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Health Care For Early Retirees
Old 01-06-2015, 07:23 PM   #1
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Health Care For Early Retirees

My wife and I retired early last year (when I was 55). We know that healthcare costs are going to be the biggest financial expense that we will incur (at least until we are eligible for Medicare).

We are financially comfortable, but we are not wealthy; consequently, we can't afford to have concierge medical care. As such, we believe that we are stuck with the likes of Blue Shield, Anthem, etc. We have been using Blue Shield's PPO health insurance last year and this year. We have been quite displeased with the coverage.

For instance, we are not happy with the quality and knowledge of the personnel that we deal with on the phone; the quality and accuracy of information that we get on the website (i.e. inaccurate list of doctors on the plan, inaccurate pricing for drug costs, unexpected expenses for non-covered procedures).

We can't afford concierge service, we are dissatisfied with traditional coverage. Is there anything in between?

Thanks for any suggestions.

David
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Old 01-06-2015, 08:48 PM   #2
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We have bought our own health insurance for quite a while, something like 8 years. We have a PPO plan with Golden Rule, a subsidiary of United Health Care.

Our HSA policy has a $10K/year deductible, and for years we never made any claim. Of course, at that deductible, one must have a serious illness to make any claim. Then, 3 years in a row, my son (who is independent now) and I took turn to be sick and hospitalized. I needed some serious surgeries and treatments. The hospital and clinics worked with our insurance and we never had to talk with the insurance at all.

All the billings were sent to our insurer, and once we paid the first $10K which did not take long, they picked up the entire cost per our policy. We have never had a procedure recommended by our doctors being declined by the insurer. We simply continued to receive letters from our insurer saying that they were paying this much on our behalf. Some medicine given to me cost $3K a shot. By the way, out of curiosity, I checked on the Web and that was the going price across the US, and I also learned that Canada system would not pay for this medicine. The drug maker was Amgen, and darn, I should have bought stock of that company.

So, no concierge service for us, just a plain old PPO policy, and I have absolutely no complaint. I used to think that their premium was high, but not anymore after seeing how much we have cost them.
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Old 01-07-2015, 07:12 AM   #3
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I have used a Federal health benefits program PPO for decades and have been happy with it. I continue with it to supplement Medicare now that I am ancient. But the hassles that medical practices face and thus instill on their clients have increased over the years. I have always found doctors I like but often the staff are ineffective so making appointments can be a hassle, problems with changes in drug providers, paperwork, etc. Just yesterday I helped DD deal with lost medical claims at a UHC affiliated group under her work provided plan. Awful paperwork nightmare for out of network reimbursements. I think that is part of the US medical system and don't see it ending soon. Maybe technology can smooth out some of the hassles but those improvements take decades so I will probably never see them. I pity the staff working at any medical practice dealing with health insurers.
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Old 01-07-2015, 07:23 AM   #4
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Good article in this week's Time magazine (sorry no link) about an expanding practice in Washington State that has concierge type practice for about $100 a month. Sounds very promising. Claim is that eliminating the paperwork pays for time with patients - what a concept.
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Old 01-07-2015, 07:31 AM   #5
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Health care coverage really varies in availability and cost by State. You need to hear from folks from California. I've lived in Michigan and California and much prefer Michigan....cost and availability. On the other hand Obamacare has affected pricing, benefits and availabiity. I know my former mega corp saw costs go up this year and "cheap" programs have very, very high deductibles. So, I truly believe your answer is to talk to people from California so you can make a decision based on available choices......good luck, you're right, health care is expensive.
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Old 01-07-2015, 08:21 AM   #6
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Maybe you can arrange your income to qualify for ACA?

Buy any income investments in your 401k/IRA accounts, then any equity investments in after tax accounts. Make sure your only income is from dividends. This should drop your income. If you need money sell some shares.
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Old 01-07-2015, 08:48 AM   #7
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Originally Posted by travelover View Post
Good article in this week's Time magazine (sorry no link) about an expanding practice in Washington State that has concierge type practice for about $100 a month. Sounds very promising. Claim is that eliminating the paperwork pays for time with patients - what a concept.
This?

