ACA for just one of us

[Finance Dave]

Currently we have ACA coverage, as we're both FIREd and under 65. DW will turn 65 before me...she's about 4 years older.

When that happens, will I be able to purchase a lower-cost ACA plan for a single person?

Thanks

 

[candrew]

The short answer is yes, depending of course on MAGI, etc.

DW & I are in a similar boat as you. She turns 65 next January and has already enrolled in her Medi-gap plan. I turn 65 in 2022.

I've gone to Health Sherpa and modeled what I might expect to pay for an ACA policy on just myself using the same MAGI as this year. Depending on any rate increases that insurers might impose for next year, it looks as though my monthly premium should almost equal what we have paid for us both this year.

 

[OldConch]

Currently we have ACA coverage, as we're both FIREd and under 65. DW will turn 65 before me...she's about 4 years older.

When that happens, will I be able to purchase a lower-cost ACA plan for a single person?

Thanks

Two steps forward, one step back. Our costs increased by $235 per month.

DW turned 65 this month. Our ACA premium increased $15 per month for one person in a two person household. Her Medicare/Supplement/Part D costs are: $135 + $67 + $16.

No subsidy next year so my premium at age 59 will be approx. $725 per month.

 

[Blueskies123]

I just went through this. I turned 65 in August and my wife is one year younger. I called ACA August 1st and they canceled our joint plan and then created a new one-person plan for my wife.
I used Boomer Benefits to help me select a Medicare supplemental plan and drug plan.

 

[Dtail]

The MAGI calculation still uses all household income for the calculation, then applies it to the single person I believe.
So if one person on Medicare is collecting a large SS already, it could affect the tax subsidies enough.

 

[CRLLS]

The MAGI calculation still uses all household income for the calculation, then applies it to the single person I believe.
So if one person on Medicare is collecting a large SS already, it could affect the tax subsidies enough.

^ This!

It seems that the authors of the ACA didn't think forward enough to account for this common occurrence. In our particular case, the ACA premium for one after subsidy stayed basically the same as what it was before with the 2 of us. I'm fairly certain that was simply an anomaly. I'm glad that we only had 10 months of this crazy "gotcha".

 

[wmc1000]

DW turned 65 prior to me. She didn't draw any SS so in our case the ACA premium for 2 was $75 per mo. and for just me was $77 per mo. Bottom line the ACA premium didn't change much but of course we had the premiums for DW Medicare/Supplement/Part D on top of that. Still, $300 total per mo. for the 2 of us was still extremely low. Now that both of us are on Medicare we pay just under $500 per mo. total which IMHO is still a huge bargain.

 

[pb4uski]

The short answer is yes, depending of course on MAGI, etc. ...

It doesn't depend on MAGI or anything... the answer is yes, you can buy an ACA policy.

Now on the separate question of whether you will be eligible for ACA subsidies, that depends on MAGI, etc.

IOW there are two separate questions... 1. Whether you can buy ACA insurance and the answer to that is yes and 2. Whether you are eligible for subsidies and the answer to that is... it depends.

 

[MRG]

I've been doing this since 2014.

 

[ShokWaveRider]

Ours did not change for DW when I went on Medicare. Same MAGI, DW pays the same as we did for 2 in the previous year (Not due to premium increases). I ran a few scenarios, and if we were both eligible for the ACA for 2019 the cost was exactly the same as it ended up being for just DW on her own. Seems like our income was not split in half for subsidies as one would expect. Seems like subsidies are based on full MAGI regardless if 1 or 2 people are eligible.

 

[ivinsfan]

Ours did not change for DW when I went on Medicare. Same MAGI, DW pays the same as we did for 2 in the previous year (Not due to premium increases). I ran a few scenarios, and if we were both eligible for the ACA for 2019 the cost was exactly the same as it ended up being for just DW on her own. Seems like our income was not split in half for subsidies as one would expect. Seems like subsidies are based on full MAGI regardless if 1 or 2 people are eligible.

Well you have 1 household not 2. And second Medicare is already subsidized by the government. Did you know in my state if I elected an Advantage plan the government would send my Advantage provider a check for around 800 dollars every single month just like clockwork? Obviously more then we pay for Part B coverage.

I don't think it's an anomaly, ACA is based on you capping out at a % of your household income for health costs. Your wife would pay more preimum on your total income if she was a household of one. you and your spouse are both still on subsidized healthcare. It could be worse and it has been worse.

 

[ivinsfan]

^ This!

It seems that the authors of the ACA didn't think forward enough to account for this common occurrence. In our particular case, the ACA premium for one after subsidy stayed basically the same as what it was before with the 2 of us. I'm fairly certain that was simply an anomaly. I'm glad that we only had 10 months of this crazy "gotcha".

It's not a gotcha. You do realize that Medicare is heavily subsidized by tax dollars? One of you has rolled from one subsidized plan to another.

 

[ShokWaveRider]

I don't think it's an anomaly, ACA is based on you capping out at a % of your household income for health costs. Your wife would pay more preimum on your total income if she was a household of one. you and your spouse are both still on subsidized healthcare. It could be worse and it has been worse.

I am not disagreeing with you, just stating what I see for us. If we were both on ACA for 2019 and all things being equal, it would have cost us $315pm LESS than what it does now I am on Medicare and DW is on ACA. For us here in Florida, as we have excellent healthcare coverage, all our doctors, specialists and hospitals are on covered by both ACA and Medicare, so no difference there.

