life before the ACA

[Conundrum]

Hello,

As you can see from some of my posts I am very concerned about future healthcare during my upcoming planned FIRE from megacorp.

My health is not particularity good. Hence the desire to FIRE at 51. Megacorp was creating physical and mental well being issues. I feel like if I can get away from the stress and 12+ hours a day and really focus on my health I will see some incremental improvement.

With ACA, health status does not present much of a problem. I am reaching out to the pre ACA FIRE folks. What happened if you were rejected? How did you get insurance? Was it crazy expensive?

I am in reasonably good shape financially. Thankfully with a 3.10% all in WR on a pretty fat budget (I inflated a lot of budget categories just to be safe) I have $23k medical funds budgeted annually and its figured into the FIRE budget

It is not my desire to turn this into a political thread. I nor you can foretell the future but I am just trying to do my due diligence.

If the ACA is dismantled am I going to be in a pinch?

 

[joeea]

If the ACA is dismantled am I going to be in a pinch?

There's no real way to know, without making some assumptions about what "dismantled" actually means.

If you mean that the ACA goes away, is replaced by nothing, and that insurers have a free-for-all, then based on past practices you can expect:
- so-called "catastrophic" policies will be offered to some with low premiums but very little coverage
- decreased premiums for some younger, healthier individuals
- increased premiums for many
- some with pre-existing conditions won't be insured
- others with pre-existing conditions will pay through the nose

If your health is "not particularly good", you probably should expect to pay more in a free-for-all world, if you are insurable at all.

But it almost certainly depends on what remains post-ACA, and what state you live in. Some states will have their own ACA-replacement rules, many will not. I live in Massachusetts and before the ACA we had Romney-care. It was very, very similar to the ACA. If the ACA is dumped but replaced by Romney-care, I'm not sure I'd notice much difference.

Without getting into politics, it's hard to imagine the ACA being dumped without something replacing it. But one never knows...

 

[MichaelB]

There's no real way to know, without making some assumptions about what "dismantled" actually means.

This makes sense. There are many ways the health insurance market could change, and trying to build a contingency plan based on all the possibilities is not productive.

Without guaranteed issue, the only sure way for an under-65 year old to obtain comprehensive health insurance is through employment with an employer that already offers it as a benefit.

 

[Rianne]

We were in the same boat in 2014. The ACA saved us in so many ways. I had cancer DX in 2011 so the pre-existing condition was an issue. No political commentary here, just to say, for peace of mind and the understanding that there is a cap on out of pocket health expenses through the ACA, I cannot imagine anyone not wanting it. We've been on the ACA since 2015. I personally would not (ever) purchase a policy without the ACA requirements. It is Russian Roulette. No one can predict a major health issue. I think we are safe that certain aspects of the ACA will prevail, regardless of the political climate.

 

[joeea]

Without guaranteed issue, the only sure way for an under-65 year old to obtain comprehensive health insurance is through employment with an employer that already offers it as a benefit.

That's how I remember the pre-ACA, pre-Romney-care days.

You needed health insurance? Better stay employed.

 

[harley]

I stayed on with Megacorp a couple of years beyond FI so that I would qualify for their retiree health coverage. It's not a significant cost savings, but at the time pre-existing conditions would have made getting coverage for DW and I pretty difficult. Being covered by MC removed that issue, so staying on was worth it back then.

If you are 51 now (or close) and were to take coverage under the ACA, I think you'd be OK. I can't imagine any of our intrepid elected officials being bold enough to endorse clawing back the pre-existing condition clause. Even if the ACA was repealed somehow, something else would replace it. And I'm pretty confident the pre-existing condition clause would be included. So the only worry would be cost, and you've got that worry with the ACA anyway. I wouldn't let it stop me. I FIREd at age 50, partially because my family dies young. I've had 12 incredible years so far, and hopefully many more to come. You won't regret it if you do it.

 

[candrew]

If the ACA is dismantled am I going to be in a pinch?

Oh, you'll be in a pinch all right if the ACA is dismantled along with others like DW & I who rely on it. Pinched, squeezed or crushed? Who knows? We can't answer that right now.

 

[candrew]

That's how I remember the pre-ACA, pre-Romney-care days. You needed health insurance? Better stay employed.

+1

That need for employer sponsored health care at times resembled a form of indentured servitude.

 

[Conundrum]

52 in August, wife 49 and in excellent health.i have to admit, I am spoiled by megacorp insurance. Excellent, I have never been disappointed.

 

[Red Badger]

I stayed on with Megacorp a couple of years beyond FI so that I would qualify for their retiree health coverage. It's not a significant cost savings, but at the time pre-existing conditions would have made getting coverage for DW and I pretty difficult. Being covered by MC removed that issue, so staying on was worth it back then.

If you are 51 now (or close) and were to take coverage under the ACA, I think you'd be OK. I can't imagine any of our intrepid elected officials being bold enough to endorse clawing back the pre-existing condition clause. Even if the ACA was repealed somehow, something else would replace it. And I'm pretty confident the pre-existing condition clause would be included. So the only worry would be cost, and you've got that worry with the ACA anyway. I wouldn't let it stop me. I FIREd at age 50, partially because my family dies young. I've had 12 incredible years so far, and hopefully many more to come. You won't regret it if you do it.