Better Healthcare for Less Money: Medicine Gets Personal

http://qliance.com
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Old 01-07-2015, 09:21 AM   #8
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Thank you all for your comments... most appreciated. Please allow me to clarify my frustrations and concerns. What I am really looking for is high quality information and competent personnel. I just posted the following on another website which hopefully explains my frustrations:

My comment regarding concierge service is based upon my experiences with my health insurance company. I have been dissatisfied with several aspects. Here are a few examples:

  • Searching For Providers on Plan: I have searched the listing of providers and facilities to see if the doctor and facility that I would like to use are on the plan.
    • Doctor #1: It looks like my doctor isn't on the plan. I contacted my doctor, spoke with tomeone from the front office. They indicated that the doctor isn't taking patients whose insurance is individual-based; they only want to take on those who have group health insurance. This isn't an issue that I have with the plan, but with the doctor and their office. Why would the doctor care if I have Blue Shield group or Blue Shield indiviudal; I would think that their costs would be covered, regardless. Perhaps, they get better pricing via group plans? I have been going to this doctor for years (under other insurance); I asked the front office person to pass along to the doctor my concerns and my request to have my current insurance accepted. I suspect the front office employee will not pass along this information to the provider. Ideally, a (conceriege) insurance provider would step in and discuss this issue with the provider.
    • Doctor #2: In searching for an alternative doctor, I reviewed the list of providers on the plan. After finding three that I thought looked like reasonable alternatives, I contacted them only to find out that they were specialists dealing and therefore not appropriate. Clearly they had dealt with this issue in the past as they proactively indicated that perhaps the health insurance provider's list was inaccurate. Firstly, to me, this is no way to select a provider. I would want to sleect a provider via professional and personal recomendations and then have the providers vetted through further research on the internet. Selecting a provider from a list is a crap shoot. Ideally, a conceriege would have done research and be able to make proper recommendations to me.
  • Drug Prices: The prices of the drugs on the insurnace company's website are rarely accurate. I would like to know what I am paying before I recveive the bill. I am paying a considerable price for services, I don't want shoddy service; a website and telephone personnel who offer inaccurate pricing is unacceptable. If the cost that is quoted for a three month supply of XYZ is $29.50, I shouldn't be charged $150.00. The use of the word concierge here is really a requested for better quality service and information being provided.
  • Facility: I could not find the facility that I wanted to use on the insurance comapny's list of providers. They are the biggest player in the area; they seem to take all insurance comapnies coverage. After not finding them on the website (perhaps the name was slightly different?) I called and spoke to a representative who seemed clueless. He seemed to suggest that the facility wasn't on the plan. I called the facility and they gave me their NPI and their tax ID. I spoke with my insurance comapny and provided this information, again they suggested the facility wasn't on the plan. A third call to my insurance company resulted in the rep offering me services for an unrelated facility. A fourth call resulted in the answer that I expected, the facility is covered. After explaining to the rep that the facility was likely on their plan (even though they weren't listed), the rep proactively called the facility and confirmed that they accept this insurance company. I would want a conceirge to deal with all of that. If I wasn't diligent, I would not have determined that this facility was on the plan.
There are several more instances, but this message is already quite long and I think you get the idea. My largest complaint is that the information on the insurance company's website is inaccurate and that the individuals that I am forced to deal with at the insruance company and at the providers offices appear to be not as competent as I would hope that they would be. I want high quality services for the prices that I am paying: accurate and easy-to-navigate information; quality personnel.

I would expect that wealthy people would not deal with this; maybe they have their own team of people who deal with this for them or maybe they have some sort of conceriege comapny that deals with this for them. Short of having a team of people to deal with this for me, it appears to me that I (and perhaps many of you) are stuck having to muddle through.
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Old 01-07-2015, 09:40 AM   #9
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I think the Blues all are free to pick their own IT stack at least parts of it. The search on the Blue I use is buggy. You must reenter the plan on each search or it goes across all plans. Not sure if that's causing some of your issues.

As far as drug prices I'd be talking with Blue, there's a name for quoting one price and charging another.

I have to say my experience with a different Blue is much different than yours. Have you asked a broker if they can help?

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Old 01-07-2015, 09:48 AM   #10
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I think the Blues all are free to pick their own IT stack at least parts of it. The search on the Blue I use is buggy. You must reenter the plan on each search or it goes across all plans. Not sure if that's causing some of your issues.

As far as drug prices I'd be talking with Blue, there's a name for quoting one price and charging another.

I have to say my experience with a different Blue is much different than yours. Have you asked a broker if they can help?

Sent from my SAMSUNG-SGH-I337 using Early Retirement Forum mobile app

I did notice that the coverage and information might differ from specific plan to plan. I was still getting inaccurate information even after I confirmed that I was getting data for my specific plan.

I'm happy to hear that you are having better luck than me with "the Blues".

Regarding the drug pricing, I have spoken with BS on several occasions; I pointed it out to the pharmacy personnel and they agreed "it was a problem" -- but that was months ago and it appears that the problems have not been corrected.

