Healthcare insurance and retirement - again!

[GTFan]

Almost no one here is actually financially independent

Those who think they are, are deluding themselves

Sucking it up vis a vis food, housing, cars, locations, even the kids college are doable. Medical care? Not. If you are fortunate you can string it along, have things end well for you then declare some kind of victory. But don't confuse that with having any control over the situation or having been actually financially independent

Um, the ACA removed caps on payouts and guaranteed you would be covered. Therefore, medical costs TODAY is not an issue for FI. Tomorrow is obviously another story that we're all speculating about.

Saying there's stuff out of your control is equally irrelevant, like the old asteroid or nuke war scenarios. It really has nothing to do with being personally FI (outside of those black swan events that affect everyone).

 

[rodi]

Please don't link paywalled articles.

It wasn't paywalled for me. I think you get a finite number of clicks per month before the paywall kicks in. Regardless.. I was able to read the article without a paywall.

 

[GTFan]

Yep, still a paywall.

 

[REWahoo]

Not a paywall for me either. You may be able to get around the paywall by googling the title.

 

[Birdie Num Nums]

The health care policy s changing quickly. Campaign documents are being removed and old ideas are replacing ideas floated during the campaign:

...Trump’s central agenda item to repeal Obamacare and replace it—something the Republican establishment has long and desperately wanted—still stands firm. But other items have conspicuously disappeared and been replaced by core Republican agenda items....

Trump’s healthcare plans get swift Republican makeover | Ars Technica

As I posted on a related thread here: Trump is already hinting at back-pedaling a bit on an outright repeal of the entire ACA, most notable being that pre-existing condition provision:

Donald Trump has said that he might not repeal Obamacare, perhaps his biggest campaign promise. The President-elect performed the apparent U-turn after his meeting with Barack Obama at the White House this week, he has said. Mr Trump is going to look at "amending" the Affordable Care Act, rather than completely repealing it, he told the Wall Street Journal.
​

According to the BBC late tonight, "He told the Wall Street Journal he favours keeping two pillars of the bill because 'I like those very much'."

Bet that Obama spent most of his meeting with Trump talking 'bout the good and bad of his legacy healthcare reform.

 

[Golden sunsets]

Please don't link paywalled articles.

This was not pay walled on my iPad.


Sent from my iPad using Early Retirement Forum

 

[MichaelB]

A NY Times article with some informed speculation on how the ACA repeal may go down

http://www.nytimes.com/2016/11/12/b...region=span-abc-region&WT.nav=span-abc-region

Please don't link paywalled articles.

This is one reason why we discourage naked links.

The linked article addresses health care and other matters. The part on healthcare is speculation and conjecture, like every other article, because no one knows, but media needs to continue publishing.

This post earlier in the thread by MBSC has no paywall, links to Health Affairs Blog, and has a pretty good overview of what might happen. http://www.early-retirement.org/for...and-retirement-again-84072-4.html#post1799121

 

[jabbahop]

In terms of FI assumptions and health care. There are those surrounding the cost of health insurance which are hopefully within one's margin of error. The wild card for me (and perhaps others with with pre-existing conditions) is whether we now have to plan for paying for worst case medical situations if we can't get insurance. My cancer treatment has probably cost $100K and if I relapse, the next level treatment will be even more expensive.

Should my plan assume I need to go out of pocket for this? Should I plan for multiple of these health scenarios? Many of us have baked in unlikely market scenarios (via Firecalc, etc.), new roofs, etc.

Perhaps this isn't necessary given the current discussions about keeping some sort of pre-existing condition protection - what are others thinking about doing that have pre-existing conditions but aren't covered by some sort of company/government plan?

 

[bingybear]

Please don't link paywalled articles.

It does not look like paywall, but the put up an add and sign in that you either need to close or scroll around. The article and video are available without actually subscribing. You do need to either close the ad or scroll a bit.

