Author Topic: Health insurance in ER - what are y'all doing?  (Read 18727 times)

spartana

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Health insurance in ER - what are y'all doing?
« on: January 16, 2015, 10:06:04 AM »
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« Last Edit: August 16, 2017, 10:45:20 AM by spartana »

dude

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Re: Health insurance in ER - what are y'all doing?
« Reply #1 on: January 16, 2015, 11:25:51 AM »
This is one of the prime reasons I value my Fed job so much -- in retirement, staying in the same insurance pool as current Fed employees, and with the same subsidized plan.  It'll still cost me (currently about $280/mo) in retirement, and will continue to go up (though hopefully not on the same trajectory it's been going for the last couple decades), but should be manageable.  Huge benefit.

geekette

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Re: Health insurance in ER - what are y'all doing?
« Reply #2 on: January 16, 2015, 12:14:45 PM »
ACA plan and crossed fingers for us.  We are paying in full (useful for credit card hacking) and will get the subsidies back with our tax return.

Our budget includes the full amount, so any refund can go toward fun stuff like travel, I hope.  If the subsidies go away, we'll still be able to afford it, assuming the insurance companies won't just go back to their old tricks.

arebelspy

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Re: Health insurance in ER - what are y'all doing?
« Reply #3 on: January 16, 2015, 12:20:17 PM »
I'm planning on staying overseas at least 11 of the 12 months some years to be exempt from the ACA and pay OOP for health care.  When we are in the US we plan to carry health insurance to comply with the mandate.  I expect to pay (have budgeted) ~5k annual for health insurance premiums.  A very large chunk of our budget.  We do not anticipate getting subsidies due to the nature of our income (rental income, rather than capital gains).
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meteor

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Re: Health insurance in ER - what are y'all doing?
« Reply #4 on: January 16, 2015, 12:27:40 PM »
I've been spending $800 a month for my insurance (for 1 person) from Kaiser.  It's depressing.  They have lower levels with high deductable levels, but when I added up the numbers of what that would cost me per visit, tests, etc, I came out ahead with my current plan.  I am also grandfathered in with a plan that does not exist anymore.  After witnessing my husband's experience with Blue Cross, you would have to drag me by my hair to leave Kaiser. Kaiser is so much better than any other health insurance.   I like that I can have video appts online with specialists and email my doctor and get messages back in the same day.   His insurance treat him miserably and he has to fight for everything.  They make it so difficult to have normal health care, he basically stops going to the doctor which is probably what they want. Example, they "claim" he gets a free tests annually.  Turns out, the private clinic they refer people to has extra fees they pile on top.  So his supposed "free" test turned out to be $500. What a scam. He gets so upset with this (I don't blame him).  I was mad too and almost forced him to go back and ask for his money back from Blue Cross.  Amazingly he was able to squeeze out about $300 of it back -- but the time involved to do that....ughhhh  is it worth it?
« Last Edit: January 16, 2015, 12:29:24 PM by meteor »

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Re: Health insurance in ER - what are y'all doing?
« Reply #5 on: January 16, 2015, 01:21:04 PM »
Stay on DW's healthcare as long as she works, then maybe COBRA for the first 6 months (till EOD) and then ACA if it still exists.

Planning on a bill of $1k/month with ACA as I am not sure the subsidy or ACA itself will survive.

meteor

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Re: Health insurance in ER - what are y'all doing?
« Reply #6 on: January 16, 2015, 02:16:22 PM »
Stay on DW's healthcare as long as she works, then maybe COBRA for the first 6 months (till EOD) and then ACA if it still exists.

Planning on a bill of $1k/month with ACA as I am not sure the subsidy or ACA itself will survive.

Make sure you do a price check on cobra compared to retail.  When I left a job I found out cobra cost double than retail because my job had a fat health insurance plan based on a 4 four family member policy.  So I was paying that price for that plan on cobra even though I was a single person. 

Cassie

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Re: Health insurance in ER - what are y'all doing?
« Reply #7 on: January 16, 2015, 03:42:11 PM »
I retired from the state & retirees often pay more then active employees for their healthcare & it is based on years of service, etc. We pay $10,000/year for the 2 of us.  WE are both consulting p.t. so would not qualify for subsidies if we went on ACA & their plans were actually more expensive in our area then our own.

Penny Lane

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Re: Health insurance in ER - what are y'all doing?
« Reply #8 on: January 16, 2015, 06:20:59 PM »
No subsidy, 1070/month for 2 with 5Kdeductable for both, HSA+.  Plan for a lot.  Yikes.

jawisco

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Re: Health insurance in ER - what are y'all doing?
« Reply #9 on: January 18, 2015, 08:21:14 PM »
I am managing my MAGI in order to qualify for very inexpensive health care through Obamacare.  There are many avenues to do this depending on your situation.

