Tips on finding health insurance in early retirement before qualifying for ACA subsidy next year?

[Floralscent]

Hello...I thought I would reach out to this amazing smart group for health insurance advice for an early retire couple before they qualify for ACA in 2027.

We are retiring and relocating to Arkansas in 2 months and are looking for health insurance to get us through July to December 2026. In 2027 we will qualify for a subsidy and plan on getting health insurance through ACA.

For coverage this year, I have contacted a few agents in AR for quotes on health insurance and it seems like all they want to do is toss premiums at me and don't want to answer my questions or maybe they aren't qualified enough too (?). I had 2 strokes 5 years ago and although I have no noticeable lasting effects, it is still a pre-existing condition that tarnishes my health history.

One option I have been given is Manhattan Life and although premiums are decent, I haven't read the best reviews and I would need a rider to cover larger health events. Paying for the insurance and rider is expensive and the coverage is not really that good.

Option 2 is United Health and although coverage seems better than Manhattan, in the fine print I read pre-existing conditions aren't covered and this is something the agent hasn't shared. Agent just said United would be willing to take me on since I am near 5 years post stroke.

Does anyone have any tips on how to find the best health insurance for the rest of this year or how to find an agent that is actually helpful?

It's interesting as when I ask if they would be able to help with ACA next year, they perk up then so I am wondering if the ACA piece is the money maker for them and maybe my 6 month policy is more of a bother. I should be more excited about retiring soon but this health insurance piece is really stressing me out.

Thank you so much!!!

 

[Koolau]

Quick question. Are you eligible for COBRA through your empl*yer? Yes it can be expensive, but essentially you are "buying" a plan you know/understand - and it's just for a short time.

 

[plsprius]

Perhaps you can sign up for an ACA plan now with a qualifying event? If your circumstances allow, then I'd do that:

What is a Qualifying Life Event (QLE)?
A Qualifying Life Event is a major change in your life, household, or coverage status that triggers a 60-day Special Enrollment Period, during which you can: enroll in an ACA plan, switch plans, update subsidy eligibility, or adjust household information. Outside this window, you generally must wait until the next Open Enrollment Period. Documentation is usually required to verify the event.

 

[jim584672]

Option 2 is United Health and although coverage seems better than Manhattan, in the fine print I read pre-existing conditions aren't covered and this is something the agent hasn't shared. Agent just said United would be willing to take me on since I am near 5 years post stroke.

That isn't an ACA policy if pre-existing isn't covered.

 

[Floralscent]

Quick question. Are you eligible for COBRA through your empl*yer? Yes it can be expensive, but essentially you are "buying" a plan you know/understand - and it's just for a short time.

That is a great option as we would both qualify for COBRA through our employers. The reason I'm not pursuing that option is premiums would be more than ACA without a subsidy and all services would be out of network.

 

[Floralscent]

Perhaps you can sign up for an ACA plan now with a qualifying event? If your circumstances allow, then I'd do that:

What is a Qualifying Life Event (QLE)?
A Qualifying Life Event is a major change in your life, household, or coverage status that triggers a 60-day Special Enrollment Period, during which you can: enroll in an ACA plan, switch plans, update subsidy eligibility, or adjust household information. Outside this window, you generally must wait until the next Open Enrollment Period. Documentation is usually required to verify the event.

This is an option and one we may end up going with. Since we don't qualify for a subsidy, I was hoping to find a decent enough plan elsewhere and then going ACA in 2027.

 

[MichaelB]

If you’re waiting until January to enroll in a subsidized ACA policy because you aren’t eligible now and can’t or won’t pay the unsubsidized rate, your options are limited. A short term plan will be your only real option, and as you already know, coverage is thin. Any plan with decent coverage will be either underwritten or pricey. If you find one that is neither, read the fine print again because you missed something.

The relocation to a new state makes you eligible for a special enrollment period ACA policy. If you had employer coverage, you also have Cobra, as Koolau pointed out.

