Author Topic: health insurance?  (Read 9064 times)

FourWinds

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health insurance?
« on: January 12, 2015, 02:14:51 PM »
Greeting mustachians,

All that stuff about lowering your expenses is great, and I totally agree with it.  However, the US tends to be a country where health insurance is on the expensive side.  If one has a family (read: wife and 2 kids), the cost multiplies.

What do you guys do with health insurance "after" you fired your boss?

Thank you all!


FarmerPete

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Re: health insurance?
« Reply #1 on: January 12, 2015, 02:17:25 PM »
Enemas.  They fix everything, and they are surprisingly cheap.

nereo

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Re: health insurance?
« Reply #2 on: January 12, 2015, 02:22:42 PM »
If you have reached FI you should be able to take a high-deductable plan from the insurance marketplaces and have more than enough in savings to cover the deductible.

Yes this will factor into your ER monthly spending.
MMM has written several times about his but the 'search' feature is just giving me error messages (time-out) when I use it.

FourWinds

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Re: health insurance?
« Reply #3 on: January 12, 2015, 03:48:55 PM »
Hmm..  Financial independence depends on insurance expenses, so you have this chicken-n-egg issue.

I looked at http://www.mrmoneymustache.com/2012/11/01/our-new-237-per-month-health-insurance-plan/, however this post was before obamacare.   Looking at ehealthinsurance.com, as he suggested give me an insurance plan of ~$8000 / year (and that's for a high deductible plan), which is a quite respectable amount.

Any other ideas / hints / tips for something cheaper?

Thanks!


dandarc

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Re: health insurance?
« Reply #4 on: January 12, 2015, 04:06:32 PM »
Pending the supreme court decision of course - post retirement you need to manage your taxable income.  Make sure your income is as low as possible to maximize your subsidy without falling into medicaid territory (unless you're ok with medicaid).  Of course balance this within your overall tax-management plan.

MakingSenseofCents

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Re: health insurance?
« Reply #5 on: January 12, 2015, 04:08:54 PM »
This is something we are still struggling with. We pay around $323 per month for a health insurance plan with a deductible of $12,700. It's the cheapest plan we qualified for in the state of Missouri. I think it's just a cost that you need to suck up and pay. However, I am not looking forward to when we have children and the cost is over $1,000 per month for a lower deductible.

forummm

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Re: health insurance?
« Reply #6 on: January 12, 2015, 07:44:17 PM »
Healthcare.gov will always have the best deal available to you.

tracylayton

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Re: health insurance?
« Reply #7 on: January 12, 2015, 08:09:17 PM »
I picked a Blue Cross Blue Shield Bronze HMO from the Affordable Healthcare Website. I pay $295/month for a 50 year old female and have a $6500 deductible.

Exflyboy

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Re: health insurance?
« Reply #8 on: January 12, 2015, 11:01:12 PM »
Of course everything will depend on what happens when the Republicans take over the White House, But then again the stock market seems to do quite well when the the needle moves to the right so maybe our investments will be worth more so we can afford the healthcare.

Unless deregulation melts down the economy again of course!

Exflyboy

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Re: health insurance?
« Reply #9 on: January 12, 2015, 11:03:01 PM »
Oh we are not totally convinced we'll be staying in the USA anyway, if we don't have jobs we could live literally anywhere in the world and just about ANYWHERE else HC is cheaper!

nereo

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Re: health insurance?
« Reply #10 on: January 13, 2015, 09:26:33 AM »
Quote
I think you will find that whoever is in office has surprisingly little influence on the day to day business of most corporate america.
+1.  At best the recent available data suffers from small sample sizes and large variances.
or put another way
"The President claims far too much credit when the economy is doing well, and is given far too much blame when does poorly"

FourWinds

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Re: health insurance?
« Reply #11 on: January 14, 2015, 06:50:29 AM »
Thank you all for the various tips and info!

