Medicare at age 55+?

[DangerousNachos]

@FD1000 Yes, ACA basically guaranteed coverage for everyone with no pre-existing condition clause or underwriting. Small group markets did the same.

Small-group and individual policies used to require underwriting, and you could have a 3/12 pre-x clause. Anything you've been treated for in the last three months was a preexisting condition and not covered for the following twelve months. It was a chore to get quotes for small groups from health insurance companies when you had to have employees fill out individual applications for each company and remember everything going on in their families, like what meds they were on, any anticipated surgeries, pregnancies, etc.

The point is, there was a reason rates were lower before the ACA. It was because insurance companies did not have to cover all risks. People were actually "uninsurable." A term you don't hear much anymore.

 

[pb4uski]

... but most of us here would have had doubled the return of what we get from SS, if we had self invested it.

Perhaps most of us here would have, but the vast majority of our peers are not savers and would have spent it on more stuff and senior poverty would be much more rampant than it is.

People keep posting that idea, but it just isn't realistic IMO.

 

[FD1000]

I’m slightly more optimistic on the first point (not much, though), and 100% agree on your 2nd point. As long as healthcare remains a business, costs will continue to climb. If we could just eliminate the business of healthcare insurance, that would reduce expenses by trillions. Maybe we could then afford to allow the “business” of healthcare to continue. But lobbyists would fight it hard.

The most straightforward issues to address are:

1. High prescription drug prices. Lowering these costs should be an obvious priority, yet our country has struggled to make meaningful progress for decades.
2. Pharmacy Benefit Managers (PBMs). Their role should be eliminated due to their impact on pricing and transparency.

It’s widely understood that certain stakeholders benefit from keeping prices high. At the same time, our politicians are corrupt and delay significant changes.

One potential step toward accountability would be to require elected officials to use the same Affordable Care Act (ACA) plans available to the general public, rather than having access to separate or more favorable coverage. This could better align their incentives with the experiences of everyday Americans.

 

[FD1000]

The ACA (Obamacare) has been great, despite enhanced subsidies not being extended as they should have been. It allowed many people including myself to retire earlier than otherwise could have afforded to. My personal cost is about $100 premiums and $500 deductible thanks to the ACA. Medicare is going to be more costly for me when I become eligible, assuming the ACA holds on as it is.

Medicare taxes probably do need increased some due to soaring costs, but the reason is to make Medicare more affordable to people 65+, not to bring on a younger contingent.

There are retirement plans that you do not need to be 55+.

There's no magic wand to make healthcare lower cost. It's actually going to keep going up in cost.

You pay so little because your income is low, but your portfolio is big. That's a loophole.
The premiums should be based on income. If your income is low, but your portfolio is worth over $300K, you pay the max because you are not poor.
We all need to pay our fair share.

 

[FD1000]

@FD1000 Yes, ACA basically guaranteed coverage for everyone with no pre-existing condition clause or underwriting. Small group markets did the same.

Small-group and individual policies used to require underwriting, and you could have a 3/12 pre-x clause. Anything you've been treated for in the last three months was a preexisting condition and not covered for the following twelve months. It was a chore to get quotes for small groups from health insurance companies when you had to have employees fill out individual applications for each company and remember everything going on in their families, like what meds they were on, any anticipated surgeries, pregnancies, etc.

The point is, there was a reason rates were lower before the ACA. It was because insurance companies did not have to cover all risks. People were actually "uninsurable." A term you don't hear much anymore.

And that’s really the core issue: you can’t insure everyone for everything.
Take car insurance as an example—if every policy had to cover every driver for every possible fault, premiums would skyrocket for everyone. That’s simply how insurance works in the real world.

That’s essentially how things worked before the ACA. Roughly 70% of people paid reasonable premiums, while those with higher health risks paid more. About 10% remained uninsured and often relied on emergency rooms for care.

In many larger countries, especially those with populations over 50 million, efforts to fully insure everyone for every type of care have faced significant challenges and trade-offs.

