Your Experience/Individual Health Coverage

[Stevewc]

Hello Forum Buddies,
What is your story and experience with your individual health care coverage in retirement?
Have you actually had to use it in a major way?
Did you feel you or family member was taken care of as well as you would have been under an employers health plan?

Yes, I'm about to jump from the frying pan into the fire of retirement and the abyss of getting my own health coverage. I found my self early this morning wondering how I might be treated financially and medically if by chance I (me or family) actually had a major medical problem and had to use the coverage the first year or two?
Any stories or experiences you could share?
Thanks for input,
Steve

 

[huusom]

My only experience with it is the high cost of HIPAA policy prevented me from proceding with my ER plan. If my memory serves me right, it was around $1,300 for me and my wife from Aetna.

 

[Martha]

When I worked I had insurance where the deductible was really small, and for a number of things there were fixed co-pays. It was a bit hard to figure out what the real cost was for things like drugs, which are our biggest expense. I got the list price for each drug and figured that with a $2000 deductible I would use up the deductible on drugs so I initially planned to get the $500 deductible plan.

t turned out, because of oddities in the insurance plan, that even if I use the entire deductible the $2000 deductible plan was cheaper than the lower deductible plans. Also unexpected is that I am not using up the deductible on drugs. Though I could figure out the list price, there also is the insurance company negotiated price. This was much lower than list.

Because my drug prices turned out to be much lower than expected, I am going to switch next year to a $5000 deductible plan, which is much cheaper for me. My insurance company (Medica) allows you to change the deductible choices every year.

 

[easysurfer]

When I FIRE'd, I got a HSA/High Deductible plan from BC/BS. My plan has no copay but a $5000 year deductible. My concern was whether the doctors and other providers would know there was no copay or would I have to explain to them that it's a HSA. So far, no problem, they seem to know that there is no copay for service and that the claim must get processed first by BC/BS before I pay the providers my portion.

Actually that seems a little odd to me because when I was w*rking, I was used to a copay but now I just show them my insurance card, get the service, walk out, then wait for the claim to get processed which may take a few weeks.

Steve, to answer your question: I didn't feel I was treated any differently with private insurance versus megacorp insurance. They were very accepting of me having individual health insurance.

 

[M Paquette]

Being an engineer, I got all methodical about this before I retired, and boy, was I ever glad I did.

Once I knew I was going to retire (e.g., I hit FI and wanted RE), I started looking into medical coverage. We had several plans to choose from at work, so initially I thought I'd just stick with the devil I knew. That plan revised payments downward and dropped the nearby lab service, so I'd have to send samples to a location a good 2 hour drive from me. That got me to dig in.

All the plans available could be continued for 18 months on COBRA. Only one of them could be continued a further 18 months on Cal-COBRA. Some of the insurers offered 'conversion coverage', the ability to move to a plan selected by the insurer without medical review, but only after exhausting COBRA and Cal-COBRA. Quite a few of them offered HSA plans for individual coverage. That wasn't an employee plan choice for me, unfortunately, because the HSA plan didn't have any local doctors or labs available.

Before retiring, I switched coverage to a plan we could live with, that had one of the best prices for COBRA coverage, and let me do an additional 18 months on Cal-COBRA. Then, once retired, I tried for an HSA plan from that provider for everyone in the family. My daughter made it onto that plan, but DW and I were turned down. I've since tried a few other plans, but so far we've been on COBRA, transitioned to Cal-COBRA, and when that runs out we are likely to continue onto the no-medical-review plan with the higher copay and deductibles (not the HSA, alas).

I suggest looking at the alternatives among work plans, and getting out a big sheet of paper to do a decision tree, a series of decision alternatives covering plans to try for, alternatives if you don't get onto a desired plan, and so on. This saved me from finding myself on a dead end path with no or only very high priced insurance, and has let my family stay with the same doctors and facilities over the whole process.

 

[unclemick]

Starting 1993, age 49, went 12 years with no health insurance. That or go back to work. Had one hairline wrist fracture - the refusal to see me with no insurance has colored my view(negative) of the medical establishment to this day. Anywise - urgent care to get one doc to refer another doc and X ray I got this funky butt wrist dohicky to wear for six weeks. Hundreds of dollars instead of some duct tape and a couple of good sticks. That was Louisiana.

