That's what I found too. Except for an ACA plan on the exchange and off the exchange (BC/BS of Va) the deductible was $6,000 instead of my current $3,500. The coinsurance was 80/20 instead of my current 0%. So basically the same monthly premium for potentially more out of pocket costs with the ACA plan. For now anyway.

The only health issue I have are my sinuses and yearly thyroid blood work (sisters have issues- I don't-I'm on "watch"). My GP routed me to an ENT. I found that every time they "scoped" my nose, they coded it as surgery. My first two visits cost me $500.00 each (deductible). When I told them this, they didn't charge me the third time.

Ive delayed the blood work for my thyroid as I know the symptoms and fee good. When or if I don't, I'll have the labs done.

Still...my point is anything outside of your yearly physical or what is deemed free such as paps and mammograms will go to the deductible (as you all already know).

[daylatedollarshort]

I looked at Healthsherpa and I have some questions.

I looked at a subsidy plan with $174 in premiums ($2088) with annual family OOP of $12,500, yet their high costs were $27K. What am I missing? I thought high costs would be $2,088 premiums + $12,500 family deductible = $14,688?

[pb4uski]

Usually the max OOP is the premiums + the $12,500 family deductible. Is the $27k perhaps based on the unsubsidized premiums + the $12,500 family deductible? so the difference is the subsidy?

https://www.healthcare.gov/glossary/...maximum-limit/

[Cobra9777]

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Originally Posted by flyingaway I am shocked by the numbers posted here. I was budgeting $4,000 per year for health insurance in retirement for a couple. It seems that I have to go back to the drawing table to work out a new budget.

Yes, $4K is probably not going to happen. DW and I both have fairly generous employer-subsidized, pre-medicare, retiree health insurance. And our premiums will be about $6K per year once DW finally retires. We estimate total healthcare cost at $9-10K per year, including all out-of-pocket... deductibles, coinsurance, copays, dental, vision, prescriptions. And we estimate medical inflation at 6% per year.

But yes, I'm a little shocked at some of the numbers posted here as well, like $1.7K per month for a couple in their 50s. That just seems crazy high. My casual shopping around of non-subsidized options doesn't generate anything that high.

But I think premiums alone can be misleading without knowing a lot more details. I'd be more curious to know what other pre-medicare retirees are budgeting for total healthcare cost, and medical cost inflation? I think my $9-10K budget is a bit conservative, but 6% inflation may be too low.

[SevenUp]

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Originally Posted by ripper1 I should have mentioned that I was looking for early retirees between the ages of 55 and 64. It seems this is the age group that gets hit the hardest.

That fits.

$640/mo for low deductible medical. Covers 2 adults & 4 kids.

$141/mo for dental. Somewhat covers 2 adults & 3 kids.

[rodi]

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Originally Posted by Cobra9777 But I think premiums alone can be misleading without knowing a lot more details. I'd be more curious to know what other pre-medicare retirees are budgeting for total healthcare cost, and medical cost inflation? I think my $9-10K budget is a bit conservative, but 6% inflation may be too low.

Premiums alone aren't enough - you also need to know state and metro area.

When I worked in suburban Philadelphia I had coworkers that lived across the river in NJ. Their insurance was close to double what the PA residents had to pay. Same group negotiation - but the residence state made a big impact.

When I moved to CA my insurance cut in half from the PA rates. (HMO vs HMO - so similar coverage). I suspect that had to do with CA's 80's era malpractice tort reform. That and competition. Kaiser Permanente is the largest insurer in the state - and they are aggressive about controlling costs and so it charges lower premiums... which forces the competition to charge less...

It's kind of like gas prices - where you live makes a HUGE difference in price.