I hope Obamacare survives and so does the subsidy - if it goes away I am not sure I will be able to be ER.  I will figure something out in that case (either move to another country/state or get a job to pay for increased costs).

Static Void

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Re: Health insurance in ER - what are y'all doing?
« Reply #10 on: January 18, 2015, 08:50:58 PM »
Spouse worked for UC (California university system) for ten years and three days, and thus qualifies for their retiree health plan. We will (shortly) leave my swanky silicon valley tech insurance, and get "UC Core Coverage" which has no monthly fee, $6k deductible and $12.7k maximum out of pocket cost (total for both of us). We can go out of network, including overseas, but they'll only pay the in-network negotiated rates.

Too soon to tell if we're happy with it...

  • Would have preferred Kaiser, on account of apparently their doctors actually *talk* to each other?!?!! But not available in our zip code.
  • We stuck around long enough to get some definitely-known-needed medical stuff done on my insurance (total hip replacement, and she's doing great, riding her bike again. :-)  )
Honestly, not sure what we'd do if not for that fortunate employment turn of hers. On the surface ACA (with subsidy) looks reasonable... Would be interested to hear if it's working well from any users.

Greystache

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Re: Health insurance in ER - what are y'all doing?
« Reply #11 on: January 19, 2015, 09:06:00 AM »
I just retired at age 55 on Dec 31st. My wife and I just started ACA health insurance. We opted for a high deductable Bronze plan with an HSA. We have always been pretty healthy.  Hope that continues. We are trying to manage or MAGI to keep it under the limit for subsidies.  We will be cutting it close this year. My wife is still working for 6 more months and her income plus my pension payments required us to jiggle or finances a little.  I had to do a direct rollover of part of my pension into an IRA.  We have maxed out our HSA and my wife's 403b contributions in order to keep MAGI below the limit.

retired?

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Re: Health insurance in ER - what are y'all doing?
« Reply #12 on: January 27, 2015, 07:26:49 PM »
I'm planning on staying overseas at least 11 of the 12 months some years to be exempt from the ACA and pay OOP for health care.  When we are in the US we plan to carry health insurance to comply with the mandate.  I expect to pay (have budgeted) ~5k annual for health insurance premiums.  A very large chunk of our budget.  We do not anticipate getting subsidies due to the nature of our income (rental income, rather than capital gains).

Canada?

retired?

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Re: Health insurance in ER - what are y'all doing?
« Reply #13 on: January 27, 2015, 07:29:47 PM »
Although I completely disagree with ACA, I'd like to feel comfortable planning to use the subsidies.

I don't feel that I can subsidies in my planning.  Currently paying 645/month for bronze bare bones, 2 kids and wife.

iris lily

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Re: Health insurance in ER - what are y'all doing?
« Reply #14 on: January 27, 2015, 07:42:16 PM »
She-rah, T minus 9 weeks for me and then FIRE!!!!!!

We are doing cobra for up to 18 months. after that will jump into the abyss of an ACA or ACA-less world for 2 years. That abyss is the scary part. our HR guy suggested that I should look into the ACA because it's much cheaper. I know that it's cheaper or it is likely cheaper but I just want the stability of cobra being exactly the same as I've had.

I don't know what our income will be anyway and that's not a big concern of mine except when it comes to the ACA.

iris lily

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Re: Health insurance in ER - what are y'all doing?
« Reply #15 on: January 27, 2015, 07:46:27 PM »
I just retired at age 55 on Dec 31st. My wife and I just started ACA health insurance. We opted for a high deductable Bronze plan with an HSA. We have always been pretty healthy.  Hope that continues. We are trying to manage or MAGI to keep it under the limit for subsidies.  We will be cutting it close this year. My wife is still working for 6 more months and her income plus my pension payments required us to jiggle or finances a little.  I had to do a direct rollover of part of my pension into an IRA.  We have maxed out our HSA and my wife's 403b contributions in order to keep MAGI below the limit.

I was looking at ACA prices today. The subsidy ceiling seems to have changed. Is that right?

The ceiling was last year $62,ooo annually for 2 adults, now it seems much higher and an income of $62'ooo will get you a lot of subsidy.
« Last Edit: January 27, 2015, 07:50:06 PM by iris lily »

geekette

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Re: Health insurance in ER - what are y'all doing?
« Reply #16 on: January 27, 2015, 09:18:36 PM »
She-rah, T minus 9 weeks for me and then FIRE!!!!!!

We are doing cobra for up to 18 months. after that will jump into the abyss of an ACA or ACA-less world for 2 years. That abyss is the scary part. our HR guy suggested that I should look into the ACA because it's much cheaper. I know that it's cheaper or it is likely cheaper but I just want the stability of cobra being exactly the same as I've had.

I don't know what our income will be anyway and that's not a big concern of mine except when it comes to the ACA.