When it comes to getting a reliable, high-quality surgery, I trust the U.S., and that’s a big reason I choose to live here and never retire anywhere else.

 

[Onda]

Because ACA insured all for all/ most procedures, all the insurance components had to increase by a lot.
Before about 70% had great cheap insurance, 20% had to pay higher premiums and the rest didn't have insurance.
Now most pay a lot. This is how insurance works. If you want a guarantee for everyone for everything, you will pay a lot and HC services will go down for everyone.
Taxing the rich and subsiding a lot of people never works.

Universal will never work either because many Doctors will quit and go to other STEM.
We have doctors shortages already.

The biggest flaw in that argument is the assumption that covering more people must automatically make care more expensive and worse. In reality, many countries manage to cover everyone, spend dramatically less per person than the U.S., and still deliver outcomes that are far better. The OECD shows the U.S. spends about $14,885 per person, while the OECD average is about $5,967—yet despite paying more than double, Americans get shorter lives, more preventable deaths, and far less peace of mind from the system.

That should make people pause: paying the highest price in the world and still not getting the best results is hard to call efficiency.

In fact, one of the main weaknesses of the ACA is that it does not cover everyone. Universal systems work differently: coverage is broad and automatic—you are in whether you personally like the mandate or not—because insurance functions best when the healthy, the sick, the young, and the old all remain inside the same large risk pool.

 

[FD1000]

Here’s another frustrating issue in healthcare that often gets overlooked: the growing reliance on physician assistants (PAs).

There was a time when you could reliably see a doctor at most clinics. Recently, I contacted multiple facilities from different providers and struggled to find one where I could actually see a physician. Many doctors now work alongside one or two PAs, and in many cases, the PA is the primary point of care.

The concern is that PAs are paid significantly less than physicians and have different levels of training, yet patients are often billed at similar rates. There’s also a broader worry that, over time, providers may rely more on less-trained staff—potentially supplemented by AI—to reduce costs while maintaining the same charges.

At the same time, specialists and large healthcare organizations continue to generate higher revenues under this model.

Another common frustration is billing practices. For example, a provider may order a test—like an MRI—and then require a follow-up visit just to review the results, resulting in an additional charge for what may be a very brief consultation.
My excellent family doctor can no longer communicate with me directly. The large healthcare company he works for decided it was too convenient for patients and not profitable. Now, if you want to speak with a provider, you have to pay for it.

Taken together, these patterns make the system prioritize revenue over transparency and value.

 

[FD1000]

The biggest flaw in that argument is the assumption that covering more people must automatically make care more expensive and worse. In reality, many countries manage to cover everyone, spend dramatically less per person than the U.S., and still deliver outcomes that are far better. The OECD shows the U.S. spends about $14,885 per person, while the OECD average is about $5,967—yet despite paying more than double, Americans get shorter lives, more preventable deaths, and far less peace of mind from the system.

That should make people pause: paying the highest price in the world and still not getting the best results is hard to call efficiency.

In fact, one of the main weaknesses of the ACA is that it still does not cover everyone. Universal systems work differently: coverage is broad and automatic—you are in whether you personally like the mandate or not—because insurance functions best when the healthy, the sick, the young, and the old all remain inside the same large risk pool.

Americans tend to have shorter life expectancies in part because of poor diet—much of our food is highly processed and produced by large companies that prioritize cost-cutting over quality.

At the same time, people often point to other countries and ask: which nations with populations over 50 million, high immigration, and a similar standard of living are able to spend around $6,000 per person while still providing fast, reliable access to a wide range of procedures and surgeries?

For example, my son lives in Kathmandu (and a similar case could be made for parts of India). When he needed a routine surgery, it was relatively easy and affordable to get care there, especially given the availability of private healthcare in a lower-cost system. However, when he needed a more complex procedure, he chose to come to the U.S.

We could reduce costs in the U.S. by making major policy changes—such as increasing government funding for healthcare, subsidizing education, and accepting higher taxes.

