Healthcare coverage preventing RE..

[scrabbler1]

To me, health insurance should be insurance against something catastrophic -- that's what insurance is supposed to do. A bronze ACA plan fills that bill. The premiums for our bronze-level coverage has gone lower every year since 2014. For 2018, The monthly premium is $0.00 after subsidy.

This is one of two reasons I have health insurance. The other is to avoid having to pay the huge cost of one of my prescription drugs. I pay $527 per month (net of small ACA subsidy) for a Silver Plan but that plan gives me a $350 reduction per month in the price of the costly drug.

 

[zinger1457]

The premiums for our bronze-level coverage has gone lower every year since 2014. For 2018, The monthly premium is $0.00 after subsidy.

Are you saying that your bronze plan premium (without subsidy) has gone down every year since 2014? If so that is far from typical. The cost of my bronze plan (HSA HDHP) has increased by over 400% since 2014, luckily for me the subsidy has helped stabilize or even lowered my monthly cost. I can feel the pain for those not qualifying for a subsidy.

 

[pb4uski]

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?

 

[ncbill]

I’ll need to solve for this starting 2020. From a pure $$ standpoint, expat is by far the most affordable. We have made a few trips to Yucatán Caribbean coast and care services, as well as insurance, is a fraction of USA... In Mexico, a few stitches and wound meds are about $20, setting and casting a broken arm about $30. Catastrophic policies are in the $200/mo range. Our system is so out of whack. It’s sad.

Down in Mexico, many expats buy into the national health insurance (IMSS) as catastrophic care for under $500 per year.

 

[audreyh1]

Are you saying that your bronze plan premium (without subsidy) has gone down every year since 2014? If so that is far from typical. The cost of my bronze plan (HSA HDHP) has increased by over 400% since 2014, luckily for me the subsidy has helped stabilize or even lowered my monthly cost. I can feel the pain for those not qualifying for a subsidy.

No - I think he means it’s gone down for him with subsidy.

 

[pb4uski]

A little out there, but any thoughts to moving to a state with a much lower ACA net cost?
Florida is one example. Perhaps drastic, but throwing out another idea.

Moving to a lower cost state is a decent idea... but Florida costs much more than my home state so I'm not so sure about that part.

One play might be to move to Vermont or New York, the only 2 states that prohibit age rating... or Mass, which restricts age rating to 2:1.

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/state-rating.html

Funny thing... I googled sttes with highest and lowest health insurance costs and this article says OP's state is one of the lowest.

https://www.huffingtonpost.com/gobankingrates/10-best-and-worst-states_b_9030422.html

Michigan is another state with low a monthly premium — just $210 a month, or $2,520 annually. The low-cost silver plan with this premium, Humana Silver 3800/Detroit HMOx, does have a $3,800 deductible, however, which is higher than most states’ silver plan deductibles, but costs are kept low with other fees, such as the $20 primary doctor visit fee and the $250 emergency room copay before deductible. ...

 

[fritz]

We retired B/4 ACA was in effect (2009 @ 58/57), and purchased individual policies out in the market. We elected to purchase separate policies as I am covered by the VA, but the VA does not normally cover emergencies in non-VA facilities. A drop on the street will get you to the nearest hospital, and we figured one of those would easily overrun the cost of just insuring me with a catastrophic type of coverage from BCBS until Medicare (was reasonable back then). ....

When affordable care act came along, we thought things would get better for us with costs/coverage (wrong)...

My policy was over two times as costly on the ACA...


I wanted to add to this post, but too late -

If one is using the VA for coverage, you cannot get any subsidy when buying on the ACA exchanges (thanks again Mr. President for stating "your covered if you're VA"). We had to take out separate policies to get different ACA coverages, and to qualify DW for any subsidy. If you're not VA and you both go on the ACA together - you'll get a much better (subsidy) deal. If VA, You would have to leave the VA system (documented in writing to the VA) to qualify for the ACA with subsidy. No guarantee you'd be accepted back if you chose to leave the VA healthcare system. A real catch-22 for veterans - no ACA subsidy with VA and no guarantee of non VA coverage in an emergency w/o ACA coverage (don't believe there are any catastrophic coverages available for this scenario either over the age of 32 and financially healthy). And subsidy for just DW was no where near what we could have gotten together. I chose to stay with VA, and costs are now going back positive with Medicare - paying back extra costs incurred with no subsidy ACA coverage. I use traditional Medicare with Hi deductible F and no part D as VA qualifies as Part D coverage, (we travel and snowbird). Would be buying Medigap G and part D w/o VA.