Cobra might not stay the same, though.  And in my experience, the price sure doesn't, come January.  Ours went from $933 to $1150 between December '13 and January '14.  The ACA plan is a little cheaper (pre-subsidy), although it doesn't cover the same (lower deductible, but doesn't cover meds as well).

I don't know about other states, but in our area, the plans that are available are with familiar insurance companies, and similar "levels" (bronze plans have smaller networks, but the silver plan is the same network I was used to before).  I've been surprisingly pleased.

But COBRA is guaranteed for 18 months, as long as you pay the premiums.  If the ACA goes "poof", I'm toast.

dividendman

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Re: Health insurance in ER - what are y'all doing?
« Reply #17 on: January 27, 2015, 09:28:59 PM »
Am I on crack here? I'm not FI yet but I was messing around with www.ehealthinsurance.com and I see plans for Arizona for $153 (single, male, 32, doesn't smoke) with no subsidy.

That seems to be way lower than what folks here are saying, hence me thinking I'm on crack.

EDIT: And for Cali in silicon valley I see plans for ~250.

sol

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Re: Health insurance in ER - what are y'all doing?
« Reply #18 on: January 27, 2015, 10:13:58 PM »
We'll be buying insurance through our state exchange. 

The plans may change between now and then, but currently we would pay about $20/month for an HSA-eligible plan.  That plan would normally cost $450/mo but with only $40k/year of AGI in retirement (from Roth conversions) the ACA subsidy pays for most of the premium.  That plan covers 100% of preventative care (like physicals, immunizations, dentists, eye exams) but after that there's an $8000 deductible which would only apply to the two adults.

So in a good year, when we get an annual physical, eye exam, and two teeth cleanings for everyone, our total health care costs would be $240 for 20 visits spread over a family of five people.  In a bad year, the out-of-pocket maximum could be as high as $12,900 if we're all in a horrible car crash together or something.

geekette

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Re: Health insurance in ER - what are y'all doing?
« Reply #19 on: January 27, 2015, 11:23:18 PM »
Am I on crack here? I'm not FI yet but I was messing around with www.ehealthinsurance.com and I see plans for Arizona for $153 (single, male, 32, doesn't smoke) with no subsidy.

That seems to be way lower than what folks here are saying, hence me thinking I'm on crack.

Add 20 years to your age, and double the number of people - see what comes up then!

dividendman

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Re: Health insurance in ER - what are y'all doing?
« Reply #20 on: January 27, 2015, 11:27:05 PM »
Am I on crack here? I'm not FI yet but I was messing around with www.ehealthinsurance.com and I see plans for Arizona for $153 (single, male, 32, doesn't smoke) with no subsidy.

That seems to be way lower than what folks here are saying, hence me thinking I'm on crack.

Add 20 years to your age, and double the number of people - see what comes up then!

:(

iris lily

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Re: Health insurance in ER - what are y'all doing?
« Reply #21 on: January 28, 2015, 10:10:55 AM »
She-rah, T minus 9 weeks for me and then FIRE!!!!!!

We are doing cobra for up to 18 months. after that will jump into the abyss of an ACA or ACA-less world for 2 years. That abyss is the scary part. our HR guy suggested that I should look into the ACA because it's much cheaper. I know that it's cheaper or it is likely cheaper but I just want the stability of cobra being exactly the same as I've had.

I don't know what our income will be anyway and that's not a big concern of mine except when it comes to the ACA.

Cobra might not stay the same, though.  And in my experience, the price sure doesn't, come January.  Ours went from $933 to $1150 between December '13 and January '14.  The ACA plan is a little cheaper (pre-subsidy), although it doesn't cover the same (lower deductible, but doesn't cover meds as well).

I don't know about other states, but in our area, the plans that are available are with familiar insurance companies, and similar "levels" (bronze plans have smaller networks, but the silver plan is the same network I was used to before).  I've been surprisingly pleased.

But COBRA is guaranteed for 18 months, as long as you pay the premiums.  If the ACA goes "poof", I'm toast.


COBRA will definitely NOT stay the same, it goes up each year and it will go up next October. For the first six months we are on it, it will be :

$1,157 monthly or the rate of $13,884 annually

But income uncertainty is part of why I don't want to jump into ACA's Marketplace. I just want at least 6 months of being retired without having to chase government forms and figure out their website and programs and qualifications. It's remotely possible that we would be under the income requirement for ACA subsidies!  Crazy, I know, but I don't want to risk it.

We are low income/high net worth and it's difficult to predict ACA subsidies in that situation.

We are prepared to pay COBRA costs as simply peace of mind. It's worth it. 

Cassie

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Re: Health insurance in ER - what are y'all doing?
« Reply #22 on: January 28, 2015, 10:15:01 AM »
Ensurance quotes you a really low rate. I tried this for my hubby & they said 250 for a 55 yo man.  Then after I did all the paperwork the bill was 700/month. I said no thanks.

