Between FIRE and 65 paid healthcare options.

[jim584672]

I keep income under 200% FPL to qualify for New York's Essential Plan, which is $20 a month.

https://info.nystateofhealth.ny.gov/sites/default/files/At a Glance-Essential Plan_1.pdf

 

[roark]

Hi joeea,

When you were in Mass did you have your ACA/Connector Plan with TUFTS when you dealt with cancer? And if so were they good and provided everything needed for treatment?(I hope successfully too) And what was your approximate MAGI when paying the 264 premium? I am asking as I live in Mass and though currently still working expect it to end in less than a year. I'm 54 and single looked into ACA/Connector options and TUFTS seems like lowest priced good option and best I can tell a single can earn up to roughly 37k MAGI and still get low cost TUFTS plan but I am finding the whole process confusing and difficult to get reliable information. Thank you.

roark

 

[joeea]

Hi joeea,

When you were in Mass did you have your ACA/Connector Plan with TUFTS when you dealt with cancer?

Yes.

And if so were they good and provided everything needed for treatment?(I hope successfully too)

Yes and yes.

And what was your approximate MAGI when paying the 264 premium?

It was under $48k, if I recall correctly. I don't recall how much of my wife's salary was being deferred to her 401k though, so I'm not sure of the MAGI. Sorry.

I am asking as I live in Mass and though currently still working expect it to end in less than a year.

Remember that you'll likely be able to use COBRA for a while, if you prefer.

I'm 54 and single looked into ACA/Connector options and TUFTS seems like lowest priced good option and best I can tell a single can earn up to roughly 37k MAGI and still get low cost TUFTS plan but I am finding the whole process confusing and difficult to get reliable information.

Make sure the plan covers the healthcare providers you prefer.

When I started on that plan, I was happy to see that my plan covered all of our existing healthcare providers for both my wife and I.

 

[Sarah S]

Joeea makes an important point about the Tufts direct network ( which is what I think you are discussing). The wider network Tufts isn’t available with an advance subsidy. Think of where you would want to go/ who you would want to see in the case of serious illness my mgh specialist does not take Direct nor does my Partners pcp

 

[jeffst]

A bit OT

Go to healthcare.gov and look at the options for your location, age, etc. You can see what the current policy premiums are, calculate your subsidy if you qualify, and see what your out of pocket maximum is.

Understanding cost is important.

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

 

[PointBreeze]

URL to browse ACA plans

That is a huge difference.

I went to healthcare.gov but I would have to answer a bunch of questions and lie since I already have employer provided insurance and will until retirement or termination. Please share your cost experiences here.

If you go to https://www.healthcare.gov/see-plans/, you don't need to enter much at all, and you can browse plans for 2019 (info for 2020 is not yet available).


I'm 59, am keeping my MAGI to ~$27K, and live in PA; my premiums for a Silver plan after subsidy are $167/month with a $1400 deductible.



Other than my premiums and deductible (which I never come close to reaching), I pay ~$120/year for prescriptions and ~$120/year for co-pays. I'm pretty healthy.

 

[PoF]

43 with a family of 4.

I looked into health sharing ministries, but opted for a bronze plan. Also looked into the open market a bit, but there wasn't anything different or better than we were able to find on the exchange.

We'll be paying $909 a month for a family of four. No subsidy, but we will be able to fund an HSA.

 

[Dtail]

Understanding cost is important.

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

I am lucky, as in FLA there is a large network of doctors and specialists who accept the ACA plans which for me are through BCBS which is the major insurer in FLA.

 

[RunningBum]

Understanding cost is important.

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

That's another totally individual question. As the plans roll out each year, you can see which doctors participate in the plans. I don't know how you can make your own decision about plans based on other people's experiences with whether their doctors were in-network or not. It didn't work well for you because your doctors aren't in plan. That means absolutely nothing to me.

It is a valid point that one should check the provider directory before committing to a plan.

Most years all of my doctors were in. One year I would've had to pay $800/month more for a plan to include my doctors. The max deductible for out of network was less than this, so I just went with the cheaper plan and mostly saw my own doctors out of network. One problem was that I didn't get their in-network rates, but I still didn't spend as much as the premiums would've been. I would have made a different decision if the gap was less. How much less is hard to say.

 

[jim584672]

Understanding cost is important.

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

My Megacorp had UHC plans, the ACA plans had the same doctors as Megacorp, so for me the network of doctors hasn't been an issue.

 

[RunningBum]

And btw when I had ACL surgery a few years ago I had the same surgeon that operates on the knees of the sports teams for the local major ACC university. So ACA does not (necessarily) imply Medicaid level medical care. Heck, I'm not sure Medcaid even implies that anymore from what I hear, but I have no experience with that.

 

[VungTau]

Left

I am 59, retired at 53, and was paying a small fortune in Calif where I lived from 2014 to 2016. Too much income to qualify for ACA so I got the cheapest high deductible plan I could find. Still paid $750 a month for essentially diaster only insurance. First 6k was my responsibility. It went up 10-20% over that time too.