 

[Mr._Graybeard]

No - I think he means it’s gone down for him with subsidy.

Yes, what DW and I pay out of pocket.

In 2015 our subsidized premium was about $300/mo; in 2016, about $225. Last year it was about $120.

 

[jollystomper]

I was fortunate in that I liked most of my job, so I kept going after retirement eligibility and ramped up the savings. I will be getting a pension so it is doubtful we will be eligible for a subsidiary. I will be turning 60 this year, and our plan is COBRA for 18 months and Megacorp subsidized insurance at greater than employee rates but still less than ACA plans. Between my target retirement date and Medicare we estimate about $120K in premiums and another potential $75K deductible exposure... not what we'd choose to spend on health care but we are going to grit our teeth and deal with it.

 

[swakyaby]

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

Really frustrated by the insane costs..

I empathize with your thoughts about the high cost of health insurance. I worked a few extra years just to have what I thought was enough to cover the skyrocketing premiums for DH (age 61) and myself (age 56) until Medicare. I decided to pay for COBRA (employer's cost plus 2% administration fee) which comes out to $1,445/month for Blue Shield High Deductible with HSA. I chose to start out with this relatively costly insurance because I need to have a somewhat elective medical procedure this year, and I have learned very few GI specialists in my area accept ACA insurance. After 18 months, I'll look more closely at the health exchanges.

 

[gauss]

IF you qualify for the subsidy (ie income < 4x FPL) and you still can't afford the premiums I think you may have larger issuers, or perhaps don't understand how it works.

You will pay no more than ~10% of your MAGI on your net health care premiums. It could be as low as ~2% of MAGI if you are closer to 138% of FPL.

Deductibles may be high, but do you hit that type of deductible every year? If you are healthy I would think not. Also the "negotiated rates" that you will get from providers when covered by a larger insurer could be 1/10th of the amount of the providers retail rates. Healthcarebluebook.com is a good survey site giving estimates of rates for procedures that are negotiated as opposed to the retail rates.

-gauss

p.s. Passage of the ACA actually helps many to ER. It certainly did in my case. It would have been too risky for me to ER under the pre-2014 rules.

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).

 

[athena53]

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?

My brother and his wife live in SC and when his previous employer stopped providing retirees coverage as of 1/1/2018 they shopped around and ended up with a policy costing $22K/year for both of them. Last year my policy in MO was $9,000, also after extensive shopping. None of us qualifies for subsidies. The OP's numbers look ballpark to me.

 

[pb4uski]

I realize that in some parts of the country that it does cost that much... but looking at the cost of bronze level plans for a couple random zip codes in the OP's state his numbers seem high.

Some people hear stories like yours and think HI is that expensive everywhere when it varies greatly across the country

Sent from my Moto G Play using Early Retirement Forum mobile app

 

[ivinsfan]

We retired B/4 ACA was in effect (2009 @ 58/57), and purchased individual policies out in the market. We elected to purchase separate policies as I am covered by the VA, but the VA does not normally cover emergencies in non-VA facilities. A drop on the street will get you to the nearest hospital, and we figured one of those would easily overrun the cost of just insuring me with a catastrophic type of coverage from BCBS until Medicare (was reasonable back then). ....

When affordable care act came along, we thought things would get better for us with costs/coverage (wrong)...

My policy was over two times as costly on the ACA...


I wanted to add to this post, but too late -

If one is using the VA for coverage, you cannot get any subsidy when buying on the ACA exchanges (thanks again Mr. President for stating "your covered if you're VA"). We had to take out separate policies to get different ACA coverages, and to qualify DW for any subsidy. If you're not VA and you both go on the ACA together - you'll get a much better (subsidy) deal. If VA, You would have to leave the VA system (documented in writing to the VA) to qualify for the ACA with subsidy. No guarantee you'd be accepted back if you chose to leave the VA healthcare system. A real catch-22 for veterans - no ACA subsidy with VA and no guarantee of non VA coverage in an emergency w/o ACA coverage (don't believe there are any catastrophic coverages available for this scenario either over the age of 32 and financially healthy). And subsidy for just DW was no where near what we could have gotten together. I chose to stay with VA, and costs are now going back positive with Medicare - paying back extra costs incurred with no subsidy ACA coverage. I use traditional Medicare with Hi deductible F and no part D as VA qualifies as Part D coverage, (we travel and snowbird). Would be buying Medigap G and part D w/o VA.