I hate to bombard my broker with too many questions; he is primarily a group plan broker (he was my broker I was working) and essentially works with me as a professional courtesy. As such, I hate to bombard him. That said, I will ask his opinion in a few weeks (after open enrollment ends and he has more time to talk).
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Old 01-07-2015, 09:57 AM   #11
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Originally Posted by DoWright View Post
Thank you all for your comments... most appreciated. Please allow me to clarify my frustrations and concerns. What I am really looking for is high quality information and competent personnel. I just posted the following on another website which hopefully explains my frustrations:

My comment regarding concierge service is based upon my experiences with my health insurance company. I have been dissatisfied with several aspects. Here are a few examples:

Would concierge service help with the issues you listed? I thought concierge service is mainly to allow better access and more time with a dedicated general physician. I assume that all other healthcare interactions (e.g. prescriptions, finding specialists, billing for anything else, etc) would still have to go through your insurance.

I could be totally wrong about concierge service if so please correct me.
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Old 01-07-2015, 10:05 AM   #12
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I would like to know what I am paying before I recveive the bill.
This. No where else in my life to I accept goods and services without knowing the price in advance or price shopping.

I also have grown to distrust medical advice on services needed. There is a conflict of interest in the way our system is set up. Medical practices make money off goods and services.

I can think of several cases where I or a family member was encouraged to under go procedures that more than likely would have only benefited the practice. For example, when my Father was 93 a dentist told my Mom he needed two teeth pulled and a bridge put in. And, when my Aunt was in very late stages of congestive heart failure, a cardiologist wanted to perform a procedure under anesthesia to do a test of her heart. The test would not have increased her life span or the quality of her life.

Our medical system is a huge broken mess.
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Old 01-07-2015, 10:33 AM   #13
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Would concierge service help with the issues you listed? I thought concierge service is mainly to allow better access and more time with a dedicated general physician. I assume that all other healthcare interactions (e.g. prescriptions, finding specialists, billing for anything else, etc) would still have to go through your insurance.

I could be totally wrong about concierge service if so please correct me.
+1. No concierge service for me, but I have the same impression as you have.

Regarding my experience with my insurance and service providers, as I mentioned earlier, my experience was positive. However, I need to clarify some issues.

When I chose a specialist or clinic, all I asked them was whether they accepted my insurance, and so far they all did. The providers then called the insurance and worked with them and I never once had to talk to or call my insurance. After the service, I usually received a letter from the insurance telling me how much they paid for the service. I usually did not know before hand how much something cost, although I usually went on the Web and researched out of curiosity. The letters from my insurance usually came as early as 3 weeks after the service. They paid fairly promptly, hence perhaps providers like them. That's just a guess.

When I knew before hand what something cost, it was mainly because of my $10K deductible. When the providers found out about my high deductible, they wanted to be paid upfront. Once I exceeded the $10K, the insurance paid 100% but my wife still kept track of the billing out of curiosity, plus we wanted to see if there was any mischarge.

About drugs, I needed no ongoing expensive medicine, hence did not have to research drug costs. The expensive drugs that I received were administered for acute care, so did not fall under the prescription drugs that one buys at a pharmacy.

For 2015, I have switched to ACA to lower the cost some, but stayed with United Health Care, the parent company of Golden Rule that we were happy with. I hope I will not regret making the switch. Being stingy can often hurt you.

Golden Rule still offers the existing policies as grand-fathered pre-ACA plans, but they most likely will not take me back now that I have pre-existing conditions.

PS. I read that United Health Care withdrew from private insurance market in California in 2014, and only offered group insurance in this state. I looked into ACA last year, but my state does not have its own ACA market and from reading what posters here talked about the Fed Web site, I did not even bother to try. United Health Care did not offer ACA plans in my state in 2014, but they do this year. So, I made the jump. I surely hope I will not kick myself for doing this.
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Old 01-07-2015, 11:26 AM   #14
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Southern Californian here.

This probably won't work for your situation - since you have doctors that you prefer, already... but Kaiser Permanente is the largest insurer in So. Ca. They have something like 40% of the market.

I just switched to a high deductible plan at Kaiser with the new year for myself and my 2 kids. My son has an appt later this month... I was able to use their online "estimator" and was pleased to get that info. We'll see at the appt. how accurate it is.

My husband just switched to a Sharp Healthcare plan... but he hasn't used it yet so no idea yet on their ability to estimate payments, estimate prescription costs, etc. I didn't switch with him because I like the simplicity of KP and have a primary I like, and I like the kids' pediatrician.
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