Looking for Health insurance advice

[freetodream]

We are trying to decide which direction to go with health insurance. We are both presently on the same high cost/low deductible plan that runs about $1300/month for my wife & $500/month for me. We can both stay on this plan until we are both 65. I am OK with my monthly cost and plan to stay on the plan until Medicare @65. We have (low key) pre-existing conditions but are healthy.

We could save about $800/month by switching to a state plan under ACA for 2018 for her after the federal subsidy is subtracted from costs based on our fixed income. If either of us drops our present group plan, the rules/policy say you can't get back on the plan. She still has several years before she reaches 65 medicare age.

It looks like 2018 is a safe bet using ACA; after that who knows. What happens to the pre-existing portion of the law remains extremely important to me/many & we presently don't know the future of that topic. It remains quite painful to pay out $22000/year on our present policy for the next several years. It would be extremely painful is she drops of our policy, goes on ACA & the "pre-existing goes away after next year.

Should we take the risk and start on ACA for 2018? If your situation is similar to ours have you made that decision to switch to an ACA plan?

[pb4uski]

Wow... that is a tough dilemma. How lucky do you feel? Just kidding. Givien what may or may not happen with health care I don't know what I would do, but it seems you have already decided that the $22k a year is an acceptable price for freedom from work.

[ivinsfan]

People read a couple of things about preexisting conditions changes and naturally start to panic. Nothing I have seen anywhere leads me to believe that if you are continually enrolled in a ACA compliant plan you need to worry about being dropped from your insurance for pre-existing conditions. Even if your insurance company leaves the state you would be able to buy from another exchange company. Changes might be aimed at cherry pickers who only buy insurance after they have problem but even that hasn't been decided. That's my 2 cents anyway.

[MichaelB]

Quote:

Originally Posted by freetodream It looks like 2018 is a safe bet using ACA; after that who knows. What happens to the pre-existing portion of the law remains extremely important to me/many & we presently don't know the future of that topic. It remains quite painful to pay out $22000/year on our present policy for the next several years. It would be extremely painful is she drops of our policy, goes on ACA & the "pre-existing goes away after next year. Should we take the risk and start on ACA for 2018? If your situation is similar to ours have you made that decision to switch to an ACA plan?

A difficult choice. Can you afford to stay on the current policies until age 65?

Does that ACA policy have the same cost sharing (deductibles and total out of pocket) as her current plan? Keep in mind the ACA policy is priced on age, so the monthly premium will rise every year and the cost difference (vs the current plan) will decrease.

The option to drop the employer plan for an ACA exchange plan never goes away, so if you don't do it now you can at some future date. For that reason alone I would stick with the current plan, if affordable. At some point in the future, you will have greater certainty that comprehensive ACA will be available to you, or if not, a clearer idea of what your insurance coverage options are. Then your choice will be easier.

[ivinsfan]

Quote:

Originally Posted by MichaelB A difficult choice. Can you afford to stay on the current policies until age 65? Does that ACA policy have the same cost sharing (deductibles and total out of pocket) as her current plan? Keep in mind the ACA policy is priced on age, so the monthly premium will rise every year and the cost difference (vs the current plan) will decrease. The option to drop the employer plan for an ACA exchange plan never goes away, so if you don't do it now you can at some future date. For that reason alone I would stick with the current plan, if affordable. At some point in the future, you will have greater certainty that comprehensive ACA will be available to you, or if not, a clearer idea of what your insurance coverage options are. Then your choice will be easier.

True but the OP only has the companies word they can stay on the policy till 65...his question was really about pre-existing conditions. And with age and the same income subsidies as they are calculated now will continue to rise. He's leaving 10 grand give or take on the table with the company plan.

[joeea]

Quote:

Originally Posted by freetodream It looks like 2018 is a safe bet using ACA; after that who knows. What happens to the pre-existing portion of the law remains extremely important to me/many & we presently don't know the future of that topic. It remains quite painful to pay out $22000/year on our present policy for the next several years. It would be extremely painful is she drops of our policy, goes on ACA & the "pre-existing goes away after next year. Should we take the risk and start on ACA for 2018?

I would get on ACA for 2018. Then keep an eye on the changing laws.

It seems very unlikely to me that folks having continuous coverage would be left hanging due to pre-conditions, no matter how foolish the politics gets.

None of us know what 2019, 2020, etc will bring. So focus on what's best for 2018, bank the savings, then make sure you stay in contact with your congressional representatives and pressure them to do the right thing (whatever you think the right thing is).

