Health Insurance Premiums when FiRED, Pre Medicare, How Much do you Pay?

[ShokWaveRider]

I got to thinking that most FiRED folk have to pay some kind of Self Funded HealthCare Insurance Premiums. It may be fully private, or ACA.

This post is is aimed at those of us caught in the "Donut Hole" between Early Retirement and Medicare Eligibility (Whatever Age to 65).

Things have changed a little with the ACA and Mandatory coverage for Pre-Existing conditions, no extra cost for certain diagnostics etc. So I thought it would be useful to get a cross section of numbers to compare.

This would not apply to our honorable Veterans who get the well earned VA care, or those who have a fully or partially funded Healthcare package from their Previous Employers Etc. Only those who have to bear the healthcare burden themselves.

I will start with what I consider to be the important information and numbers for 2016, please advise if I missed something important.
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2 People Married, Non Smokers, one with pre-existing conditions. All numbers for in plan services, all doctors we use were covered.

Male: 62
Female: 57

Monthly Premium for both of us together: $1,360.11 ($341 After ACA subsidy)

GP Office Visit CP: $5
Specialist CP: $25

Co-Insurance: 30% of Certain Services (Plan Pays 70%)
Max OOP Single: $2,250
Max OOP Family: $4,500

State: Florida
Coverage: All States in USA (Emergencies)

Travel Insurance: Extra as needed

 

[ZMAN]

I am on Medicare. DW is not yet.

She pays $8000 per year for a high deductible plan in Western NY. Good carrier and good network. Looking forward to Medicare for her.

I use Traditional Medicare with Part F Plan F through United Healthcare. Zero copay and zero deductible and Silver Scripts for Part D. I got 100% surcharged for income in year one so cost is around $6000 per year. So far so good.

 

[pb4uski]

Actually, SWR, yours is a good example of why we will hold off changing our residence to Florida even though we recently bought a condo down there and plan to spend almost 6 months a year down there. I priced out premiums for a plan similar to ours and it was about $1,500 a month (we are both 60). Here, we pay about $460/month (for two) for a catastrophic HDHP and a non-cat plan would be ~$800/month. A good part of the reason for the difference is that our state does not age-rate health insurance premiums.

So if we changed residence to FL our health insurance would be ~$12k a year higher, much less than any income tax savings we would have.

 

[Big_Hitter]

Is it higher in FL due to malpractice costs or is it related to pooling?

 

[scrabbler1]

I am in an ACA Silver plan here in New York. My premium is $442 per month, but a federal subsidy of $39 per month knocks it down to $403 per month. My copays are $50 for specialists and $0 for my PCP. I had some extra stuff done by one specialist so that visit cost more. I pay $0 for lab work and $0 for my prescription drugs, one of which is pretty costly otherwise. I had some PT done last month which cost me $35 per visit. My annual deductible is $5,900 which I won't get near this year, as long as I stay out of the hospital (I was hospitalized for 12 days in 2015).


My premium is going to rise something like 13% in 2017. That's nothing like what I had in 2009-2011 (pre-ACA) when my premiums rose 50% in 2 years, pushing it from $469 to nearly $700 per month! I ditched that plan and was underinsured for 2 years before the ACA's exchanges came in in 2014.

 

[rodi]

Mine is a bit different since there are kids involved. I'll break it down though.

All ACA plans purchased through CoveredCA.com (California exchange)

DH - male age 64, HDHP with HSA. Sharp HMO
Deductible = 6000; OOP max = 6500; monthly premium = $572

Me - female, age 54 (turning 55 this year), HDHP with HSA. Kaiser Permanente HMO
Indiv. deductible = 4500; Family Deductible =9000;
Ind OOP max = 6500;Family OOP max = 13000;
monthly premium = $408.14

Kids (2) - under 18, HDHP with HSA, Kaiser Permanente HMO.
Indiv. deductible = 4500; Family Deductible =9000;
Ind OOP max = 6500;Family OOP max = 13000;
Monthly premium = 243 (both combined)

DH didn't want to be on Kaiser Permanente anymore - which messed us up on the deductible thing...

All of these are FULL premiums, with no ACA adjustment. This is because CoveredCA did not support having families on 2 different plans and having premium assistance up front. It all works out - we get the premium tax credits when we file our federal taxes.

Next year DH goes on medicare - and even with a fancy plan F we'll save some $$.

