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

[Packman]

I am 59 and DW is 58. We pay $700/month (combined) for a HDHP ($6,000 deductible each) policy in AZ on the ACA (insurance provider is small outfit only in AZ). The policy basically pays nothing until we hit the deductible. They try to charge us for annual preventative care and lab work. When I call customer service, they have no clue and I get nowhere.

Next year, I plan to look off of the ACA since we don't qualify for the subsidies, but I've been told the premiums are the same on or off the ACA website. Is that true?

 

[serie1926]

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.

WOW!!!

I wonder what happens to those when/if the "ACA Fairy" stops giving?

Is there not someway to get a catastrophic only policy and pay out of pocket for anything less than worst case?

 

[Just_Steve]

ACA should be asset based like food stamps and all of the other social giveaways.

 

[Slow But Steady]

I just retired, so August is my first month. Both my wife and I retired from companies that offer retiree medical. We elcted to take the one from my company. It's the same coverage we had when I was working. The coverage is very good. It's an Aetna PPO with a thirty dollar co-pay for primary care docs and $40 for specialists. The deductible is $300 per person, and the out-of-pocket max is $2500 (each) per year.

However, even though the company is paying part of the cost, the retiree group is much more expensive then the employee group. We pay $1005 per month for the two of us, whereas when I was working it was $438 per month.

It's still way better coverage than an ACA plan, and cheaper too, since we wouldn't get much (if any) subsidy.

 

[MichaelB]

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

There's not that much difference between the states. A few are more expensive, such as Hawaii, Alaska, and NY. The big differences among policies are due to type of coverage - HMO vs PPO, and network size - large, broad national networks vs restricted local and regional ones.

 

[MichaelB]

We're on the road right now so I'll give my best estimate of our insurance cost. Each of us has an HSA plan with a $6.5k deductible / TOOP. DWs (64) premium is $740 and mine (62) is $670. Next year her coverage will increase, her deductible will fall to $150 and her premium will fall to around $550. Next year my premium will increase to around $1250, as my insurer is leaving me and there's only one policy left that gives me access to a national provider network.

 

[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.

The numbers that I quotes are all gross... no reductions for ACA premium subsidies.... we don't get any... since our health insurance is so affordable we have chosen to pay and take advantage of Roth conversions.

 

[pb4uski]

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?...

Just part of the price of freedom (from work).

 

[Fermion]

We pay about $290 a month for a couple, mid 40s, for a super subsidized silver plan with cheese ($250 deductible, $500 max OOP). Hard to say what the value of the cheese (cost sharing) is, but the unsubsidized policy would be about $700 a month.

America is already great again!

 

[serie1926]

Just part of the price of freedom (from work).

For this price, may be worth continuing to work.

If we were retired today, we'd be spending $19k approximately for just insurance (estimated health, home with flood, auto, and umbrella). For this amount, almost makes sense to self insure.

 

[travelover]

For this price, may be worth continuing to work.



If we were retired today, we'd be spending $19k approximately for just insurance (estimated health, home with flood, auto, and umbrella). For this amount, almost makes sense to self insure.

Seriously? Do you have any idea what a major illness or injury can cost?

 

[MichaelB]

For this price, may be worth continuing to work.

If we were retired today, we'd be spending $19k approximately for just insurance (estimated health, home with flood, auto, and umbrella). For this amount, almost makes sense to self insure.

Self-insure is not the same as no-insure.

That $19k is close to the average cost of a family group plan in the US. The high cost is not because of insurance companies, it's because health care is very expensive. No health insurance is a financially risky move, you can lose all your assets because of an accident or a sudden serious illness.

 

[MBSC]

Next year, I plan to look off of the ACA since we don't qualify for the subsidies, but I've been told the premiums are the same on or off the ACA website. Is that true?

If the benefits are the same then the premium with that insurer will be the same. However, sometimes the insurer will offer additional off-exchange only plans using a different provider network or having other differences which will impact the premium.

Is there not someway to get a catastrophic only policy and pay out of pocket for anything less than worst case?

ACA compliant catastrophic plans cannot have an OOP limit of more than $6,850 ($7,150 in 2017). Since Bronze plans have OOP limits in a similar range, the premiums are quite similar unless you live in one of the few community rated states where the cat premiums are lower.