[Another Reader]

If your employer plan offers the doctors and hospitals you would want to use in the event of a major illness, I would be inclined to stay on that plan. Check the plans offered under ACA to see if they offer your preferred doctors and hospitals. In general, the less expensive the plan, the narrower the network of providers. Many inexpensive ACA plans do not have the teaching hospitals or the other good hospitals on their provider list. Provider lists change every year. In an effort to keep premiums down, insurance companies can and will narrow their networks in future years. A PPO that offers you choices today may become an HMO offering you very limited alternatives next year or the year after.

I have no idea what the ACA or health insurance will look like in two years, much less however long it will be until your DW hits Medicare. For that reason, and because you don't know what ACA plans will be available in the future and what providers they will cover, I would stick with your employer's plan.

[Live And Learn]

I wish I had taken my retiree medical plan - even though it was $2k / month and more expensive than ACA. Look at your potential total cost between the two (premium plus out of pocket max) and see what the difference it. It may make it easier to swallow. Peace of mind is SO important during retirement.

[Likes_to_Lurk]

I retired 3 yrs ago at 60 and have been using my Megacorp retiree insurance. I am currently paying $760/month for a $1,750 deductible policy for just myself. Like the OP, I cannot opt back in if I drop out.

Before I took the plunge, I looked at ACA policies in NY where I live. The networks were terrible and there is no out of network coverage. I would not be comfortable with that situation.

FOR ME, paying the much higher retiree rates is worth the piece of mind. I had baked these rates into my retirement budget and knew that I could manage them for the 5 years until Medicare. YMMV.

[Aerides]

If you like what you have, and can afford it, and can't ever go back to it... you might want to wait until 2019.

What if ACA implodes or providers back out in your market? For me, ACA is available, and coverage is reasonable, but until the current atmosphere calms down and provides a long term direction, it does not provide peace of mind (which it sounds like is a feature of your current plan). Were I you, I'd wait and look again this time next year.

[JoeWras]

To the OP: agree with a few others to at least stick with Megacorp's plan for another year with the hope of more clarity by next year. Pre-existing conditions and ACA may result in more cost, but probably not access denial. But who knows? At least you know Megacorp's works for now.

I want to mention one important thing. I discovered that in my Megacorp's plan, I am considered "in the plan" even if I only take basic dental for about $30 per month. During open enrollment, I can join back in the medical plan (for about $800 per month, single) at any year. This was enlightening to me and gives me some options. Like most plans, once you are out, you are out forever. I didn't know that keeping just one aspect of the plan entitles me to the others during enrollment.

So, despite the dental plan not being very useful, the access to the medical during open enrollment is going to make it worth it -- as a backup.

This is all so tricky. I'm actually going to have to "lose" my regular insurance before DW so I can get on her plan, i.e. have a qualifying event. This means I'll retire before her, for at least a month. Getting on her plan makes sense because it is highly subsidized by her Kilocorp and is much more affordable.

And then the final insult in all of this: Megcorp has all these disclaimers right up front that they can drop the plan at any time. Wonderful. Another reason to treat it only as back up and use Kilocorp's plan. You would think Kilocorp, being smaller, would have less security than Megacorp. Not always true. Megacorp can be ruthless, whereas Kilocorp still treats their retirees with some respect. It could fail, but they won't just yank it away to save a few cents.

[VanWinkle]

My wife and I are both going on the ACA this year with 2 and 2.5 years to Medicare. My wife comes off an 18 month cobra, and I will drop my high price retirement Insurance to join her on the ACA. Next year we will work with what is available as the future is unknown to everyone at this time. My premiums would have been 24000 per year for both of us on the retirement plan.

[freetodream]

I have been carefully reading the replies so far- thanks so much to each of you for your thoughtful replies & input.

Some updates: HI costs I mentioned were only for premiums; we pay more for deductibles/copays which adds 1-2 thousand in low cost years. We can stay on the plan after age 65 for Medicare B..D.. for (less) $ costs I haven't looked into much yet.

Rough tally so far from posters:
6 say Stay (I'm more in this camp today & am usually here)
1 says Switch (a few days ago I was here)
1 says Tough decision (so right you are)
1 says Can't be dropped for pre-existing ( I think/hope you are correct?)
1 says We are switching to ACA in 2018 (I understand why)

Still in decision process for the next few weeks. Peace of mind for staying is certainly true for me. So is spending excessively for unnecessary premium costs.