In my opinion, most problems in the U.S. are solvable. Healthcare, however, is different. Addressing it would require fundamental, system-wide changes at the root level.

 

[Onda]

At the same time, people often point to other countries and ask: which nations with populations over 50 million, high immigration, and a similar standard of living are able to spend around $6,000 per person while still providing fast, reliable access to a wide range of procedures and surgeries?

Let me help you: Italy, Spain, Germany, France, Japan (Japan does not have high immigration) are some of them.

 

[Chuckanut]

@pb4uski I didn't choose age 55 arbitrarily. It aligns with existing retirement plan language—the IRS Rule of 55 and 72(t) distributions. It is a threshold that already has meaning in retirement planning. It wasn't chosen to set up a future expansion to 45.
And the eligibility is specific by design. Not everyone 55+ qualifies. Only those without employer coverage who choose to enroll.

Wouldn’t most employers simply tell their staff that at 55 they will no longer offer regular health insurance. Instead, at 55+ they only offer a Medicare supplement plan.

 

[Chuckanut]

In many countries the first line of medical care is the local pharmacy. I found that out in Europe where I was offered oral antibiotics for an infected toe. In the USA that would have required a visit to a doctor to get the prescription. And a doctor visit fee of at least $75 back then.

 

[Chuckanut]

And why in the world do we need a prescription from a doctor for extra strength Voltarin, when many European countries sell the extra strength version OTC.

 

[Time2]

You pay so little because your income is low, but your portfolio is big. That's a loophole.
The premiums should be based on income. If your income is low, but your portfolio is worth over $300K, you pay the max because you are not poor.
We all need to pay our fair share.

I have preached that before, Millionaires should not have their Health Insurance Premiums subsidized by people earning $50k a year. But, the response, that is the way the law was written, and it was. Also trying to implement an asset test is troublesome.

 

[pb4uski]

.... One potential step toward accountability would be to require elected officials to use the same Affordable Care Act (ACA) plans available to the general public, rather than having access to separate or more favorable coverage. This could better align their incentives with the experiences of everyday Americans.

Members of Congress and their staffs use ACA for their health insurance, the same as others who do not have employer provided health insurance, and they have since the very beginning of ACA.

The on thing that is different is that their employer, the federal government, contributes a portion of their premium similiar to other federal employees and many private sector health plans with the remainder being withheld from the employee's paycheck.

Actually, an interesting idea would be to have all health insurance work similiarly, with all people chosing an ACA plan and their employer contributing towards the cost. I'm guessing that with such a large pool of potential customers that insurers would sharpen their pencils when pricing premiums.

 

[GenXguy]

You pay so little because your income is low, but your portfolio is big. That's a loophole.
The premiums should be based on income. If your income is low, but your portfolio is worth over $300K, you pay the max because you are not poor.
We all need to pay our fair share.

Wait, that looks like a contradiction. You said premiums should be based on income, and they are. But then you made a comment about portfolio worth, which is not relevant to the law or compatible with your statement that premiums should be based on income. And by the way, $300K would be a pretty small portfolio for a retired person using the ACA marketplace.

Here’s another frustrating issue in healthcare that often gets overlooked: the growing reliance on physician assistants (PAs).

Where I live, it's more nurse practitioners. The only PA I knew of was working in ER. I actually had to see a NP for a while when my doctor left the practice. And sometimes, an NP does a refill of a prescription for me that regular nurses can't refill.

 

[pb4uski]

... My excellent family doctor can no longer communicate with me directly. The large healthcare company he works for decided it was too convenient for patients and not profitable. Now, if you want to speak with a provider, you have to pay for it. ...

My experience, both here in Texas and previously in Florida, was very different. Both groups had robust portals that could be used for communicating. Sometimes my doc would respond and other times a PA or admin person would respond (for appointment scheduling fo example).

I regularly get responses from my doc through their portal.

