Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 11-22-2015, 03:51 PM   #81
Thinks s/he gets paid by the post
mpeirce's Avatar
 
Join Date: Feb 2012
Location: Columbus area
Posts: 1,597
Quote:
The reason insurers are having such a hard time is that the people who are buying insurance on the Obamacare exchanges are in much poorer health than insurers had anticipated, partly because healthier people are shying away from buying policies they consider much too expensive.
Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.

"Sick" people have no choice, so they end up on the exchanges.
__________________

__________________
mpeirce is offline   Reply With Quote Reply
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 11-22-2015, 04:00 PM   #82
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,613
Quote:
Originally Posted by mpeirce View Post
Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.
Can you even do that any more? I believe any individual plans with medical underwriting are older, grandfathered plans, and I don't believe grandfathered plans can add new customers.
__________________

__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline   Reply With Quote Reply
Old 11-22-2015, 04:46 PM   #83
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 16,537
Quote:
Originally Posted by mpeirce View Post
Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.

"Sick" people have no choice, so they end up on the exchanges.
Because you can't buy those policies anymore.
__________________
Well, I thought I was retired. But it seems that now I'm working as a travel agent instead!
audreyh1 is online now   Reply With Quote Reply
Old 11-22-2015, 04:54 PM   #84
Full time employment: Posting here.
 
Join Date: Jan 2014
Posts: 663
Most new off-exchange policies requiring underwriting are short-term health or medical indemnity plans. Medical indemnity (fixed benefit) plans have payment caps. Neither meet the ACA "minimum essential coverage" guidelines.

Quote:
Fixed benefit plans are not minimum essential coverage and will not help you avoid the fee for having health insurance.

Beware brokers who try to pass off fixed benefit health plans as ObamaCare compliant plans. As a rule of thumb if a plan starts right away, is suspiciously cheap and is being sold outside of the marketplace you may be being pitched a supplemental, fixed benefit, short-term or other type of non-ObamaCare compliant plan and will still owe the per month fee for not having health insurance.
Source: Fixed Benefit Health Insurance

Example plan: http://www.regallifeofamerica.com/plans/
__________________
MBSC is offline   Reply With Quote Reply
Old 11-22-2015, 04:56 PM   #85
Thinks s/he gets paid by the post
photoguy's Avatar
 
Join Date: Jun 2010
Posts: 2,301
Quote:
Originally Posted by rdy2go View Post
This link contains a chart showing the projected profit of 2% for plans on the exchanges. It shows a 2,7% profit for plans off the exchanges. Not good, but a tad better. If profits are that thin it takes a tremendous amount of business to make the cash flow large enough to invest to generate a better return. That may explain the recent mergers.

I didn't see a link in your reply (maybe it didn't come through in the post for whatever reason). But your numbers 2.0% and 2.7% match the first link from MichaelB's post in #18 (exhibit #2 in the article). As I understand the table, these figures are profit as a function of revenue. While 2% and 2.7% seem very small compared to other businesses, I don't think measuring profit in terms of revenue makes much sense for a health insurer (that essentially produces nothing and passes through payments) and it would probably be better to use a measure like return on equity.

I couldn't find recent figures for return on equity for a health insurer but this blog post from 2010 reports that while profit as a function of revenue for health insurers was only a measly 4% the profitability in terms of ROE was 23%. This seems very healthy to me.

Musings on Markets: How do you measure profitability?

Now with MichaelB's link, return on revenue has dropped since 2010 so it wouldn't surprise me if ROE dropped as well. But the ROE was 23% so there's lots of leeway for a decrease while still maintaining a good ROE.

I'm no expert at valuing businesses (i.e. I'm a total noob) so I might be confused here and mis-interpreting the numbers or the terminology, but the 2% profitability on revenue doesn't seem like cause for concern. I think it would be interesting to see post ACA ROE figures if anybody has them.
__________________
photoguy is offline   Reply With Quote Reply
Old 11-22-2015, 04:57 PM   #86
Moderator
Alan's Avatar
 
Join Date: Jul 2005
Location: Eee Bah Gum
Posts: 21,146
Quote:
Originally Posted by Dreaming of Freedom View Post
Most Americans are not early retirees who have the ability to move elsewhere if health insurance/healthcare costs in the US become unaffordable or unattainable. I have health insurance through my employer right now, but even that policy is very expensive and does not cover anything until I spend a ton of money. Spending half of my income on health care and health insurance in retirement is crazy. If ACA is repealed, I might not even be able to get health insurance because the high risk state insurance pools no longer exist.