Jon_Snow

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Re: Health insurance in ER - what are y'all doing?
« Reply #23 on: January 28, 2015, 10:20:48 AM »
When I read these healthcare related threads I find myself doing a silent, mental "fist pump" that I am Canadian.


Static Void

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Re: Health insurance in ER - what are y'all doing?
« Reply #24 on: January 28, 2015, 08:55:22 PM »
When I read these healthcare related threads I find myself doing a silent, mental "fist pump" that I am Canadian.

*Sigh*, it makes me shake my fist in the direction of Canada, as well.

Go, Team America. :(

Tyler

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Re: Health insurance in ER - what are y'all doing?
« Reply #25 on: January 30, 2015, 11:26:33 AM »
We signed up for an ACA Silver plan, and are carefully managing our cash flow and investments to optimize reported income to maximize subsidies and cost sharing. I have my same insurance provider and doctor network as before. The premium for the two of us is less than $100/month, with a $150 deductible and a $2k out-of-pocket max. That's significantly cheaper than my previous employer-subsidized plan, and is a great deal for a frugal early retiree. Note that we budgeted for the unsubsidized amount ($500/month) so we aren't worried about future subsidy changes if they happen.

BTW, if you qualify for subsidies ALWAYS browse the silver plans. Because of how subsidies and cost sharing are distributed, the silver plans (and only those plans) can have bronze-level premiums with platinum-level deductibles and out-of-pocket limits depending on your income.
« Last Edit: January 30, 2015, 11:30:54 AM by Tyler »

arebelspy

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Re: Health insurance in ER - what are y'all doing?
« Reply #26 on: January 30, 2015, 11:50:49 AM »
We signed up for an ACA Silver plan, and are carefully managing our cash flow and investments to optimize reported income to maximize subsidies and cost sharing. I have my same insurance provider and doctor network as before. The premium for the two of us is less than $100/month, with a $150 deductible and a $2k out-of-pocket max.

Holy crap, that's amazing.  What state are you in?  Mine is at least 5x that for premiums, OOP, etc.
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beltim

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Re: Health insurance in ER - what are y'all doing?
« Reply #27 on: January 30, 2015, 12:01:28 PM »
I wonder if people will begin moving to states that have better ACA premiums or are Medicaid expanded? Wonder if there will be some kind of residency requirements that make it harder for people to just up and move in order to get better benefits. I think Calif requires an 18 month stay before a person can be considered a state resident for in-state tuition, so maybe that will happen with ACA situations too.

No way would that be legal.  There's a legal requirement to have health insurance, and moving states is one of the events that allows you to purchase health insurance on the exchanges outside of open enrollment.  There's no way a state could supersede those federal requirements.

Tyler

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Re: Health insurance in ER - what are y'all doing?
« Reply #28 on: January 30, 2015, 12:02:23 PM »
Holy crap, that's amazing.  What state are you in?  Mine is at least 5x that for premiums, OOP, etc.

I live in the Austin area.  Just the two of us, no kids, late 30's.  Note that the unsubsidized version of the same plan is $500/month with a $5200 deductible and a  $12,900 OoP Max.  Planning your income carefully makes a huge difference!
« Last Edit: January 30, 2015, 12:07:25 PM by Tyler »

seattlecyclone

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Re: Health insurance in ER - what are y'all doing?
« Reply #29 on: January 30, 2015, 01:43:50 PM »
I think the cost sharing is less well known than the premium subsidies. This article gives a good summary of the financial aspects of ACA plans.

If you have an income under 400% of the poverty level, you get a premium subsidy valued at enough to make a silver plan have a net cost matching a certain sliding percentage of your income. Most people know about this. The particulars are described in Table 2 of the article I linked.

The cost sharing is an added benefit only available to households with income between 100-250% of the poverty level. Normally bronze plans have an "actuarial value" of 60%, meaning the plan will pay for 60% of the average person's medical bills. Silver plans have an actuarial value of 70%, and gold plans have an actuarial value of 80%. But for people in the right income group, silver plans have to raise their actuarial value to as high as 94% (details in Table 4). They way they do that is by lowering deductibles, out-of-pocket maximums, co-payments, co-insurance, etc.

The result of this is that the net monthly premium can be very low because of the premium subsidies and the coverage level can be even better than a gold plan due to the cost sharing requirements.

To illustrate how big of a difference income can make, I did a quick comparison on Washington state's exchange website. I looked up rates for a 30-year-old married couple.

At $40k income (just over 250% of the FPL), Premera's "Silver 2500" plan has a $5,000 family deductible, $8,200 out-of-pocket maximum, and 20% coinsurance, for a $343 monthly premium after tax credits.
At $30k income (just under 200% of the FPL), the same Premera "Silver 2500" plan has a $1,500 deductible, $2,300 out-of-pocket maximum, and 20% coinsurance, for a $218 monthly premium after tax credits.
At $22k income (just over 133% of the FPL), that same plan has a $500 deductible, $1,000 out-of-pocket-maximum, and 20% coinsurance, for a $132 monthly premium after tax credits.

