Healthcare coverage preventing RE..

[24601NoMore]

Is this alleged $24k in premiums for 2 that you mention based on shopping or just a pre-conceived notion? I selected a couple random MI zip codes (in Detroit and Lansing) and an unsubsidized bronze plan for 2 was less than $1k/month. That my friend, is the price of freedom.... pure and simple.

Have you actually priced health insurance on healthsherpa.com or the ACA site? Or do you just like to rant?

Yes, I did price on the ACA website.

 

[HtownRose]

My approach was to take a part time job that provides good, inexpensive health insurance. (Airline reservations)

Would love to be totally retired, but this is a good compromise for me & I think of it as "my nice little retirement job."

I'm not mobile at this point (elderly Mom who is fairly independent, but don't want to leave her) & in my area (Houston) there are no PPOs on the individual market, at any price. (Last I checked, anyway.)

While I could afford one of the ACA HMO plans, & it would probably be fine for me at this point - no health issues, no Rx - I would not have peace of mind due to the possibility of major health problems arising before Medicare eligibility at age 65 - I want to be able to access a strong network of providers + the limited outside of network coverage if needed.

 

[fritz]

No apology necessary, government language is hard to navigate ..and unfortunately VA employees aren't always clear either. VA is not shy about paying outside charges when warranted. MY DH went to a VA walk in clinic with what turned out to be some cardiac issues. Within 30 minutes he was on his way by ambulance to a non VA cardiac hospital. I had a signed yellow sheet in my hand saying VA would be responsible for 100% of the bill. There was a highly regarded VA hospital an hour and a half away where he could have been treated or moved to after they were satisfied he wasn't in any immediate danger (which he wasn't) but they let him complete all the necessary follow up testing and 4 days in the hospital on the VA's dime in the local hospital.

He ended up needing valve repair surgery and we were so impressed with the care at the hospital the VA sent us to, that we elected to use our standard insurance and just pay the deductible out of pocket for the surgery. But the VA was exemplary in this situation.

I think there is so much abuse of the emergency/non-emergency issue that , the VA deliberately keep it a grey area. In a real emergency you or your family contact the VA ASAP explain what happened and ask how the VA wants to handle it. You can't call 2 weeks later and ask them to pay the bill.
In your situation if you don't have full faith in the VA, paying rack rate for regular insurance seems like a high price. Why wouldn't you just opt out of the system.

This is a little OT here, but that's our VA experience.

Your story is unique with the VA, and the VA isn't any different than any other healthcare system. You state you had gone to the VA Outpatient Care facility in your area. Not sure that you had an appointment, but they usually won't see anyone w/o one. The VA hospital is different and won't turn any veteran away. VA will tell you to go to the VA hospital over a clinic whenever you feel something is critical. Walk in to a clinic with obvious acute chest pain and they'll tell you to get in an ambulance and go to the nearest hospital (I've witnessed this scenario while at my CBOC).

Getting pre-approval paperwork from them (as you did) eliminates the unclear from their documents judgement/approvals after you've incurred some serious hospital emergency bills. A lot of the documents from the Va (and there are many) address everyone connected with the VA. This is veterans of all types of service, from 2 years and out - to career retired and on Tricare. Add to this those who left relatively unscarred to those mentally/physically scarred for life, and you can see why it's so complicated.

I've been with the VA for quite awhile now, and appreciate everything they've done for me over the years at little to no cost out of pocket. When evaluating the ACA and this scenario, I elected to stay with the VA and pay for ACA coverage (with no available subsidy) as a just in case. I figured that it would start paying back to me (financially) on Medicare, staying with the VA and traditional Medicare coverage - and it has...

If one chooses to leave the VA for ACA coverage, there's no guarantee you'll be accepted back when you go on Medicare or just decide to return (they do state that you'll have to reapply and be accepted). If you stay with the VA, you have to really look at this area of concern with their non-service related coverage at non-VA facilities under the age of Medicare coverage. This was the reason I stated it's my catch 22 scenario - staying with VA leaves one vulnerable to emergency coverage judgement, and ACA coverage to insure against this area of concern doesn't allow any subsidy. Getting a subsidy requires a veteran to leave the VA.

FYI - since you are more than 40 miles from your nearest VA hospital, the local CBOC probably has a SOP in place to provide pre-approval paperwork
for the local hospital. The 2014 Veterans Choice Policy allows them to do this along with if you have to wait more than 30 days to see a doctor.