Post Katrina moved to Missouri - got 5k deduct BC/BS, age 62, at a much more reasonable price - also time in the market made it more affordible portfolio wise.

Now - 66 aka Medicare plus suppliment and affordible. I still could be sucked into wag the dog debates - the extreme being American Passport and medical tourism.

heh heh heh - I shall remain calm cause the Saint's are still winning - but alas the Pat's - a good football team are next. I'm just not gonna get sick - that's all there is to it. .

 

[Martha]

I suggest looking at the alternatives among work plans, and getting out a big sheet of paper to do a decision tree, a series of decision alternatives covering plans to try for, alternatives if you don't get onto a desired plan, and so on. This saved me from finding myself on a dead end path with no or only very high priced insurance, and has let my family stay with the same doctors and facilities over the whole process.

Good point.

The Georgetown University site, Health Insurance and Coverage Help for Consumers Everywhere, has a booklet on comparing health plans with a worksheet you can use to do a comparison when buying. Here is the link: http://www.healthinsuranceinfo.net/managing-medical-bills/Understand_Private_Health_Insurance.pdf

 

[REWahoo]

When I FIRE'd, I got a HSA/High Deductible plan from BC/BS. My plan has no copay but a $5000 year deductible. My concern was whether the doctors and other providers would know there was no copay or would I have to explain to them that it's a HSA. So far, no problem, they seem to know that there is no copay for service and that the claim must get processed first by BC/BS before I pay the providers my portion.

Actually that seems a little odd to me because when I was w*rking, I was used to a copay but now I just show them my insurance card, get the service, walk out, then wait for the claim to get processed which may take a few weeks.

I've had essentially the same BC/BS $5,000 deductible HSA plan for the past three years and had the same experience - until my last visit to my GP. The billing office insisted I pay 50% of the bill prior to leaving the office - before it had been run through BC/BS. The end result was they owed me money and, no surprise, have not been very forthcoming in sending a refund.

Not a lot of $, but next time they won't get more than 40% from me up front.

 

[easysurfer]

I've had essentially the same BC/BS $5,000 deductible HSA plan for the past three years and had the same experience - until my last visit to my GP. The billing office insisted I pay 50% of the bill prior to leaving the office - before it had been run through BC/BS. The end result was they owed me money and, no surprise, have not been very forthcoming in sending a refund.

Not a lot of $, but next time they won't get more than 40% from me up front.

That's horrible that your GP made you pay 50% in advance. What was their respsonse when you tried to explain to them that it's a HSA with a $5000 deductible and should be processed first before you pay?

 

[REWahoo]

What was their respsonse when you tried to explain to them that it's a HSA with a $5000 deductible and should be processed first before you pay?

Something along the lines of "Sorry, since you have not met your deductible, we require a minimum payment of 50% when services are provided."

I should have refused, but I really like the GP and I thought once run through BC/BS, the bill would probably be somewhere in the 50% range. Turns out the amount allowed by BC/BS vs. the amount billed on all the tests (it was for a routine physical exam) was closer to the 30%.

We're not talking big bucks here (~$60) but I did want to point out what might be a change in how medical providers are approaching high deductible policies. I emphasize might be, as this is obviously only one data point.

 

[FurBall]

I have BC/BS $2700 deductible HSA. I don't come anywhere close to using the deductible.

Positive: At the opthamologist when they asked if I was there for a full exam, I told them that my deductible was so high I was the equivalent of self-pay and therefore wanted only what was necessary. Self-pay was written in big red letters on my chart. Doctor mentioned they'd skip certain tests that were not absolutely required. My bill was dramatically less than DH's (on Medicare/Medigap).

Negative: 10% increase first year. 40% premium increase last year. Terrified of what this year's increase will be. Increases do not appear to be related to either claims or age.

 

[Poundkey]

Steve, I recently had a large bladder stone broken up and removed in an out patient procedure. I was pleased in general with the way things worked out. DW and I each have policies similar to what others here have described. BCBS 5K deductible, but not HSA.

