Poll of What is Your Health Insurance Choice for 2016

[harley]

I stayed at my jerb for 2 years after FI, just to become eligible for retiree insurance coverage. It as mostly for the guaranteed coverage (pre-ACA), since I had to cover a lot of the premium as a penalty for retiring so early. We're still on it, although I keep expecting Megacorp to dump us into the ACA pool. Still too young for Medicare.

 

[utrecht]

Whats the difference between buying a plan on an exchange and buying a plan directly thru an insurance company?
How do you find a broker?

 

[MBSC]

Whats the difference between buying a plan on an exchange and buying a plan directly thru an insurance company? How do you find a broker?

The only real difference is who submits and updates the application, you or an agent.

If your income is low enough to qualify for premium subsidies, the plan must be purchased thru the exchange. A broker can submit your application thru the exchange for you. If you go directly to an insurance company's website to submit an application you will be redirected to the exchange if you indicate an income low enough for premium subsidies.

Even if you submitted the initial exchange application, a broker can make the annual income update on your behalf, so you don't accidentally cancel the policy as in this thread: Income Update Gone Bad

If your income does not qualify for a subsidy you can still purchase an exchange plan. However, you can also purchase off-exchange plans from a broker or insurer's website so this gives you more options. For a particular plan, the rates will be the same whether you use a broker or not. The commission and renewal residuals are already built into the premiums.

If you decide to use a broker, choose an independent. They can use a health insurance quote engine to get the best combination of rate and provider network, especially with off-exchange plans. The National Association of Health Underwriters allows you to search for a broker.

NAHU link: https://www.nahu.org/consumer/findagent2.cfm

 

[Dash man]

COBRA can last 18 months if willing to pay. In general, it's freaking expensive. Study your options then decide.


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We're going on Cobra from DW's company (she's retiring December) and at $1345/month it's a bargain compared to comparable plans on the marketplace. We'll then have to choose an ACA plan beginning mid 2017 for 4 1/2 years until Medicare kicks in.


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[DEC-1982]

Just got my 2016 open enrollment package and the premium is unchanged for the third straight year.

My ex-employer premium went up 12.8% for 2016. In this sense, employer premiums are not dissimilar to Obamacare, the premium increases are varying widely.

 

[utrecht]

The only real difference is who submits and updates the application, you or an agent.

If your income is low enough to qualify for premium subsidies, the plan must be purchased thru the exchange. A broker can submit your application thru the exchange for you. If you go directly to an insurance company's website to submit an application you will be redirected to the exchange if you indicate an income low enough for premium subsidies.

Even if you submitted the initial exchange application, a broker can make the annual income update on your behalf, so you don't accidentally cancel the policy as in this thread: Income Update Gone Bad

If your income does not qualify for a subsidy you can still purchase an exchange plan. However, you can also purchase off-exchange plans from a broker or insurer's website so this gives you more options. For a particular plan, the rates will be the same whether you use a broker or not. The commission and renewal residuals are already built into the premiums.

If you decide to use a broker, choose an independent. They can use a health insurance quote engine to get the best combination of rate and provider network, especially with off-exchange plans. The National Association of Health Underwriters allows you to search for a broker.

NAHU link: https://www.nahu.org/consumer/findagent2.cfm

Thx a lot

 

[HFWR]

My ex-empl*yer subsidized HI increased around 7.7% from last year.

 

[iac1003]

We're going on Cobra from DW's company (she's retiring December) and at $1345/month it's a bargain compared to comparable plans on the marketplace. We'll then have to choose an ACA plan beginning mid 2017 for 4 1/2 years until Medicare kicks in.


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I am on COBRA for myself alone for $907/month which started in September. I looked at a BCBS multi-state plan and it was $1200+ a month (I'm moving some time in the near future.)

I will be on Medicare before the 18 months of COBRA are up. I should probably stick with my AETNA half PPO-half HMO type plan, which may have a different premium starting in January. I try not to use it.


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[John Galt III]

I currently have a PPO through the ACA, but in 2016 I may change over to an HMO due to price increases, to save on premiums. I know with an HMO I need a referral from my primary care physician to see a specialist. Can I request any specialist I like (in the HMO network, of course) and just ask my pcp to refer me to him/her? or do I have to accept the one my pcp wants to refer me to? I also noticed in the HMO documentation that the HMO must approve the referral also. I found all the specialists I want, by name, in the HMO's network directory, so that's good. Should I be concerned? I've heard people don't like HMO's because if the lack of choice. And what about getting your pcp to make multiple referrals for second or third opinions? Is that a problem?

note: I just found plenty of threads on this topic, which I will read, but I'll leave my post here.

 

[Gotadimple]

I currently have a PPO through the ACA, but in 2016 I may change over to an HMO due to price increases, to save on premiums. I know with an HMO I need a referral from my primary care physician to see a specialist. Can I request any specialist I like (in the HMO network, of course) and just ask my pcp to refer me to him/her? or do I have to accept the one my pcp wants to refer me to? I also noticed in the HMO documentation that the HMO must approve the referral also. I found all the specialists I want, by name, in the HMO's network directory, so that's good. Should I be concerned? I've heard people don't like HMO's because if the lack of choice. And what about getting your pcp to make multiple referrals for second or third opinions? Is that a problem?

note: I just found plenty of threads on this topic, which I will read, but I'll leave my post here.

