healthcare decision after Cobra expires

[engr]

I retired from a Megacorp aerospace company at the end of May 2014. My DW has major gastrointestional health issues that requires the injection of a nutritional supplement (TPN) three times a week for 11 hours each. At the beginning of May, a layoff was looming and, being one of the old employees, the writing was on the wall so I decided to retire in order to support my DW and get a small severance package.

I chose Cobra medical insurance since it was good insurance (20K/yr). When filling out the paperwork I knew the duration was 18 months. Since my DW is SS disabled I later learned that I could have applied for an additional 11 months but it had to be requested within a 60 day period. My thinking was that as the 18 months was concluding I could ask for the extension at that time. This is apparently incorrect as I should have notified SS at the beginning of Cobra, not the end. I was told I could ask to be reinstated for the additional 11 months but it didn't sound like I would be approved. I also discovered I would be paying 150% (> $30K) of the premium instead of 102% for those last 11 months.

Her TPN costs run $8K/month. MY retiree SPD does not state a maximum out-of-pocket cost for prescriptions. There is an OOP for medical costs but I'm unsure I could get her TPN medication under the medical category. If her TPN falls under prescription where no OOP exists I feel like all costs will be billed to me. A nurse comes out to the house each week for bloodwork. It's analyzed and then a doctor tweaks it as he sees necessary. The next week bloodwork is retaken and the TPN composition is again tweaked if necessary.

If I'm on the hook for all the expenses it will amount to $100K/year. I am 61, DW is 58. Are there other less expensive options available?

 

[2B]

Have you looked into how well the individual ACA plans would cover your wife's expenses? You are paying significantly more for Cobra than I will and the ACA bronze policies available to me are also significantly less expensive.

You need to look into the policies available to you and see what is covered. You don't want to go without insurance.

 

[Texas Proud]

You can also look at a higher metal level plan if you want.... you pay more in premiums, but have less OOP....

You need to do it quickly as the date to enroll is coming fast...

 

[iac1003]

If your wife is disabled under Social Security she should be able to qualify for Medicare after 2 years. At least that's the way it used to be with my disabled patients. Check with the Social Security Administration.


Sent from my iPhone using Early Retirement Forum

 

[ERhoosier]

It may help to talk to a trustworthy insurance agent about your options. Coverage details can vary surprisingly between same 'metal' level Exchange plans, e.g. networks, home/convalescent care, etc.
And don't forget to include HI premiums in your analysis. My view of current individual HI is that, unless subsidy eligible, it's all catastrophic coverage. In my area most Gold/Platinium plans just don't make financial sense because the HI premiums are SO much higher. IOW- The higher cost of annual HI premiums for Gold/Platinum often exceeds the OOPmax of the cheaper Bronze Plans (same carrier and provider networks).