 

[Floralscent]

That isn't an ACA policy if pre-existing isn't covered.

The options I mentioned (Manhattan Life and United Health) were through an agent and not ACA. Was exploring options other than ACA since we won't qualify for subsidy.

 

[Aerides]

That is a great option as we would both qualify for COBRA through our employers. The reason I'm not pursuing that option is premiums would be more than ACA without a subsidy and all services would be out of network.

COBRA is intended to continue your existing plan, with you paying full cost. The premiums are expensive, yes, but they are also HSA eligible, and you "keep" your existing deductible contributions, so it can often be less outlay than it looks at the start. For you, would it be OON because you'd be moving to another state? It should be the same in-network coverage as you already have, by definition. And it's one less thing to worry about changing for just a few months.

Other than that, an ACA policy sans-subsidy is your best bet with pre-existing conditions, as non-Aca compliant policies are going to have too much fine print with your history.

 

[Floralscent]

Does anyone know if I can get an ACA policy for myself only for 2026 and then get a non-ACA policy for my husband since he doesn't have any pre-existing conditions?

 

[RetiredHappy]

ACA without subsidy is your best option for this year. I buy off-exchange individual health insurance and doctors are better than ACA plans but the rates are comparable to ACA unsubsidized rates. I have been paying full freight since I was 54 (retired at 53) and will do so until I get to Medicare age next year.

 

[Aerides]

The relocation to a new state makes you eligible for a special enrollment period ACA policy. If you had employer coverage, you also have Cobra, as Koolau pointed out.

Loss of job/retiring, also makes them eligible, even if they aren't moving.

You can decline to take COBRA and hop on the ACA the day you quit.

 

[RetiredHappy]

Does anyone know if I can get an ACA policy for myself only for 2026 and then get a non-ACA policy for my husband since he doesn't have any pre-existing conditions?

Yes. But pre-existing condition or not, full coverage off exchange costs about the same as unsubsidized ACA policies.

 

[Pluperfect]

One option I have been given is Manhattan Life

I went to the Manhattan Life website and don't see any mention of offering major medical health insurance plans. I'm betting what the agent is pitching is an indemnity plan, which is NOT major medical health insurance, although often sold to people as if it is.

If your agent hasn't made that clear, run away.

Also, about Manhattan Life, on their website listing of products offered, there's Accident Insurance, which is described as: "Accident's can happen without warning. Accident coverage helps provide financial protection after an expected injury." There are some things I just can't abide.

 

[COcheesehead]

My first year attempting to find ACA health insurance I visited a broker and despite what some may think he was actually very helpful showing me how to evaluate policies. If you need guidance like I did, I would consider a broker.
After that, I selected every other policy on my own, but the time with the broker was pretty valuable.

 

[TripleLindy]

This is an option and one we may end up going with. Since we don't qualify for a subsidy, I was hoping to find a decent enough plan elsewhere and then going ACA in 2027.

The upside is that you’re only exposed to the unsubsidized premium for half of the year. As others have indicated, options outside of ACA plans usually don’t have much substance. I did a deep dive into indemnity plans this year that were roughly 50% of the ACA premium, but the coverage was awful and mostly hidden. It took persistence, but I finally got a copy of covered fees for things like knee surgery. The marketing materials show good inpatient coverage, but very little healthcare occurs in an inpatient setting.

 

[momoney]

Quick question. Are you eligible for COBRA through your empl*yer? Yes it can be expensive, but essentially you are "buying" a plan you know/understand - and it's just for a short time.

Are you always eligible for COBRA if your employer has more than 20 employees as long as there is no misconduct?

 

[Pluperfect]

My first year attempting to find ACA health insurance I visited a broker and despite what some may think he was actually very helpful showing me how to evaluate policies.

It's hard to know in advance what kind of broker you're getting.

