Healthcare Insurance Options - Pre Medicare

[+ PhileasFogg]

I’m 61 and retired several months ago.  Under my employment contract, my employer continues to provide coverage for 18 months.   I have roughly 12 months left in that.  After that, I will need to bridge myself to Medicare.

In some casual conversations, I’ve been advised that private coverage will run me about $1,500/mo.  That’s not a problem.   But, I’m also very healthy, active, and in good shape.  So, combine $18k/yr, plus I’m guessing a deduction of a few more thousand, I wonder if I should:

1) self insure with an extremely high deductible/low premium plan so I essentially just have “catastrophic” coverage, 

2) continue a blue cross plan similar to what I have now with the $1,500 monthly premium, $6,000 deductible, and 20% copay (100% coverage of preventative care), or

3) explore options through ACA (which I’m totally unfamiliar with)

I’m hoping some of you have direct experience with this situation that you’re willing to share to help me lay out options proactively.  

[+ Vegas_Millennial]

13 hours ago, PhileasFogg said:

I’m 61 and retired several months ago.  Under my employment contract, my employer continues to provide coverage for 18 months.   I have roughly 12 months left in that.  After that, I will need to bridge myself to Medicare.

In some casual conversations, I’ve been advised that private coverage will run me about $1,500/mo.  That’s not a problem.   But, I’m also very healthy, active, and in good shape.  So, combine $18k/yr, plus I’m guessing a deduction of a few more thousand, I wonder if I should:

1) self insure with an extremely high deductible/low premium plan so I essentially just have “catastrophic” coverage, 

2) continue a blue cross plan similar to what I have now with the $1,500 monthly premium, $6,000 deductible, and 20% copay (100% coverage of preventative care), or

3) explore options through ACA (which I’m totally unfamiliar with)

I’m hoping some of you have direct experience with this situation that you’re willing to share to help me lay out options proactively.  

Congratulations on your retirement 🎈 

You're already ahead of most folks who don't know to consider both premiums and expected deductables and co-pays when shopping for insurance.  You know your own health the best: you know what medicines you take and what specialists you typically see in a year.  So you'll best know if a low premium, high deductible plan will actually save you money over the next year. 

Regarding ACA plans, I believe the government provides you a subsidy based on your income and based on the state in which you live.  Given that you said $18K per year in premiums is not that big a deal, then my bet is that you have too much income to qualify for any ACA subsidy.  But, if your income is mostly from non-taxable Roth IRA withdrawals, then you may qualify.

Start here:  

Welcome to the Health Insurance Marketplace®

WWW.HEALTHCARE.GOV

---

Welcome to the Health Insurance Marketplace®. Official government website.

 

Enter your state, and your income, then shop!

I did this once with a former boyfriend about 5 years ago, and I believe there were only about a half dozen plans to choose from the ACA marketplace for my state.  So it shouldn't be overwhelming. 

Keep in mind if your doctor is in a certain network.  I choose to pay a higher premium plan simply because it has my doctor who I've been seeing for 20 years; and, my plan has very low penalties for out of network coverage.  I travel a lot, so I like the peace of mind knowing I could stop in to a doctor or hospital or pharmacy almost anywhere and be covered by my higher-premium insurance.

Once again, congratulations on retirement!

Edited September 24, 2024 by Vegas_Millennial

[BiGuyNola]

I am 66, and if you're looking for health coverage options, I highly recommend checking out your state's official health website. By visiting the [your state name here] State of Health website, you can explore the different discounted extremely low cost Medicaid plans available to you. Medicaid is a state and federally funded program that provides health coverage to people of all ages, but even including seniors who are on Medicare.

[handiacefailure]

Health care is what's stopping me from retiring (I'm 58 1/2).   I have enough saved I can live comfortably but need the insurance.

How the election turns out is going to play a big part in when I retire.   If trump gets in and ACA gets reversed I;m screwwed.

I'm told ACA premiums are based on your taxable income.   If you have a lot of money in a roth, I would draw on that until you're 65, since that is non-taxable income and shouldn't have an impact on your premiums

[+ Vegas_Millennial]

3 hours ago, handiacefailure said:

 If you have a lot of money in a roth, I would draw on that until you're 65, since that is non-taxable income and shouldn't have an impact on your premiums

Not only the ACA, but Medicare premiums after one turns 65 are also subsidized based on one's taxable income.  Usually, it makes more sense to draw down taxable income first, and save Roth withdrawals for last.

Edited September 26, 2024 by Vegas_Millennial

[EZEtoGRU]

20 hours ago, BiGuyNola said:

I am 66, and if you're looking for health coverage options, I highly recommend checking out your state's official health website. By visiting the [your state name here] State of Health website, you can explore the different discounted extremely low cost Medicaid plans available to you. Medicaid is a state and federally funded program that provides health coverage to people of all ages, but even including seniors who are on Medicare.

