Author Topic: Healthcare in FIRE  (Read 6876 times)

heybro

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Healthcare in FIRE
« on: January 07, 2018, 11:20:56 PM »
Hello,

How does a person take care of healthcare costs after they have quit a standard job and are FIRE?

I ask this because our system is primarily Employer based.

I know the HSA is your best friend when it comes to saving for medical expenses.  This includes using a High Deductible Plan.

If people continue to use High Deductible Plans when in FIRE, I wanted to ask this also:

While I have been working, I have taken out Employer Based Plans that were high deductible and I have also, a year or two here and there, taken out plans that were very, how do you say, well, they covered A LOT.  They weren't that much more expensive but I sure did need them for that year or two. 

I'm sure I could find a good plan without an employer but it would be high deductible I am assuming.
I sort of am scared to even know what a plan that would cover a lot, with a low deductible, that is not employer based would cost.

The reason I am asking this is because, it may be a better bet to take my hours at work down to 30 (that which is considered full time and still includes benefits) instead of trying to go all out with FIRE.  Thank you.

soccerluvof4

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Re: Healthcare in FIRE
« Reply #1 on: January 08, 2018, 03:56:48 AM »
Hello,

How does a person take care of healthcare costs after they have quit a standard job and are FIRE?

I ask this because our system is primarily Employer based.

I know the HSA is your best friend when it comes to saving for medical expenses.  This includes using a High Deductible Plan.

If people continue to use High Deductible Plans when in FIRE, I wanted to ask this also:

While I have been working, I have taken out Employer Based Plans that were high deductible and I have also, a year or two here and there, taken out plans that were very, how do you say, well, they covered A LOT.  They weren't that much more expensive but I sure did need them for that year or two. 

I'm sure I could find a good plan without an employer but it would be high deductible I am assuming.
I sort of am scared to even know what a plan that would cover a lot, with a low deductible, that is not employer based would cost.

The reason I am asking this is because, it may be a better bet to take my hours at work down to 30 (that which is considered full time and still includes benefits) instead of trying to go all out with FIRE.  Thank you.


Sparta is right. Having said that not knowing much about you based on your opening like your age etc... I would work the minimum to get the coverage and in the meantime look up the plans on ACA and see what it would cost you a year to add that to your fire amount including inflation. Again , kinda hard to tell not know more about you BUT its good your taking this into consideration because its going to be a game changer for many. Don't take risks with the political landscape the way it is now and have everything wiped away you have worked for till you figure this all out.

frompa

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Re: Healthcare in FIRE
« Reply #2 on: January 08, 2018, 12:16:07 PM »
Heybro - while it is true that for those who worked for a company, their health insurance was often provided as a benefit of their employment, I secured my and my family's health insurance for the decades I worked before stepping away from work last year.  Finding health insurance that fits your situation is not a mystery, but rather is like handling your money in general -- it's unlikely anyone else will do it better than you can do it yourself, assuming you do your homework.  Study up on what you need, on what's available, ask questions when you're uncertain, and then make your best choice.  This is a rational process, and you need not be ruled by fear of the unknown -- even employer provided health insurance was analyzed by mere human beings set out to determine the best overall options.  If you are otherwise ready to RE, don't let fear of health insurance keep you working.  If you expect your income to exceed such as would qualify you for subsidy, or you want to hedge your bets, make sure you have enough cushion in your savings to cover a reasonable amount for health insurance.  (What's reasonable depends on your age, location, health needs, # and age of dependents, etc... all mostly quantifiable.)  Best of luck. 

Fishindude

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Re: Healthcare in FIRE
« Reply #3 on: January 08, 2018, 01:18:22 PM »
I believe most people who are FIREd (or plan to soon) plan to have a much lower taxable income (MAGI) once retired and count on getting subsidized ACA medical insurance to reduce premiums but maintain good coverage. I believe the Silver level covers most things at a reasonable OOP max. I use the VA hospital myself for coverage as I have a military service disability and can use it for free.

Not always.
I retired at year end and intend to remain on COBRA using my former employer plan for the 18 months I am legally allowed.   We have invested well, have income generating side gigs, planned for retirement and won't see much reduction in income, so private insurance is quite expensive.   COBRA runs about $800 per month and private coverage will be around $1100 for my wife and I.

Hopefully the private health insurance market will get better in the next year and a half, but regardless we will suck it up and buy privately after COBRA.

StetsTerhune

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Re: Healthcare in FIRE
« Reply #4 on: January 09, 2018, 02:44:44 AM »
My ACA plan is ludicrously good this year. I have structured my investments to generate as little "income" as possible, so I can harvest capital gains to hit almost any income target I want. This year I'm expecting some medical expenses, so I am aiming for a low income and getting cost sharing subsidies as well as premium subsidies. For something like $60 a month my wife and I get a plan with a $1200 family deductible. It is absolutely not fair and is ludicrous on a societal level... but they write the laws and I feel no guilt about taking advantage of it.

boarder42

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Re: Healthcare in FIRE
« Reply #5 on: January 09, 2018, 04:04:46 AM »
Unless you're retiring I. The next year or so I think it's pretty fruitless to try to calc or assume any cost. The healthcare market will be dynamic and changing until Washington and the healthcare industry get their shit together. Meaning make pricing transparent then most of these issues will fix themselves and healthcare costs will drop substantially. I have a buddy who is a physical therapist. If you walk in of the street no insurance it's 90. With insurance it's 250. But the insurance agreements typically knock that down to 60-70. He doesn't get why he can't just charge everyone 70 and call it a day.

