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

[MichaelB]

Folks, the discussion of costs and alternatives to healthcare insurance is interesting, so let's keep on that theme and not let politics or election issues creep into the discussion.

 

[pb4uski]

I use a Co-Op that is accepted by ACA meaning no penalty. There are three Co-Ops accepted by ACA. I pay $150 per month and have a $500 per incident "Cost-Share"....

Here is what I had in mind when I mentioned the 'third option' - combining non-ACA-compliant health insurance with the ACA non-participation tax penalty to lower my overall insurance costs. Could this work? I don't know, but it's worth exploring for 2017.

https://resources.ehealthinsurance.com/affordable-care-act/critical-illness-insurance

Scary. What if you have a major illness or medical emergency and the total medical bills are $500,000? How much of that bill would be covered? How much would you have to pay?

True... you're saving $8-12k a year or so in premiums but you are putting EVERYTHING that you have at risk.

 

[socca]

Scary. What if you have a major illness or medical emergency and the total medical bills are $500,000? How much of that bill would be covered? How much would you have to pay?

True... you're saving $8-12k a year or so in premiums but you are putting EVERYTHING that you have at risk.

I would purchase a critical illness policy (CIP) for catastrophe-impact-reduction, not risk elimination. The question is whether the amount of impact reduction is worth the CIP premium. At this point, this is all hypothetical because I don't know if any reputable carriers offer CIPs in Florida, and if so, many other details would need to be examined before I would go this route.

One nice thing about the market for CIPs is that it may be largely unregulated. I've been purchasing health insurance in the private market since 2007, so I'm comfortable playing in a relatively unregulated space.

 

[SteveNU]

Just got notified today that our company retiree health insurance is going to be dropped at the end of this year. We will have to get private insurance. The good news is that the company will provide a $6500 per person subsidy.

Right now we are paying about $14,000 for premiums and deductibles/oop. A quick look at the offerings in our state (CT) shows the cost to be around $24-$28k +- for somewhat comparable coverage. So our costs will probably stay about the same as they are now for worse coverage and the hassle of shopping for new coverage.

Sent from my Nexus 6P using Early Retirement Forum mobile app

 

[doxiemama]

Scary. What if you have a major illness or medical emergency and the total medical bills are $500,000? How much of that bill would be covered? How much would you have to pay?

True... you're saving $8-12k a year or so in premiums but you are putting EVERYTHING that you have at risk.

I have unlimited coverage through the Co-Op. I participate in "Brothers Keeper" and it adds about $100 per year to the cost. I am in the "Gold" program $150 per month. The other programs do have a limit on coverage. Gold with Brother's Keeper is unlimited coverage:

Brother's Keeper

 

[pb4uski]

I assume that Brother's Keeper is not a licensed insurer... what happens if it has a run of claims and is unable to pay yours?

 

[LakeRat1]

I am very interested in the CO_OP with Brother's Keeper...... I have been to the web page, but do not quite understand how any bills are paid if and when you require medical services ....... How do you get the $$$ from the CO_OP to pay the bills??

 

[travelover]

I am very interested in the CO_OP with Brother's Keeper...... I have been to the web page, but do not quite understand how any bills are paid if and when you require medical services ....... How do you get the $$$ from the CO_OP to pay the bills??

I found this article on a similar arrangement interesting.

Each time Ms. Bixby visited her hospital for tests or chemotherapy, she explained that she was a self-pay patient and a member of a cost-sharing ministry. Sometimes the receptionist nodded; sometimes she got a blank stare. The hospital never denied her treatment, but “I was getting a two-inch stack of bills every month, and threats that they would take me to collections,” she told me.
Christian Healthcare Ministries assigned her case to a “member advocate,” who negotiated discounts on her fees. These counted toward Ms. Bixby’s $5,000 deductible, so she paid out of pocket only for office visits. In the end, the ministry persuaded the hospital to lop $220,900 off a bill of $301,540 and reimbursed or paid directly the remaining $80,640.

http://www.nytimes.com/2015/02/01/opinion/sunday/onward-christian-health-care.html

 

[pb4uski]

Interesting, "but the ministry makes no guarantees of payment" got my attention. It's nice that they have been able to negotiate some great discounts for their members, but I wonder about how many instances where the providers refused to play ball and the person got stuck with large medical bills to pay happen and we don't hear about those.

An interesting approach, but not a substitute for health insurance, where legitimate claims are paid, insurers are required to have adequate reserves and capital and state guaranty funds (and an ability to collect taxes from solvent insurers) stand behind insurers who become insolvent.

 

[doxiemama]

I am very interested in the CO_OP with Brother's Keeper...... I have been to the web page, but do not quite understand how any bills are paid if and when you require medical services ....... How do you get the $$$ from the CO_OP to pay the bills??

I submit a claim to CHM and they pay me directly and then I pay the provider.

 

[doxiemama]

Interesting, "but the ministry makes no guarantees of payment" got my attention. It's nice that they have been able to negotiate some great discounts for their members, but I wonder about how many instances where the providers refused to play ball and the person got stuck with large medical bills to pay happen and we don't hear about those.

An interesting approach, but not a substitute for health insurance, where legitimate claims are paid, insurers are required to have adequate reserves and capital and state guaranty funds (and an ability to collect taxes from solvent insurers) stand behind insurers who become insolvent.