The $40k income couple might have to pay as much as $8,200 + ($343 * 12) = $12,316 in the worst case.
The $30k income couple might have to pay as much as $2,300 + ($218 * 12) = $4,916 in the worst case. (a $7,400 cost difference for a $10,000 income difference!)
The $22k income couple might have to pay as much as $1,000 + ($132 * 12) = $2,584 in the worst case. (a $2,332 cost difference for an $8,000 income difference)

That seems like a mighty strong incentive to keep one's income below that 200% of FPL line during retirement if at all possible.
« Last Edit: January 30, 2015, 01:46:06 PM by seattlecyclone »

Tyler

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Re: Health insurance in ER - what are y'all doing?
« Reply #30 on: January 30, 2015, 02:00:12 PM »
That seems like a mighty strong incentive to keep one's income below that 200% of FPL line during retirement if at all possible.

Exactly.

FWIW, playing with the healthcare.gov website, I calculated that the additional reported income required to meet my mortgage payments would increase our health insurance costs by $1900/year in premiums and $3650/year in deductibles.  That additional cost largely negated any projected profits from investing an amount equal to our mortgage, making the decision to pay it off before retirement a lot easier.

Everyone's situation is different, but it's something to consider.

(edited for brevity)
« Last Edit: January 30, 2015, 02:25:55 PM by Tyler »

Dr. Doom

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Re: Health insurance in ER - what are y'all doing?
« Reply #31 on: January 30, 2015, 02:01:22 PM »
Count me as another doing ACA through my state exchange.  Silver plan.

It'll be subsidized because my income will be about 20K/yr in ER as I move funds from Traditional IRA to Roth.

Check out the Kaiser calculator if you are thinking about going this route, it'll help ballpark costs and estimate your subsidy.  It's been recently updated with 2015 data. 

$1,002 for the year, 5% of income.  Subsidy estimate is 1500 annually.

Ready2Go

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Re: Health insurance in ER - what are y'all doing?
« Reply #32 on: January 30, 2015, 03:53:32 PM »
I think the cost sharing is less well known than the premium subsidies. This article gives a good summary of the financial aspects of ACA plans.

Seattlecyclone -- Thank you so much for posting this information.   I had not looked into the cost sharing features of the ACA at all, and this information sends me to rethink how we will structure our finances.   I was assuming we would rely on DH's gov. retirement health care benefit,  but the ACA is looking like a much more cost effective solution in our case. 

brooklynguy

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Re: Health insurance in ER - what are y'all doing?
« Reply #33 on: January 30, 2015, 05:33:24 PM »
FWIW, playing with the healthcare.gov website, I calculated that the additional reported income required to meet my mortgage payments would increase our health insurance costs by $1900/year in premiums and $3650/year in deductibles.  That additional cost largely negated any projected profits from investing an amount equal to our mortgage, making the decision to pay it off before retirement a lot easier.

When you performed this analysis, did you assume that the mortgage payments that would have been required had you kept your mortgage outstanding would have translated into a need for additional income on a dollar-for-dollar basis?  If so, that's not true--in fact, getting rid of your mortgage does not necessarily make it any easier to keep your income low in any material way (at least in the early years).  Because you can control how much income you realize when you draw down on your investments, keeping your mortgage outstanding and investing the proceeds can require almost no increase in income until many years down the road (when your cost basis has significantly decreased, and when you may already be in Medicare-world and have no need for ACA eligibility).

Apologies if you've already correctly factored this into your analysis, but your numbers lead me to believe you may not have.  And I initially fell into this trap myself when analyzing the "to prepay or not to prepay" mortgage question in light of ACA subsidies, and I've been on a bit of a crusade pointing out this fallacy in every "invest vs. mortgage pay off" thread I come across where this issue comes up.  For anyone interested in reading more detail, see the discussion in Sol's thread on this topic, in particular, my response # 56 on page 2 of that thread:

http://forum.mrmoneymustache.com/ask-a-mustachian/should-i-pay-off-my-mortgage-early/

Tyler

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Re: Health insurance in ER - what are y'all doing?
« Reply #34 on: January 30, 2015, 08:58:05 PM »
Good question!  You're right about income vs. mortgage payments wrt capital gains.  It's not necessarily dollar-for-dollar, although particulars of my portfolio, investing plan, and tax strategy certainly played a part in my assumptions.  You make a good point that your mileage may vary based on personal circumstances and strategies.

For example, in my particular situation my mortgage was already more than half paid down.  So my payment was high compared to the outstanding principal and I had much less money remaining to invest than you may be assuming based on a brand new mortgage. In my personal situation at the time, it made sense to go ahead and pay it off even assuming a reasonable cost basis for payment purposes.  And no, I personally have no interest in refinancing to a new 30-year mortgage at this point in my financial journey.  Again, YMMV. 