Roadrunner53

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Healthcare in FIRE
« Reply #6 on: January 10, 2018, 08:50:59 AM »
Hub retired in 2015 and I was on his employee healthcare plan. We both transitioned to ACA in May of 2015 when he retired. First year on ACA doesn't penalize you for prior income that year. They take into consideration your future income after you retire which should be less than when you were employed. At the time Hub started Social Security in March of 2015, he has a small pension from a previous employer and we took out some money from IRA's plus savings. We were eligible for the subsidy for being below the 400% poverty level. Silver plan is the only one that offers the subsidy. Got to be very careful to keep below the radar screen in income to keep getting subsidy. Hub went off to Medicare March 2017 and I remained on ACA. Cost was MORE than the two of us on it together. It is still based on family income, not individual income. Still have to stay below the radar screen to qualify for subsidy. I have 6 more months till I move onto Medicare. Can't wait to get off it due to the turmoil on whether they will kill it or not. Plus, it is a pain to worry about falling off the subsidy cliff. I want to withdraw more from IRA instead of sucking out money from savings. However, subsidy savings was over $12K last year and will be $8,400 this year. I go to Medicare in August so only a partial year on ACA. If you apply for it make sure you submit paperwork when asked. They will pull the subsidy in a flash. I started inquiring about ACA way before we were ready to go onto it and that started the wheels turning on the ACA machine. For some reason the computer decided we were ready to start and kept sending letters for documentation. We were not ready and we didn't send paperwork. Then we got on it and one week later they pulled the subsidy because they didn't get the paperwork! OMG, it was a nightmare. You can't believe the amount of letters we got prior to starting ACA. This is CT and our system is called Access Health so maybe they have a different system than other states. It took several months and we had to pay the full amount without subsidy for a couple of months. They finally fixed and we got the subsidy money returned to us it but it wasn't easy because no one seemed to understand what the problem was. Talk about government red tape!

Gin1984

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Re: Healthcare in FIRE
« Reply #7 on: January 10, 2018, 08:55:33 AM »
I believe most people who are FIREd (or plan to soon) plan to have a much lower taxable income (MAGI) once retired and count on getting subsidized ACA medical insurance to reduce premiums but maintain good coverage. I believe the Silver level covers most things at a reasonable OOP max. I use the VA hospital myself for coverage as I have a military service disability and can use it for free.

Not always.
I retired at year end and intend to remain on COBRA using my former employer plan for the 18 months I am legally allowed.   We have invested well, have income generating side gigs, planned for retirement and won't see much reduction in income, so private insurance is quite expensive.   COBRA runs about $800 per month and private coverage will be around $1100 for my wife and I.

Hopefully the private health insurance market will get better in the next year and a half, but regardless we will suck it up and buy privately after COBRA.
Check your state, California allows you to extend COBRA for an additional 18 months (36 total).  Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Roadrunner53

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Healthcare in FIRE
« Reply #8 on: January 10, 2018, 09:35:50 AM »
Last year (2017) Hub and I on ACA in CT:
Premium $1916.54
Subsidy  $1409.00
Payment $507.54

Last year (2017) Hub off ACA in CT, Me only:
Premium: $950.54
Subsidy:  $440.00
Payment: $510.54

This year (2018) Me only on ACA in CT:
Premium $1264.20
Subsidy  $769.00
Payment $495.20

Just below 400% poverty level, income approx. $60K

RedmondStash

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Re: Healthcare in FIRE
« Reply #9 on: January 10, 2018, 11:11:53 AM »
Yeah, this is something we're dealing with too. I just left my job and am on COBRA for the next 12-18 months; spouse is on Medicare. Our income is likely not to look as low as I'd like since we're doing IRA conversions for spouse over the next few years. Add spouse's Social Security to that, and good-bye, subsidies.

Basically I look at it as a mathematical question: Over the last 10-20 years, at what rate have health insurance costs increased? The answers are grim, but they're clear. I don't believe healthcare costs can continue to rise that astronomically forever, but it will likely be at least a few years before that sea change happens. So I calculate how much I expect premiums to cost for us, and the rate at which I expect them to rise over the next decade or so, and I figure those numbers into our FIRE plan.

It's all just math in the end.

soccerluvof4

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Re: Healthcare in FIRE
« Reply #10 on: January 10, 2018, 12:23:47 PM »
I believe most people who are FIREd (or plan to soon) plan to have a much lower taxable income (MAGI) once retired and count on getting subsidized ACA medical insurance to reduce premiums but maintain good coverage. I believe the Silver level covers most things at a reasonable OOP max. I use the VA hospital myself for coverage as I have a military service disability and can use it for free.

Not always.
I retired at year end and intend to remain on COBRA using my former employer plan for the 18 months I am legally allowed.   We have invested well, have income generating side gigs, planned for retirement and won't see much reduction in income, so private insurance is quite expensive.   COBRA runs about $800 per month and private coverage will be around $1100 for my wife and I.

Hopefully the private health insurance market will get better in the next year and a half, but regardless we will suck it up and buy privately after COBRA.
Check your state, California allows you to extend COBRA for an additional 18 months (36 total).  Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.


about 3 years ago when I fire'd i did cobra for family of 6 it was about 18k so I feel your pain.

RyanAtTanagra

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Re: Healthcare in FIRE
« Reply #11 on: January 10, 2018, 12:39:25 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.

Gin1984

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Re: Healthcare in FIRE
« Reply #12 on: January 10, 2018, 01:19:48 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.
Yeah I'd be running off to another country if I had to pay that much! Maybe they are too high income to get subsidies so have to pay full cost premiums. Or have had to use it often enough to pay high OOP max each year. At your projected FIRE income (assuming ACA is still around...and I'm doubtful)  you probably will pay less than $100/month and get cost sharing too.
Oh, that does not include the OOP max, that is another $6000.  I was just listing what my COBRA costs would be if I retired today.  Mostly because I don't expect ACA to be around by the time I retire and I have medical conditions so I need insurance so I plan for full cost.

