Healthcare insurance and retirement - again!

[MichaelB]

It looks like we may have a new opportunity to discuss health care insurance and early retirement. It will be challenging to do so without getting into partisan politics, but that’s the only way we can have a constructive dialog here. Our discussion should focus on specific measures proposed in Congress, how they affect us, what our options are, what actions we can take to minimize our health insurance risk .

Let’s please avoid campaign rhetoric and partisan proposals that are not active or under consideration for legislation.

 

[Senator]

I personally do not see many changes coming from the consumer level. The pre-existing mandate will not change. I do see more competition which should lower prices.

Overall, I think insurance will be cheaper. I am not sure if it will be more efficient, or the cost paid from other areas by someone else.

As a disabled veteran, I am hoping I can go to any hospital and get free care. That is the way it should be.

 

[FIREmenow]

I think crossing state lines would be huge.

 

[Mr._Graybeard]

I think crossing state lines would be huge.

I don't.

 

[razztazz]

I think crossing state lines would be huge.

I cannot remember if it was posted here or on another board at hit from time to time but I believe one state (Georgia?) some yrs ago opened up and allowed cross state insurance selling and it was a resounding thud.

This might be a function of "It doesn't really work with ONE State, everybody has to do it to work." People with more of an economics or insurance background might be able to illucidate on that.

I suspect merely allowing selling across state lines is not going to lead to the "acceptable level of nirvana" people think it implies. My reason for thinking this is: If it was good they'd have been doing it already. Now, there might be some fairly simple techniques applied to make it work, but again those closer to the business would know better

 

[FIREmenow]

I cannot remember if it was posted here or on another board at hit from time to time but I believe one state (Georgia?) some yrs ago opened up and allowed cross state insurance selling and it was a resounding thud.

This might be a function of "It doesn't really work with ONE State, everybody has to do it to work." People with more of an economics or insurance background might be able to illucidate on that.

I suspect merely allowing selling across state lines is not going to lead to the "acceptable level of nirvana" people think it implies. My reason for thinking this is: If it was good they'd have been doing it already. Now, there might be some fairly simple techniques applied to make it work, but again those closer to the business would know better

Depends on who it was good for.

 

[bamsphd]

I joined the class of 2013 after the Supreme Court upheld the ACA when I knew Cobra could bridge me to ACA coverage. Prior to that a preexisting condition made individual health insurance unavailable to me at any price. I've been buying our insurance in the marketplace (no subsidy). I was planning to buy an exchange policy again this year, but for about $3,000/year more I could buy an off-the-exchange policy instead.

Given the Republican sweep, the ACA's days certainly seem numbered. However, I've yet to see any credible plan for the "replace" part. Though it certainly seems likely that this is the last year exchange policies will be offered.

My biggest question now is should I buy an off-the-exchange policy to minimize (but not eliminate) my risk of not being able to buy a policy at all for 2018, and to minimize the smaller risk that 2017 exchange policies might be terminated during 2017?

 

[bingybear]

I think crossing state lines would be huge.

I don't.

I don't have any data to know if allowing selling across state lines would be good or not. I would like to see better coverage when travelling. Most of the individual plans I've looked at are out of network when outside the state I'm insured in. The emergency care is for life threatening events. I've ask what this means and the common example is a compound fraction (bone thru the skin) is covered, but if it is not thru the skin it is not seen as life threatening and thus not covered.

I would think that driving a couple thousand miles to get back in network for a broken bone that needs set should be covered.

 

[MRG]

I personally do not see many changes coming from the consumer level. The pre-existing mandate will not change. I do see more competition which should lower prices.

Overall, I think insurance will be cheaper. I am not sure if it will be more efficient, or the cost paid from other areas by someone else.

As a disabled veteran, I am hoping I can go to any hospital and get free care. That is the way it should be.

Why do you think that preexisting conditions will be OK in the future? I'd love to share that viewpoint, but I'm thinking the insurance companies want to quantify their risks. Please tell me I'm wrong.

 

[euro]

I joined the class of 2013 after the Supreme Court upheld the ACA when I knew Cobra could bridge me to ACA coverage. Prior to that a preexisting condition made individual health insurance?

I know a good number of folks (myself included) sitting in that same boat....we'll see if anyone comes up with a viable solution to the "replace" portion of "repeal and replace". So far, I haven't heard one.

 

[FIREmenow]

@RandPaul: "One of the things I would do, initially, is legalize the sale of insurance, all forms of insurance."

 

[Senator]

I suspect merely allowing selling across state lines is not going to lead to the "acceptable level of nirvana" people think it implies. My reason for thinking this is: If it was good they'd have been doing it already. Now, there might be some fairly simple techniques applied to make it work, but again those closer to the business would know better

I am not sure either, but it certainly works for car insurance. It cannot hurt. Maybe there will be a mandated Medicare type system, albeit a few dollars higher, and be paid right out of paychecks. Or be paid with a national sales tax.

One thing for certain, the existing ACA plans, sans subsidies, do not work for most people.

If we had more manufacturing here, more jobs would have paid healthcare.

 

[bingybear]

I joined the class of 2013 after the Supreme Court upheld the ACA when I knew Cobra could bridge me to ACA coverage. Prior to that a preexisting condition made individual health insurance unavailable to me at any price. I've been buying our insurance in the marketplace (no subsidy). I was planning to buy an exchange policy again this year, but for about $3,000/year more I could buy an off-the-exchange policy instead.