So based on these results, it appears the ACA is more subsidized than Medicare, hence overall cheaper than Medicare. Whether that is right or wrong is not what I am saying.

Kinda puts a downer on Medicare for All as that would increase a lot of costs for those who currently get subsidies with the ACA. I am not saying that is good or bad, just sayin'.

 

[ivinsfan]

I am not disagreeing with you, just stating what I see for us. If we were both on ACA for 2019 and all things being equal, it would have cost us $315pm LESS than what it does now I am on Medicare and DW is on ACA. For us here in Florida, as we have excellent healthcare coverage, all our doctors, specialists and hospitals are on covered by both ACA and Medicare, so no difference there.

So based on these results, it appears the ACA is more subsidized than Medicare, hence overall cheaper than Medicare. Whether that is right or wrong is not what I am saying.

For you it would be because ACA is income based and Medicare is not, except for the fact that if you have higher income you will pay more in Part B premiums.

It's just two different kinds of subsidies based on different models. I don't know if it's right or wrong either. There certainly isn't much logic to it. It's not either seamless or intuitive so lots of person are caught off guard.

 

[ShokWaveRider]

One could argue for the low income consumer ACA is better, and for the higher income consumer, (Not Super high as for them it does not make any difference as they do not have financial constraints) Medicare is better.

On the other hand if we adopted an "ACA for ALL" it could all work out in the wash. I do not like that idea at all as it puts all the cards in the insurance companies hands, which IMHO is a recipe for disaster, and was one of the main problems with the system before ACA. It would only end up benefitting them and their shareholders. But that is a different discussion.

 

[ivinsfan]

One could argue for the low income consumer ACA is better, and for the higher income consumer, (Not Super high as for them it does not make any difference as they do not have financial constraints) Medicare is better.

On the other hand if we adopted an "ACA for ALL" it could all work out in the wash. I do not like that idea at all as it puts all the cards in the insurance companies hands, which IMHO is a recipe for disaster, and was one of the main problems with the system before ACA. It would only end up benefitting them and their shareholders. But that is a different discussion.

It is a different discussion true and not only would it be a different discussion, it would probably bring in more unknown problems. As for the insurance company, I learned from my broker when I was leaving ACA for Medicare how much they are paid from the government. So I can't explain why it's not a conflict of interest for the government to put you on Medicare, pay an insurance company monthly to provide your care and leave you to fight with the insurance company about co pays and approved providers. Once I understood the Advantage plans have a major vested interest in refusing my claims, I crossed them off my list. In my mind that's not Medicare ,it's just insurance that the government is paying for.

 

[ShokWaveRider]

I learned from my broker when I was leaving ACA for Medicare how much they are paid from the government. So I can't explain why it's not a conflict of interest for the government to put you on Medicare, pay an insurance company monthly to provide your care and leave you to fight with the insurance company about co pays and approved providers. Once I understood the Advantage plans have a major vested interest in refusing my claims, I crossed them off my list. In my mind that's not Medicare ,it's just insurance that the government is paying for.

That is an excellent point and I am with you on that.

 

[Finance Dave]

The MAGI calculation still uses all household income for the calculation, then applies it to the single person I believe.
So if one person on Medicare is collecting a large SS already, it could affect the tax subsidies enough.

Well that's good to know. We will not be collecting SS for quite some time yet, but the amount we take out of our TIRAs may have to be adjusted if the MAGI cutoff goes down....I'll have to investigate this.

Wife is currently 61, so I have a few years to sort it out.

 

[Finance Dave]

Thanks to all for the responses. The short answer is that it looks like I'll end up paying more in total...about the same ACA premium for one person vs. 2 people PLUS DW's Medicare premiums.

The bad news is that I was not expecting the ACA premium to be about the same...thought it might be more like half. The good news is that the current amount we're paying is less than what we planned for, so I will be "banking" the amount saved so we can use it when she hits Medicare age.

Of course, something may change by then LOL.

 

[audreyh1]

DH and I have always had individual ACA policies. We don’t qualify for subsidies so buy directly from the insurer. When DH starts Medicare next year it won’t affect my policy.

 

[kimcdougc]

DH and I have always had individual ACA policies. We don’t qualify for subsidies so buy directly from the insurer. When DH starts Medicare next year it won’t affect my policy.

Thanks for that tip. I was beginning to worry about this when DH starts Medicare in 3 years and me in 5 1/2 years.

 

[CRLLS]

It's not a gotcha. You do realize that Medicare is heavily subsidized by tax dollars? One of you has rolled from one subsidized plan to another.

Call it what you will. I look at it from the ACA perspective that it costs me the same to insure 1 as it does to insure 2. WTH? Once one of us are on Medicare, the cost is higher than if we were on ACA. now we are both on Medicare, the cost is about the same as what ACA was for the two of us. The left hand doesn't have anything to do with the right hand.

 

[LARS]

Went thru this. Most bizarre situation in the world until you consider you're dealing with the Government.

Wife just went off ACA for Medicare. She is 2 1/2 years older than me.

For me alone, post her leaving ACA, the premium for me alone went up $185 per month.

Effectively ACA was paying us $185 per month to have DW on insurance plan.

Talk about wacky!

 

[audreyh1]

Yeah, if you are receiving subsidies I can see how price could go up for just one remaining on ACA. But at least you only have to deal with half the high deductible.

Since we are paying full freight now, we expect medical insurance to drop on Medicare plus much lower deductible.