Anyone Working Just for Health Insurance?

[Toast]

DH and I still have 11 years before we reach Medicare age. We have the financial means to retire but are nervous about relying on the ACA for so many years. Basically, we continue to work because we have excellent health insurance, and there is something about relying on the ACA that makes us hesitant to make the leap.

A bit of history, DH had a pretty scary diagnosis in his late 40s which makes us cautious, perhaps overly so. Treatment was successful, and he’s been fine for 5 years now.

Our current plan is for me to retire in September 2024 and DH will continue working until 63 1/2. This would allow us to COBRA to 65. My job is high stress 24/7. His job pays quite well and isn’t terrible. That said, we talk/plan/dream of retirement every day. Retirement would also allow us to move closer to friends and family.

Is anyone in a similar position? What did you decide? Are you happy with your decision? Anything that might help our thought process? Importantly, did anyone retire with a health concern and have a good experience using ACA insurance? Has anyone developed a severe health issue while on an ACA plan? If so, did you receive high quality treatment?

Would love to hear your experiences.

Thanks in advance!

 

[EQMAN]

I retired at 55 and used cobra to fininsh out the calendar year then moved to ACA for the last 6 years. Some years I managed my income low enough that my preminues are less than $100 per month with very manageable out of pocket costs. The thing with ACA plans where I live is that they are HMO or PPO based. So you have to make sure they have a good network. Our travel plans are such that we are normally only out of state for less than 2 weeks at a time so the lack of a nation wide network is not a problem for us. We would be comered if it was an emergency even if out of network. I have been in the PPO plan and it had all the Docs and Hospitals that we would want to go to. During the time I have been on ACA I was diagnosed with cancer and it has covered everything. Just have 4 more years for me and 5 for DW and we will be on Medicare. I do have access to retiree medical from Mega Corp as a back-up is ACA goes down the tube, but think that is unlikely during my time horizon.

 

[Souschef]

My wife was brain injured in 1993, and passed away in 2005. I worked to keep our medical insurance.

 

[athena53]

This won't work for everyone but our Diocesan Treasurer (either PT or volunteer but doesn't qualify for benefits from the Diocese) ER'd from banking. He had a wife and 2 teenagers at home so they needed coverage. He found a local college that offered insurance to students- even if he took just one course per semester. It was very reasonable, probably because it was based on a low average age for the group.

The risk, I suppose, is that they could start charging based on age or tighten eligibility requirements.

 

[Toast]

The thing with ACA plans where I live is that they are HMO or PPO based. So you have to make sure they have a good network. I do have access to retiree medical from Mega Corp as a back-up is ACA goes down the tube, but think that is unlikely during my time horizon.

I’m sorry to hear about your diagnosis and hope you are doing really well. This is actually our concern along with being on an HMO plan. We’ve never been on an HMO plan and as irrational as it is, we tend to remember stories we’ve heard from people who had negative experiences. If we stop working, we won’t have access to any employer plan after COBRA ends.

One safety net is that I am in a high need profession and know I could go back to work at any point if need be.

Thanks again,

 

[Toast]

My wife was brain injured in 1993, and passed away in 2005. I worked to keep our medical insurance.

So sorry for your loss. I am familiar with your story from reading many of your post over the last several years. Knowing you have access to the good care when needed is priceless.

 

[Toast]

He found a local college that offered insurance to students- even if he took just one course per semester.

Thanks, Athena! I actually enjoy taking classes and will look into this. Lots of interesting fields of study to explore.

 

[Markola]

DW and I are semi-retired in our late 50s and purchase an HSA-qualified Bronze level plan with HealthPartners on the ACA for about $20K/year counting the max HSA contributions, which we always seem to spend to zero. DW is high need as a two time cancer survivor, and other health issues. This is our third year on the ACA and it’s covered everything the same as when we had employer health insurance.

 

[bloom2708]

I didn't work for one year in between jobs. The health plan I had was identical to the health plan I went on upon returning to the work force.

If you can manage your income to the AGI ~$62k level (married filing jointly), the subsidy would make ACA worth using compared to working solely for healthcare.

These ACA plans are the plans that are available for your area. Especially if you have HSA funds available to help until you meet the deductible.

ACA is firmly entrenched at this point and it would be very difficult to take it away. Unless some better plan is adopted.

 

[pacergal]

Yes, I continued working for health insurance reasons. I could have retired at age 54, with 30 years and received full pension. But, if I worked until age 60, I could get employee rate for health insurance until Medicare age. It was well worth it as the cost at that time was less than $200 for family rate for excellent coverage.
Plus those last 5 years, we honed our budget and pushed as much $ as we could into retirement funds.
We pay more for insurance now that we are on Medicare than when I was working orchid retiree health insurance.
Never needed ACA.