Your opinion not mine. I am happy with this option. The doctor I see has a practice full of CHM patients. Many have had surgery, all claims have been paid. Insurance companies also get great discounts so CHM tries to not pay more than insurance companies have to pay. It is great to have options!

 

[bclover]

Milk

I don't know that there are any bad guys. Perhaps the doctor making $300,000 a year, but she likely spent a lot of effort getting to that point. Maybe the drug manufacturer who lost all of their investor's money trying to get a drug through billion dollar trials is the bad guy?

Maybe the consumer who sues at the drop of a hat is also a culprit, who FORCE the drug companies to get through those trials.
Every day on my way to work there is a popular commercial from a local law firm encouraging anyone who ever used baby powder to join a class action against J&J. Even if your not sick, just in case you develop cancer in the future.
It's an all around broken system

Anyhoo,
I have retiree medical from mega corp.
I'm single with 2 college students on my plan.
$8000k annually. 2500 deductible. No copays, includes dental

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[ShokWaveRider]

One other thing that plagues DW & I is the fact every year things potentially change, prices go up, rules change, one has to re-apply, potential dropping of coverage. Makes it very hard for the FIREd folk to do financial planning.

 

[pb4uski]

I count our blessings that our health insurance plan has been very stable and the premium increases have been relatively modest.

 

[MichaelB]

We're in South Florida and so far have been fortunate. There are more insurance options in this state than just about anywhere else in the US. We've changed plans each year, allowing us to continue to find excellent coverage without suffering the major price increases elsewhere. I expect that to end now, and for the next enrollment period plan on a 2x increase in premium, but thankfully that will only affect me, as DW enrolls in Medicare.

 

[ShokWaveRider]

We're in South Florida and so far have been fortunate. There are more insurance options in this state than just about anywhere else in the US. We've changed plans each year, allowing us to continue to find excellent coverage without suffering the major price increases elsewhere. I expect that to end now, and for the next enrollment period plan on a 2x increase in premium, but thankfully that will only affect me, as DW enrolls in Medicare.

Michael:

We live in NE Florida, our current payment for both of us is $341pm with Florida Blue after subsidies. We are living off our Post Tax nest egg to keep income low and NOT taking anything from our IRA's. Our Post Tax positions are about 60% of our total stash.

I hope the premiums do not double for 2017 $682.... Our plan is with Florida Blue HMO that has worked out VERY well this year so far. Plan Number 1477b.

 

[MichaelB]

Michael:

We live in NE Florida, our current payment for both of us is $341pm with Florida Blue after subsidies. We are living off our Post Tax nest egg to keep income low and NOT taking anything from our IRA's. Our Post Tax positions are about 60% of our total stash.

I hope the premiums do not double for 2017 $682.... Our plan is with Florida Blue HMO that has worked out VERY well this year so far. Plan Number 1477b.

I expect our premium to double because our current insurer, Humana, will not offer this policy next year, and the only remaining option (for a national network) will be a BCBS "BlueOptions" plan that, after a 9.8% price increase plus the age adjustment, will cost double what we are currently paying. Nothing I can do about this except suck it up for another 22 months. Such is life ..

BCBS Fl has proposed increases of 11.6% for BlueSelect and 9.8% for BlueOptions. I didn't see a separate rate request for FloridaBlue HMO, but it should be in the same range as the other FL-BCBS products. Your cost depends on the premium assistance calculation, which in turn is based on the 2od lowest silver, so that adds some complication, but it should not be a "budget breaking" increase.

 

[pb4uski]

.... Nothing I can do about this except suck it up for another 22 months. Such is life .. ....

The price of freedom!

 

[ShokWaveRider]

The price of freedom!

Canada is free too.

 

[pb4uski]

Until you do your tax return.

 

[MichaelB]

The price of freedom!

I wasn't complaining. The ACA has been a boon to us, neither of us could get pre-ACA individual insurance due to pre-existing conditions.

The CHM option described by doxiemama is interesting. It's not insurance, and the literature is a bit loosely worded, but after reading it this morning my first thought was to ask if it might not work as a compliment to our current insurance to offset the high deductibles.

 

[ivinsfan]

Michael:

We live in NE Florida, our current payment for both of us is $341pm with Florida Blue after subsidies. We are living off our Post Tax nest egg to keep income low and NOT taking anything from our IRA's. Our Post Tax positions are about 60% of our total stash.

I hope the premiums do not double for 2017 $682.... Our plan is with Florida Blue HMO that has worked out VERY well this year so far. Plan Number 1477b.

So here the problem that us full pay people have to deal with, your premium will not double, you have premium caps because of your subsidies. Ours will double because we don't. This has worked out very well for some and not so well for others. That's just the way it is and why I said in some cases it encourages people to stop working.Your feeling about the ways this works probably depend on which side of the equation you are on.

 

[ShokWaveRider]

We certainly would not have been able to get insurance without ACA either.

 

[ShokWaveRider]

So here the problem that us full pay people have to deal with, your premium will not double, you have premium caps because of your subsidies. Ours will double because we don't. This has worked out very well for some and not so well for others. That's just the way it is and why I said in some cases it encourages people to stop working.Your feeling about the ways this works probably depend on which side of the equation you are on.

Yet ANOTHER argument for single payer. Why are so many people against it?

 

[Ronstar]

Thanks for the discussion.