RyanAtTanagra

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Re: Healthcare in FIRE
« Reply #13 on: January 10, 2018, 02:37:53 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.
Yeah I'd be running off to another country if I had to pay that much! Maybe they are too high income to get subsidies so have to pay full cost premiums. Or have had to use it often enough to pay high OOP max each year. At your projected FIRE income (assuming ACA is still around...and I'm doubtful)  you probably will pay less than $100/month and get cost sharing too.

That's at least encouraging.  I don't expect ACA as it is to be around either, but hopefully SOMETHING will still be that helps lower income people cover health care.

MrThatsDifferent

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Re: Healthcare in FIRE
« Reply #14 on: January 10, 2018, 09:35:39 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.
Yeah I'd be running off to another country if I had to pay that much! Maybe they are too high income to get subsidies so have to pay full cost premiums. Or have had to use it often enough to pay high OOP max each year. At your projected FIRE income (assuming ACA is still around...and I'm doubtful)  you probably will pay less than $100/month and get cost sharing too.

That's at least encouraging.  I don't expect ACA as it is to be around either, but hopefully SOMETHING will still be that helps lower income people cover health care.

Yeah, cause this administration really cares about the health care of lower income people.

RyanAtTanagra

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Re: Healthcare in FIRE
« Reply #15 on: January 10, 2018, 11:24:12 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.
Yeah I'd be running off to another country if I had to pay that much! Maybe they are too high income to get subsidies so have to pay full cost premiums. Or have had to use it often enough to pay high OOP max each year. At your projected FIRE income (assuming ACA is still around...and I'm doubtful)  you probably will pay less than $100/month and get cost sharing too.

That's at least encouraging.  I don't expect ACA as it is to be around either, but hopefully SOMETHING will still be that helps lower income people cover health care.

Yeah, cause this administration really cares about the health care of lower income people.

Well I probably won't be FIREing during this administration, unless it runs 8 years, and nothing done is permanent (except maybe damage to the environment)

DanLee

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Re: Healthcare in FIRE
« Reply #16 on: January 11, 2018, 03:14:44 AM »
Is medical tourism not a option?

We in the netherlands pay 74,95 euro's a month for all the basic hospital healthcare all basics included like surgery and cancer treatments etc. With the first 850 euro for your own risk per year. And if you earn less then 20500 before taxes. you get 94 euro's back from the goverment. Bud only if you own less then 107.752 in stocks and savings.
You are can get dutch healthcare if you live or work in the netherlands.

Nick_Miller

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Re: Healthcare in FIRE
« Reply #17 on: January 11, 2018, 07:32:34 AM »
Options in some states (like mine) are VERY limited.

In my county of my state, there is ONE ACA exchange option this year. ONE. That is it. We had 5-6 insurers writing individual plans as recently as 2 years ago, but for this coming year, only one insurer is still writing individual policies. It is very scary. I spoke with a broker who said, "Yep, that's it." He tried to help, but the best suggestion he could make was for me to increase the size of my side writing business to hire an employee and then with 2 people, I could buy a "group plan" from him.

The network for the one remaining insurer is VERY small, and people who buy the insurance frequently have to change PCPs, pediatricians, etc. (I checked this out myself, and it would have been true for us too.) We were prepared to suck it up and do it, but at the eleventh hour my wife ended up finagling me and the kiddos onto her company's health plan for a very cheap rate (the boss pulled strings for her), but I view it as a year-to-year situation at best, because if we were paying the full price for her family plan through work, it would be over $1200/month.


jim555

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Re: Healthcare in FIRE
« Reply #18 on: January 11, 2018, 08:28:20 AM »
Is medical tourism not a option?

We in the netherlands pay 74,95 euro's a month for all the basic hospital healthcare all basics included like surgery and cancer treatments etc. With the first 850 euro for your own risk per year. And if you earn less then 20500 before taxes. you get 94 euro's back from the goverment. Bud only if you own less then 107.752 in stocks and savings.
You are can get dutch healthcare if you live or work in the netherlands.
I don't thing this is a realistic option for most in the US.  Big pain to move and get visas, then deal with the tax headache of both countries.

I could see moving to another state since there are huge differences in pricing between states.

whiskeyjack

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Re: Healthcare in FIRE
« Reply #19 on: January 11, 2018, 02:09:43 PM »
Is medical tourism not a option?

We in the netherlands pay 74,95 euro's a month for all the basic hospital healthcare all basics included like surgery and cancer treatments etc. With the first 850 euro for your own risk per year. And if you earn less then 20500 before taxes. you get 94 euro's back from the goverment. Bud only if you own less then 107.752 in stocks and savings.
You are can get dutch healthcare if you live or work in the netherlands.

If you mean 'can you retire and move to Europe and use the European healthcare plan' - it's challenging. Most countries are not willing to take American expats for long-term stays (over 90 days) without a letter of employment or being enrolled in university. This the post-FIRE board where presumably no one will want a job, so what are the other options?

To become a resident of the Netherlands requires you to apply in one of many categories, but the only one that might apply to retirees from the US who do not have family there is an 'investor' visa, which requires 1250000 euros invested.

boarder42

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Re: Healthcare in FIRE
« Reply #20 on: January 11, 2018, 02:12:58 PM »
Is medical tourism not a option?

We in the netherlands pay 74,95 euro's a month for all the basic hospital healthcare all basics included like surgery and cancer treatments etc. With the first 850 euro for your own risk per year. And if you earn less then 20500 before taxes. you get 94 euro's back from the goverment. Bud only if you own less then 107.752 in stocks and savings.
You are can get dutch healthcare if you live or work in the netherlands.
I don't thing this is a realistic option for most in the US.  Big pain to move and get visas, then deal with the tax headache of both countries.

