Buying health insurance for ER

[2Muchfun]

I looked in 2012 for health insurance rates to prepare for my ER budget. Rates seem to have gone up a lot and AARP no longer offers Health Insurance (major medical). I am looking/hoping to ER in 6 weeks. I can use COBRA if needed. Rates look to have doubled since 2012 for me (55) and my wife (48).

I live in Florida, if that makes a difference to your answer, but where is the best place to go to compare rates and choose a policy?

 

[Midpack]

As you might imagine, a lot has been written here on retiree health care. I'd start here:

http://www.early-retirement.org/forums/f47/faq-archive-on-ppaca-66345.html
http://www.early-retirement.org/forums/f47/patient-protection-and-affordable-care-act-61961.html
http://www.early-retirement.org/forums/f47/faq-archive-buying-private-health-insurance-30756.html

And it's no surprise some providers no longer offer coverage or that costs have risen for those who do. I'd plan on premiums and/or out-of-pocket costs continuing to increase faster than CPI too...

 

[pb4uski]

Start with healthsherpa.com to compare rates, then healthcare.gov or the Fl state exchange if they run their own.

 

[MichaelB]

I use healthsherpa (here) to get a list of plans and prices available to us, then use each insurer's website for detailed policy information, including network size and reach.

 

[tomz]

healthcare.gov allows you to compare 2014 plans and see how much your subsidy might be for Florida residents. You do not need to be registered to view this info. Florida does not have its own exchange.

 

[2Muchfun]

Does $800 - $1000 a month for both of us sound right with a larger deductible? Also, what are your thoughts on HSA vs HMO vs PPO?

 

[sengsational]

You can probably find last year's information on Florida Health Insurance Exchange | Healthcare.gov

 

[tfudtuckerpucker]

We needed coverage for a few months this year, and ended up with Assurant Insurance, with a high deductible. The cost was much lower (in our state) than other providers- cheaper than from other sites like healthsherpa. The drawback is they don't cover substance abuse recovery, which is not a risk for us anyway. However, Obamacare regulations require substance abuse coverage, so they could fine us. But even with a fine, the price is a lot lower.

 

[2Muchfun]

Wait until next year?

So it looks like my rate is high, because I am still working and make a six figure income. Next year, my income will be <$25K in retirement and the insurance drops way down. Does that sound right?

The calculator shows this year, I'll pay $786 a month for one particular policy and next year, when my income is <$25K, I'll pay $82 a month.

Maybe I should get a short term policy this year (or do Cobra) for Nov and Dec and start next year with the annual policy.

 

[Options]

I read the healthcare threads/polls in the BH forum (and this one) last year to get an idea of what people are spending on healthcare. I deduced people are spending on average about $5K per year per person. After reading Burns/Kotlikoff's The Coming Generational Storm, based on recent trends, I am budgeting 7% yearly increases for Medicare premiums. If it's less than that (I doubt it), I'll be happy.

 

[GTFan]

So it looks like my rate is high, because I am still working and make a six figure income. Next year, my income will be <$25K in retirement and the insurance drops way down. Does that sound right?

The calculator shows this year, I'll pay $786 a month for one particular policy and next year, when my income is <$25K, I'll pay $82 a month.

Maybe I should get a short term policy this year (or do Cobra) for Nov and Dec and start next year with the annual policy.

You have it right - your estimated income for ACA next year will be your anticipated income due to ER, not your reported 2013 or 2014 income. So you'll just want to extend with COBRA this year and then go on the exchange, and may have to explain why your income for 2015 is so much lower to get the subsidy.

I'm retiring at end of year but my severance, profit sharing, and vacation payouts will show up in early 2015 and will put me well past the subsidy cutoff. So I have to get an unsubsidized policy next year but will be reporting much lower income in 2016 to get one with a subsidy.

 

[TimSF]

So it looks like my rate is high, because I am still working and make a six figure income. Next year, my income will be <$25K in retirement and the insurance drops way down. Does that sound right?

The calculator shows this year, I'll pay $786 a month for one particular policy and next year, when my income is <$25K, I'll pay $82 a month.

Maybe I should get a short term policy this year (or do Cobra) for Nov and Dec and start next year with the annual policy.

Your projections are consistent with my experience this year. I er'd last year, was paying 1300 for cOBRA for two, and this year it is 177 under ACA with a silver plan. Income is a little higher than what you've projected.

 

[Options]

ACA does not cover dental. You can "unbundle" the insurance coverage when you choose COBRA. This means if you have health, dental, vision insurance through your employer, you can choose to continue all three insurrances, or just one or even two (e.g., dental and/or vision and/or medical or any combination thereof). So if you find medical coverage under ACA, you could choose to continue dental for another 18 months under COBRA (which is usually cheaper than getting an individual plan).