To qualify for Medicaid, you have to have very low income and/or very limited financial assets.  Based on the OP's opening comments, it seems like he would not qualify.  Assuming I am correct on that, he will be looking for coverage options via his state's open insurance market or through the Healthcare Marketplace. 

[Rudynate]

21 hours ago, BiGuyNola said:

I am 66, and if you're looking for health coverage options, I highly recommend checking out your state's official health website. By visiting the [your state name here] State of Health website, you can explore the different discounted extremely low cost Medicaid plans available to you. Medicaid is a state and federally funded program that provides health coverage to people of all ages, but even including seniors who are on Medicare.

Medicaid is subsidized health coverage for low-income families and individuals.   Most, except for the low-income segment for which it is provided, would not qualify for it.

[+ PhileasFogg]

23 hours ago, handiacefailure said:

Health care is what's stopping me from retiring (I'm 58 1/2).   I have enough saved I can live comfortably but need the insurance.

How the election turns out is going to play a big part in when I retire.   If trump gets in and ACA gets reversed I;m screwwed.

I'm told ACA premiums are based on your taxable income.   If you have a lot of money in a roth, I would draw on that until you're 65, since that is non-taxable income and shouldn't have an impact on your premiums

Honestly, I don't think ACA would be repealed.  It's become part of the DNA of too many voters.   

I think it's more likely that the law will be modified to properly define the mandate requirement so that it turns into an actual risk pool rather than a government subsidy.

 

 

[BonVivant]

This is something I have wondered about. So I did some searching  

This might help. See what this says:

https://www.healthcare.gov/retirees/

And scroll to this:

 

[+ augustus]

On 9/23/2024 at 8:39 PM, PhileasFogg said:

I’m 61 and retired several months ago.  Under my employment contract, my employer continues to provide coverage for 18 months.   I have roughly 12 months left in that.  After that, I will need to bridge myself to Medicare.

You should apply for a policy through the Exchange.  At your age, you can get a Silver Plan (which is decent) for about $800-$900 a month.  That is with NO subsidies if you have a higher than most income level.  Prescription benefits are good, and you'll pay about $30 for a doctor visit.  Now if you get a serious medical condition, your out-of-pocket expenses can be up to $7k I believe.  After that they pay for everything. 

[Frequentflier]

On 9/26/2024 at 8:31 PM, PhileasFogg said:

Honestly, I don't think ACA would be repealed.  It's become part of the DNA of too many voters.   

I think it's more likely that the law will be modified to properly define the mandate requirement so that it turns into an actual risk pool rather than a government subsidy.

 

 

 

Premiums for an ACA policy are not based on income. To quality for premium subsidies from the Federal government your income has to be below I believe 400% of an amount considered low income. Said otherwise, if you make $10 million a year in income you pay the same premium as someone making $125,000 a year.

About pre-existing conditions, there should continue to be as now NO additional premium for having ANY pre-existing condition.  With ONE exception - people who smoke. Smokers can be charged higher premiums. Other than that, you could be just be a head in a jar and you'd pay the same as someone else who runs marathons. And, yes, gross premiums before subsidies vary by market and provider.

 

[misterhumphries]

On 9/23/2024 at 7:39 PM, PhileasFogg said:

I’m 61 and retired several months ago.  Under my employment contract, my employer continues to provide coverage for 18 months.   I have roughly 12 months left in that.  After that, I will need to bridge myself to Medicare.

In some casual conversations, I’ve been advised that private coverage will run me about $1,500/mo.  That’s not a problem.   But, I’m also very healthy, active, and in good shape.  So, combine $18k/yr, plus I’m guessing a deduction of a few more thousand, I wonder if I should:

1) self insure with an extremely high deductible/low premium plan so I essentially just have “catastrophic” coverage, 

2) continue a blue cross plan similar to what I have now with the $1,500 monthly premium, $6,000 deductible, and 20% copay (100% coverage of preventative care), or

3) explore options through ACA (which I’m totally unfamiliar with)

I’m hoping some of you have direct experience with this situation that you’re willing to share to help me lay out options proactively.  

This is a tough one. Your healthcare choices must be made to suit YOU and your situation. The only caveat with the ACA is most of its plans are HMOs and to get full benefit from the plan you'd be limited to seeing the physicians who participate in the plan. You'd also need referrals to see a specialist (who also must be in network). If you have a favorite primary care physician or specialist, that could be one way to narrow your choices. Find a plan in which your provider is a member.

[+ PhileasFogg]

7 hours ago, misterhumphries said:

This is a tough one. Your healthcare choices must be made to suit YOU and your situation. The only caveat with the ACA is most of its plans are HMOs and to get full benefit from the plan you'd be limited to seeing the physicians who participate in the plan. You'd also need referrals to see a specialist (who also must be in network). If you have a favorite primary care physician or specialist, that could be one way to narrow your choices. Find a plan in which your provider is a member.

Exacerbated by the fact that I have a concierge dr and I’m about to relocate to another state 😅