[GTFan]

Wow, guess I'm lucky to be retired from a Megacorp that lets you bounce in/out of the retiree HC plan every year during open enrollment. Even though it's full cost (currently around $1100/mo. for two), it will always be a backup option for us if the ACA implodes.

Didn't realize that this was the exception and not the rule for Megacorps.

[JoeWras]

Quote:

Originally Posted by freetodream Some updates: HI costs I mentioned were only for premiums; we pay more for deductibles/copays which adds 1-2 thousand in low cost years.

For budgetary reasons, I always assume the max OOP will occur. If we're healthy, we can use the bonus as mad money.

Quote:

Originally Posted by GTFan Wow, guess I'm lucky to be retired from a Megacorp that lets you bounce in/out of the retiree HC plan every year during open enrollment. Even though it's full cost (currently around $1100/mo. for two), it will always be a backup option for us if the ACA implodes. Didn't realize that this was the exception and not the rule for Megacorps.

That is unusual. Just about everyone I know who pays full cost HI with Megacorp have the rule that once you lose it, you are done forever. (or if you fail to enroll at retirement).

Some old Megacorps with generous plans may be different, but those are usually heavily subsidized too. Double bonus. Sound like you have a winner. Just watch them carefully. They may change the rules on you.

[Scuba]

I would stay as long as you can in the employer plan. ACA plans may not give you as much flexibility as to provider network, covered drugs, and out of state coverage. Plus, have you seen the headlines about how much the ACA premiums have been going up? You may not be spending as much additional money as you think.

[Rianne]

Quote:

Originally Posted by freetodream I have been carefully reading the replies so far- thanks so much to each of you for your thoughtful replies & input. Some updates: HI costs I mentioned were only for premiums; we pay more for deductibles/copays which adds 1-2 thousand in low cost years. We can stay on the plan after age 65 for Medicare B..D.. for (less) $ costs I haven't looked into much yet. Rough tally so far from posters: 6 say Stay (I'm more in this camp today & am usually here) 1 says Switch (a few days ago I was here) 1 says Tough decision (so right you are) 1 says Can't be dropped for pre-existing ( I think/hope you are correct?) 1 says We are switching to ACA in 2018 (I understand why) Still in decision process for the next few weeks. Peace of mind for staying is certainly true for me. So is spending excessively for unnecessary premium costs.

IMHO would hire a broker. Usually through ACA, the insurance company pays for their service. A broker will walk you through all pros and cons of your dilemma, they know the HI details and have inside information about what company is best for you if you decide to go with ACA. I was amazed at the out of pocket/deductible game the insurance companies play. You meet with a broker, face to face, they discuss HSA and how it will benefit/or not your situation depending on your tax situation. We found our broker through word of mouth. I, as you, was so confused about what to do.

[GTFan]

Quote:

Originally Posted by JoeWras That is unusual. Just about everyone I know who pays full cost HI with Megacorp have the rule that once you lose it, you are done forever. (or if you fail to enroll at retirement).

I don't understand why - mine is self-insured (as are most) and retirees get basically the same Bronze plan as any employee could pick, albeit at full cost vs. heavily subsidized for employees. Whether you enroll or not each year doesn't cost them more money in other words, unless they see folks are cherry-picking known high cost years when you have to have work done. But that would be true for any middle-aged employee as well.

[CRLLS]

What makes the decisions process worse is that, in my case, every year my chosen plan under ACA had been eliminated and I had to choose another, less desirable more costly plan. The plan I had after 3 years was nothing like the one I had when I first joined ACA. But every year while I was in Mega, those plans changed too. Albeit, less than the ACA changes. It seems that there are no guarantees for the future either way you choose.

This med insurance dilemma during the bridge between RE and Medicare has always been there, even before ACA times. I thankfully transitioned to Medicare yesterday. I don't know what I would do in your situation. Sorry I can't add anything more.

[JoeWras]

Quote:

Originally Posted by GTFan I don't understand why - mine is self-insured (as are most) and retirees get basically the same Bronze plan as any employee could pick, albeit at full cost vs. heavily subsidized for employees. Whether you enroll or not each year doesn't cost them more money in other words, unless they see folks are cherry-picking known high cost years when you have to have work done. But that would be true for any middle-aged employee as well.

I think you got it, the cherry picking aspect. As for the middle-aged employee, not sure what you mean since employees (at least in my plan) have to be enrolled and are paying a premium for that even in healthy years. They can't opt out in the healthy years. In my case, we pay $50 to $70 per month (single). And of course, all the young employees pay in too.