 

[ivinsfan]

Your story is unique with the VA, and the VA isn't any different than any other healthcare system. You state you had gone to the VA Outpatient Care facility in your area. Not sure that you had an appointment, but they usually won't see anyone w/o one. The VA hospital is different and won't turn any veteran away. VA will tell you to go to the VA hospital over a clinic whenever you feel something is critical. Walk in to a clinic with obvious acute chest pain and they'll tell you to get in an ambulance and go to the nearest hospital (I've witnessed this scenario while at my CBOC).

Getting pre-approval paperwork from them (as you did) eliminates the unclear from their documents judgement/approvals after you've incurred some serious hospital emergency bills. A lot of the documents from the Va (and there are many) address everyone connected with the VA. This is veterans of all types of service, from 2 years and out - to career retired and on Tricare. Add to this those who left relatively unscarred to those mentally/physically scarred for life, and you can see why it's so complicated.

I've been with the VA for quite awhile now, and appreciate everything they've done for me over the years at little to no cost out of pocket. When evaluating the ACA and this scenario, I elected to stay with the VA and pay for ACA coverage (with no available subsidy) as a just in case. I figured that it would start paying back to me (financially) on Medicare, staying with the VA and traditional Medicare coverage - and it has...

If one chooses to leave the VA for ACA coverage, there's no guarantee you'll be accepted back when you go on Medicare or just decide to return (they do state that you'll have to reapply and be accepted). If you stay with the VA, you have to really look at this area of concern with their non-service related coverage at non-VA facilities under the age of Medicare coverage. This was the reason I stated it's my catch 22 scenario - staying with VA leaves one vulnerable to emergency coverage judgement, and ACA coverage to insure against this area of concern doesn't allow any subsidy. Getting a subsidy requires a veteran to leave the VA.

FYI - since you are more than 40 miles from your nearest VA hospital, the local CBOC probably has a SOP in place to provide pre-approval paperwork
for the local hospital. The 2014 Veterans Choice Policy allows them to do this along with if you have to wait more than 30 days to see a doctor.

Yes those rules on ACA and VA co-existing insurance are pretty clear and I think fair enough. We all have to make health choices. .it's the catch 22 comparison that causes confusion..in that asking to get double subsidies from the same source isn't realistic. You have already gotten your subsidy by using the VA. A lot of people would be happy having one of those choices open to them.

For any vets out there wondering, my DH did not have an appointment at the urgent care, that's why its urgent care. And the signed paperwork covering the bill was presented to us by the attending doctor before we even had time to ask about coverage.

Don't want to wander too far off topic but the subject of VA healthcare came up early in this thread.

 

[Freedom56]

Hey, gang.

W*rk has gotten to the point that it's taking years off my life, so it's high past time to RE - at the ripe old age of 54.

I'd RE TOMORROW if I could figure out how to pay for the HC without taking a huge chunk out of my retirement savings.

Curious what approaches the rest of you who have already RE'd (or are thinking of RE) are taking..here's my list..

- Manage income to < 4X FPL; get subsidies (still sucks - HUGE cost even after subsidies for anything that's not a HMO with ridiculous deductibles).

- Health Sharing - scares the bajeebus out of us. BIL is using this for his < 65 DW and I just can't see doing something with no contractual guarantee of reimbursement. Oh, he's saving a bundle monthly over the ACA exchange plans, but what if a major illness hits - are they ever truly going to get reimbursed?

- Something outside of the ACA exchange (is there such a thing any longer? I keep reading about healthcare brokers..does anyone have any good info on that option?)

Really frustrated by the insane costs..it's literally $24K premiums for the 2 of us before subsidies..with $3,500 - $6K pp deductibles. WHO CAN AFFORD THAT?

So, in the meantime..I continue to slog away at a j*b that I absolutely hate and which is probably killing me.

Appreciate any and all suggestions/help.

TIA..

We are in our 50's and we pay $878 per month for a Bronze EPO with OSCAR Health. We get no subsidies so we buy directly from the insurance company. There are lower costs options such as Kaiser HMO but we want access to better doctors and facilities. We only use our coverage for preventive care which is included in the premiums. Neither of us are on any regular prescription medication. My recommendation would be to stay in shape and exercise regularly and go for your annual physicals. If you don't have any chronic health issues, buy a bronze plan. If you are out of shape, buy a bike and go cycling regularly. It's cheaper that the alternative.