During discharge the hospital (Baylor Medical Dallas) realized I had the high deduct policy and asked for the 5K upon release. DW told them we didn't have funds available at the present time to cover the 5K. They agreed to a $500 down and monthly payout. The doctors involved were also willing to let us make payments if we chose. The lab work wasn't covered by insurance, but we were given a 50% discount.

This procedure was considered 'urgent' by the doctor. Had it not been urgent and scheduled well in advance I suspect the full 5K may have been expected up front, but don't know for sure.

Having insurance for these unexpected problems is a must as far as I'm concerned. I felt like I was taken care of exactly as I would have been under an employers plan. I was treated by a very good urologist in a major hospital. BCBS did their part and payed within 30 days of receiving the claims. I'll end up paying around 7K of a total bill that was over 20K.

 

[Goonie]

I have the exact same BC/BS health insurance coverage as I did while employed, so there has been no changes or differences in pre- and post-retirement. All of the coverages, deductibles, and out of pocket remained the same. The only difference...and there is only one...is that my monthly premium went up because active employees pay 20% of the total monthly premium, and retirees pay 25%.

 

[Stevewc]

Thanks for all the replies.
I've been out of town for a few days and just now reading them.
Good info provided.
Thanks Again,
Steve

 

[Buckeye]

While still living in OH, DH (60) and I (50) purchased a 5K (per person) high deductible policy with an HSA from American Community. I knew months in advance I was going to be laid off and that COBRA was prohibitively expensive so we started working with our local insurance broker. A neat feature of our policy is that it covers charges related to an accident/injury (versus an illness) 100% for the first 30 days regardless of where we are in meeting the deductible. Although this policy can't be sold in FL, it does have a network which covers FL (our new home). I have priced the same type of policy in FL and it's a minimum of 50% more expensive than our current policy.

We are low consumers of healthcare but so far so good with 2 chiropractor visits. They asked for a 90% payment (covered all the charges after rebilling) on the first visit. On the second visit, I knew what the ultimate amount would be so that's what I paid. We don't expect to come anywhere close to meeting our deductible but the potentially high cost of poor health has helped me get more fish and veggies into DH!

 

[eridanus]

I have an HDHP with an HSA. I pay at the time of service.

I've never met the deductible but I have had problems with getting an emergency provider to recognize that I was covered.

 

[kevink]

We had a 5K deductible (each) w. United Health Care for 5 years after ER, went to Mexico and let coverage lapse. Were going to re-up but did a lot of research and found best rates through AARP's Hartford insurance. Our premiums with United had gone up every year and it was a revelation to find out that's the "reward" you get as a long-time customer from most insurers. It pays to be systematic about re-shopping both health and car insurance annually.

Never spent close to our deductible but found it a struggle to afford the out-of-pocket preventive care (chiropractic, Chinese medicine, etc.) we found most helpful, and the plan we had didn't cover any routine stuff (annual physicals, mammograms or colonoscopies, etc.). Now living full time in Mexico and happily paying out-of-pocket at ~20 cents to the dollar for better care than we ever had in Colorado.

 

[teejayevans]

We had a 5K deductible (each) w. United Health Care for 5 years after ER, went to Mexico and let coverage lapse. Now living full time in Mexico and happily paying out-of-pocket at ~20 cents to the dollar for better care than we ever had in Colorado.

Where in Mexico?? Does Mexico have health insurance or you just pay as you go? I be interested in knowing more about it works there.
TJ

 

[kevink]

We live in the Lake Chapala area, home to the single largest Canadian and American expat community in the world. You can buy into the Mexican national system for about $350 per person per year, but there's a two year waiting period and pre-existing conditions are excluded. Obviously for an annual price that's less than a lot of people's monthly premiums in the U.S. that kind of complete catastrophic coverage is worthwhile, but on a day-to-day basis nearly all the expats here pay out-of-pocket for routine care.

You walk into a doctor or dentist's office here and prices for the most common procedures are posted on the wall, and you can find out what anything costs simply by asking. Obviously a different world from the U.S. There are a lot of reasons why care is generally better and cheaper here. Frequent ER board posters Billy and Akaisha Kaderli have a ton of information on their site (Retire Early Lifestyle) and I'd encourage you to have a look.