To be clear, health subsidies were not the only reason we ultimately made that decision.  They were simply one factor of many, and not all were purely financial.  I'd simply like to point out that they are often overlooked and should not be dismissed.
« Last Edit: January 31, 2015, 12:38:33 AM by Tyler »

GizmoTX

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Re: Health insurance in ER - what are y'all doing?
« Reply #35 on: January 30, 2015, 09:26:51 PM »
DH & I have Medicare plus Aetna medical supplement & UHC Rx supplement. We each pay $587.23/month for all of it, or $1,174.46/month for both of us.

We bought BCBS-TX PPO Choice Catastrophic plan for DS, age 21, which costs $220/month with $6,600 annual deductible, effective Jan. 1. We had the chance to try it out last Sunday because he came down with the flu, type A, even with a flu shot last December. We went to PrimaCare, which wanted either $140 against our deductible or the $40 office visit co-pay (we had to ask for this). The surprise came when I filled his prescription for TamiFlu -- $0, while the retail price was $149. However, we are now paying $60/month more for this plan than last year's (and the deductible quadrupled), & it's unlikely he will have any more prescriptions.

EscapeVelocity2020

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Re: Health insurance in ER - what are y'all doing?
« Reply #36 on: January 30, 2015, 09:35:39 PM »
We'll be buying insurance through our state exchange. 

The plans may change between now and then, but currently we would pay about $20/month for an HSA-eligible plan.  That plan would normally cost $450/mo but with only $40k/year of AGI in retirement (from Roth conversions) the ACA subsidy pays for most of the premium.  That plan covers 100% of preventative care (like physicals, immunizations, dentists, eye exams) but after that there's an $8000 deductible which would only apply to the two adults.

So in a good year, when we get an annual physical, eye exam, and two teeth cleanings for everyone, our total health care costs would be $240 for 20 visits spread over a family of five people.  In a bad year, the out-of-pocket maximum could be as high as $12,900 if we're all in a horrible car crash together or something.

$20/mo?  The first thing that came to mind is that this is obviously not a sustainable cost for the services I would ever hope to expect (given that most Americans spend more than that at a low-expertise burger flipping establishments, aka McDonalds) every month.  It would make me wonder how far and how fast costs will rise.

Worse yet, you add on that costs would be '$240 for 20 visits'... so these people could mow lawns for better income (especially since it's an 'off the books' cash transaction) than provide medical and dental expertise?  What long term expectation do you have?  Certainly, in a wealthy part of the world, this is a product of a sudden sea-change in policy subject to substantial change.  So 10 years from now, what worst case have you planned for; and I feel really sorry for you if you think this is how ACA will be. 

I'm old enough now to see that people are always happy in the short term, but struggle to stitch it together to make it last.  Kinda why I chose the username 'EscapeVelocity' - once achieved, it's self-sustained.  But it takes a whole lot of planning to achieve :)

brooklynguy

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Re: Health insurance in ER - what are y'all doing?
« Reply #37 on: January 31, 2015, 05:39:38 AM »
Good question!  You're right about income vs. mortgage payments wrt capital gains.  It's not necessarily dollar-for-dollar, although particulars of my portfolio, investing plan, and tax strategy certainly played a part in my assumptions.  You make a good point that your mileage may vary based on personal circumstances and strategies.

For example, in my particular situation my mortgage was already more than half paid down.  So my payment was high compared to the outstanding principal and I had much less money remaining to invest than you may be assuming based on a brand new mortgage. In my personal situation at the time, it made sense to go ahead and pay it off even assuming a reasonable cost basis for payment purposes.  And no, I personally have no interest in refinancing to a new 30-year mortgage at this point in my financial journey.  Again, YMMV. 

To be clear, health subsidies were not the only reason we ultimately made that decision.  They were simply one factor of many, and not all were purely financial.  I'd simply like to point out that they are often overlooked and should not be dismissed.

Good points.  I had started drafting a response about the possibility of refinancing, but I see you already edited your post to address that option.  I'll just note that for anyone whose mortgage doesn't still have decades of remaining life to maturity and whose "invest vs. payoff" decision is motivated purely by financial considerations (and who is seeking to retire at the earliest possible time), refinancing into a new, low-rate 30-year mortgage may be the optimal approach.

$20/mo?  The first thing that came to mind is that this is obviously not a sustainable cost for the services I would ever hope to expect (given that most Americans spend more than that at a low-expertise burger flipping establishments, aka McDonalds) every month.  It would make me wonder how far and how fast costs will rise.

Although I wouldn't recommend designing one's retirement around the assumption that today's ACA-subsidized premium rates will last forever, there is no reason that they are not inherently sustainable.  The ACA (including the associated changes to the tax system) was carefully designed so that the subsidized rates would be sustainable in the long-run.  Certainly the subsidized rates (including the $20 per month in sol's example) are no less sustainable than "free" as is the case in the government-subsidized health care systems of many other first-world countries.  (My concerns about the sustainability of the current subsidized rates stem more from my worries about the ability of the ACA itself to continue in its current form in light of the political climate than from concerns about the viability of the current system if it were allowed to remain in effect.)