 

[HadEnuff]

Hey, gang.

W*rk has gotten to the point that it's taking years off my life, so it's high past time to RE - at the ripe old age of 54.

I'd RE TOMORROW if I could figure out how to pay for the HC without taking a huge chunk out of my retirement savings.

Curious what approaches the rest of you who have already RE'd (or are thinking of RE) are taking..here's my list..

- Manage income to < 4X FPL; get subsidies (still sucks - HUGE cost even after subsidies for anything that's not a HMO with ridiculous deductibles).

- Health Sharing - scares the bajeebus out of us. BIL is using this for his < 65 DW and I just can't see doing something with no contractual guarantee of reimbursement. Oh, he's saving a bundle monthly over the ACA exchange plans, but what if a major illness hits - are they ever truly going to get reimbursed?

- Something outside of the ACA exchange (is there such a thing any longer? I keep reading about healthcare brokers..does anyone have any good info on that option?)

Really frustrated by the insane costs..it's literally $24K premiums for the 2 of us before subsidies..with $3,500 - $6K pp deductibles. WHO CAN AFFORD THAT?

So, in the meantime..I continue to slog away at a j*b that I absolutely hate and which is probably killing me.

Appreciate any and all suggestions/help.

TIA..

Your reality, IMO, is a harsh one. Not only is healthcare expensive, but the longer period of time for which you have to guess how expensive it will be, the bigger risk you take.
When we try to calculate our retirement finances, we make some educated guesses about expenses, inflation, market returns (and risk therein) etc etc but nowhere are our guesses more filled with wild uncertainty than in figuring our healthcare costs.

We seem to be at the mercy of the industry (especially Big Pharm and the Big Insurance), and I don't think I'm taking this thread into the political danger zone by suggesting that whatever happens to ACA, or how such a plan is implemented, it is very likely to be a political football for at least the next 2 or 3 Presidential Terms, and even Medicare won't be immune to being punted back and forth down the field a few times in your lifetime.

If you are scared, you should be.

If I may make a suggestion: if you are even close to thinking you could retire at age 52, from a job that is taking years off of your life, how about some intermediate move? How about a job that you can live with, that at least pays enough for your healthcare costs? Let the nut grow (hopefully) or at least not get smaller as you work your way through your 50s.

Don't despair.

 

[Livefree]

I retired this past June, and was able to get a Silver Plan for $468 per month for the wife and I with no deductible and 1500 Out of Pocket.

I could have gotten plans for $200 per month, but not many doctors or specialists would take these plans.

It did go up $100 for 2018

 

[joeea]

My wife and I pay $262/month for a subsidized Silver Plan on the exchange.

Here in Massachusetts we have had RomneyCare/ObamaCare for a long time. I have to say it has worked out extremely well so far. We have a better plan now, with lower deductibles and cheaper than when I paid for the employee portion when I was working.

With what has been done to the ACA over the past year of so that may change down the road. But so far we are very happy with our choices, and expect that will take us to Medicare down the road.

I feel bad for those who don't have options as good as we do. Sadly, I don't see US healthcare changing for the better in the near future, the way things are going. Fortunately, we have planned for far worse cases than we have now and can deal with it financially.

As long as existing conditions continue to be covered, we'll be fine. The cost of my current cancer treatment is over $21k per infusion - that's not something I'd like to pay out of pocket.

 

[fritz]

Yes those rules on ACA and VA co-existing insurance are pretty clear and I think fair enough. We all have to make health choices. .it's the catch 22 comparison that causes confusion..in that asking to get double subsidies from the same source isn't realistic. You have already gotten your subsidy by using the VA. A lot of people would be happy having one of those choices open to them.

For any vets out there wondering, my DH did not have an appointment at the urgent care, that's why its urgent care. And the signed paperwork covering the bill was presented to us by the attending doctor before we even had time to ask about coverage.

Don't want to wander too far off topic but the subject of VA healthcare came up early in this thread.

The reference to my catch-22 was not specifically referring to any subsidy lost with being with the VA (although paying ACA policy full boat was not pretty). It was that being with the VA left me with one of two choices to cover a very unclear potential VA coverage gap as stated in previous posts - and that neither choice was ideal (leave the VA for subsidized ACA with wife, or buy non-subsidized ACA policy and stay).