I know for most people overseas care is not an option, and I don't want to make it sound like a paradise here because it's not - especially for Mexicans, who struggle to afford the out-of-pocket expenses we gringos consider to be a bargain. My wife and I hope to return to the U.S. to live at some point and progress towards fixing the broken health care system at home will be one of the things that determine when and if that's possible.

 

[walkinwood]

We have seen no difference in treatment after moving to an individual policy with a large deductible.

I let my primary physician know that I was paying for my own insurance, and he told me to remind him to look for samples when he wrote me a prescription.

Luckily, we have not had any major issues, so can't comment on that.

 

[toofrugalformycat]

I had to bridge several years between quitting and being old enough to retire on my State plan. I was in my 40s. COBRA was prohibitively expensive. I picked my ancestors poorly and had trouble getting individual coverage. Finally Mutual of Omaha picked me up and I could afford catastrophic coverage, but it took many months to get them to accept my application (they were waiting on something from my doctor).
Then after a year or so they pulled out of the State of Alaska entirely. They gave me one month's notice. I reapplied to several companies, and luckily my insurance broker informed me that when I was rejected and/or given unreasonable exclusions I could apply for the State high-risk pool. This I did, paying hand over fist for catastrophic coverage only (15000 deductible) until I retired.
When applying for individual coverage be prepared to list EVERY doctor visit or procedure you have EVER had. If you miss one they can use it as a basis for rescission if you ever actually make a claim for anything serious. For me it helped to have an insurance broker of my approximate age and same sex, because think about some of the things you might have to list. I tried not to think about where those applications went and who looked at them.

 

[TromboneAl]

Here's an insurance gotcha. I tried to get DW onto my BCBS 3500 deductible HSA plan, but they denied her because of a prior condition (so she stay on her non-HSA 5K deductible plan).

It turns out this was a good thing. If two people are on the 3500 plan, then it turns into a $7,000 family deductible plan. That is, you have to have combined charges of over 7K before they start paying!!

Also, you can HSA savings for medical expenses for your spouse even if he/she isn't on the plan.

 

[Billy]

What is your story and experience with your individual health care coverage in retirement? Have you actually had to use it in a major way?
Did you feel you or family member was taken care of as well as you would have been under an employers health plan?

Billy and I were self-employed (1979) and have had our own individual health care coverage since that time, except for the years that Billy was working for Dean Witter Reynolds. When we retired in 1991 prices for COBRA were shocking and so we continued to use individual coverage, shopping every year or two for better prices.

We chose the largest deductibles available at any time, going from $2,500 to $5,000 to our current $10,000.

Over these many years we have used hospital services for ‘major’ events. I must say that personal or fiscal treatment has been inconsistent, depending on the service provider - not because of any insurance we may be carrying. I’ve not (knock on wood) had any issues with the insurance companies.

What I have found in general, is that I must stay on top of the billing departments, and follow the charges, dates, co-pays and services given very closely. Otherwise, these charges can be duplicated or we can receive an over-charge.

If the billing is a large amount, I make it a point to contact the billing department (of the doctors or hospital) right off the bat. I let them know that I am waiting for all the bills to come in so that I can make sense of them first, before I start paying anyone. I have not received any flack for doing this.

What has surprised me the most is the time delay between service received and the billing statement that follows. Yes, I know they go through my insurance company first (or not) but when the doctor’s office or hospital can carry the float of these bills for 2 and 3 months at a time it makes me wonder. We are very aware that we are not the only clients whose bills are being carried. Having been in business ourselves we couldn’t ever consider carrying such a large float of unpaid bills.　

It turns out this was a good thing. If two people are on the 3500 plan, then it turns into a $7,000 family deductible plan. That is, you have to have combined charges of over 7K before they start paying!!

I wonder if each plan is different - Billy and I are on the same insurance plan, with $10,000 deductible and our family total is $20k (for preferred providers. Out of network is a different total). However, when we individually meet our personal $10k deductible, our insurance kicks in. We do have a cap on Out of Pocket - and after that is met, then our insurance pays 100%.

Akaisha
Author, The Adventurer’s Guide to Early Retirement