I'm not sure what your quarrel is with these rules. The VA rules and subsidy issue is the same as the Medicare rule..One spouse on Medicare the younger spouse gets a little less money for her subsidy. That's not a Catch-22 that's common sense.

Now true emergency care WILL be covered by the VA..I've never seen anything to the contrary.. Depending on the situation you might be moved ASAP to a VA hospital. Of course the burden is on the Vet to be sure it's an emergency situation. In exchange for this you get virtually free health care and heavily subsided drugs. And before anyone comments on the last sentence I mean free cost wise. All vets earned their coverage by serving their country.

You already got your cost subsidy baked into the VA coverage, why would you be offered a double dip in the subsidy pool.

If a vet is uncomfortable with the VA rules or location of their providers they have complete freedom to buy a full price policy and go for a subsidy, if they drop completely out of the VA system. It seems you think a belt and suspenders health care coverage should get you a double subsidy.

 

[steinj]

I have seen many early retirees move to central america for a few years then return when eligible for medicare....health insurance outside the US is way cheaper.

 

[MBSC]

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?

My brother and his wife live in SC and when his previous employer stopped providing retirees coverage as of 1/1/2018 they shopped around and ended up with a policy costing $22K/year for both of them....The OP's numbers look ballpark to me.

The OP stated he is only 54 years old. A Bronze family plan for a couple of 54 year olds in South Carolina is $1225/mo or $14,700/yr before subsidy.

 

[Mr._Graybeard]

This is one of two reasons I have health insurance. The other is to avoid having to pay the huge cost of one of my prescription drugs. I pay $527 per month (net of small ACA subsidy) for a Silver Plan but that plan gives me a $350 reduction per month in the price of the costly drug.

For sure, if we had significant prescription costs, we'd be in a silver plan. DW takes a couple prescription pills, but they're cheap generics.

 

[GTFan]

p.s. Passage of the ACA actually helps many to ER. It certainly did in my case. It would have been too risky for me to ER under the pre-2014 rules.

Same here, I would not have considered ER before I took it at the end of 2014 (even though I have unsubsidized, $1k+/mo. MegaCorp retiree HC as an option). With the ACA I get a huge subsidy for a low OOP Silver plan by managing income below 200% of FPL. Pre-subsidy it's something like $1500/mo. for two, after it's less than $100.

Obviously this isn't an option for some here so I agree for them, unsubsidized ACA is basically a big shaft now. But at least you are guaranteed coverage which wasn't the case before 2014.

Biggest ACA uncertainty now is lack of insurers and restricted networks IMO, cost is secondary if you can get subsidies.

 

[pj.mask]

With the new laws pushed out this year, isn’t the Unsubsidized price going to increase?

 

[fritz]

I'm not sure what your quarrel is with these rules. The VA rules and subsidy issue is the same as the Medicare rule..One spouse on Medicare the younger spouse gets a little less money for her subsidy. That's not a Catch-22 that's common sense.

Now true emergency care WILL be covered by the VA..I've never seen anything to the contrary.. Depending on the situation you might be moved ASAP to a VA hospital. Of course the burden is on the Vet to be sure it's an emergency situation. In exchange for this you get virtually free health care and heavily subsided drugs. And before anyone comments on the last sentence I mean free cost wise. All vets earned their coverage by serving their country.

You already got your cost subsidy baked into the VA coverage, why would you be offered a double dip in the subsidy pool.

If a vet is uncomfortable with the VA rules or location of their providers they have complete freedom to buy a full price policy and go for a subsidy, if they drop completely out of the VA system. It seems you think a belt and suspenders health care coverage should get you a double subsidy.