CBOC (clinic) is not emergency care. I went to one I'm not signed up with while snowbirding in Florida a few years back, and they told me I should bring a book (expect a long day), as I was not in their VA system and an appointment would be further out than my remaining stay. VA hospital (where I would be accepted) was 4 hours away). Other choice was to go to local emergency care clinic w/o coverage - ACA policy didn't pay anything until max out of pocket/deductible $6000.00 was met). Not sure what type of VA facility you have in your area - it may give more care than a normal CBOC since you're so far from your VA hospital.

 

[scrabbler1]

The ordeal isn't getting the quote, it's paying for it..I wonder how much that policy would have gone up in 7 years, both in price and out of pocket number..I'm guessing there is no budget projection that would have covered that number.

I sometimes wonder how expensive my original individual HI policy would be had the ACA's exchanges not come into existence in 2014.

When I first ERed in late 2008, I had found a reasonable HI policy for $469 a month starting in 2009. But when I faced a 20% increase in 2010 and a nearly 25% increase in 2011, I was now paying nearly $700 per month and wondering how expensive HI would be if these big increases continued year after year. In 2 more years I'd be paying $1,000 a month, and 2 years after that I'd be up at $1,500 a month. My whole ER would be in some jeopardy and I was becoming concerned about my budget getting busted if I couldn't get this under control.

But the ACA got passed in 2010 with the exchanges starting in 2014. So, all I had to do was hang in there for the rest of 2011 and all of 2012 and 2013. I was healthy at the time (although my later ailments were being awakened), so I made the decision to be underinsured for 2 1/2 years, until the end of 2013. I chose a cheap, hospital-only plan for under $200 a month. This was effectively a catastrophic plan, as I'd be covered for an expensive hospital stay and little else.

I don't qualify for a big premium subsidy, maybe a few hundred dollars per year, because my MAGI is near the upper limit. (In fact, I an over the ACA premium subsidy cliff for 2017, but I am still getting it for 2018.)

I live in New York, which does not allow age rating, or else I'd be paying a lot more. But the COL is high in NY (I pay $4,000 in SALT) so what I don't pay to the insurance companies I pay to the SALT collectors.

 

[KidBrother]

Options for Health Care

Options for Health Care
DW & I retired in 2017 at 63 & 64.
We joined CHM (Christian Healthcare Ministries) in 2017 & are paying $300 monthly for our health care, $150 per unit (Gold Level).

Quoting CHM here:"Our ministry is made up of more than 200,000 members across the country. CHM, a ministry of Christians serving fellow Christians, has been in operation since 1981, is a Better Business Bureau Accredited Charity, and is an eligible option for individuals under the Affordable Care Act (our members are not penalized for not having health insurance). Our website is www.chministries.org"

 

[GTFan]

I understand may people are hyper sensitive about health expenses (because REASONS!), but it seems to me if you are planning ER it's really just another expense that you should check into before pulling the plug.

When I FIREd (2011) we had visited a health insurance broker to get a quote on coverage. Didn't seem like a particular ordeal - we'd done this before when I did various stretches of consulting (self employment) in the past.

When you are preparing for ER, you should understand your expenses and be able to cover them. All of them.

Sure, but NO ONE in 2011 expected premium increases on the scale that we've seen in the last couple of years. Kinda hard to budget for that.

 

[GTFan]

If I may make a suggestion: if you are even close to thinking you could retire at age 52, from a job that is taking years off of your life, how about some intermediate move? How about a job that you can live with, that at least pays enough for your healthcare costs? Let the nut grow (hopefully) or at least not get smaller as you work your way through your 50s.

Don't despair.

Agreed, OP there are decent PT jobs out there with affordable insurance. Take a look and perhaps step down to a low-stress job, don't stay in something that's killing you.

 

[24601NoMore]

I retired this past June, and was able to get a Silver Plan for $468 per month for the wife and I with no deductible and 1500 Out of Pocket.

I could have gotten plans for $200 per month, but not many doctors or specialists would take these plans.

It did go up $100 for 2018

Where on earth are you finding that? Our deductibles for Silver are $6,500 - $7,350 PER PERSON and a premiums are a LOT higher than $468/mo..

 

[samcat]

We gave our up our $2300 per month $6k per person deductible bronze plan in December and joined Christian Healthcare Ministries. It's only been three months with no serious medical issues but from what I read, it should work great. We did a lot of research and asking questions and think this is our solution. We are self insuring the small stuff getting cash discounts and getting prescriptions at Costco.