A number of healthy people not eligible for subsidies are choosing non-compliant plans as an alternative. These include short-term health plans and accident/illness indemnity plans. Due diligence is required before purchasing non-compliant products. Most are also exempt from the penalty because the cheapest available Bronze plan is over 8.13% MAGI.

 

[ZMAN]

I am self employed and remain so even now. As such I have been paying full health premiums since 2006 when DW retired from her job. Until then we used her corporate subsidized insurance.

ACA or not, our experience has been that low deductible low copay policies cost the two of us around $16,000 per year and high deductible cost $8000 per year, both for the family plan. That did not change when our son got a job and went off the policy. And indeed did not change much when I went off the policy and on to Medicare.

For us the ACA made it easier for her to get a policy on her own when I aged off my pre Medicare coverage. She stayed with the same carrier, but the cost for one was not much less than the cost for 2.

I like the Canada strategy and we live in a border town. But for those who have done the research, it is just about impossible for oldsters to emigrate to Canada, even with money in the bank.

 

[pb4uski]

....Is there not someway to get a catastrophic only policy and pay out of pocket for anything less than worst case?

There is a provision of ACA that allows you to buy catastrophic health insurance coverage if the lowest cost bronze plan available to you exceeds 8.15% of your household income even if you are over 30 years old. Normally, only those under 30 can buy catastrophic coverage. We have been doing that for 3 years now.

However, in many states the cost of a catastrophic plan is not much different from the cost of a bronze plan, so you need to see how premiums and benefits compare in your state. In our state, premiums are about 40% lower and benefits are pretty similar... but in Florida for us the cat premiums and bronze premiums would be about the same (I suspect in part because they are age-rated plans in Florida and our state doesn't allow age rating).

Since we buy health insurance principally to protect us from the financial cost of a catastrophic illness or accident and to gain access to negotiated rates with medical providers, the cat plan works well for us. YMMV.

BTW, $12k a year for a couple isn't that bad. That is what I was looking at for a bronze plan when I retired 4 years ago in that at that time our COBRA premium for a high-deductible plan was $900, so I'm sure it is over $1,000 now. Like I said, it is part of the price of freedom... if you can't afford it or are unwilling to pay it then you can just continue to work. I worked part-time for a number of years because I wasn't ready and even working 50% or more allowed me access to subsidized employer health insurance benefits.

 

[ShokWaveRider]

I did some Research in British Columbia Canada, as it is the only Provice we would consider moving to. These are directly off their web site:

These are the 2017 Monthly Premiums for BASIC BS, MSP (Medical Service Plan) Even if we had a system the tripled or quadrupled these premiums it would be a good deal. Remember No Copays or Deductibles for the most part. Any BC Residents please feel free to comment.


Effective January 1, 2017

• There are no premiums for children under the age of 19.
• MSP premium rates will be determined by the number of adults on an MSP account (the MSP account holder and, if applicable, a spouse.)

Adjusted Net Income is the BOLD Number, One Adult is the first number below that, and Two Adults in a Family is the number below that. (The columns did nor come through with the Paste.

$0 - $24,000 - Net Income​

$0.00 - One Adult​

$0.00 - 2 Adult Family​

$24,001 - $26,000​

$12.00​

$24.00​

$26,001 - $28,000​

$24.00​

$48.00​

$28,001 - $30,000​

$36.00​

$72.00​

$30,001 - $34,000​

$48.00​

$96.00​

$34,001 - $38,000​

$58.00​

$116.00​

$38,001 - $42,000​

$68.00​

$136.00​

Over $42,000​

$78.00​

$156.00​

When determining premium rates, B.C. residents may claim allowable MSP deductions to their net income to determine their adjusted net income. Individuals may claim $3,000 for every person on their MSP account that is age 65 or older this year, and $3,000 for each child on their account. In addition, if you claimed a disability on your tax return for yourself, spouse or child included on your MSP account, you may claim $3,000 for each disabled person. To determine if you qualify for deductions, please refer to the Application for Regular Premium Assistance Form for more information.

 

[pb4uski]

Are you a U.S. citizen or Canadian citizen? If U.S., how can you qualify for that program?