Indemnity plans started being pervasively marketed in the fulltime traveler universe a few years ago when Texas no longer had any ACA plans that had access to a nationwide network. Texas is home to the largest mail-forwarding service, and the domicile for an enormous number of fulltime travelers. Indemnity plans were advertised as having nationwide coverage, which is the main thing fulltime travelers want/need. And that's all they see, and almost nobody realized it wasn't actual health insurance.

When I complained to one broker that his website wasn't clear that the plans weren't health insurance as most people understand it, he pointed to this language: "These are not ACA Obamacare plans and should not be mistaken for 'major medical health insurance.' Instead these are fixed-benefit health plans that indemnify either you or your medical provider for medical services rendered at a fixed benefit level."

The vast majority of people would need their broker to explain exactly what that last sentence means. And, even then, it's not that accurate. The services aren't rendered at a fixed benefit level.

And for the record, even some respected RV organizations were promoting these plans through affiliations. A few of us were trying to hold their feet to the fire, but they seemed to think their plans were okay because they were better than nothing? I never really got it, but then again, I wasn't making money on people buying them.

 

[engineernerd]

Does anyone know if I can get an ACA policy for myself only for 2026 and then get a non-ACA policy for my husband since he doesn't have any pre-existing conditions?

Pre-existing conditions do NOT affect your eligibility or premiums on ACA. Arkansas does not have its own ACA exchange so the place you'd go to shop plans is healthcare.gov.

I very much recommend just signing up for an ACA plan and paying the full premiums for the rest of the year. ACA plans are regulated. They have to provide a baseline of benefits (including specific preventive care items free of charge) and are not allowed to take your existing health condition into account when determining eligibility or premium.

Be a bit careful about agents in the business of helping people choose ACA plans, they make their money via kickbacks, and some plans make them more money than others. There are actual businesses offering training to such agents in how to maximize their income

If you sign up for a Bronze plan you can contribute to an HSA account (prorated by number of months covered), which is nice because your contributions reduce your AGI and MAGI as well as your taxable income - and as long as you spend HSA funds on qualifying medical costs and/or your eventual Medicare premiums, withdrawals are not taxed.

ADD: ACA plans have to include a MOOP (maximum out of pocket) limit on your share of costs for the coverage period. This is super-important.

 

[COcheesehead]

It's hard to know in advance what kind of broker you're getting.

Indemnity plans started being pervasively marketed in the fulltime traveler universe a few years ago when Texas no longer had any ACA plans that had access to a nationwide network. Texas is home to the largest mail-forwarding service, and the domicile for an enormous number of fulltime travelers. Indemnity plans were advertised as having nationwide coverage, which is the main thing fulltime travelers want/need. And that's all they see, and almost nobody realized it wasn't actual health insurance.

When I complained to one broker that his website wasn't clear that the plans weren't health insurance as most people understand it, he pointed to this language: "These are not ACA Obamacare plans and should not be mistaken for 'major medical health insurance.' Instead these are fixed-benefit health plans that indemnify either you or your medical provider for medical services rendered at a fixed benefit level."

The vast majority of people would need their broker to explain exactly what that last sentence means. And, even then, it's not that accurate. The services aren't rendered at a fixed benefit level.

And for the record, even some respected RV organizations were promoting these plans through affiliations. A few of us were trying to hold their feet to the fire, but they seemed to think their plans were okay because they were better than nothing? I never really got it, but then again, I wasn't making money on people buying them.

You have to pick an ACA authorized broker. That whittles it down pretty quick.

 

[Pluperfect]

You have to pick an ACA authorized broker. That whittles it down pretty quick.

The broker with the what I consider misleading pitch on his website also sold ACA plans. The problem was that in a lot of states, there were no ACA plans that were suitable for fulltime travelers, and of course no one wants to be told there is no solution to their problem, and salesmen definitely don't want to tell people they have no solution to their problem. So indemnity plans become the solution.

As for "regular" people, I can see an opportunity for the same thing to happen. Someone says they cannot or will not pay whatever the premium is for an ACA plan, period. Rather than lose the business, the broker will try to sell an indemnity plan instead, and then it becomes a matter of how honest the broker is about what the plan actually does.