I could see moving to another state since there are huge differences in pricing between states.

in the current system i think its highly likely you'll see certain states become retirement states for those who quit early and attract more entreprenuers if they have good healthcare available.  but the individual mandate is gone now correct? so we can go back to buying catastrophic plans right?

Threshkin

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Re: Healthcare in FIRE
« Reply #21 on: March 27, 2018, 03:33:31 PM »
Though I am totally jealous of your cost, our health insurance cost $19,000/year, I'm not looking forward to COBRAing that.

Jesus, your people's healthcare costs scare me.  That's as much as my FIRE number itself.  I haven't figured out the healthcare numbers yet (employer pays 100% currently, so it's not a cost for me), but thinking I might have to DOUBLE my FIRE number is discouraging to say the least.
Yeah I'd be running off to another country if I had to pay that much! Maybe they are too high income to get subsidies so have to pay full cost premiums. Or have had to use it often enough to pay high OOP max each year. At your projected FIRE income (assuming ACA is still around...and I'm doubtful)  you probably will pay less than $100/month and get cost sharing too.

That's at least encouraging.  I don't expect ACA as it is to be around either, but hopefully SOMETHING will still be that helps lower income people cover health care.

Yeah, cause this administration really cares about the health care of lower income people.

This administration did not create the ACA (Obama Care) program.  They also have not significantly changed it (yet).  High health care costs in the US are a bipartisan problem that have been growing for years.

DreamFIRE

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Re: Healthcare in FIRE
« Reply #22 on: March 27, 2018, 03:47:21 PM »
in the current system i think its highly likely you'll see certain states become retirement states for those who quit early and attract more entreprenuers if they have good healthcare available.  but the individual mandate is gone now correct? so we can go back to buying catastrophic plans right?
No, the individual mandate is not gone yet.  It is still in effect for 2018 for which you will file taxes in 2019.

DreamFIRE

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Re: Healthcare in FIRE
« Reply #23 on: March 27, 2018, 03:49:16 PM »
This administration did not create the ACA (Obama Care) program.  They also have not significantly changed it (yet).
Not for a lack of trying, though.

Threshkin

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Re: Healthcare in FIRE
« Reply #24 on: March 27, 2018, 04:05:03 PM »
Hello,

How does a person take care of healthcare costs after they have quit a standard job and are FIRE?

I ask this because our system is primarily Employer based.

I know the HSA is your best friend when it comes to saving for medical expenses.  This includes using a High Deductible Plan.

If people continue to use High Deductible Plans when in FIRE, I wanted to ask this also:

While I have been working, I have taken out Employer Based Plans that were high deductible and I have also, a year or two here and there, taken out plans that were very, how do you say, well, they covered A LOT.  They weren't that much more expensive but I sure did need them for that year or two. 

I'm sure I could find a good plan without an employer but it would be high deductible I am assuming.
I sort of am scared to even know what a plan that would cover a lot, with a low deductible, that is not employer based would cost.

The reason I am asking this is because, it may be a better bet to take my hours at work down to 30 (that which is considered full time and still includes benefits) instead of trying to go all out with FIRE.  Thank you.

I FIREd in late 2016 and have been on COBRA since.  I am now about to transition to ACA because COBRA runs out at the end of April.  My DW is still working but is a 1099 employee without health care.

<removed redundant info>

Here are a few statistics and useful bits of information to keep in mind.

1) Our COBRA is about $950/month for a HDHP plan.  We never hit the deductible so the main benefit we received was the negotiated rates and lower drug costs.  Not much benefit for the amount we spent but we were also protected in case of unexpected catastrophic medical bills.

2) We initially went with COBRA because our income in 2016/17 prevented us from getting any subsidies and Silver ACA plans at that time would have cost roughly the same amount.

3) IMPORTANT  Once you are on COBRA you must let it run our naturally or you will not be eligible for ACA subsidies.  We checked into that last November because our 2018 income is way down and COBRA went up.  COBRA ending naturally after 18 months is a qualifying event but voluntarily dropping it is not (hence no subsidy).

4) Key income limits to consider for ACA subsidies for a 2-person family are:  $21,599 (below this are you are on Medicaid) and $64,960 (above this and you receive no subsidies).  The numbers change for different family but are easy to find online.  We used an estimated income (AGI) of $35K for subsidy calculations.  We will get there through side gigs and Trad to Roth IRA conversions as needed.   

5) A Bronze plan with Kaiser will cost us less than $4.00/month after subsidies.  A Silver plan is about $105/month.  This is a huge savings from our current costs!

6) We are planning to select the Bronze plan because we plan to be traveling internationally a lot this year and mainly need catastrophic coverage.  The $900/month savings from our current plan should cover our normal expenses with lots left over.

7) We may also purchase travel healthcare insurance for our travels but have not researched that much yet.

« Last Edit: March 27, 2018, 04:12:18 PM by Threshkin »

Threshkin

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Re: Healthcare in FIRE
« Reply #25 on: March 27, 2018, 04:06:17 PM »
This administration did not create the ACA (Obama Care) program.  They also have not significantly changed it (yet).
Not for a lack of trying, though.

Agreed!  ;)

Roadrunner53

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Re: Healthcare in FIRE
« Reply #26 on: March 27, 2018, 04:29:28 PM »
I am on Obamacare and have been since 2015. Have kept our income below the 400% poverty level of around $64,000 to get the subsidy.

Hub went off to Medicare last year and even though I am the only one on O-care, I still pay the same amount! That is crazy!

I go to Medicare in August and glad I had O-care but glad to be done with it too. Now I don't have to worry about falling off the income cliff and losing out on the subsidy. I can tap my IRA's more moola if I so desire! Or get a part time job if I want next year. I still have to stay within the 400% poverty level for the rest of the year. 2019 will be a different story!