MidwestBiker

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Re: Health insurance in ER - what are y'all doing?
« Reply #38 on: January 31, 2015, 06:46:19 AM »
Great information! Thanks especially to Tyler and Seattlecyclone for posting. I turn 55 tomorrow, will be retired/severed by the end of the year, and likely to be looking for health insurance for me and my wife in early 2016. We are in great shape, financially and health-wise, so lots to be thankful for.

benjenn

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Re: Health insurance in ER - what are y'all doing?
« Reply #39 on: January 31, 2015, 07:21:25 AM »
We're incredibly blessed that DH served 24 years in the Air Force and we'll have Tri-Care prime as our health insurace.  The annual premium is around $500 for the two of us.  We could stay on the insurance we have through my employer and they would pay a portion of the premium (they currently pay 100% of the premium for all employees) based on years of service *3 (which would be 66% for me) but they pay that portion of the Medicare rate, not the regular rate.  We would end up paying WAY more and Tri-Care is excellent insurance so we're going with that.  We'll be living 30 minutes away from the nearest AFB but lots of providers take Tri-Care and we plan to stay as healthy as we can for as long as we can.  This benefit is truly one of the things letting us retire as early as we are.

sol

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Re: Health insurance in ER - what are y'all doing?
« Reply #40 on: February 02, 2015, 08:32:36 AM »
$20/mo?  The first thing that came to mind is that this is obviously not a sustainable cost

Medicaid costs $0.  Is that also obviously unsustainable?

Like Medicaid and Medicare, the ACA plans are sustainable for as long as we continue to support redistributive taxes. 

Quote
so these people could mow lawns for better income (especially since it's an 'off the books' cash transaction) than provide medical and dental expertise?

I'm not sure if you're trolling or just dense, so I'll explain how health insurance works just to give you the benefit of the doubt.

Health care providers get paid by insurance companies for services they provide to people who have purchased health insurance.  The amount of money the provider gets paid is determined by a negotiation between the provider and the insurance company, and has nothing at all to do with what the insured person pays to the insurance company.

So for you to suggest that my doctor could make more money mowing lawns than providing health care, just because my premiums are low, is somewhat confusing.  I'm choosing to believe you're ignorant of everything in the above paragraph, because the alternative is that you're deliberately trying to mislead people here.

Quote
What long term expectation do you have? 

I expect that the future will look a lot like the past.

Do you expect that America will disintegrate because of the ACA?  That's what I think your post is implying, and that's dumb.

Exflyboy

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Re: Health insurance in ER - what are y'all doing?
« Reply #41 on: February 08, 2015, 07:01:33 PM »
one option we are considering is moving out of the USA altogether.

Either to a low cost country or one with universal HC.

 

arebelspy

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Re: Health insurance in ER - what are y'all doing?
« Reply #42 on: February 08, 2015, 07:37:47 PM »
one option we are considering is moving out of the USA altogether.

Either to a low cost country or one with universal HC.

We're planning on the same, for now.
We are two former teachers who accumulated a bunch of real estate, retired at 29, and now travel the world full time with two kids.
If you want to know more about me, or how we did that, or see lots of pictures, this Business Insider profile tells our story pretty well.
We (occasionally) blog at AdventuringAlong.com.
You can also read my forum "Journal."

seattlecyclone

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Re: Health insurance in ER - what are y'all doing?
« Reply #43 on: February 10, 2015, 12:21:50 PM »
Where do you potential ex-pats plan to move? How do you plan to attain residency, or will you be able to use another countries healtcare as a traveller?

I've looked into this a lot myself even though I can use the VA for free/low cost care here in the states so not as dependent on the ACA as other's are,  but haven't really come up with a place here it's less expensive as an ex-pat - at least not for major illnesses/injuriies. My Mom is German born and raised, as are my maternal grandparents. My paternal Grandparents are Swedish born and raised and I was born in the UK (but am a US citizen). Figured there might be some way to get EU residency status with that but no go.

When were you born? Are you a naturalized US citizen, or did you acquire US citizenship at birth?

If you were born after 1975, you were likely a German citizen at birth because your mother is German. If you were born before 1975, only the father could pass on German citizenship so you're probably not a German citizen. However if you're a naturalized US citizen, you likely lost your German citizenship when you became a US citizen.

If you were born before 1983, you're probably already a British citizen, unless your parents were visiting diplomats at the time. If you were born after 1983, your parents needed to be "settled" in the UK (living there with no time limit on their residence) for you to be a citizen there. Unlike Germany, the UK does not automatically revoke citizenship if you're naturalized elsewhere.