Anyway, I am just trying to identify contingency plans if ACA does not survive for one reason or another.
I think you'll find emigrating to a suitable country with universal healthcare is quite a long and difficult process. You may well be better off hanging on until you get to Medicare age.

However you may find it a useful exercise to explore what it takes. If you do a bit of googling you will find expat sites that have good wiki's on the visa process for the countries you may be interested in.
__________________
Retired in Jan, 2010 at 55, moved to England in May 2016
Now it's adventure before dementia
Alan is online now   Reply With Quote Reply
Old 11-22-2015, 05:24 PM   #87
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Mulligan's Avatar
 
Join Date: May 2009
Posts: 7,384
Quote:
Originally Posted by mpeirce View Post
Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.

"Sick" people have no choice, so they end up on the exchanges.

I assume you still have an underwritten plan pre ACA. Mine got yanked last year, more did this year. I imagine the rules and insurers desires, will choke most of them off in relatively short order. However, even if that doesn't occur, you have this problem facing underwritten plans...Although you bought as individuals, you were assigned a group. As this group becomes unhealthier or people drop it by either moving or getting employer sponsored insurance the pool will shrink and the costs will increase. No new healthier members or any for that matter are allowed to join.


Sent from my iPad using Tapatalk
__________________
Mulligan is offline   Reply With Quote Reply
Old 11-22-2015, 05:35 PM   #88
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,291
Quote:
Originally Posted by mpeirce View Post
Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.

"Sick" people have no choice, so they end up on the exchanges.

I think others have commented about this, but I have not read what I am going to say....

If your plan is not ACA compliant, you would have to pay the penalty (at least from what I read).... so you might be buying cheaper insurance, but you would have to lie on your tax return not to pay the penalty...


Then again, maybe your premiums and penalty is cheaper than an ACA plan....
__________________
Texas Proud is offline   Reply With Quote Reply
Old 11-22-2015, 06:29 PM   #89
Thinks s/he gets paid by the post
Lakewood90712's Avatar
 
Join Date: Jul 2005
Posts: 1,316
When I was on COBRA last year, I was looking at Anthem/BC and at United healthcare , both PPO plans in the CA exchange. The United plan seemed too good to be true on cost, like 25% less .
__________________
Lakewood90712 is offline   Reply With Quote Reply
Old 11-22-2015, 07:35 PM   #90
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,291
Quote:
Originally Posted by Lakewood90712 View Post
When I was on COBRA last year, I was looking at Anthem/BC and at United healthcare , both PPO plans in the CA exchange. The United plan seemed too good to be true on cost, like 25% less .
This is one of the things that I do not like... (not saying they did this, just a observation)...


I noticed that there were two very low cost silver plans that looked like they were set up to attract people... but not much in networks or docs... OK, not a problem, BUT it affects the credit that I can get for the high cost bronze plan that I want...

I have chosen a low cost bronze.... and will likely do so for next year.... however, the Medicaid people are starting to offer plans and it is getting worse.... the second lowest cost silver is now from Molina and is $150 less than a BCBS plan and it is a skinny plan itself....
__________________
Texas Proud is offline   Reply With Quote Reply
Old 11-22-2015, 08:34 PM   #91
Thinks s/he gets paid by the post
 
Join Date: Feb 2014
Posts: 1,050
Quote:
Originally Posted by Alan View Post
I think you'll find emigrating to a suitable country with universal healthcare is quite a long and difficult process. You may well be better off hanging on until you get to Medicare age.

However you may find it a useful exercise to explore what it takes. If you do a bit of googling you will find expat sites that have good wiki's on the visa process for the countries you may be interested in.
Good thing my mother was British, may have to have the Brits recognize my citizenship so I can move for the NHS.
__________________
jim584672 is offline   Reply With Quote Reply
Old 11-22-2015, 08:41 PM   #92
Moderator
Alan's Avatar
 
Join Date: Jul 2005
Location: Eee Bah Gum
Posts: 21,146
Quote:
Originally Posted by jim584672 View Post
Good thing my mother was British, may have to have the Brits recognize my citizenship so I can move for the NHS.
That is also my backup plan.
__________________
Retired in Jan, 2010 at 55, moved to England in May 2016
Now it's adventure before dementia
Alan is online now   Reply With Quote Reply
Old 11-22-2015, 08:55 PM   #93
Recycles dryer sheets
 