Padonak

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Re: Healthcare in FIRE
« Reply #27 on: March 27, 2018, 05:49:15 PM »


5) A Bronze plan with Kaiser will cost us less than $4.00/month after subsidies.  A Silver plan is about $105/month.  This is a huge savings from our current costs!

6) We are planning to select the Bronze plan because we plan to be traveling internationally a lot this year and mainly need catastrophic coverage.  The $900/month savings from our current plan should cover our normal expenses with lots left over.

7) We may also purchase travel healthcare insurance for our travels but have not researched that much yet.

I am also planning to travel internationally when retired. For $4/month, i would keep US insurance just in case and maybe have a cheap international travel insurance with medical evacuation option.

What income does a single person need to get very low cost ($4-50/month after subsidies) insurance policy? Does it depend on the state? If I choose a zero state income tax state and get a mailbox there, can I get medical insurance in that state and travel internationally?

DreamFIRE

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Re: Healthcare in FIRE
« Reply #28 on: March 27, 2018, 06:45:34 PM »
I think the income cut off between ACA subsidies and Medicaid depends on if your state expanded Medicaid. In expanded states its probably around $16k/year for a single person.
Yeah, that's about right.  I figured $17K would be about perfect for me, but I don't think I'll end up keeping my MAGI quite that low based on the funds I need available for my entertainment and travel budget.  For non-expanded Medicaid states, it's about $12K for a single person.

Mrbeardedbigbucks

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Re: Healthcare in FIRE
« Reply #29 on: March 28, 2018, 05:39:28 AM »
Hey Bro! Thatís a fun username.

Like others have said, your healthcare insurance costs will vary greatly by age, geographic location and your personal needs. Who knows about the state of the ACA in coming years but to get an idea of what premiums might look like for you, have you tried to run premium estimates on healthcare.gov or your statesís insurance exchange website?

My wife left her job in June 2017 and Iím done with mine in 2 days. Hereís our case study if youíre curious and want to poke some holes in it:

https://forum.mrmoneymustache.com/case-studies/is-this-fire-plan-'razor-thin'/

To give you an idea of what we pay, for just the wife and I (no kids), ages 39 & 44, with an estimated MAGI of 32k, weíre paying $129 month for a silver level plan. The deductible is $1400 & max out of pocket is $2800. For now, our monthly health insurance premiums are less expensive than my employer based HDHP. It could be a different story in 2019. We live in a county in N.H. that still has four insurance companies to chose from. The plan we chose is accepted by both of our primary care doctors and three major hospitals within a 25 mile drive. From my understanding other parts of the country are not as lucky.

Nick_Miller

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Re: Healthcare in FIRE
« Reply #30 on: March 29, 2018, 10:05:46 AM »
Some states are starting Medicaid policies that require recipients to work or actively seek work for at LEAST 20 hours per week just to retain Medicaid eligibility.

So that puts a nasty, hairy fly in the "I'll just apply for Medicaid" ointment.



jim555

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Re: Healthcare in FIRE
« Reply #31 on: March 29, 2018, 10:22:14 AM »
Some states are starting Medicaid policies that require recipients to work or actively seek work for at LEAST 20 hours per week just to retain Medicaid eligibility.

So that puts a nasty, hairy fly in the "I'll just apply for Medicaid" ointment.



Not really.  Worst case Roth convert up to 138% + 1% and get to a metal plan.  Also blue states would not require it.  Besides it isn't even legal since the law would need to be changed.

Much Fishing to Do

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Re: Healthcare in FIRE
« Reply #32 on: March 29, 2018, 02:45:57 PM »
I've been self-employed or worked for employers who offered insurance so little over my career I've basically been on private insurance for the 25 years since I've been on my own.  Let me just throw out there that your experience with a particular insurance/insurance company is just as or more important than the stated details.  I've had insurance companies that had very low premiums that would just deny stuff that didn't make sense.  You of course figure out that if you push back with some they'll then they'll just say you;re right and then approve it. More commonly, there are also those that have MUCH better negotiated rates with your hospitals/doctors than others.  This matters GREATLY if you're on a high deductible/coinsurance type plan.  Two plans that look like identical high deductible plans on their face can have dramatically different results...e.g. I had a kid have a set of X-rays that cost me ~$200 with one plan and just about the same ones cost ~$1100 with another because with neither did I meet the deductible but one had that much better a price than another negotiated as the cost "allowed".  In fact, except for extreme examples of horrible emergencies this points out the main reason to have insurance in the first place...the sticker price from a hospital will kill you, the price they charge you when you have insurance from the right companies is so much lower whether the insurance company itself actually pays any of it is kinda secondary to this main price discount benefit.

I currently pay $1100/mth for my family of five and though when I shop around I seem to find better options I now know how good my current one is with all these details and so don't let myself get suckered in by the lower sticker prices alone.

Nick_Miller

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Re: Healthcare in FIRE
« Reply #33 on: March 30, 2018, 07:40:28 AM »
Some states are starting Medicaid policies that require recipients to work or actively seek work for at LEAST 20 hours per week just to retain Medicaid eligibility.

So that puts a nasty, hairy fly in the "I'll just apply for Medicaid" ointment.



Not really.  Worst case Roth convert up to 138% + 1% and get to a metal plan.  Also blue states would not require it.  Besides it isn't even legal since the law would need to be changed.

True, blue states would likely not require it. I'm just pointing out that the environment in some states is shifting, and people should be aware before just assuming they could intentionally lower their income and become eligible for Medicare in some states. Kentucky has already gotten approval (see link). Lots of other states are seeking permission to require "community engagement" for eligibility. Expect more red states to follow suit on this very soon.