 

[RetiredAt49]

I retired in 2021 at age 49. Been on ACA and it’s been as good or better than my mega employer’s health plan and cheaper too because I get subsidies. My spouse has some health issues but all covered.

If you can financially retire do it! Your stress will drop significantly and if one of you were to pass away… you’d be upset that you worked for no reason.

 

[FLSUnFIRE]

I did not and am currently healthy. I walked away from really nice HI to ACA. Fortunately, in my state there is a PPO (even the cheap option, I could have chosen a larger network) that is exactly the coverage I want (HDHP) and it was actually cheaper than my employer sponsored (total cost and my portion after subsidy/employer contribution). It's not a national plan is the only meaningful difference. While I cannot put myself in anyone else's shoes and it's hard to say for sure if it happens to you, I think if I had a condition it would not cause me to delay retiring.. if anything might motivate me to live for today even more. If all my options were HMOs I would definitely be more hesitant.


I can say that being FIREd, I am healthier than I've been in years and I've always been pretty healthy. Mentally and stress-wise, especially. I was thinking yesterday that I can't recall my last ture "bad day." I have bad moments and downtimes but they just roll by live waves under my feet on my board. Not working leaves me with so much more energy to deal with things and is also a source of constant gratitude. I expect the health dividend to continue to payout.

 

[Sojourner]

DH and I still have 11 years before we reach Medicare age.

Same here. Semi-retired for almost 10 years now (fully retired for about 3) and have been on ACA since the day I left my full-time gig.

Importantly, did anyone retire with a health concern and have a good experience using ACA insurance? Has anyone developed a severe health issue while on an ACA plan? If so, did you receive high quality treatment?

Sounds like you might not be fully aware of how ACA plans work. My apologies in advance if this isn't the case. Two nice things about ACA insurance are that the premiums are not adjusted based on pre-existing conditions or your how healthy/sick you are, and you cannot be denied coverage due to anything in your health history or profile. The premium for a 55 year old with a history of cancer and diabetes is exactly the same as it would be if that person had a perfect health record. Also, even the cheapest ACA plans (typically, HMO "bronze" plans) have an annual, out-of-pocket maximum that ensures you won't pay more than $X regardless of any worst-case health scenario. In my case, $X = $7,000 for my bronze plan.

The downsides of ACA plans are that they're extremely expensive for people who don't qualify for tax subsidies and they are of marginal benefit for people in excellent health who see their doctor only for routine care. For everyone else (i.e., the vast majority of ACA enrollees), they get the job done at a reasonable price. Unfortunately for me, I'm not in that majority, so I'm paying full freight and getting marginal benefits... so far.

From your description of your medical situation, OP, I would not hesitate to go ahead and FIRE due to your concerns about ACA. Just be sure to include the cost of your premiums (and yearly increases) in your FIRE budget.

 

[Aerides]

I retired in 2016 and watched some serious attempts to undo the ACA over the first couple of years being retired.

I still have 12 years to go until Medicare, and I'm less worried today than I was 5 years ago. And every year the ACA stays in existence, the less worried I get. Of course, over that 5 years, we've been bigger consumers of healthcare, and added a few annoying entries on our charts, so our personal risk is greater if it were dismantled.

If I'd opted to stay working for retiree medical I'd still be there, with a couple more years to go.

If things go south, I'd figure one or both of us would have to find whatever minimal employment provided coverage. Or private insurance would return and fill the void, expensively.

There will be some option for those with a bit of smarts and money, in this country there always is.

 

[MarieIG]

My health coverage is through DH's union. After ACA came in, the office where I was working at the time got terrible insurance for their employees. (Obviously, they were not retired.) There were two of us and a spouse undergoing cancer treatment at the same time; and it was much faster for me to get approval. What each of them had to go through was a saga, including a partner having to threaten to sue the carrier after they denied reconstructive surgery for his wife as cosmetic, after a large portion of her jaw bone was removed due to cancer. DH worked until he qualified for lifetime healthcare, for himself and me.

If your spouse has health issues, I would get the best plan available.

 

[Toast]

Thanks for the reassurance about ACA covering care and sticking around. I’ve looked at plans in the zip code of the area we want to move and they seem alright. There are a couple PPO options. Definitely a price difference.

This seems like the most difficult decision we have faced. Both sets of parents (now deceased) had amazing coverage from TRICARE for Life. We don’t have friends or family in a similar situation so nobody to talk things over with.


Was anyone hesitant to retire early because they’d be relying on the ACA?

 

[athena53]

Also, even the cheapest ACA plans (typically, HMO "bronze" plans) have an annual, out-of-pocket maximum that ensures you won't pay more than $X regardless of any worst-case health scenario. In my case, $X = $7,000 for my bronze plan.