Join Date: Jun 2014
Posts: 96
Quote:
Originally Posted by Alan View Post
That is also my backup plan.
I was stunned when we had to go back to the UK for a death. My wife left my son with my parents and he got sick. So my parents took him to the family doctor. They just filled in a form to say he lived abroad and they treated him for free.
I was panicking when they told me because the UK would likely love to tax me. In checking it seems anyone could use primary care. Hospital would cost.
Seems like a massive giveaway. Treating an ear infection I guess is cheap but it could have been anything.
My father thought this completely reasonable since the kid has a UK passport but I haven't paid any more than a couple of pounds in UK taxes in 20 years. I guess not counting VAT.
__________________
Neill is offline   Reply With Quote Reply
Old 11-22-2015, 09:04 PM   #94
Moderator
Alan's Avatar
 
Join Date: Jul 2005
Location: Eee Bah Gum
Posts: 21,146
Quote:
Originally Posted by Neill View Post
I was stunned when we had to go back to the UK for a death. My wife left my son with my parents and he got sick. So my parents took him to the family doctor. They just filled in a form to say he lived abroad and they treated him for free.
I was panicking when they told me because the UK would likely love to tax me. In checking it seems anyone could use primary care. Hospital would cost.
Seems like a massive giveaway. Treating an ear infection I guess is cheap but it could have been anything.
My father thought this completely reasonable since the kid has a UK passport but I haven't paid any more than a couple of pounds in UK taxes in 20 years. I guess not counting VAT.
An American colleague of mine had a similar incident when they were on vacation there about 15 years ago. One of their children got sick and they took him to the doctors. They offered to pay but payment was refused for a simple visit like that. They may be more strict these days, but I do know that ER visits (for true emergencies) are free to visitors.
__________________
Retired in Jan, 2010 at 55, moved to England in May 2016
Now it's adventure before dementia
Alan is online now   Reply With Quote Reply
Old 11-22-2015, 09:34 PM   #95
Recycles dryer sheets
 
Join Date: Oct 2010
Posts: 230
Quote:
Originally Posted by Alan View Post
An American colleague of mine had a similar incident when they were on vacation there about 15 years ago. One of their children got sick and they took him to the doctors. They offered to pay but payment was refused for a simple visit like that. They may be more strict these days, but I do know that ER visits (for true emergencies) are free to visitors.
Not the same situation, but your comment reminded me of this clip from "30 Rock". Jack Donnelly couldn't get the hospital to take his money.

__________________
jimbee is offline   Reply With Quote Reply
Old 11-22-2015, 11:24 PM   #96
Recycles dryer sheets
 
Join Date: Jan 2015
Posts: 170
Quote:
Originally Posted by Alan View Post
I think you'll find emigrating to a suitable country with universal healthcare is quite a long and difficult process. You may well be better off hanging on until you get to Medicare age.

However you may find it a useful exercise to explore what it takes. If you do a bit of googling you will find expat sites that have good wiki's on the visa process for the countries you may be interested in.
I was not actually thinking of becoming a citizen of another country, maybe just a temporary or permanent resident if the cost of healthcare & health insurance are not reigned in within the US. I don't want to sound like Debbie Downer, but will Medicare even exist or be considered decent coverage for my generation and beyond? (Gen X & Y).
__________________
Dreaming of Freedom is offline   Reply With Quote Reply
Old 11-23-2015, 12:24 AM   #97
Thinks s/he gets paid by the post
Lakewood90712's Avatar
 
Join Date: Jul 2005
Posts: 1,316
Quote:
Originally Posted by Dreaming of Freedom View Post
I was not actually thinking of becoming a citizen of another country, maybe just a temporary or permanent resident if the cost of healthcare & health insurance are not reigned in within the US. I don't want to sound like Debbie Downer, but will Medicare even exist or be considered decent coverage for my generation and beyond? (Gen X & Y).
I am confident you will receive medicare years from now. I am also confident the medicare tax will rise very soon.