Edited to add: And we should keep in mind that "red states" are generally LCOL, and for that reason are frequently mentioned as potential target retirement destinations on these boards. Very few people living in Ky or In or Ohio plan to move to California to retire, but I see it the other way around a lot.

https://www.npr.org/sections/health-shots/2018/01/12/577659054/kentucky-gets-ok-to-require-work-from-medicare-recipients
« Last Edit: March 30, 2018, 07:42:30 AM by Nick_Miller »

jim555

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Re: Healthcare in FIRE
« Reply #34 on: March 30, 2018, 10:53:22 AM »
These new requirements are not part of the Federal law, do not serve the objectives of Medicaid, and attempt to re-write a law outside of Congress.

Legal complaint to stop it:
https://www.splcenter.org/sites/default/files/complaint_redacted.pdf

Mrbeardedbigbucks

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Re: Healthcare in FIRE
« Reply #35 on: March 30, 2018, 10:58:24 AM »
Some states are starting Medicaid policies that require recipients to work or actively seek work for at LEAST 20 hours per week just to retain Medicaid eligibility.

So that puts a nasty, hairy fly in the "I'll just apply for Medicaid" ointment.

This is probably just a knowledge gap for me so correct me if Iím wrong but I thought Medicaid forced you to spend down your assets to a certain level in order to qualify. Does that spend down vary by state? Iím trying to figure out how anyone who FIREs with a substantial amount of assets can qualify for Medicaid. What am I missing? Why would anyone ďjust apply for MedicaidĒ if they would be required to spend down their assets?

jim555

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Re: Healthcare in FIRE
« Reply #36 on: March 30, 2018, 11:06:58 AM »
Some states are starting Medicaid policies that require recipients to work or actively seek work for at LEAST 20 hours per week just to retain Medicaid eligibility.

So that puts a nasty, hairy fly in the "I'll just apply for Medicaid" ointment.

This is probably just a knowledge gap for me so correct me if Iím wrong but I thought Medicaid forced you to spend down your assets to a certain level in order to qualify. Does that spend down vary by state? Iím trying to figure out how anyone who FIREs with a substantial amount of assets can qualify for Medicaid. What am I missing? Why would anyone ďjust apply for MedicaidĒ if they would be required to spend down their assets?
That would be for Traditional Medicaid, not Expansion Medicaid, which has a sole income test.

lhamo

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Re: Healthcare in FIRE
« Reply #37 on: March 30, 2018, 02:14:16 PM »
6) We are planning to select the Bronze plan because we plan to be traveling internationally a lot this year and mainly need catastrophic coverage.  The $900/month savings from our current plan should cover our normal expenses with lots left over.

7) We may also purchase travel healthcare insurance for our travels but have not researched that much yet.

If you still have Blue Cross/Blue Shield options in your area, you might be able to find a silver plan that includes emergency medical treatment at their network of globally certified hospitals.  You have to read the fine print because not all BCBS plans do.  But if you can find one, it might be less costly to go that route than bronze + travel policy.   The BCBS hospitals tend to be the better ones -- the very expensive private hospital we used in Beijing when we had great insurance as expats under Cigna was on their list, for example.   

Padonak

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Re: Healthcare in FIRE
« Reply #38 on: March 30, 2018, 03:33:52 PM »
6) We are planning to select the Bronze plan because we plan to be traveling internationally a lot this year and mainly need catastrophic coverage.  The $900/month savings from our current plan should cover our normal expenses with lots left over.

7) We may also purchase travel healthcare insurance for our travels but have not researched that much yet.

If you still have Blue Cross/Blue Shield options in your area, you might be able to find a silver plan that includes emergency medical treatment at their network of globally certified hospitals.  You have to read the fine print because not all BCBS plans do.  But if you can find one, it might be less costly to go that route than bronze + travel policy.   The BCBS hospitals tend to be the better ones -- the very expensive private hospital we used in Beijing when we had great insurance as expats under Cigna was on their list, for example.

I wonder what kind of insurance may be offered by ACA-eligible plans for traveling overseas.

Both of my non-BCBS employer-sponsored plans (from current and previous employer) offer emergency travel insurance (e.g. if you break a leg while traveling). I don't know about the details of that coverage, e.g. would they cover extended trips for several months, what are the limits etc. However, it is possible that some ACA insurance plans also provide this kind of coverage. If they do, it may be a better deal for low-income retirees who travel/live abroad to get ACA plans as opposed to travel insurance from a company like World Nomads. Last time I checked, world nomads offered basically emergency coverage for around $100/month (corrected) for traveling the entire year. If you can get an ACA plan with similar coverage for less, it may be a better deal than World Nomads insurance, because that one doesn't cover you when you come back to the US.
« Last Edit: March 30, 2018, 04:53:13 PM by Padonak »

lhamo

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Re: Healthcare in FIRE
« Reply #39 on: March 30, 2018, 03:44:39 PM »
I mentioned BCBS specifically because when I did my research on plans available in WA state (Seattle area, specifically) the only plan I found that offered overseas coverage was a BCBS plan -- and only one of the companies that offered BCBS plans had that option.  But since BCBS has an established international network of affiliated hospitals, that is one way for someone interested in this to fast-track their research -- at least to the point of seeing whether it is an option.

I'm very surprised that you saw annual coverage for $100/person -- that seems really low.  When I've looked at separate travel policies in the past they have typically been $50-150/month, depending on age (DH is 10 years older than me, so coverage for him is considerably more).

Padonak

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Re: Healthcare in FIRE
« Reply #40 on: March 30, 2018, 04:53:51 PM »
I mentioned BCBS specifically because when I did my research on plans available in WA state (Seattle area, specifically) the only plan I found that offered overseas coverage was a BCBS plan -- and only one of the companies that offered BCBS plans had that option.  But since BCBS has an established international network of affiliated hospitals, that is one way for someone interested in this to fast-track their research -- at least to the point of seeing whether it is an option.

I'm very surprised that you saw annual coverage for $100/person -- that seems really low.  When I've looked at separate travel policies in the past they have typically been $50-150/month, depending on age (DH is 10 years older than me, so coverage for him is considerably more).