 

[athena53]

I'm a 63- year old female in the Kansas City area and I have a non-exchange plan with BCBS for $640/month. That's with a deductible of $5,000 and a 20% co-pay on out of network charges. Since my medical care is rarely anything but preventative, I'm not sure what happens after I meet the deductible; I hope never to go there. Looking forward to Medicare!

 

[ivinsfan]

Mine is a bit different since there are kids involved. I'll break it down though.

All ACA plans purchased through CoveredCA.com (California exchange)

DH - male age 64, HDHP with HSA. Sharp HMO
Deductible = 6000; OOP max = 6500; monthly premium = $572

Me - female, age 54 (turning 55 this year), HDHP with HSA. Kaiser Permanente HMO
Indiv. deductible = 4500; Family Deductible =9000;
Ind OOP max = 6500;Family OOP max = 13000;
monthly premium = $408.14

Kids (2) - under 18, HDHP with HSA, Kaiser Permanente HMO.
Indiv. deductible = 4500; Family Deductible =9000;
Ind OOP max = 6500;Family OOP max = 13000;
Monthly premium = 243 (both combined)

DH didn't want to be on Kaiser Permanente anymore - which messed us up on the deductible thing...

All of these are FULL premiums, with no ACA adjustment. This is because CoveredCA did not support having families on 2 different plans and having premium assistance up front. It all works out - we get the premium tax credits when we file our federal taxes.

Next year DH goes on medicare - and even with a fancy plan F we'll save some $$.

So this isn't your net cost, or is this the ACA cost?

 

[rodi]

So this isn't your net cost, or is this the ACA cost?

That is the cost pre-ACA tax credits. I will get back $8880 in premium tax credit (or 740/month) when I file my taxes.

I'm not sure how it would break down between the Kaiser and Sharp plans since CoveredCA doesn't allow this splitting family among plans.

Net premiums (for entire family) would be $483.14/month rather than $1223.14/month.

 

[ShokWaveRider]

One point I should probably make perfectly clear is the number I use for my monthly premium is EXCLUDING any tax credits. As a lot of us can control what our income is for any given year (I can control ours) I figured everyone's subsidy would be a different percentage of the total.


I am also curious why some states are so much cheaper than others.

 

[RobbieB]

Single man, 61, Kaiser bronze high deductable HSA plan, northern CA

$538/mo, direct from Kaiser, no subsidy.

 

[CyclingInvestor]

$750 per month for ACA Platinum plan in SCal for 58yo male.

No subsidy (due to 72t withdrawals).

 

[H2ODude]

Not an option for most, but last employer allowed continuation of insurance at full cost. For me and DW (any age, but this lasted from 60-65) it started at $1200 a month and just as we went on MC this spring it jumped to over $1300 a month. It was good insurance, I think $2500 deductible, $20 copay. It was a local government self insured plan, and I had confidence in their coverage even though we hardly used it. I took a brief look at ACA when it came out in NC but it wouldn't have saved us much if anything and I didn't dare trust a plan I had no knowledge of.

FWIW all in our coverages w MC, medigap, and drug plan is running about half that. We have used it (just had my eyelids lifted so I can SEE!) a few times and I'm stunned that A) MC sends us a paper bill every three months, each of us, and takes Amex (which it takes them 30 days to process)and B) they send a detailed multipage envelope anytime we use it...as does the medigap. Neither medigap or drug plan would take CC.

 

[ivinsfan]

One point I should probably make perfectly clear is the number I use for my monthly premium is EXCLUDING any tax credits. As a lot of us can control what our income is for any given year (I can control ours) I figured everyone's subsidy would be a different percentage of the total.


I am also curious why some states are so much cheaper than others.

Understood,yet I am more interested in what people actually pay, in reality those of us who are 100% self pay generally gravitate to a HD plan, not really the plan we'd prefer to have. ACA will give you a chance as lowering your OOP expenses. So we don't know if some of these numbers are real world or not.

I guess the words "self funded" threw me off...if you get a larger tax refund something isn't really self funded.

 

[ShokWaveRider]

Understood,yet I am more interested in what people actually pay, in reality those of us who are 100% self pay generally gravitate to a HD plan, not really the plan we'd prefer to have. ACA will give you a chance as lowering your OFP expenses. So we don't know if some of these numbers are real world or not.

I guess the words "self funded" threw me off...if you get a larger tax refund something isn't really self funded.