As far as reigning in cost's , healthcare is one of those areas that hit a brick wall years ago. Most medical supplies, equipment , etc are already from the lowest cost producers around the world., and the working conditions for many medical occupations are just nuts . Not much left to automate or offshore, so you are seeing the real rate of inflation. If some medical sector is getting rich, I'd like to know , my pharma stocks make money, but not out of line with other large cap co's.
__________________
Lakewood90712 is offline   Reply With Quote Reply
Old 11-23-2015, 12:32 AM   #98
Thinks s/he gets paid by the post
 
Join Date: May 2008
Posts: 3,425
How about all those non profit hospitals which are raking in the cash?

Or the physician groups which own the labs from which they order all the tests?

These probably wouldn't be publicly traded entities.
__________________
explanade is offline   Reply With Quote Reply
Old 11-23-2015, 05:24 AM   #99
Recycles dryer sheets
 
Join Date: Nov 2012
Posts: 63
Another cost driver is the high end medical practice buildings popping up all over our town. These buildings are not basic. High ceilings, huge waiting rooms, trim detail, artwork, and high end furniture. These buildings cost a lot to build, maintain, heat and cool.

I remember when I came to town and started with a practice 30 years ago. The doctors were young, the practice was in a cramped, rented, older office building, the exam rooms were tiny, the waiting room had a linoleum tile floor, and the furnishings were Spartan. Fast forward to today and the same practice is in a palatial custom built freestanding clinic the doctors built and rent back to the practice, no doubt with a high margin. Lots of architectural detail, lots of wasted space, expensive executive level furnishings.

Not to mention the two receptionists who once did checkins and checkouts as well as administrative tasks are now a staff of 8 clerks, 4 dedicated receptionists, and a full time office manager. In the old days the paperwork was hand processed, today it is all electronic. The doctors walk into the exam room accompanied by a scribe caring an iPad. The doctor also carries a laptop from which she views my medical record. During the exam, the scribe takes notes and at the end of the consultation pushes a button. Outside the exam room the scribe retrieves the bill from a printer, hands it to me, and sends me to the checkout desk.

The quality of my healthcare is the same as it was when the doctors were in a very basic, low rent location with a skeleton staff and one desktop PC. Actually the quality is probably less since the formerly 20 minute appointments now are 10 minutes and if I don't schedule the appointment more than two weeks in advance I'm likely to see a physicians assistant or nurse practitioner instead of an MD.

Don't even get me started on the local hospital where the construction crews are ever present building new and ever more luxurious additions and patient rooms during an era when more and more surgical procedures are being done on an outpatient basis. Perhaps the extra space is for the expanding armies of bureaucrats and administrators who provide zero health care services.

Someone needs to value engineer the entire system to eliminate the exploding costs not associated with the actual delivery of diagnostic and care services.



Sent from my iPad using Early Retirement Forum
__________________
Retired at 57. Now a happy camper!
NC 57 is offline   Reply With Quote Reply
Old 11-23-2015, 07:43 AM   #100
Recycles dryer sheets
 
Join Date: May 2015
Location: Atlanta suburbs
Posts: 355
Quote:
Originally Posted by Lakewood90712 View Post
If some medical sector is getting rich, I'd like to know , my pharma stocks make money, but not out of line with other large cap co's.
Comparing average annual return for healthcare funds with large cap companies for the last 10 years. Using S&P 500 as a proxy for large-cap.

Vanguard HealthCare Fund 12.77%

Vanguard Healthcare ETF 11.39%.

Vanguard S&P 500 Index Admiral 7.84%

Huge difference.

Vanguard HealthCare Fund has a return of 17.28% from inception (1984). That is over a 30-year period. If anybody can provide the comparable number for S&P500 since 1984, I would love to see it for comparison purposes.

I think the healthcare cost problem has been around for a long time, as seen by these fantastic returns; it just didn't affect some of us or many of us directly.

Going forward - I am using FIDO RIP planning for reference - you cannot have general inflation of 2.5% and healthcare inflation of 7% without somebody in healthcare making tons of money.
__________________

__________________
DEC-1982 is online now   Reply With Quote Reply
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
ACA Exchange Dental Plans for 2015 FUEGO Health and Early Retirement 6 11-15-2014 09:53 PM
Stop Stop Scrounging for Income and Sell Some Stocks clifp FIRE and Money 88 12-27-2013 08:17 AM
United Healthcare Stops Offering Insurance to Children dgoldenz FIRE Related Public Policy 30 05-06-2010 09:50 AM

 

 
All times are GMT -6. The time now is 07:07 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.