 

[pb4uski]

Wouldn’t most employers simply tell their staff that at 55 they will no longer offer regular health insurance. Instead, at 55+ they only offer a Medicare supplement plan.

No, it would work the same as Medicare does now for people who are 65+ and still working. Those employees would need to sign up for Part B but they would still be covered by their employer plan. There are literally millions of people 65+ who are on Part B and also on employer plans because they are still working.

 

[MichaelB]

Actually, an interesting idea would be to have all health insurance work similiarly, with all people chosing an ACA plan and their employer contributing towards the cost. I'm guessing that with such a large pool of potential customers that insurers would sharpen their pencils when pricing premiums.

Take that one step further (or a couple of steps) and make the entire US one single risk pool, not the thousands of separate risk pools we have today. Then require insurers to provide broad regional coverage. Not pick and choose only those small segments they are interested in.

 

[Chuckanut]

I’ve had experiences with at least six PAs or nurse practitioners in the past. All have been excellent for the need they met. The need being quick access to medical advice or a simple procedure and maybe an Rx when my usual MD was not accessible.

 

[pb4uski]

You pay so little because your income is low, but your portfolio is big. That's a loophole.
The premiums should be based on income. If your income is low, but your portfolio is worth over $300K, you pay the max because you are not poor.
We all need to pay our fair share.

You are correct that ACA subsidies are based on income, but where you say if "your portfolio is worth over $300K, you pay the max" that is incorrect.

The reason there is no asset or net worth test is because it would be a devil to administer. OTOH, most people file a tax return so income is very readily available.

I don't disagree with you in theory, but IMO there are really so few rich folks getting subsidies that it would probably cost more to administer than the subsidies that are being paid tho thos who manage their income for ACA subsidies.

 

[FD1000]

Wait, that looks like a contradiction. You said premiums should be based on income, and they are. But then you made a comment about portfolio worth, which is not relevant to the law or compatible with your statement that premiums should be based on income. And by the way, $300K would be a pretty small portfolio for a retired person using the ACA marketplace.

Where I live, it's more nurse practitioners. The only PA I knew of was working in ER. I actually had to see a NP for a while when my doctor left the practice. And sometimes, an NP does a refill of a prescription for me that regular nurses can't refill.

There’s no contradiction here.
If someone has a low income and isn’t paying the maximum, that’s one factor—but I would also look at their portfolio size. It’s not currently part of the law, but we could design a smarter system that takes both into account.
Most retirees under age 65 don’t have portfolios larger than $300,000, and it’s important to note that portfolio size is not the same as total net worth.
On another issue, nurse practitioners (NPs) and physician assistants (PAs) provide valuable care, but they are not physicians. One potential reform could be to limit what providers can charge based on their level of training—for example, capping PA/NP services at a percentage of physician rates. That alone could reduce some of the pricing distortions we see today.
Nothing is easy but...
My broader point is simple: many of these loopholes could be reduced with more thoughtful policy design.

Let me help you: Italy, Spain, Germany, France, Japan (Japan does not have high immigration) are some of them.

Let's check. How long do you need to wait for a nonemergency MRI?
Spain: around 73 days to 98 days
Italy: several months to a year
France: 30 to 45 days
Germany: 2 to 6 weeks with public insurance, often extending up to 3 months for non-critical cases or popular specialists.
How long did it take me to get an MRI several times in the past? The last time was 2025. one day.
If I needed to do a surgery, Germany would be good, like everything else they do. I would select my doctors and hospitals over any other big country in Europe.

Germany has a higher overall tax burden than the US, with income taxes often exceeding 40% including social charges (health, pension, unemployment) for average earners. The US has lower income taxes, generally ranging from 10–37% federally, but higher private costs for healthcare and education. Germany charges a 19% VAT on goods, while the US uses lower, state-level sales taxes.