 

[Livefree]

Where on earth are you finding that? Our deductibles for Silver are $6,500 - $7,350 PER PERSON and a premiums are a LOT higher than $468/mo..

We were able to keep our income below 250% FPL to get cost sharing and that premium by managing our income.

 

[pb4uski]

Yes, I did price on the ACA website.

What level plan did you get prices for?

You might want to consider moving somewhere with more reasonable health insurance costs.... there are plenty of places in the US where a bronze level plan for 2 is less than $1,000/month... half the cost of what you were quoted.

 

[gauss]

If OP can manage income to less than 400% FPL and receive the subsidies then he would not need to move anywhere.

Net Premiums will be determined by his MAGI.

Retail prices may be higher in state to state, but the subsidy will increase to offset. Of course, this is all under current law.

The result of the upcoming November elections should provide actionable information on the future of this for OP, as the 2012 presidential election did for myself.
-gauss

 

[ivinsfan]

We were able to keep our income below 250% FPL to get cost sharing and that premium by managing our income.

Kind of an important detail...!

 

[ivinsfan]

What level plan did you get prices for?

You might want to consider moving somewhere with more reasonable health insurance costs.... there are plenty of places in the US where a bronze level plan for 2 is less than $1,000/month... half the cost of what you were quoted.

With the huge upheaval in the markets that strikes as overkill. What if you move to a place with a small number of insurers and they pull out of the market. Or the only insurer remaining is a high priced option. If you to move fine don't move just to get cheaper insurance....you could end chasing your tail.

 

[Pilot2013]

I am thinking that the subsidy for people who retire before Medicare (pre-65) will be caught up in changes as we move forward, and this loophole for people to take advantage for ER purposes will be closed. Then it will be back to making a plan (savings) that covers HI as part of one's ER endeavor.

 

[pb4uski]

.... You might want to consider moving somewhere with more reasonable health insurance costs.... there are plenty of places in the US where a bronze level plan for 2 is less than $1,000/month... half the cost of what you were quoted.

With the huge upheaval in the markets that strikes as overkill. What if you move to a place with a small number of insurers and they pull out of the market. Or the only insurer remaining is a high priced option. If you to move fine don't move just to get cheaper insurance....you could end chasing your tail.

What else would you suggest?

OP hates his job, wants to quit and RE but doesn't want to pay $24k/yr in HI premiums nor go the health ministry route. What other options does he have?

It seems to me that moving is better than staying in a job you hate or paying $24k/year for health insurance where he lives now.

Now I would agree that if he does RE and move to find more affordable HI that he should seek out somewhere with a relatively stable HI market.... there are plenty of places like that out there.

 

[brucethebroker]

Why is ACA off the table for you? Since you have worked some in 2018, you may not get a large PTC this year, but next year when you presumably only have passive income you could pay very little for ACA.

Yep.
Actually, you would better to use your non-qualified savings or borrow money (HELOC) for your income rather than pull it out of IRA/401-k. OR, start a PT business and write it off your taxes. Gut it out to Medicare.

Aggressive, yes. But legal. It is all about the income, not assets with ACA. Read all you can about how much you can earn. Learn what reduces MAGI. Earn up to the limit you choose and borrow/WD the rest. Worth it, since the
the savings/tax credits are sizable. Become an expert.

 

[brucethebroker]

I am thinking that the subsidy for people who retire before Medicare (pre-65) will be caught up in changes as we move forward, and this loophole for people to take advantage for ER purposes will be closed. Then it will be back to making a plan (savings) that covers HI as part of one's ER endeavor.

Could happen. Might not. Plan on today, not what might happen in the future.

 

[Mr._Graybeard]

Yep.
Actually, you would better to use your non-qualified savings or borrow money (HELOC) for your income rather than pull it out of IRA/401-k. OR, start a PT business and write it off your taxes. Gut it out to Medicare.

Aggressive, yes. But legal. It is all about the income, not assets with ACA. Read all you can about how much you can earn. Learn what reduces MAGI. Earn up to the limit you choose and borrow/WD the rest. Worth it, since the
the savings/tax credits are sizable. Become an expert.

Good post. We also got a lot of good advice on coverage from a private health insurance broker when we signed up for ACA insurance in 2014. The broker gets his commission from the insurer, so he works for the insured free of charge.