OK, I will post both before and after subsidies in my original post. Go back and take a look.

In addition a few of the folk posting are not really giving all the info either. If they can also change theirs it would be helpful.

 

[rodi]

For total expenses - I can give you last year and this year (to date) for OOP/deductible.

Last year medical bills/prescriptions/etc - $8980.82
This year (to date) - $2943.55

I'm hoping last year was the outlier.... but I have set aside funds for full max OOP, just in case.

 

[rodi]

To be super complete - should we post the tax benefit we receive from HSA accounts?

 

[ShokWaveRider]

To be super complete - should we post the tax benefit we receive from HSA accounts?

I think this is fine. Thanks you. Seems like ACA has been good to you.

 

[Teacher Terry]

I retired from the state and they subside our plan a little but I still pay 900/month for the 2 of us which is really high. However, we have co-pays only instead of a deductible. The ACA here has high deductible plans for about the same price at our ages 62 & 57. I am looking forward to medicare for myself. At that point we will take him off of my insurance and go with the ACA because they would still charge 700/month just for him if I am off which is more then I am paying for him now. I am sure that will be even higher in 3 years.

 

[sheehs1]

61 year old female (will turn 62 next April). Live in Virginia. Private policy (off exchange. Since I don't qualify for a subsidy no reason to do the exchange. Quoted plan prices are basically the same, on or off exchange in my state).

Bronze level BCBS plan with HSA. My premium is $579/mth, $6,000 deductible, $6550 Max Out of Pocket (family Max Out of Pocket is $13,100 but does not apply to me).
15% coinsurance
No subsidy
RX Tier 1, 2, 3, 4 = 15%

The HSA piece of this saves me about $1,000 in taxes in my bracket if I do a straight line calculation of my effective tax rate X the HSA contribution.

I opted for a Bronze plan since I don't have to go to the doctor often (no medications, no conditions that need monitoring, etc.). When I do go, I have to pay all charges until I meet the $6,000 deductible (non preventive office visit = $71.00)

Since ACA started and during last 2 years since I started this plan, I am money ahead, having chose Bronze. Every year that goes by the closer I am to Medicare (cross fingers).

It all depends on one's health status I suppose and how often one thinks they will use it. The good thing (for now) is that it can be changed yearly or with a qualifying event.

 

[serie1926]

This is insane! My wife and plan to retire at 55, end of 2017, and will need purchase insurance on the open market.

There has to be a better way than $12k/yr?

On a similar topic. Did anyone catch this mornings episode of "On the Money"? There was a story about Blink Health (https://www.blinkhealth.com). Appears quite impressive what the 2 brothers have built to lower prescription meds.

 

[ShokWaveRider]

This is insane! My wife and plan to retire at 55, end of 2017, and will need purchase insurance on the open market.
There has to be a better way than $12k/yr?

There is but no one wants to fix it. Modify ACA add a single payer option and go. More effort seems to be going into repealing ACA other than fixing it. That is certainly insane.

My family could not have Er'd without the ACA that is for sure. Still very expensive but manageable.

It can cost more to buy health insurance than to rent a condo in Canada and never live in it simply to get health care. For those of Xpats with dual citizenship who can do so. Who do not like the cold.....

 

[ivinsfan]

There is but no one wants to fix it. Modify ACA add a single payer option and go. More effort seems to be going into repealing ACA other than fixing it. That is certainly insane.

My family could not have Er'd without the ACA that is for sure. Still very expensive but manageable.

It can cost more to buy health insurance than to rent a condo in Canada and never live in it simply to get health care. For those of Xpats with dual citizenship who can do so. Who do not like the cold.....

You really think that 175 bucks a month per person is VERY expensive and with a lower OOP costs then most people on self pay? What do think would be a "fair" price?

 

[ShokWaveRider]

You really think that 175 bucks a month per person is VERY expensive and with a lower OOP costs then most people on self pay? What do think would be a "fair" price?

I meant WITHOUT ACA. Ours would be unaffordable with Pre-existing conditions. Worse, we were told we were uninsurable before ACA. (While one of us was working)

 

[Winemaker]

DW an I recently paid $18,640.46 to DW's old employer for 12 month. It was the same insurance plan we had while she worked; the above includes dental and eye care. Her health care premium is discounted(?) and we pay $10 for office visit, no co-pay. We are both close to 60.