Solution: Left the USA. I moved to Vietnam and now have a worldwide plan with low deductible, good benefits like dental and eye care for $2000 a year. The coverage excludes the USA. Price would double if I included it. Medical care had been great so far - fractured ankle while hiking and a voluntary surgery. Both experiences went without a hitch and cost peanuts.

We are really getting screwed on medical costs in the USA!

 

[joeea]

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

Very happy. But that probably depends on the state and perhaps the county as well.

When we lived in MA, our plan covered both of our PCPs and all of our specialists.

Since we have moved to ME, our new plan required us to get new PCPs (no problem). But I was glad to see that I could retain my oncologist. I'm very pleased about that.

 

[zinger1457]

And btw when I had ACL surgery a few years ago I had the same surgeon that operates on the knees of the sports teams for the local major ACC university. So ACA does not (necessarily) imply Medicaid level medical care. Heck, I'm not sure Medcaid even implies that anymore from what I hear, but I have no experience with that.

My guess is that the insurer has a set rate that they will pay for a specific service, doubt they care if it's a well known surgeon or some unknown, just as long as the surgeon is willing to accept the insurers negotiated rate.

 

[kbst]

I’m 59. I’ve been retired for 9 years. I pay ~$1000 a month through my wife’s plan at Suntrust. It’s a high deductible plan that pays nothing for the first $1500 and 80% after that with a annual payout of $3000 as long as you stay in network. Otherwise it’s $6000.

 

[Miarocks]

I pay $672/month with a $275 deductible through my employer-provided retiree insurance (BCBS PPO). I’ve been paying that for 4 years (retired at 55), and in one more year (at age 60), said employer (school district) will pay the premium for five years until I’m 65 and eligible for Medicare. DH is 7 years my senior, worked for same employer, retired 2 years ago at 64... so his premiums were paid by the district for 1 year, until MC eligibility. Combined OOP expenses (after premiums) have been about $1500- 2500/year.

 

[triangle]

There a popular Clint Eastwood film where he says something like "Do you feel lucky? ...well do ya?"

Meaning carry no insurance, essentially pocketing the insurance premium costs and rolling those dollars forward as part of your own self-insurance plan. Yes it is foolish, but given the high premiums and high deductibles before the first dollar of insurance coverage is paid out it is most tempting. Especially if you travel a lot making the coverage less valuable and the yearly reset arrives after fewer days pass while in your coverage area.

As a side comment, now I understand those news stories of people signing up for ACA and stop paying the premiums before the year ends...why bother if Christmas is near and the high deductible is likely out of reach for the calendar year.

 

[joeea]

There a popular Clint Eastwood film where he says something like "Do you feel lucky? ...well do ya?"

Meaning carry no insurance, essentially pocketing the insurance premium costs and rolling those dollars forward as part of your own self-insurance plan. Yes it is foolish

Yes, it most certainly is.

Calling that a "self-insurance plan" is quite a stretch.

 

[marko]

Until I got on Medicare 2 years ago we were paying full freight of about ~$2.5K a month with a $3K deductible for BCBS.

Now it's the same plan but only for DW who pays $1200 a month; she has another 3 years before Medicare but that will be mitigated--and then some--by her SS which will start one year from this month.

What was interesting was that we originally were paying via her COBRA thinking we were getting a deal. Once COBRA expired we ended up paying about $20 a month more; her former company was apparently doing nothing as far as getting a deal.

 

[DawgMan]

Having been self-employed for my career, shopping healthcare annually has unfortunately become part of my job description. Having raised 4 kids (last one just graduated and hope to have fully employed/insured soon!), I am expecting my healthcare analysis to get a little simpler. To me, its about making a business decision and evaluating the risks/rewards. Barring the major catastrophes (i.e cancer), I feel like I have enough experience where I can guesstimate my annual out of pocket costs for my different healthcare buckets (i.e. dental, prescription drugs, checkups) and then also plan for the annual unknown expense (i.e. tooth implant, knee surgery, physical therapy). DW and I are both 55 and in good overall health with are biggest issues being related to old sports injuries. I hit a wall almost 2 years ago when my ACA plan as it not only became ridiculously expensive (no subsidy due to income level), but had none of our desired doctors. I did my research and decided to try a health share ministry plan. So far, I couldn't be happier with the plan and have saved over $18K/yr in premiums alone! Additionally, I can go to any doctor/health facility I choose without needing a referral! I have had 2 "claims" so far (knee injections for an old ACL injury and a broken foot) that totaled approximately $12K - $15K in costs and I paid essentially zero out of pocket after reimbursements. I am fortunate that I have significant resources to cover out of pockets which weighs into my risk/reward analysis, but I also can look back and say I am over $18K ahead after 1 year on the plan.

As the rules and options continue to change, I will continue this strategy of doing an annual assessment as before in hopes this bridges the gap until 65. From what I have read, if the SHTF and I came down with a ridiculously expensive condition and my health share plan just didn't provide the expected coverage (no reason to believe that yet), I could bail and go back on ACA, even at the higher premiums as that might be the better business decision at that time.