I've attached a couple of pdfs of the VA's policy on coverage provided from non-VA facilities (the VA mailed the fact sheet to me when the ACA was first implemented). VA does cover service connected issues (injuries/illness that occurred during service) in non-VA facilities, but will not specifically state they will cover non-service connected issues in a non-service facility in an emergency (heart attack, or stroke where the ambulance takes you to the nearest hospital). I called the VA for clarification at the time, and was not successful with getting anything verbal or in writing regarding this issue (was actually told that if it were me, I'd buy the insurance). It's pretty much a judgement call by the VA after the fact - when you've incurred the emergency expense. There are forms one must fill out and submit to the VA for them to evaluate if they will pay your incurred emergency bills. If you have something that addresses this issue in writing - please let me know. I've brought this up here before and a person connected with the VA was looking into this, but never obtained further clarification.

Apologize if you see this as a rant or quarrel with the VA, but I stated I stayed with them (as I am fortunate to be able to afford to pay for an ACA policy w/o subsidy in early retirement). I was just clarifying this from my earlier post for those readers who are veterans covered by the VA that might not be aware of this area of questionable coverage and might not have considered buying additional coverage from the ACA exchange.

 

[anethum]

My actual numbers are similar to what the OP is seeing. I chose a silver PPO plan with cost sharing the 2 previous years. After the current administration's decision regarding cost sharing, a silver plan is now priced higher than a gold plan for this year in my area. I decided to go with a bronze PPO plan this year. It has an annual deductible of $6,550. The monthly premium is $1,386 or $16,632/year. That is for an individual policy. If I keep my MAGI just below 400% of the FPL, I'll get a $661/month subsidy. That still leaves me with an annual premium cost of $8,700 with a $6,650 deductible before the policy begins to pay for anything beyond mandated preventive care.

I'm grateful that the ACA exists, but health insurance and healthcare are completely FUBAR in the USA. I'll hit Medicare age next year. It can't come soon enough.

 

[Mr._Graybeard]

Same here, I would not have considered ER before I took it at the end of 2014 (even though I have unsubsidized, $1k+/mo. MegaCorp retiree HC as an option). With the ACA I get a huge subsidy for a low OOP Silver plan by managing income below 200% of FPL. Pre-subsidy it's something like $1500/mo. for two, after it's less than $100.

Obviously this isn't an option for some here so I agree for them, unsubsidized ACA is basically a big shaft now.

Yep, the subsidy framework could be a lot better for people with upper-middle incomes. Unfortunately for them, the likelihood of improvements to that area seem remote for the foreseeable future.

The system is still deeply flawed, no doubt about it. But it's been a huge boon for early retirees. Moreover, if a 64-YO couple can get high-deductible health insurance without an out-of-pocket cost, I have to assume it's also within reach for a healthy 20-something.

With the new laws pushed out this year, isn’t the Unsubsidized price going to increase?

Could happen. Our unsubsidized premium rose 50% for 2018, but our available subsidy jumped 100%. We actually left $200/mo in subsidy money on the table. We briefly thought of upgrading to a gold plan, but ultimately decided that the basic bronze was the best fit for us.

 

[mpeirce]

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.

 

[ivinsfan]

I've attached a couple of pdfs of the VA's policy on coverage provided from non-VA facilities (the VA mailed the fact sheet to me when the ACA was first implemented). VA does cover service connected issues (injuries/illness that occurred during service) in non-VA facilities, but will not specifically state they will cover non-service connected issues in a non-service facility in an emergency (heart attack, or stroke where the ambulance takes you to the nearest hospital). I called the VA for clarification at the time, and was not successful with getting anything verbal or in writing regarding this issue (was actually told that if it were me, I'd buy the insurance). It's pretty much a judgement call by the VA after the fact - when you've incurred the emergency expense. There are forms one must fill out and submit to the VA for them to evaluate if they will pay your incurred emergency bills. If you have something that addresses this issue in writing - please let me know. I've brought this up here before and a person connected with the VA was looking into this, but never obtained further clarification.

Apologize if you see this as a rant or quarrel with the VA, but I stated I stayed with them (as I am fortunate to be able to afford to pay for an ACA policy w/o subsidy in early retirement). I was just clarifying this from my earlier post for those readers who are veterans covered by the VA that might not be aware of this area of questionable coverage and might not have considered buying additional coverage from the ACA exchange.

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.

 

[ivinsfan]

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.

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.