Insurance the final frontier...These are the voyages from ER to Medicare

[Luck_Club]

WOO HOO! I ran my numbers, know when the reinforcements arrive, have my one more year planned, sketched out my travel, but insurance is a wet blanket.

DW & I will be 53 and 52 when we FIRE her insurance. We will still have kids in college, and plan to travel enough to be out of network more than in network, so not sure if that is important or not. I come up with about $1-2k per month, depending on national or local plan. However, there are so many options and comparison it is extremely difficult to decipher.

Assuming good health reasonable sick visits and preventative care visits, what should we be looking for. Or more accurately what have you found to be most cost effective and successful. I think in total my medical bills for the past 30 years have been a bit over $30K. But the one emergency issue racked up most of the $30K.

Is there a simple $25 co pay for 2-5 office visits, and if you get something really bad or go more than that it is just a 20% co pay up to $2K-$5K for like $6K or is that wishful thinking? Has anyone used a creative group or association to get the rates down? IE member of chamber of commerce.

We wish we had retiree benefits, but we don't, and they aren't available.

 

[athena53]

Good luck with that. The picture is changing as we speak. I've bought insurance on my own since retiring in May, 2014 and qualify for Medicare early next year. Every year it's gotten worse; my 2016 premiums were $641 per month and this year they're $776 with the same deductible ($6,000) and a crappier network. Every renewal they try to sneak in policies with zero out-of-network coverage. I live in MO- every state is different. In theory, if you travel, they do cover out-of-network charges for emergencies away form home but I'm always wary that the insurer will decide retrospectively that it was not an emergency and you should have waited till you got home. For international travel I buy travel policies with good primary medical coverage.

My guess is that even if you find something with small copays on doctor visits it will be very expensive. Like you, I'm blessed with very good health and have had only a few Doc In the Box visits, all of which fell under the deductible, and the recommended preventative care, which is 100% covered. All Obamacare policies must cover preventative testing.

I wish you well- for me that would be the scariest part of ER right now.

 

[shortstop14]

Every renewal they try to sneak in policies with zero out-of-network coverage. I live in MO- every state is different. In theory, if you travel, they do cover out-of-network charges for emergencies away form home but I'm always wary that the insurer will decide retrospectively that it was not an emergency and you should have waited till you got home.

I sure agree with this. Same policy, different years - but all of a sudden out-of-network charges at urgent care places isn't covered - it has to be at an emergency room. Fortunately the urgent care charges were only in the $300 range, so the lesson in reading the fine print wasn't too expensive. I'm concerned that if something serious like a car accident happens, they'll find that tests and other aspects of treatment aren't 'emergency' enough.

We've kept our income purposefully low so we can get a subsidized ACA plan. It limits the amount of Roth conversions and 0% capital gains I can do, but it saves over $1000 a month in premiums. We're probably living on borrowed time with this, but it works for this year.

This is the biggest financial variable in our ER - still five more years before Medicare for both of us.

 

[GTFan]

My problem isn't keeping income low to max out subsidies and CSRs (saves me over $1k a month too), it's seeing all the insurers leave the market which means we have to keep switching plans and possibly providers.

I think things will continue to get worse with the exchanges until some breaking point is reached. Won't be 2018 but might not be much longer than that. And yeah we have 10-12 years to go until Medicare too, so it's a big concern for us.

 

[shortstop14]

Fortunately in our case, we've got a punt position if the ACA implodes or gets legislated out of existence. My wife retained her eligibility to purchase insurance through her state teachers' retirement - current cost is $1400 per month and climbing, but at least it's an available option. Might cause us to dial back our travel expenditures a bit to keep our withdrawal rate reasonable, but we can live with that.

It's definitely a concern as we bridge the gap to Medicare. Given our low level of actual medical expenses, it would be ideal if some company offered a high deductible plan for a reasonable premium - but it's not currently available. Our medical expenses are kind of lumpy, given my apparently every-five-years orthopedic surgery costs due to sports injuries.

 

[MichaelB]

Just a couple of thoughts. The average premium for an employer provided high deductible plan is $6,024 (yearly) for 2017. The source is the KFF 2017 Employer Benefits Survey (here). There is no age based pricing here. So, for an individual policy, add 20% for overhead, and multiply by two for age rating. Total cost is $1K per month, with a high deductible.

If you find comprehensive coverage that costs less, you really need to identify why. Lower prices the result of some policy limitation.

Another thing to keep in mind is that health care providers are now billing using reference or list prices that are unreal, 2-10 times higher than the actual price they have negotiated with insurers. Individuals are usually not in a position to negotiate these rates. If your health care need is not urgent or immediate, you may be in a position to wait, look for options, and negotiate. Maybe even go abroad for care. This "system" has been set up to discourage people from not having insurance, though, and it severely punishes those caught exposed. One unplanned encounter with a hospital can bankrupt a retirement plan.

The only way to not have high future health care costs over time is to avoid using the US health care system.

 

[GTFan]

Wow I guess it still pays to be working for a MegaCorp then - the current Silver level premium is still less than $300/mo. for a family at my former employer. And that's for way better national PPO insurance than you can get on the exchange here (almost all of it is local HMO-only stuff). Yeah, it's heavily subsidized in other words - full-cost retiree Bronze policies are over $1k/mo. for two.

It's a real shame that insurance market equalization among employed and non-employed was never a serious part of reform. That's probably the biggest obstacle to fixing the group-related issues in the individual market, and insurance will continue to tie people down to jobs they may not want.

 

[Luck_Club]

From what I understand the employer sponsored plans are very expensive. even though the employee's piece may be small. I've known several small to large employers, and they all said the same thing used to be about $1K per month. Now my wife's company's fully burdened cost is $21K.

 

[easysurfer]

Being healthy for the most part, but years away from Medicare, I'm depending on my HSA funds as the bridge between now and Medicare. The high deductible and climbing premiums, I just consider as the sign of the times. Really kind out of my control.

 

[wmc1000]

I have to admit I was too cheap to retire at 60 because I didn't want to pay $21K per year for HI even though we could have afforded it. Didn't have the confidence that subsidies would stay around for 5 years back in 2013

Fortunately I was able to reduce work hours to 30 per week for 3 years until I pulled the plug this past Jan. as I was confident that we could qualify for subsidies and CSR's for the period until we were eligible for Medicare. DW did have surgery in 2015 that could have cost us the $6500 OOP max if I had been retired then.