100 per month for World Nomads travel insurance, of course, not per year. I corrected my post.

LAGuy

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Re: Healthcare in FIRE
« Reply #41 on: April 02, 2018, 03:42:39 PM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?

DreamFIRE

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Re: Healthcare in FIRE
« Reply #42 on: April 02, 2018, 06:54:35 PM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?
My biggest problem with this is that I see a doctor every year, and it's rarely because I'm sick.  The yearly office visit is about $400.  and then, I had an injury and had thousands of dollars in medical/PT services last year.  I wouldn't want to rely on Medicaid, whether or not I actually got sick also.

jim555

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Re: Healthcare in FIRE
« Reply #43 on: April 02, 2018, 09:19:32 PM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?
I think if an income stream is lumpy they can smooth it so it is even for each month in the year, as long as it is periodic and repeating.  They might say your annual "realized income" is a periodic and repeating event and should be annualized to get a monthly amount.  This would limit it to 138%.

LAGuy

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Re: Healthcare in FIRE
« Reply #44 on: April 02, 2018, 10:18:07 PM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?
I think if an income stream is lumpy they can smooth it so it is even for each month in the year, as long as it is periodic and repeating.  They might say your annual "realized income" is a periodic and repeating event and should be annualized to get a monthly amount.  This would limit it to 138%.

I should clarify more what I meant on the income side. Say you're a standard MMM retiree. You have a mixture of Roth, IRA, and taxable brokerage funds. You also have a year or two worth of spend in cash. During retirement, your plan is to rollover money from the IRA to the Roth but to pay a zero percent tax rate on the money. Also, to keep it simple, you're single. So, you roll over from the IRA to the Roth up to the standard deduction, $12000. You also collect dividends on the taxable brokerage money, let's say it's about $7000 all qualified. That still leaves you about $30000 in capital gains to realize and reset your basis on in the taxable brokerage, minus what you need to add to your cash account to cover next years spend. You have a total income of just under $50,000 but pay zero in taxes. So far, this is a pretty normal tax and spend plan for most early retirees I'm assuming?

However, during any given year you don't have to realize ANY of that income except for the dividends. Come December 31st, your income is only going to be what you collected in dividends ($7000). That puts you well under the Medicaid threshold. If you get sick at anytime during the year, you just don't do any of the above until two days later on January 2nd of the following year. A year in which you'll now be covered under ACA insurance. However, if you didn't get sick during the year, just go ahead and realize all of your income on December 31st and do the same thing again next year. With no mandate, I don't see any penalty in pursuing this option? I know some people think Medicaid is no good, but it's good enough to keep you from the poor house when you show up in ER with a heart attack and no insurance. Obviously this plan doesn't work out well if you do plan to consume a fair amount of medical care, but for those of us that are rather healthy, why buy insurance when you can just go ahead and get it at the time you need it?

Shane

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Re: Healthcare in FIRE
« Reply #45 on: April 02, 2018, 10:53:18 PM »
Unless, for some reason, you have to be in a state that offers lousy ACA/Medicaid options during FIRE, why not shop around and become a resident of a state that offers a better deal on health insurance? Either that, or you could just buy a travel insurance policy through a company like World Nomads and list your home as a country that offers good-quality medical care that is inexpensive enough that you could afford to pay out of pocket for treatment. Our family of 3 is paying ~$150/month for a travel insurance policy through WN. We have our home country listed as the US, because, at least for now, we are still covered by Medicaid in our home state. If that changes in the future, before we would pay exorbitant rates just for health insurance premiums, we would strongly consider either relocating to a country with cheaper healthcare costs, or else, paying for travel insurance when we were in the US that would cover any immediate emergency medical expenses and also cover the costs of evacuating us to a more affordable country in the event of a serious accident or illness. That anyone is willing to pay $10K-$20K/year just for health insurance premiums seems mind boggling to me. Maybe there's something I'm not understanding, though. There are many countries in the world where it would be really hard to rack up anywhere near that much in medical bills, even at the most expensive private hospital in the country with state of the art facilities and English speaking, Western trained physicians...

Shane

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Re: Healthcare in FIRE
« Reply #46 on: April 02, 2018, 11:03:28 PM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?
I think if an income stream is lumpy they can smooth it so it is even for each month in the year, as long as it is periodic and repeating.  They might say your annual "realized income" is a periodic and repeating event and should be annualized to get a monthly amount.  This would limit it to 138%.

I should clarify more what I meant on the income side. Say you're a standard MMM retiree. You have a mixture of Roth, IRA, and taxable brokerage funds. You also have a year or two worth of spend in cash. During retirement, your plan is to rollover money from the IRA to the Roth but to pay a zero percent tax rate on the money. Also, to keep it simple, you're single. So, you roll over from the IRA to the Roth up to the standard deduction, $12000. You also collect dividends on the taxable brokerage money, let's say it's about $7000 all qualified. That still leaves you about $30000 in capital gains to realize and reset your basis on in the taxable brokerage, minus what you need to add to your cash account to cover next years spend. You have a total income of just under $50,000 but pay zero in taxes. So far, this is a pretty normal tax and spend plan for most early retirees I'm assuming?

However, during any given year you don't have to realize ANY of that income except for the dividends. Come December 31st, your income is only going to be what you collected in dividends ($7000). That puts you well under the Medicaid threshold. If you get sick at anytime during the year, you just don't do any of the above until two days later on January 2nd of the following year. A year in which you'll now be covered under ACA insurance. However, if you didn't get sick during the year, just go ahead and realize all of your income on December 31st and do the same thing again next year. With no mandate, I don't see any penalty in pursuing this option? I know some people think Medicaid is no good, but it's good enough to keep you from the poor house when you show up in ER with a heart attack and no insurance. Obviously this plan doesn't work out well if you do plan to consume a fair amount of medical care, but for those of us that are rather healthy, why buy insurance when you can just go ahead and get it at the time you need it?