MooseOutFront

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Re: health insurance?
« Reply #12 on: January 14, 2015, 09:30:56 AM »
Keep in mind that when you retire early your income will go down and you'll qualify for subsidies on the exchange.  As currently constructed the subsidies are significant for a family of 4 even at decent income levels.

sstants

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Re: health insurance?
« Reply #13 on: January 14, 2015, 09:58:25 AM »
As someone who works on the data/consulting side of healthcare, here's my take on being a responsible consumer of healthcare services in the US. Change can come from regulators but it can also come from consumer behavior too! Where and how we spend our healthcare dollars will contribute to demand for certain kinds of services to be offered at certain prices. Your insurance plan is just one piece of the puzzle.

Totally agree with getting the cheapest 'catastrophic' plan out there. With the ACA in effect, even these plans will cover reproductive health and an annual checkup at 100%...awesome start! Then you must comparison shop, the same way you would for a car or anything else! How do you do this in an industry where everything is still so opaque?

1. Ask. Get prices for services (visits etc) from different offices beforehand. Ask about the self-pay option which may be much less than your carrier's negotiated rate. If you aren't going to hit the deductible anyway, paying cash to go see the doc for a sore throat may be a great option and in my experience you can save 50% or more in your out of pocket cost. You can ask your carrier what their reimbursement rates are as well. These typically go along with the CPT procedure code that is billed for different visit types.

2. Look elsewhere. Make sure your level of care fits your need. If you are going to an ER for a sore throat (as a crazy example) you will overpay. Try a minute clinic instead at a CVS or Walmart. For more urgent issues (a very high fever in your little one, broken bone etc) try a stand-alone urgent care center. And always ask about self-pay options and the cost/necessity of different medical services.

3. Prevent. Gym it up, eat a bunch of veggies and drink water. Your body is great at taking care of itself if you give it the tools to do so.

FourWinds

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Re: health insurance?
« Reply #14 on: January 14, 2015, 05:41:31 PM »
Paying out of pocket and getting reimbursed later is a great idea!

Thanks!

forummm

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Re: health insurance?
« Reply #15 on: January 15, 2015, 10:29:44 AM »
Totally agree with getting the cheapest 'catastrophic' plan out there. With the ACA in effect, even these plans will cover reproductive health and an annual checkup at 100%...awesome start! 

1. Ask. Get prices for services (visits etc) from different offices beforehand. Ask about the self-pay option which may be much less than your carrier's negotiated rate. If you aren't going to hit the deductible anyway, paying cash to go see the doc for a sore throat may be a great option and in my experience you can save 50% or more in your out of pocket cost. You can ask your carrier what their reimbursement rates are as well. These typically go along with the CPT procedure code that is billed for different visit types.

I'd be careful with this approach. Note that by "reproductive health", ecarr26 presumably means an annual well-woman visit, birth control (all methods--not necessarily all options within that method), and cervical cancer screening. There isn't any other reproductive health I can think of that's included for free (and without the deductible applying) with catastrophic plans. If you have a baby, that's going to cost you a lot out of pocket. The only services that are "free" with Marketplace plans can be found here: www.cdc.gov/prevention

Note that it can be very difficult to find out what some medical service is going to cost you, even if you do have the CPT code(s) (which are a pain to get). Even when I've tried this approach I've been told wildly inaccurate information (literally being wrong by double). And you will need to know in advance all the codes that will be used for your service, including provider billing, facility billing, lab billing, etc. If you get some additional service while you're there (often happens with medical visits), that's another set of codes you'd need. So if you're just going to have and office visit and get a prescription and nothing else, this is easier to figure out. If you're doing anything more complicated, it gets more complicated. YMMV.

And if you pay in cash, you aren't following the contract you have with your insurer. This is OK if your expenses are under the deductible anyway. However, if you have an expensive year, you could cost yourself money because your cash payments that you run through the insurer are not included in your deductible. They may not let you add them back later since you did not use their negotiated rate. Caveat emptor.