None of this should be a problem. It looks like the HMO has a very broad network of providers. Your PCP (primary care physician) shouldn't have a problem regarding a referral, especially, if you have an established relationship with a specialist(s) and they are in network. As for second or third opinions, the HMO plan can tell you what their policy is - call customer service.

 

[Bikerdude]

I have MC part A & B and retiree supplemental BCBS that includes drugs. I also have dental through employer. Cost is less than Medigap but BCBS is not as good as the best Medigap.

 

[harley]

I currently have a PPO through the ACA, but in 2016 I may change over to an HMO due to price increases, to save on premiums. I know with an HMO I need a referral from my primary care physician to see a specialist. Can I request any specialist I like (in the HMO network, of course) and just ask my pcp to refer me to him/her? or do I have to accept the one my pcp wants to refer me to? I also noticed in the HMO documentation that the HMO must approve the referral also. I found all the specialists I want, by name, in the HMO's network directory, so that's good. Should I be concerned? I've heard people don't like HMO's because if the lack of choice. And what about getting your pcp to make multiple referrals for second or third opinions? Is that a problem?

In our HMO (Kaiser Permanente) our PCP just gives a referral to some specialty, say Neurology, and we pick the facility and the specialist we want, then make the appointment. She never even gives us a name unless we ask her opinion. Knock on wood, we've never had a condition serious enough to need a second or third opinion, so I can't answer for that.

 

[Katsmeow]

Getting a policy through a private exchange so an individual policy. But, DH's former employer subsidizes the purchase.

 

[mickeyd]

I'm a Medicare/Tricare guy. All that I seem to pay is the Medicare premium that is deducted each month from my SS.

 

[jfn111]

Retiree Healthcare for Myself and spouse. The rate jumped up 41% this year.
I'd be upset but $376 a month, for the 2 of us, for medical, dental and optical isn't to bad I guess.

 

[Montecfo]

I know this is an old thread but thought some might still read it. For those of us without a retiree health plan from employer, it seems to make sense to manage your income so as to qualify for subsidy with ACA. Seems pretty doable for early retirees who are living off their taxable accounts anyway.

Do many folks use this strategy?

 

[athena53]

I haven't even tried. We have a lot in after-tax accounts and, between mutual fund distributions and occasional trades as I tweak the portfolio, there are capital gains. I have two other issues with the exchange- first of all, in our state, I'm pretty sure the "exchange" has only one participating company, so not much choice. Second, I feel like the subsidies are there for people to poor to afford full premiums. I just paid $1,600 to have some jewelry remounted (that included buying another diamond and a platinum setting) and it barely made a dent in the budget. We aren't poor.


I turn 65 in early 2018; DH is 78 so already on Medicare. So, I pretty much just need to get through the 2017 renewal now.

 

[ShokWaveRider]

For those of us without a retiree health plan from employer, it seems to make sense to manage your income so as to qualify for subsidy with ACA. Seems pretty doable for early retirees who are living off their taxable accounts anyway.

Do many folks use this strategy?

That is exactly what we do.

 

[Montecfo]

I haven't even tried. We have a lot in after-tax accounts and, between mutual fund distributions and occasional trades as I tweak the portfolio, there are capital gains. I have two other issues with the exchange- first of all, in our state, I'm pretty sure the "exchange" has only one participating company, so not much choice. Second, I feel like the subsidies are there for people to poor to afford full premiums. I just paid $1,600 to have some jewelry remounted (that included buying another diamond and a platinum setting) and it barely made a dent in the budget. We aren't poor.


I turn 65 in early 2018; DH is 78 so already on Medicare. So, I pretty much just need to get through the 2017 renewal now.

Well it sounds like portfolio composition is different. My taxable accounts, which are about a third of my portfolio is the most conservative part, comprised almost completely of low-beta individual stocks which i hold for the longterm, muni funds, and cash equivalents. I harvest losses and do charitable giving with large gain positions. Accordingly, I tend to have loss carryforwards (I seldom sell gain positions outright), qualifying dividends, and tax-free interest. With most of my portfolio in tax-advantaged accounts, my taxable income would naturally be low as i am not tapping them.

We are also well off. However, I did not get that way by paying more than necessary for the same thing. The government designed the ACA including its pricing. As a taxpayer I am paying subsidies for ACA. I see no reason why I should pay more than I owe.

Just another view.

 

[scrabbler1]

I know this is an old thread but thought some might still read it. For those of us without a retiree health plan from employer, it seems to make sense to manage your income so as to qualify for subsidy with ACA. Seems pretty doable for early retirees who are living off their taxable accounts anyway.

Do many folks use this strategy?

I can't say I tried to manage my income to qualify for subsidies under the ACA, but for a few years I tried to manage my itemized deductions to lessen my federal income tax bill. I did this through "bunching" my deductions because by doing so I could move some itemized deductions from January into December (or vice versa) to enable me to take the standard deduction in the "off" year. But with my medical expenses having risen in 2016 due to more doctor visits and higher HI premiums, I can itemize my deductions every year whether I bunch some others or don't bunch them.