Good counsel here. No one can predict ACA, etc, but I agree that certain aspects (such as pre-existing coverage) will not likely be clawed back.

I think you'll be in a larger pinch if your health condition deteriorates and you're still w*rking.

You. Get. One. Life. On this rock. Go live it.

 

[John Galt III]

Back in 2013 (must have been pre ACA) I decided to quit my job and retire. I got individual health insurance, with a pre existing condition of hypothyroidism, for $230 per month. I had it for one year, paid every monthly premium, and never used it, not even for a routine physical. The annual deductible was $10,000. I think it was Capital Blue Cross. Previously I had been paying $41 per month for employer-sponsored health insurance. In 2014 I signed up with the ACA and got health insurance for (subsidized) $21 per month with a $500 deductible.

 

[harley]

Back in 2013 (must have been pre ACA) I decided to quit my job and retire. I got individual health insurance, with a pre existing condition of hypothyroidism, for $230 per month. I had it for one year, paid every monthly premium, and never used it, not even for a routine physical. The annual deductible was $10,000. I think it was Capital Blue Cross. Previously I had been paying $41 per month for employer-sponsored health insurance. In 2014 I signed up with the ACA and got health insurance for (subsidized) $21 per month with a $500 deductible.

That was definitely after the ACA had started (~2011, iirc). That sounds incredibly cheap for pre-ACA coverage with a preexisting condition like that, even taking cost inflation into account.

 

[Conundrum]

I think you'll be in a larger pinch if your health condition deteriorates and you're still w*rking

That’s kind of what my brain was gravitating to. My doctors agree that work is playing a large role in my health.

I am a little naive maybe but I think I can get some of my health back in shape in the absence of stress, unhappiness and more time to exercise and prepare better meals. Believe it or not I have just putting my head down and pushing through for about the last 4 years. I’m cooked to a crisp

 

[MRG]

That’s kind of what my brain was gravitating to. My doctors agree that work is playing a large role in my health.

I am a little naive maybe but I think I can get some of my health back in shape in the absence of stress, unhappiness and more time to exercise and prepare better meals. Believe it or not I have just putting my head down and pushing through for about the last 4 years. I’m cooked to a crisp

It can happen. I was allowing my j*b to kill me. Since retiring DW and I dropped weight and medications....lots of them.

Obviously that means nothing if you develop a serious problem. Lot of healthy people die from cancer.

I left the w*rking world in 2013, rode out COBRA until ACA. I have preexisting conditions too. My backup was what others did prior, layers of policies, that may give some protection. I'd met with a broker, well known by friends, who had a plan that she had as a backup. Costs seemed similar to the first year of ACA.

 

[Red Badger]

That’s kind of what my brain was gravitating to. My doctors agree that work is playing a large role in my health.

I am a little naive maybe but I think I can get some of my health back in shape in the absence of stress, unhappiness and more time to exercise and prepare better meals. Believe it or not I have just putting my head down and pushing through for about the last 4 years. I’m cooked to a crisp

I am blessed with good insurance. But please let me share another side of the coin. My DW has a handful of health issues - that's primarily why I retired (but work sucked as well). In retirement, I walk about 3 miles every day. Then, my DW and I take the Grand Mutt for his walk and we are hand in hand for that 20 minute stroll. I have no stress, work is a distant memory and life is so, so beautiful. If I were to die this week, the last year would be my best ever. Please consider what your life has to offer. Get that work stress out of your life. As the Doctor of Retirement, I am prescribing 8-12 hours daily of doing what pleases you (and you may find out how much pleasing others pleases you). In my case, I make breakfast for DW most days, and vol at the soup kitchen each Tuesday.

Best of everything in a big decision.

 

[walkinwood]

We had pre-ACA insurance in two states, so I can tell you what it was like. Joeea covered the future very succinctly.

Our aim in getting health insurance is protection of assets and to get the negotiated rates that insurance companies get. We are and have been pretty healthy, so premiums are the major expense.

NJ was a community rating state which meant that anyone who wanted it could get insurance and there was no pre-exisiting condition penalty. I can' remember now if there was an age based pricing. Since anyone who wanted it could get insurance, but there was no mandate that everyone have it, only people with assets to protect (like us) or who were sick, got insurance. Prices were high and were rising by the max allowed 15% every year. But it was real insurance with no upper limit on payouts.

We then moved to Colorado which had a more free-form insurance market. We made sure we got coverage before leaving NJ. Pricing was much lower than NJ - about a third or half for comparable (ie cheapest real insurance with no upper limit on payouts).

ACA premiums were reasonable till 2016 and were still below what we were paying in NJ in 2010/11. We had a huge bump in premiums in 2017 and then again this year. If this continues, it will hurt.