Tyler

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Re: health insurance?
« Reply #16 on: January 15, 2015, 10:47:39 AM »
For those who qualify for subsidies, remember that cost sharing (reducing the deductible and out-of-pocket expenses to virtually nothing depending on your income) only applies to ACA silver plans. And the subsidized silver premiums can be quite low as well depending on your circumstances.  Basically, don't just hit the "bronze" filter and assume that will always be the best deal.

MooseOutFront

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Re: health insurance?
« Reply #17 on: January 15, 2015, 10:58:07 AM »
I'm not sure I understand what you mean Tyler.

Tyler

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Re: health insurance?
« Reply #18 on: January 15, 2015, 11:17:49 AM »
Reduced premiums apply to all plans on the exchange, but they're not the only kinds of subsidies offered.

Many people also qualify for cost sharing which reduces the deductibles and out-of-pocket max as well. However, cost sharing only applies to the silver plans. Look at the same plan with different reported income levels to see what I mean. For reference, $22k is a sweet spot for most states.

The end result is that if your income is at the optimum level, you can get platinum-level deductibles at bronze-level premiums by looking at the silver plans. Basically, bronze is not necessarily "cheapest", and gold/platinum is not necessarily "best". Look around.

If the subsidies go away, all bets are off. But as-is, the silver plans are often the best deal depending on your situation.
« Last Edit: January 15, 2015, 11:37:41 AM by Tyler »

MooseOutFront

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Re: health insurance?
« Reply #19 on: January 15, 2015, 03:15:41 PM »
I was completely unaware of that. Thank you for the insight. I know someone who nails that income range and selected a bronze plan. I'll let her know to look very closely at sliver next enrollment period.

forummm

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Re: health insurance?
« Reply #20 on: January 16, 2015, 07:55:39 AM »
Yes, the cost sharing subsidies are available for people with income at 100-250% FPL (or 133%-250% FPL in states that expanded Medicaid, since you can't get subsidies for private insurance if you qualify for Medicaid).

If you're in that range, you might find that a silver plan has a $50/mo higher premium than a bronze plan, but has a deductible of $0 or $1000 instead of $6500. Just an example from helping my brother look at plans.

jflo

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Re: health insurance?
« Reply #21 on: January 16, 2015, 08:38:23 AM »
Mooseoutfront: Your friend has until Feb 15 to switch if the silver w cost-sharing makes more sense than Bronze.
There's 3 levels of cost-sharing depending on income. If you're projected below 200% of the federal poverty level, it turns your silver plan to a gold, effectively; below 150%, you've got platinum coverage. Not a whole lot of difference in the tier for folks in the 200-250% fpl range.

MooseOutFront

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Re: health insurance?
« Reply #22 on: January 16, 2015, 10:55:32 AM »
Mooseoutfront: Your friend has until Feb 15 to switch if the silver w cost-sharing makes more sense than Bronze.
Thanks for the info!

dandarc

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Re: health insurance?
« Reply #23 on: January 16, 2015, 11:04:34 AM »
If you're in that range, you might find that a silver plan has a $50/mo higher premium than a bronze plan, but has a deductible of $0 or $1000 instead of $6500. Just an example from helping my brother look at plans.

My mom signed up for a Silver plan recently.  She's semi-retired now (just working a few days a week for something to do) and got a plan for $1.20/mo, $500 deductible, $500 max oop.  Last month she was talking about getting a Bronze plan, then I explained to her the cost-sharing subsidies available with Silver plans.  The Bronze would have been a $0 premium, but for $1.20/mo she was able to cut her deductible and max oop from $6,000 to $500.  She is healthy, very active, and avoids doctors as much as possible, but the $500 caps are nice peace of mind for her.
That's in-line with what I was seeing when running some quotes because I have to be prepared 10 years in advance apparently - this is a new fun aspect to the game for early retirees.