My history with HI has been varied in the last 9 years. Back in 2007 when I was still working, I reduced my weekly hours worked (again) and fell below the minimum 20 weekly hours to be eligible for the company's group plan. I went on COBRA but that lasted only 18 months until the end of 2008 when I FIREd.

I found an individual group plan but here in New York, a hostile state for finding affordable individual plans (pre-ACA), it was expensive and became more expensive when my insurance company increased its rates 50% in the next 2 years, putting a strain on my ER budget.

In mid-2011, after the ACA had been thankfully passed, I got rid of that costly policy and switched to a much cheaper, bare-bones policy which left me underinsured. It was meant to hold me over until the end of 2013 when the ACA's exchanges would become active.

I signed onto a Silver plan in 2014 through BCBS which, even without any subsidy, was cheaper than my older plan before its big rate increases. My income is near the top end of the income limit, so the subsidy is pretty small.

BCBS raised its premium in 2015 but the subsidy also went up a little. However, I became sick in 2015 so BCBS paid for most of the bills (including the big hospital bill) once I exceeded the deductible and max OOP cost. But I also saw the weaknesses in the policy long-term so I ditched it, especially after it had another fairly large increase for 2016.

I am now with OSCAR which has been much better. All of my doctors are in their plan. Their drug plan is much better (no ExpressScript mail-order nonsense), as is their customer service. The monthly premium is lower than BCBS's even excluding the subsidy which OSCAR is allowing me to take as a monthly reduction even though I didn't even ask for it! OSCAR did file for a pretty big increase for 2017 but they are still lower than what I'd be paying BCBS in 2016 had I stayed with them. Also, a drug which was originally slated for a $50 copay per month ended up having no copay, a $50 per month savings to offset any premium increase.

 

[Jaded salami]

I know this is an old thread but thought some might still read it. For those of us without a retiree health plan from employer, it seems to make sense to manage your income so as to qualify for subsidy with ACA. Seems pretty doable for early retirees who are living off their taxable accounts anyway.

Do many folks use this strategy?

I live in a state where I can qualify for Medicaid because of my extremely low taxable income. I'm sure this isn't what Obamacare intended but I don't feel guilty about taking advantage of it, at all. Health care in this country has been too expensive for what we get out of it.

 

[athena53]

I'm not convinced that all health insurance plans are created equal. Back when I had a private Coventry policy, my gyno's office told me they accepted that, but not the Coventry policy from the exchange. I also read somewhere that MD Anderson, the highly-respected cancer treatment center in Houston, doesn't accept the insurance policy from the TX exchange.

 

[Just_Steve]

Well it sounds like portfolio composition is different. My taxable accounts, which are about a third of my portfolio is the most conservative part, comprised almost completely of low-beta individual stocks which i hold for the longterm, muni funds, and cash equivalents. I harvest losses and do charitable giving with large gain positions. Accordingly, I tend to have loss carryforwards (I seldom sell gain positions outright), qualifying dividends, and tax-free interest. With most of my portfolio in tax-advantaged accounts, my taxable income would naturally be low as i am not tapping them.

We are also well off. However, I did not get that way by paying more than necessary for the same thing. The government designed the ACA including its pricing. As a taxpayer I am paying subsidies for ACA. I see no reason why I should pay more than I owe.

Just another view.

Thats why ACA should be asset based and not income based.
As a taxpayer I shouldn't have to subsidize the "Well off"

 

[pb4uski]

I know this is an old thread but thought some might still read it. For those of us without a retiree health plan from employer, it seems to make sense to manage your income so as to qualify for subsidy with ACA. Seems pretty doable for early retirees who are living off their taxable accounts anyway.

Do many folks use this strategy?

For us, in the long run the benefit of doing low tax cost Roth conversions from when we ERed at 56 until my pension starts and we start drawing SS at 66 or later exceeds any ACA benefits that we would receive. However, our situation may be unique in that we live in a state where health insurance is not age rated and we also qualify for low cost catastrophic health insurance coverage so the benefit of ACA is only ~$5k a year.

Thats why ACA should be asset based and not income based.
As a taxpayer I shouldn't have to subsidize the "Well off"

I agree, but it isn't and probably will never change so I suggest you get used to it.

 

[shortstop14]

Thats why ACA should be asset based and not income based.
As a taxpayer I shouldn't have to subsidize the "Well off"

Is there any current situation where taxpayers are required to report all assets to the IRS? Can't imagine how complicated that would get - look at how complicated the tax code is now, mostly involved in determining what constitutes 'income'. And given unanticipated consequences, the next step after asset reporting would likely be using assets to means test Social Security.

That being said, I'm taking advantage of the ACA subsidy. I've calculated that at least for the next couple of years, it's more to my advantage to take the ACA credit rather than do Roth conversions. Roth conversions will be most of my income, I just won't convert much so as to keep the subsidy.

I didn't write the tax code, but I'll take advantage of it. Mitt Romney gets carried interest in his IRA, after all.