 

[2Muchfun]

Thanks everyone

Your answers are really helpful.

 

[athena53]

So if you find medical coverage under ACA, you could choose to continue dental for another 18 months under COBRA (which is usually cheaper than getting an individual plan).

I wish I'd considered COBRA dental. I dropped it because it was May and I'd maxed out coverage for the year. I'm finding that private plans greatly limit coverage the first 6 months or even the first year, paying for cleanings only. That makes sense if you haven't had coverage before and they don't want to pay for pre-existing problems, but I've had continuous coverage for a few decades.

Right now I'm uncovered; I may change my mind and buy it but it irks me that the company is pretty much guaranteed a profit the first year.

 

[EastWest Gal]

ACA does not cover dental. You can "unbundle" the insurance coverage when you choose COBRA. This means if you have health, dental, vision insurance through your employer, you can choose to continue all three insurrances, or just one or even two (e.g., dental and/or vision and/or medical or any combination thereof). So if you find medical coverage under ACA, you could choose to continue dental for another 18 months under COBRA (which is usually cheaper than getting an individual plan).

There is dental insurance under ACA on healthcare.gov.


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[EastWest Gal]

We went uncovered for dental for three years. For X-rays and cleanings, out of pocket was cheaper, as it should be.


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[athena53]

We went uncovered for dental for three years. For X-rays and cleanings, out of pocket was cheaper, as it should be.

I have a pretty erratic record. I can go for 3 or 4 years with nothing but cleaning but I have a few bridges and crowns and when one of those goes bad, it's expensive. In February I chose to deal with decay under a tooth holding up a bridge (which had already been root-canalled) by getting implants in the gap and in the place where that tooth was. (Which is why I maxed out my coverage!) This is typical of bridges and crowns; they can last for decades, but not forever.

I could change my mind and get it later; I just have to be aware that it won't be worth much for the first 6 months to 1 year.

 

[spncity]

Can I ask a clarification question here: I thought I recalled on one of the early ACA threads - that folks were saying - if you opt for COBRA you have to use all 18 months of COBRA before switching to ACA.

But here folks are talking about using a couple of months of COBRA and then switching to ACA.

What did I miss or which is it?

Thank you for any comments.

 

[MichaelB]

If you opt for COBRA you can drop it and enroll in a marketplace plan during the open enrollment period. Outside that period, however, you must continue with the COBRA policy until it runs out. See here https://www.healthcare.gov/what-if-i-currently-have-cobra-coverage/

 

[spncity]

If you opt for COBRA you can drop it and enroll in a marketplace plan during the open enrollment period. Outside that period, however, you must continue with the COBRA policy until it runs out. See here https://www.healthcare.gov/what-if-i-currently-have-cobra-coverage/

Ah, thank you!

 

[ziggy29]

Can I ask a clarification question here: I thought I recalled on one of the early ACA threads - that folks were saying - if you opt for COBRA you have to use all 18 months of COBRA before switching to ACA

It used to be under pre-ACA law that you had to exhaust all 18 months of COBRA before you could enroll in any health insurance policy without preexisting conditions exclusions. As MichaelB points out, that has changed with ACA, but merely deciding COBRA is too expensive does not trigger a special enrollment opportunity outside the open enrollment window.

 

[rodi]

I'm on cobra since I retired in June. I will switch our family to ACA coverage in the coming year. We will look at dental closely - my kids are winding up braces - but both have hit max coverage for the plan - switching might get us a bit more orthodontic coverage. (But probably not.)

 

[fh2000]

There is dental insurance under ACA on healthcare.gov.


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Only for children under 16 I believe:
10 Essential Facts About the Affordable Care Act, Dental and Vision Benefits | BenefitsPro

 

[pb4uski]

It used to be under pre-ACA law that you had to exhaust all 18 months of COBRA before you could enroll in any health insurance policy without preexisting conditions exclusions. As MichaelB points out, that has changed with ACA, but merely deciding COBRA is too expensive does not trigger a special enrollment opportunity outside the open enrollment window.

Ziggy, I don't think that is correct. You can also go directly into an ACA plan for the rest of the year rather than into COBRA if you wish since by losing employer health insurance you have had a change in circumstances that allows you to enroll in ACA even if it is not the open enrollment period.

https://www.healthcare.gov/glossary/special-enrollment-period/
https://www.healthcare.gov/glossary/qualifying-life-event/