 

[ShokWaveRider]

Are you a U.S. citizen or Canadian citizen? If U.S., how can you qualify for that program?

I have Tri Citizenship, my wife is dual. Canada and USA are common. We both paid our fair share into the system in our early years too but rarely used it, I did have one hospital stay and it was excellent.

 

[John Galt III]

The monthly premium for my ACA HMO is $580. But I only have to pay $36 per month thanks to massive subsidy. $500 deductible, $2,250 max oop. I feel sorry for those worker bees with the $6,000 deductibles and large premiums, who are not getting a large subsidy! I used to be one of them.

 

[photoguy]

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.....

This thought had occurred to me as well but it remains a backup plan as I really don't want to go back to -20 to -30 degree winters. Also I really hate flying out of Pearson.

Right now, we're paying 200-300 under ACA for monthly premiums (with tax credit) for mid 40s couple. Which in my view is an exceptional deal. Still we've allocated way more than that in our budget due to lumpiness of expenses and uncertainty.

 

[jim584672]

Controlling your MAGI / moving is the best way to control the expense. In NY 0-150 FPL is free, 150-200 FPL is $20 a month. Also NY is cheaper for older people since age is not allowed in premium pricing.

My back up plan is to move to the UK for NHS if worst case happens in the US.

 

[Sue J]

DH and I have the same policy so I'll just combine the numbers. It's an ACA Bronze plan with $6650 deductible each, $6850 OOP Max each. $40/$80 copay for PCP/Specialist. We use the Rx plan (CVS Caremark) for some Rxs, for a few we don't use the insurance and use GoodRX coupons instead.

The cost of this plan is $776/mo but we get a subsidy of $650 so our cost is $126/mo.

The first two years of ACA we had Bronze HSA plans. For 2016 all the HSA plans in our area were several hundred dollars more than the Bronze non HSA plans with a co-pay.

When I estimated our income for 2016 for the ACA subsidy I included DH's taxable pension, our taxable interest and my small part time income. By the end of the year my entire part time income will be in a traditional IRA so our ACA MAGI will be smaller than I estimated and we will be getting back a portion of what we already paid in premiums.

Every year I've looked at Silver plans, too. The monthly cost is so much higher than Bronze and at the top tier (200-250% FPL) the cost sharing benefits are not that attractive.

Our only alternative to using ACA insurance is DH's retiree insurance. It offers much better coverage but would have cost us around $800/mo which makes it higher than the limit of "affordable" by the ACA. DH's retiree plan is eliminating any subsidies for spouses so next year I would have to pay the full premium of $959/mo just for me.

We both have about 3.5 years left until Medicare. Just hanging on until then.

 

[rodi]

For those of us with ACA premium tax credits (whether taken in the form of premium subsidy, or at tax time).... Do you budget for the full cost?

When I was getting ready to retire I looked at the COBRA prices for my employer insurance (Kaiser Permanente, HMO, no deductible, $20/copay). It was $1100/month. I used COBRA for the remainder of the year I retired. I budgeted for $1400/month figuring that my large employer had negotiated a better deal than I could get. That's only a little higher than what the plan I have now is - but my plan now is a HDHP - so a lot more out of pocket.

Tax laws can change - and the ACA premium tax credits are a tax credit I plan to take advantage of while I can... if it changes, then health insurance will go to the highest line item BY FAR. Higher even that paying for groceries for 2 teenagers (which is a lot of groceries - especially now that they're playing water polo.)

My budget is for the worst case - but I am happy to take any tax credits coming my way.

 

[easysurfer]

For those of us with ACA premium tax credits (whether taken in the form of premium subsidy, or at tax time).... Do you budget for the full cost?

...

For me, any subsidy is calculated at tax time. I budget for the full cost. Any $ I get back, I'll deposit (no splurging ) in my checking account for premium payments the following year.

 

[ShokWaveRider]

For us we have a joint plan too. We only pay Florida Blue our portion they look after claiming the subsidy from the government. If I underestimated out income it will be adjusted at tax time.


We are just so scared that ACA will be repealed if things go pear shaped, that we do not know what to do. Hopefully we will still be able to use ACA for 2017 regardless as we will sign up ASAP in November.