 

[audreyh1]

Just watching the news. It looks like perhaps a softening of the issue. For those who propose waiting for legislation to be presented - Wake up. Make your opinion known to your reps now. Sheep never lead.
This IS important and beyond the scope of politics. Thank-you

Great point!

Don't be passive about this.

Write your Senators and Congressperson. They need to hear from you now.

I am.

Audrey

 

[donheff]

Great point!

Don't be passive about this.

Write your Senators and Congressperson. They need to hear from you now.

I am.

Audrey

+1 The replace part will be hard. Make your views known - this is particularly true for those of you who voted for the rep/senator you will be writing to.

 

[EastWest Gal]

+1 The replace part will be hard. Make your views known - this is particularly true for those of you who voted for the rep/senator you will be writing to.

The Senator or Congressperson has no idea how you voted. That doesn't matter. I,DH and DS will be writing letters this weekend.

Congress voted to repeal the ACA multiple times. They never intended to replace it. They probably don't intend to now. The goal needs to be that the consequences of such an action be considered before it takes place. We can never know all the consequences. But they still can be analyzed a bit.

 

[REWahoo]

Congress voted to repeal the ACA multiple times. They never intended to replace it. They probably don't intend to now.

I have to disagree.

The reelection survival instinct will force Congress to find/create a replacement. While the country may be divided on many issues, a substantial majority agrees we must have available and at least somewhat affordable health insurance. Failure to come up with that would be political suicide.

 

[niven]

My prediction is they will move to the Romneycare model-which was actually managed medicaid plans actually filling out state medicaid forms with higher qualifying amounts

That doesn't reconcile with what I've read:
https://en.wikipedia.org/wiki/Massachusetts_health_care_reform

Yes, Romneycare has expanded Medicaid (just like the ACA), but it has most of the other features of ACA as well, including health care plans provided through their Commonwealth Health Insurance Connector Authority (like the ACA marketplace).

 

[ivinsfan]

Late to this thread having been gone for a week, but I most certainly would expect some type of means testing to enter the picture, which would have a negative impact on some posters here.

 

[niven]

correct-read my post number 287 in this thread. I have actually had both Romneycare and Obamacare plans in massachusetts-i live there.

If you wanted a subsidized plan in massachusetts under Romneycare-you were directed to click to a different site. the 5 plans there that were subsidized were all Managed medicaid plans -they were not called medicaid. You were directed to fill out a masshealth form for these. I know they were actually manged medicaid plans because i am a retired retail pharmacist in massachusetts. i actually filled scrpts under these before i retired

I did not qualify for a subsidy-i went to the full pay directed site-however i did research the subsidy one to see if i might qualify

Maybe I'm confused, or we're talking about pre-ACA Romneycare vs post-ACA Romneycare. The list of plans (from 2014) in the Wikipedia article do not look like any Medicaid plans. You have PPO vs HMO, HSA eligible/ineligible, different deductible/copay levels, etc. Anyway, didn't mean to offend you.

EDIT: Sorry, I guess you're saying none of the non-Medicaid plans were subsidized. If so, I understand now.

 

[nun]

I get the feeling that the Trump administration will keep some basic ACA concepts like "pre-existing conditions", allow interstate competition and then push implementation down to the states. They'll be block grants to the states and that will be the end of Federal involvement. So any subsidies, how you qualify and what's covered in the plans will be up to the states, apart form things like abortion coverage and contraception which will be excluded from any plans that get matching Federal funds.

However, just like the ACA, this will do nothing to reduce costs. Maybe some states will come up with a way to do that, but I won't hold my breath. MA will have to go back to RomneyCare as it's in state law....unless the legislature changes the law.

 

[ziggy29]

What concerns me a bit is that while there seems to be consensus about preserving the prohibition on pre-existing condition exclusions (a good thing), there doesn't seem to be much about whether or not medical underwriting could resume (meaning pre-existing conditions could be covered but no one could afford it), or how any elimination of a "universal mandate" or penalty for being uninsured could bring enough healthy people in the insured pool to keep rates almost reasonable.