 

[big-papa]

COBRA is intended to continue your existing plan, with you paying full cost. The premiums are expensive, yes, but they are also HSA eligible, and you "keep" your existing deductible contributions, so it can often be less outlay than it looks at the start. For you, would it be OON because you'd be moving to another state? It should be the same in-network coverage as you already have, by definition. And it's one less thing to worry about changing for just a few months.

Other than that, an ACA policy sans-subsidy is your best bet with pre-existing conditions, as non-Aca compliant policies are going to have too much fine print with your history.

Agreed - I retired mid-year 2023 and went on COBRA for the remainder of that year before starting an ACA plan in January 2024. The reason was that it was one of those rare years where we met the deductible because my daughter had an ER visit earlier in the year. The timing was such that she was only on our COBRA for one month before she got her own employer plan. All of the HSA-compliant ACA plans in our area were actually the most expensive ones, but we were able to continue HSA contributions through the end of that year. We also had nationwide coverage with my employer's plan through COBRA.

2024 ACA plan was a good plan. But the umbrella company providing it was hit with a ransomware attack mid year and they exited the business at the end of 2024.
2025 ACA plan was provided by a local non-profit and was relatively inexpensive. The cheapest bronze plan in the area, in fact. Not HSA compliant. But it was mostly amateur hour in customer service. It took months to clear up the reason why one claim kept getting rejected until I finally got to a supervisor who discovered that the provider missed the leading "zero" in my ID number. 3 months in and my wife went on medicare and we lost all subsidies, making my premiums alone higher than what our premiums together were. It wasn't a surprise as the subsidy rules are pretty clear.
2026 ACA plan was the same as my 2025 plan, just a little more expensive at over $1K per month just for me. HSA compliant because all bronze plans are HSA compliant this year. T-minus 27 days and counting until I'm on medicare and my total premiums (Parts, B, G, D) drop by about 62% or so, with better coverage, and not limited to a small geographical area (outside of emergencies). I never thought I'd be impatient about actually turning 65.

Cheers.

 

[big-papa]

ADD: ACA plans have to include a MOOP (maximum out of pocket) limit on your share of costs for the coverage period. This is super-important.

Exactly. When I first went shopping for a plan, I pulled out a spreadsheet and looked at the total, worst case cost we might ever have in a year: 12 months of premiums plus MOOP and asked myself whether, in a really bad year, we could afford that, knowing how long it would be before we started medicare. I then looked at what a "normal" year might look like. I also looked at those that were HSA-compliant. Until this year when all bronze plans were deemed HSA-compliant, all HSA-eligible plans were very expensive in my area for some reason.

Except for the first year's plan, the analysis I did led us to the cheapest plan on the exchange in the 2nd and 3rd(final) year.

Cheers.

 

[Flieger]

My first year attempting to find ACA health insurance I visited a broker and despite what some may think he was actually very helpful showing me how to evaluate policies. If you need guidance like I did, I would consider a broker.
After that, I selected every other policy on my own, but the time with the broker was pretty valuable.

I used a broker as well, if for nothing else to have a 2nd set of eyes. The nice thing was having her check all of the different pharmacy items against competing plans. Yes, I could (and do now) do it but again, just a 2nd set of eyes the first time around. Cost me nothing.

Flieger

 

[COcheesehead]

The broker with the what I consider misleading pitch on his website also sold ACA plans. The problem was that in a lot of states, there were no ACA plans that were suitable for fulltime travelers, and of course no one wants to be told there is no solution to their problem, and salesmen definitely don't want to tell people they have no solution to their problem. So indemnity plans become the solution.

As for "regular" people, I can see an opportunity for the same thing to happen. Someone says they cannot or will not pay whatever the premium is for an ACA plan, period. Rather than lose the business, the broker will try to sell an indemnity plan instead, and then it becomes a matter of how honest the broker is about what the plan actually does.

I had a really great experience with the broker and using one should not be dismissed.