@LAGuy , The only hesitation I'd have with your plan would be emergencies. Things could get really complicated if you got hit by a bus while crossing the street and woke up in the ICU at your local hospital a week later. You could very easily find yourself in a position where you were physically and/or mentally incapable of making the phone calls and filing the proper paperwork necessary to get yourself signed up for Medicaid. By the time you got well enough to get yourself covered by health insurance, you could easily already have racked up hundreds of thousands of dollars in medical bills. If I were you, I'd have some sort of insurance in place to cover me in the event of a catastrophic accident or sudden debilitating illness. Just in case.

jim555

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Re: Healthcare in FIRE
« Reply #47 on: April 03, 2018, 01:37:02 AM »
With the insurance mandate going away for 2019, is there anything to stop those of us in FIRE and with the ability to tailor our income from engaging in the following scenario:

1) Don't buy any insurance in 2019. Don't realize any income other than taxable accounts dividends.
2) One of the following:
     a) Get sick sometime in 2019. Sign up for Medicaid. It's my understanding there's no enrollment period on Medicaid and you can get it at anytime. Near the end of the year, assuming you expect to have ongoing medical issues, sign up for ACA during open enrollment for 2020. Realize income in 2020.
     b) Don't get sick in 2019. Realize income for 2019 in the final few days of the year. Repeat the following year.

You'd need to keep enough cash on hand for a year's worth of expenses, but otherwise no need to pay for health insurance except when you get sick. No need to preach if this is the "right" thing to do or not, but is it possible? Anything in the laws that prevent one from doing this?
I think if an income stream is lumpy they can smooth it so it is even for each month in the year, as long as it is periodic and repeating.  They might say your annual "realized income" is a periodic and repeating event and should be annualized to get a monthly amount.  This would limit it to 138%.

I should clarify more what I meant on the income side. Say you're a standard MMM retiree. You have a mixture of Roth, IRA, and taxable brokerage funds. You also have a year or two worth of spend in cash. During retirement, your plan is to rollover money from the IRA to the Roth but to pay a zero percent tax rate on the money. Also, to keep it simple, you're single. So, you roll over from the IRA to the Roth up to the standard deduction, $12000. You also collect dividends on the taxable brokerage money, let's say it's about $7000 all qualified. That still leaves you about $30000 in capital gains to realize and reset your basis on in the taxable brokerage, minus what you need to add to your cash account to cover next years spend. You have a total income of just under $50,000 but pay zero in taxes. So far, this is a pretty normal tax and spend plan for most early retirees I'm assuming?

However, during any given year you don't have to realize ANY of that income except for the dividends. Come December 31st, your income is only going to be what you collected in dividends ($7000). That puts you well under the Medicaid threshold. If you get sick at anytime during the year, you just don't do any of the above until two days later on January 2nd of the following year. A year in which you'll now be covered under ACA insurance. However, if you didn't get sick during the year, just go ahead and realize all of your income on December 31st and do the same thing again next year. With no mandate, I don't see any penalty in pursuing this option? I know some people think Medicaid is no good, but it's good enough to keep you from the poor house when you show up in ER with a heart attack and no insurance. Obviously this plan doesn't work out well if you do plan to consume a fair amount of medical care, but for those of us that are rather healthy, why buy insurance when you can just go ahead and get it at the time you need it?

@LAGuy , The only hesitation I'd have with your plan would be emergencies. Things could get really complicated if you got hit by a bus while crossing the street and woke up in the ICU at your local hospital a week later. You could very easily find yourself in a position where you were physically and/or mentally incapable of making the phone calls and filing the proper paperwork necessary to get yourself signed up for Medicaid. By the time you got well enough to get yourself covered by health insurance, you could easily already have racked up hundreds of thousands of dollars in medical bills. If I were you, I'd have some sort of insurance in place to cover me in the event of a catastrophic accident or sudden debilitating illness. Just in case.
Medicaid can be retroactive up to 90 days.  However you must have been eligible in that retroactive period.  So in December when he is realizing the income he would not be eligible and better hope nothing happens.  Even 30 days can add up to a huge sum.

Exflyboy

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Re: Healthcare in FIRE
« Reply #48 on: April 03, 2018, 01:49:11 AM »
Get get an ACA bronze plan for $15/month for both of us.

We pretty much live on our rental income plus after tax dividends which comes to about $30k/year.. We probably spend about $35k.

The great thing about the HSA is that you can put say $8 of taxable income away thus reduce your AGI by $8k.

But then you can sell enough of your after tax investments to generate $8k's worth of capital gains.. Now our gains represent about 28% of the sale of assets.

So we would have to sell about $25k's worth of assets to generate $8k.. So you can get way more money for very little impact on your MAGI.. Thus you can keep your ACA subsidies high and have plenty of money to live on.

We could probably re-invest most of what we take out and thus gradually dilute the cost basis of our after tax investments.. which means lower taxes in the future.

I love these games but eventually they will get me when I have to start spending the 401k..:)

Exflyboy

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  • Posts: 5394
  • Age: 56
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: Healthcare in FIRE
« Reply #49 on: April 03, 2018, 01:54:18 AM »
Oh be wary of your ACA plan "covering" you for out of network emergencies.. Basically its bullshit and you are wide open to very large balance bills!

All OON coverage means is your insurance company will pay your OON hospital what they would normally pay their in network hospital.

As this sum will be way less than than OON hospital will charge.. guess who gets the bill for the remainder?... YOU DO!

Basically if we travel more than about 50 miles we are out of network!

Another option is healthshare ministries which can provide travelling insurance. If we ever buy the van and tour the US we would probably go that route