France generally has a significantly higher tax burden (approx. 67% total, including high social contributions) compared to the US (approx. 37%), with France’s system focusing on high social security contributions (30% employer) and progressive income tax (up to 45%). While France has higher payroll and consumption taxes (VAT), it often results in lower out-of-pocket costs for healthcare and education compared to the US.

Sure, lobbyists have bought our politicians, and many overlaps exist, causing the US to spend too much on many services.

Why do I have near me state police, county police, and city police? Why not one police force for my state?
Why Doctors make so much money in the US? When I go to see them, it looks like a German dealership.
A friend of my kids finished her studies to be an ER DR. First salary was over $300K for just 35 hours. That was 10 years ago. Why do many ortho doctors make over $500K and cardio doctors make $800K-1 million?

 

[GenXguy]

There’s no contradiction here.
If someone has a low income and isn’t paying the maximum, that’s one factor—but I would also look at their portfolio size. It’s not currently part of the law, but we could design a smarter system that takes both into account.

The contradiction is that you said "The premiums should be based on income." But then you said a small portfolio size of just $300K should make you have to pay the max, but portfolio size not "income". I see pbuski replied about that as well.

 

[FD1000]

The contradiction is that you said "The premiums should be based on income." But then you said a small portfolio size of just $300K should make you have to pay the max, but portfolio size not "income". I see pbuski replied about that as well.

You still didn't get it.

Let's make it a basic case. The numbers are just an example. You have only 2 choices: $500 per month or $100.
* If your income is above $50K you pay $500 for ACA per month. You are done.
* If your income is below $50K
Then you have 2 choices
*** If your portfolio is greater than $300K, you pay $500 per month.
*** Else, you pay $100.

pbuski talked about the difficulty of implementing this idea.
Everything is doable. Imagine a simple solution: just self-report your portfolio correctly in some cases.
If the government later finds that you lied, you will have to pay a penalty of five times the amount retroactively.

 

[GenXguy]

You still didn't get it.

Let's make it a basic case. The numbers are just an example. You have only 2 choices: $500 per month or $100.
* If your income is above $50K you pay $500 for ACA per month. You are done.
* If your income is below $50K
Then you have 2 choices
*** If your portfolio is greater than $300K, you pay $500 per month.
*** Else, you pay $100.

pbuski talked about the difficulty of implementing this idea.
Everything is doable. Imagine a simple solution: just self-report your portfolio correctly in some cases.
If the government later finds that you lied, you will have to pay a penalty of five times the amount retroactively.

OK, but I was keying in on your line that said "The premiums should be based on income." NOT portfolio.

Anyway, using portfolio or assets would not be a practical solution, and I don't see that ever happening. It seems we are going in the other direction, even for some other services that used to have an asset limit.

Anyway, enough about that. It's based on income, and that's the end of the story. And that allows me to have very reasonable premiums and deductible, and it has allowed many people to retire earlier, which is why I said ACA (Obamacare) is a great. Not just for me, but many early retirees.

 

[Onda]

Let's check. How long do you need to wait for a nonemergency MRI?
Spain: around 73 days to 98 days
Italy: several months to a year
France: 30 to 45 days
Germany: 2 to 6 weeks with public insurance, often extending up to 3 months for non-critical cases or popular specialists.
How long did it take me to get an MRI several times in the past? The last time was 2025. one day.
If I needed to do a surgery, Germany would be good, like everything else they do. I would select my doctors and hospitals over any other big country in Europe.

In plain English: good healthcare matters most where early diagnosis, continuous management, or fast intervention can stop death or disability. (Not in how long you waited for nonemergency MRI).

Country	Life	Healthy	Infant	Preventable	Treatable
Spain	82.7	71.1	2.6	92	50
Italy	82.2	70.6	2.5	93	52
France	81.9	70.1	3.5	114	48
Germany	80.5	68.9	3.1	129	66
United States	76.4	63.9	5.4	217	95

Life = life expectancy
Healthy = healthy years of life
Infant = infant deaths / 1,000 births
Preventable / Treatable = deaths per 100,000