No one size fits all, but that's my plan (and has been my plan for 31 years) and until I find a better mousetrap, will run accordingly.

 

[Aerides]

Understanding cost is important.

My question to those on ACA - are you happy with the choice of physicians/specialists?

When I looked at plans in our state that was the issue I saw. None of the doctors we have seen over the past decade accepted any of the plans.

We went on our first ACA plan this year. A bronze Hi/HSA plan with Florida Blue. Premiums for 2 about $420 pm, w/6500 each deductible. Yes, we had to change our docs, but had a wide range of choices. We chose a new PCP as part of a group associated with a university.

Dh met w/new PCP early in the year. She was more proactive than his old PCP and immediately zero'd in on a test that the old PCP had been going "eh, probably fine." Had him to some specialists. Turned it wasn't fine, but it was easily resolved. Had we continued going "eh" then in another year or two it would have been a much bigger issue.

Sometimes getting a new doc isn't a bad thing.

 

[joeea]

What was interesting was that we originally were paying via her COBRA thinking we were getting a deal. Once COBRA expired we ended up paying about $20 a month more; her former company was apparently doing nothing as far as getting a deal.

Why did you think COBRA would be more than a $20 deal?

I've paid less on ACA plans than I did when I was an employee. COBRA (since you pay both sides plus an administrative fee) was more than twice that amount.

 

[bada bing]

I'm not much of a data point, but here's my plan. My mega-corp employer is self-insured, with claims handled by Aetna. They allow retirees to stay on the same plans available to active employees for their cost. The HDHP/HSA I'm on now as an active employee will be available to me for $8K per year as a single. I am planning on using that, as I won't qualify for ACA subsidies. The plan is 100% coverage with no network requirement, drugs, dental, vision with $2K annual deductible and a good zero expense HSA available.

I haven't done extensive research yet, but the little bit I have done leads me to believe it's a better than open-market deal for a plan that fits my needs.

 

[johnhkc]

Please share. Anyone between retirement and age 65 your paid out of pocket HC experiences. I am not interested in the provided HC stories. Good for you. I am interested in learning who is doing what and how much it costs annually to cover you and you spouse. Sorry is this is redundant but I have searched back a ways and have not found this discussion. Thanks for any and all information shared.

I'm single, male, age 51. I use Golden Rule HSA Saver. Grandfathered under [mod edit ACA ]. $417 per month minus ~$100 tax rebate on the HSA part. Premiums tax deductible through my LLC so final cost is about $190 per month. Deductible is $5K. PPO. Nationwide coverage and no networks - skinny or otherwise. Unlimited lifetime max coverage. Includes prescriptions, too.

Out of pocket 2015 was 781.15, 2016 was 854.07, 2018 was 888.58, 2019 so far is 695.01. I have type 2 diabetes so it's gone up a little.

These OOP numbers include dental expenses which are not covered under medical insurance but the spreadsheet I use for budgeting doesn't separate medical vs dental and I'm too lazy to do it now. Probably subtract about $150 per year for the dental stuff.

I also use Christian Health Ministries Silver plan. It costs $101 per month. $1K unshared per incident. Incident max sharing is $525,000. Ministry plans pay bills exceeding the unshared amount but count discounts toward that amount so basically I owe nothing for any incident above $1,000. CHM is also federal tax deductible and in Missouri at the state level, too. So that's another $30-ish/month off.

Dental insurance is $22.98 per month, $1500 max benefit per year, 50 - 80% discounts on covered procedures. The name of the plan is AlwaysCare. It's a company in Louisiana. Don't remember the company name.

 

[johnhkc]

There a popular Clint Eastwood film where he says something like "Do you feel lucky? ...well do ya?"

Meaning carry no insurance, essentially pocketing the insurance premium costs and rolling those dollars forward as part of your own self-insurance plan. Yes it is foolish, but given the high premiums and high deductibles before the first dollar of insurance coverage is paid out it is most tempting. Especially if you travel a lot making the coverage less valuable and the yearly reset arrives after fewer days pass while in your coverage area.

As a side comment, now I understand those news stories of people signing up for ACA and stop paying the premiums before the year ends...why bother if Christmas is near and the high deductible is likely out of reach for the calendar year.

What you could do is save like crazy into 401k/HSA/Roth, etc. Use CHM Gold plan at $162 per month to "share" most health expenses with your savings as a backup. Now you've self-insured the bits and pieces that the ministry plan won't share without paying out the a**. Ministry plans have no networks so no surprise bills.

Also, for any expense that is not share-able, CHM has the Prayer Page where members voluntarily chip in to pay your remaining bills. Every month, the 400,000 members collectively contribute millions of dollars to pay the remaining bills of other members. The amount wobbles over time but typically a contribution of $11 per month pays off any expenses that aren't shareable under the main CHM plans.