 

[clifp]

I retired in 1999 so I had many years of insurance pre ACA.
When I moved to Hawaii there were only two insurance choices Kaiser, and Blue Cross affiliate HMSA. I went with Kaiser, and my plan was grandfathered in after ACA. It is still about $100/month cheaper than the equivalent ACA silver plan, with a deductible that is generally equivalent to gold level ACA. It is lack prescription drug coverage and of course all the new ACA mandates like free birth control pills, maternity coverage, mental health none of which are relevant to me.

Before ACA, I did apply to get the Blue Cross coverage and was turned down. My health is good but I'm overweight (now obese) and borderline pre-diabetes.

I believe (not very confident) that my health insurance started 120/month and the equivalent plan is now 380. After ACA become law I switched to catastrophic plan which covers nothing until $6,600 deductible is reached. This means my annual physical and blood test went from <$200 to $700 but since I'm saving $200/month. I'm still coming out ahead.

 

[Yarnstormer]

I divorced in 2006 - was able cobra my ex's insurance. It went from 400 to over 1000 in a few years. High deduct of course. I tried to shop around and was denied by humana for a history of "acne, and undiagnosed cervical (neck) pain" I work at a computer so yeah...my neck hurts. Now I know to play down any issues on an application.
I found a job with insurance finally in 2009. My point is that back in the day they would reject you for ANYTHING. My brother, who is in poor health but rarely went to the doctor (smokes, drinks heavily) was insured at the same time high deduct etc 25k a yr. Hey at least they would take him!
I have an asthma diagnosis now so I'd be screwed if the pre existing condition part of the ACA goes away. I have a high deduct HSA compatible ACA plan.
I will say that now that I work at home part time and have a less stressful life I take fewer meds and rarely visit the doc.

 

[Conundrum]

Super input everybody. Thank you so much for taking the time to post. This is the type of information I was after. Thanks again!

 

[daylatedollarshort]

We had COBRA and then a COBRA conversion policy. Our premiums for a family started out at $900 and then rose to over over $2K a month for premiums alone with high deductibles and out of pocket max. The year before ACA one family member had surgery with an out of network specialty surgeon, in network hospital with some random out of network charges (California has made this illegal now), deductibles, co-pays and some medical travel added up to a $50K medical year.

We were looking at moving overseas where I think for $50K annually we could live well in many places with that as an annual budget instead of paying that just for health care alone in the U.S. But then the ACA came along and this year we've paid $10 in premiums for health care so far and that is it. It has been a wild ride. I budgeted $20K a year starting out. Last year with the ACA our premiums and deductibles came to about $8K.

 

[Human]

I’m 50, purchase my plan on the open market (not subsidized), and currently pay about $1k per month for a high deductible HSA plan (family - just me and wife).

I’ve been buying my own insurance for over 15 years. The big difference post ACA is less fear that I’ll be dropped/forced out. Price-wise, I’ve experienced similar yearly increases pre and post ACA.

 

[brucethebroker]

No guarantees if you retire before age 65. (In addition to health insurance risk, the stock market could crash. The housing market could crash. Certain tax benefits could be revoked, etc.)

There has always been an affordability and accessibility issue for health insurance. ACA solved the accessibility issue. Will it continue? IMHO-the genie is out of the bottle....

Affordability is another subject. But, there are ways to work around it. Existing tax credits are one solution ("gaming" the income/MAGI threshold). Another is to be self employed. Check with your CPA about tax deduct-ability of premiums.

Is the security of employer insurance more important than improving your health by leaving the stress of work? Only you can answer that.

 

[John Galt III]

That was definitely after the ACA had started (~2011, iirc). That sounds incredibly cheap for pre-ACA coverage with a preexisting condition like that, even taking cost inflation into account.

My memory is hazy, but maybe in 2013, my 2012 income, which is what my 2013 ACA premiums would be based on, was too high for me to benefit much from the ACA. I do remember now that I had to jump through a lot of hoops, agonizing over how to fill out the forms, worrying about white coat syndrome and high blood pressure, etc, to get the Capital Blue Cross insurance. I never even went to a routine physical out of fear that they would screw me over somehow, even though it was supposed to be 'free'. The ins cos were rightly regarded as evil back then. Way back around 2005 I went without any health insurance while driving a cab for a year, which provided no health ins. I paid cash for anything I wanted. Paid $45 for an annual routine physical. Called around to labs and got a low price for a blood test for my thyroid levels.Very cheap, as I recall, like $30, which included the blood draw and the actual test. Other labs were charging $100 for the very same thing. Paid cash full price for my synthroid which I got from mail order, also cheap, $25 for a hundred pills.

 

[68bucks]

It seems like I remember pre-ACA that the preexisting condition clauses only kicked in when there was a coverage gap, like 90 days or 6 months, something like that. Does anyone else recall it being that way?

 

[joeea]

It seems like I remember pre-ACA that the preexisting condition clauses only kicked in when there was a coverage gap, like 90 days or 6 months, something like that. Does anyone else recall it being that way?

I'm sure that for some states, and for some insurers, it worked that way.
But not all states. Not all insurers.