Given the Republican sweep, the ACA's days certainly seem numbered. However, I've yet to see any credible plan for the "replace" part. Though it certainly seems likely that this is the last year exchange policies will be offered.

My biggest question now is should I buy an off-the-exchange policy to minimize (but not eliminate) my risk of not being able to buy a policy at all for 2018, and to minimize the smaller risk that 2017 exchange policies might be terminated during 2017?

What I've usually seen off exchange are the same or very similar policies to on exchange. These are usually ACA compliant. I'm not sure why they would stay viable if the ACA was repealed and the others would not.

But you never know.

 

[razztazz]

If we had more manufacturing here, more jobs would have paid healthcare.

Not to drag this off of insurance but why would manufacturing jobs make things better?

 

[Senator]

Not to drag this off of insurance but why would manufacturing jobs make things better?

Better jobs provide healthcare. Service jobs typically do not.

 

[Big_Hitter]

what i think will happen:

Cadillac tax will get repealed
Individual mandate (penalty) will get repealed
pre-existing conditions and kids to age 26 will remain
3 to 1 rule may get repealed
individual plans will move to a DC-type approach with HSAs and high-deductible options with a refundable tax credit
minimum essential coverages will be scaled back


ymmv

 

[daylatedollarshort]

Our retirement plans were pre-ACA anyway. We like the subsidies, but we're closer now to Medicare age than we were, so if we had to pay the full rates again it would not be a game changer for us. What would be a game changer is reinstatement of the pre-existing condition clause.

Before ACA we had a COBRA conversion policy without the pre-existing condition clause. The rates were crazy high but we had insurance in case of a $1M car accident or serious illness. We've been talking about what we would do if we became uninsurable in the U.S. Get a job again? Back in tech full-time or something low key just for the insurance? Move to another country until we are both on Medicare? If so, where? Europe or Mexico? Rent the house or sell it if we move? We like where we live in the U.S. but I don't really want to either have a full-time megacorp or retail kind of job just for the health insurance.

There used to be states that had banned pre-existing condition clauses we could move to until age 65 or we had the option of getting group insurance because of our small businesses of two. But who knows if either of those will still be an option going forward.

 

[donheff]

To me the question is how do you keep the ban on preexisting conditions without a mandate (which ACA opponents despise) and how do you make HI insurance affordable for the rural, low paid workers who voted for this change without the Medicaid expansion and supplements? If you don't get rid of the supplements and mandate you haven't repealed and replaced. Just tweak the ACA and call it a replacement? Will that sell?

 

[bamsphd]

I would like to see better coverage when travelling.

Yes, last year as far as I can tell only Maine Community Health Options, one of the non-profits setup by the PPACA, was the only company offering individual policies with nationwide in-plan coverage, and the only company offering any non-emergency out-of-network coverage.

Unfortunately, they withdrew from my state this year leaving only HMO policies covering essentially only in-state providers.

Of course if the PPACA is repealed now, will all those non-profits also cease to exist?

 

[Suppertime]

I was planning on retiring end of this year, was shopping for insurance on Covered California. These are the questions I have today.

In pre-obamacare days was insurance in the individual market even available for someone between 50 and Medicare age?

How long will the Senate Democrats manage to filibuster the repeal of ACA?

And this selling across state lines business, doesn't that just mean insurance companies get to choose which state will regulate them, so they'll all end up in one state similar to how corporations all end up in Delaware?

I don't want to have to move to a country with socialized medicine.

 

[Senator]

To me the question is how do you keep the ban on preexisting conditions without a mandate (which ACA opponents despise) and how do you make HI insurance affordable for the rural, low paid workers who voted for this change without the Medicaid expansion and supplements? If you don't get rid of the supplements and mandate you haven't repealed and replaced. Just tweak the ACA and call it a replacement? Will that sell?

I think you can keep the pre-existing coverage thing, IF you already have healthcare. So you do not need to buy insurance, but if you do not have insurance, then the pre-existing exclusion applies.

Switch plans, switch companies, there will be no pre-existing exclusion. Take the gamble, and you really take the gamble...

 

[jim584672]

New York tried preventing pre-existing as a condition. What happened? People only bought a policy when they got sick, premiums became so high no one could afford insurance. It was a disaster.

 

[exnavynuke]

what i think will happen:

Cadillac tax will get repealed
Individual mandate (penalty) will get repealed
pre-existing conditions and kids to age 26 will remain
3 to 1 rule may get repealed
individual plans will move to a DC-type approach with HSAs and high-deductible options with a refundable tax credit
minimum essential coverages will be scaled back


ymmv

I think the 3 to 1 rule is the key to making it "affordable" for most people and without that changing I don't see how any legislative changes could make things "better" for people overall.
The downside of that change is that it will likely price the "pre-existing condition" customers out of health insurance once again, even if they can't be "denied" just because of it (a $10k/month plan may not be a denial, but it effectively denies the plan to most people).

 

[NW-Bound]

The insurers can demand to see continuing insurance coverage. Pre-ACA, this was what we had to do, showing proof of previous insurance. Even so, they excluded pre-existing conditions, which I did not have any that I knew of. I do now.

 

[Big_Hitter]

I think the 3 to 1 rule is the key to making it "affordable" for most people and without that changing I don't see how any legislative changes could make things "better" for people overall.
The downside of that change is that it will likely price the "pre-existing condition" customers out of health insurance once again, even if they can't be "denied" just because of it (a $10k/month plan may not be a denial, but it effectively denies the plan to most people).

the 3 to 1 rules makes it affordable for you but not for the 25 year old married couple with two kids - they get hammered by it