Read the conditions carefully. At renewal I was once offered an alternative plan I "might like" that had no OOP max on out-of-network charges. Most times they cover out-of-network if it's an emergency but guess who's in charge of defining "emergency".

 

[TripleLindy]

ACA has pros and cons, probably more cons for us. We’ve been on ACA plans for 5 years and only once did I meet the deductible, and that required 2 surgeries to do so (knee and shoulder). In 2 of the 5 years, I had to repay the subsidy, as investment income was higher than expected. Since ortho procedures are about the only use we get out of our insurance, it’s really used as catastrophic insurance, in the event there’s a serious injury or illness. Without the subsidy, it’s very expensive when that’s all you’re getting.

In regards to physician access, I’ve realized that if I can find a plan that includes a local major health system in-network, I can usually find a specialist that is employed by that system that accepts the plan. Unfortunately, our ortho practice is independent and does not accept any ACA plans, so I’ll often still see a doc at that practice and just pay the cash rate if I don’t expect to hit the deductible for the year. If you have a specific health care need, be sure to check the facilities/physicians that are in-network. This changes on an annual basis, so it can be tough to navigate.

I have 5 years to go for Medicare and my wife has 6, assuming Congress doesn’t change the age requirement. For those of us born past 1960, there’s been talk of changing Medicare eligibility to 67 to match SS full retirement age. That would be a gut punch.

 

[Sojourner]

Read the conditions carefully. At renewal I was once offered an alternative plan I "might like" that had no OOP max on out-of-network charges. Most times they cover out-of-network if it's an emergency but guess who's in charge of defining "emergency".

Yes, absolutely essential to read the fine print carefully. I always check the in-network and out-of-network OOP max numbers each year when I renew or change policies. The most important thing is that there actually IS a limit for both, not necessarily what the exact limit is (within reason). I also check things like how much ambulance rides and ER visits would cost me, etc.

 

[Sue J]

We used ACA insurance plans from 2014 when it started until Medicare in 2020. In our area we had enough options for the insurance companies and networks that it worked well enough for us.

There were times when we had to change doctors because of the networks. So if you have a doctor or hospital that is a necessity double check that you choose a plan that includes them. Check with the provider every year. Don't assume that the provider list on the plan's website is accurate. Also, a provider may accept an insurance company's plan for employees (commercial) but not for Marketplace (ACA) plans. Be careful with the plan names and specifics such as "Summa Connect" vs "Summa Select" as one denotes a more narrow network.

For us, choosing an Bronze HDHP plan with an HSA (and contributing the full amount) made our subsidies large and our premium costs low. Some years that worked very well. We were always prepared to cover the cost of the deductible.

We never had a claim denied. Once or twice we had to have something preapproved but it was not a big deal.

Your zip code and your income will determine what's available to you and the costs. Some areas have plenty of options while other areas have very limited choices.

 

[Sojourner]

Was anyone hesitant to retire early because they’d be relying on the ACA?

I was not hesitant. I was in good health at the time, and I knew (with 99% certainty) I could cover the premiums and out-of-pocket costs until I reached Medicare age. It has been painful to see my premiums go up so much over the years, but I look at it simply as a "small" price to pay for my ER freedom.

 

[aaronc879]

I have been on ACA for most of the last decade and it has been less expensive than employer coverage due to subsidies with no reduction in coverage. That varies by state and even location within each state so check you area and make sure you would be covered by the doctors/clinics/hospitals you want to be covered by. I don't think having to go on ACA is a reason to not retire for a very large majority of people.

 

[Sojourner]

I don't think having to go on ACA is a reason to not retire for a very large majority of people.

Completely agree, and I would even say that the availability of ACA coverage is what enables some (most?) people to retire early.

 

[aaronc879]

Completely agree, and I would even say that the availability of ACA coverage is what enables some (most?) people to retire early.

It absolutely does. If you can manage income to get very good subsidies then ACA is cheaper than Medicare and most employer plans with similar coverage.

 

[Aerides]

Thanks for the reassurance about ACA covering care and sticking around. I’ve looked at plans in the zip code of the area we want to move and they seem alright. There are a couple PPO options. Definitely a price difference.

One more thing on this. ACA experiences can differ greatly based on your geography and the plans available.

We have a Bronze PPO with BC/BS. HSA eligible to help manage income for good premiums, High Deductible, but we know the in/out caps and can plan - ie, a surgery I have coming up will be almost completely out of pocket, so I'm doing it early in the year vs. late. Haven't had issue finding good docs in a number of specialties. I also know we have about 7 other alternate plans that would work, and over 35 total offerings each year across the all plans.

Some counties have 2 plans, only HMO, that sort of thing. I'd be less happy if that were me.