Also haven't heard much about the future of the elimination of lifetime benefit caps.

 

[target2019]

What concerns me a bit is that while there seems to be consensus about preserving the prohibition on pre-existing condition exclusions (a good thing), there doesn't seem to be much about whether or not medical underwriting could resume (meaning pre-existing conditions could be covered but no one could afford it), or how any elimination of a "universal mandate" or penalty for being uninsured could bring enough healthy people in the insured pool to keep rates almost reasonable.

Also haven't heard much about the future of the elimination of lifetime benefit caps.

Glad I re-entered this long thread.
Your post captures the essence of my concerns. We'll just have to stay tuned and see what happens. I know from long ago that last minute negotiations and secret deals can produce an act that is very different than what is publicized up to the last minute.

 

[niven]

What concerns me a bit is that while there seems to be consensus about preserving the prohibition on pre-existing condition exclusions (a good thing), there doesn't seem to be much about whether or not medical underwriting could resume (meaning pre-existing conditions could be covered but no one could afford it), or how any elimination of a "universal mandate" or penalty for being uninsured could bring enough healthy people in the insured pool to keep rates almost reasonable.

Right - it makes me wonder if enough people understand how any insurance works. For example, are there people who think that their individual auto insurance premiums are enough to cover their own risk? It takes the large group of people who have little to no claims to cover the ones who do. Insurance companies have good years when they actually experience claims less than premiums, so-so years when the conservative investments on their reserves keeps them in the black, and bad years when they still lose money.

 

[poorcarver]

One interesting note. For the Cook County, IL area, there are no insurance carriers who offer individual plans, either in the exchange or off it, that have a network that includes any of the university medical centers or any of the what we might call the upper tier of hospitals. So, for my wife who is two years from medicare, she cannot purchase a plan, at any price, that offers the standard of care that is actually available in our area. In her case, we are working to get one of our friends to put her on the "payroll" at zero wages and zero work, but allow her corporate medical care. If that does not work, then we have to consider moving or at least changing official residence.

 

[ziggy29]

One interesting note. For the Cook County, IL area, there are no insurance carriers who offer individual plans, either in the exchange or off it, that have a network that includes any of the university medical centers or any of the what we might call the upper tier of hospitals.

We've been dealing with this in Texas. As far as I know, as of 1/1/2016 in many parts of Texas, there were no plans available through the Marketplace which included Houston's M.D. Anderson Cancer Center and a few other top tier regional medical centers. It's been a big concern for a lot of people.

 

[daylatedollarshort]

What concerns me a bit is that while there seems to be consensus about preserving the prohibition on pre-existing condition exclusions (a good thing), there doesn't seem to be much about whether or not medical underwriting could resume (meaning pre-existing conditions could be covered but no one could afford it), or how any elimination of a "universal mandate" or penalty for being uninsured could bring enough healthy people in the insured pool to keep rates almost reasonable.

Also haven't heard much about the future of the elimination of lifetime benefit caps.

All good points. Kaiser in our area is by far the worst care and wait times compared to the other local hospitals and networks but we used to be on it because they were our only choice of plans from DH's last job that didn't have lifetime caps.

 

[scrabbler1]

Dear Scrabbler---what have you been doing for your health insurance?

I have a Silver plan through the ACA (New York Marketplace). I changed companies in 2016 and I may have to change it again because they dropped several doctors including one important one.

 

[scrabbler1]

Right - it makes me wonder if enough people understand how any insurance works. For example, are there people who think that their individual auto insurance premiums are enough to cover their own risk? It takes the large group of people who have little to no claims to cover the ones who do. Insurance companies have good years when they actually experience claims less than premiums, so-so years when the conservative investments on their reserves keeps them in the black, and bad years when they still lose money.

+100. I worked in the actuarial field for 23 years, specializing in personal auto insurance. Ziggy has is right on target - you need the personal mandate to make the coverage work if you get rid of the exclusion for pre-existing conditions. And the subsidies make the coverage affordable for lower-income people.