If you're already a citizen of either Germany or the UK, you should be able to apply for a passport of that nation and get all the EU residence rights associated with said country's citizenship.

For those of us with no existing ties to Europe, I've read that Ireland is relatively easy to retire to. You have to get permission from an immigration officer to stay longer than three months, but this permission is generally granted for a year at a time to anyone who can prove they have enough money to support themselves (but you won't be allowed to work). If you live there for at least five years, you're eligible to apply for citizenship.

seattlecyclone

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Re: Health insurance in ER - what are y'all doing?
« Reply #44 on: February 10, 2015, 05:46:38 PM »
It would definitely be easier as a dual EU/US citizen! According to the EU's official website, any EU citizen can retire to any other EU country as long as they have health insurance and enough income that they won't need to resort to social welfare payments in their new country. You may have to register with the local authorities and pay a small one-time fee (no more than what a local citizen might pay for an ID card), but that's it! You would also have unlimited right to work in your new country if you so desire.

As a US-only citizen, your right to retire to an EU country depends on that country's immigration laws. It may not be allowed at all, and where it is allowed it would almost certainly be subject to more uncertainty, restrictions, and immigration fees.

Of course, even if you are a UK citizen, your EU migration rights will likely only continue as long as the UK remains in the EU in the first place. Given the current political climate in Britain, this does not look like a sure thing.

UnleashHell

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Re: Health insurance in ER - what are y'all doing?
« Reply #45 on: February 11, 2015, 04:14:16 AM »
if your Dad was British (may have been a US too but the Brits don't let you give up citizenship) then I believe it means you qualify for British citizenship. (they amended the rule to either parents at some point) If so it does mean that you can stay in Europe as long as you like. It also means you can use your UK passport and go visit Cuba!!

Worth looking into.

looking at this site indicates that you should qualify. (random site on the internet - no idea how legit and I've never used them before!!)
http://www.whatpassport.com/countries/United-Kingdom/Passport_and_Nationality/British_Citizenship

Jeremy

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Re: Health insurance in ER - what are y'all doing?
« Reply #46 on: February 11, 2015, 10:21:40 AM »
We are outside the US.  I self-insure, and while we are in Taiwan at least my wife is covered by the national healthcare here.  Outside of Taiwan, we both self insure

I went to the Dr for a chest x-ray, EKG, and some blood work.  Total bill:  ~$50

EscapeVelocity2020

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Re: Health insurance in ER - what are y'all doing?
« Reply #47 on: February 13, 2015, 08:13:37 PM »
$20/mo?  The first thing that came to mind is that this is obviously not a sustainable cost

Medicaid costs $0.  Is that also obviously unsustainable?

Like Medicaid and Medicare, the ACA plans are sustainable for as long as we continue to support redistributive taxes. 

Quote
so these people could mow lawns for better income (especially since it's an 'off the books' cash transaction) than provide medical and dental expertise?

I'm not sure if you're trolling or just dense, so I'll explain how health insurance works just to give you the benefit of the doubt.

Health care providers get paid by insurance companies for services they provide to people who have purchased health insurance.  The amount of money the provider gets paid is determined by a negotiation between the provider and the insurance company, and has nothing at all to do with what the insured person pays to the insurance company.

So for you to suggest that my doctor could make more money mowing lawns than providing health care, just because my premiums are low, is somewhat confusing.  I'm choosing to believe you're ignorant of everything in the above paragraph, because the alternative is that you're deliberately trying to mislead people here.

Quote
What long term expectation do you have? 

I expect that the future will look a lot like the past.

Do you expect that America will disintegrate because of the ACA?  That's what I think your post is implying, and that's dumb.

Well, this conversation took a wrong turn.  All I was trying to say was, in a traditional insurance scheme, the people with the least risk generally over-pay in order to make up for those that actually break even or get a little benefit (and some is skimmed off, unfortunately).  So, given the fact Sol is ER with a family, and expects to pay $20/mo - well although that may be the rational cost for a family that only needs a 'diabolical plan' and no regular checkups, it is pretty unsustainable if any similar family requires any 'real medical' coverage whilst paying such a sum (insurance getting screwed only happens once).

I was pretty shocked when you said Medicare was sustainable (well sure, if taxpayers go along with paying higher and higher and higher taxes and come to terms with the fact that there is never going to be anything promised in return, but I would hope that somebody is bound to organize a march on Washington sooner or later in this gigantic screwing of a generation); Medicare is the largest underfunded liability that the US has.  Social Security could be suspended indefinitely and it really wouldn't change the picture on Medicare/Medicaid's liability.  I didn't think this was a secret (I'd be happy to link to all the scary stuff out there, if need be), most people I talk to are very nervous about how their medical care will be provided in their old age.  I'd prefer to hear why you think $0 Medicare at 65 for us is sustainable, even given the federal government's ability to tax and spend.  Do you expect Medicare/Medicaid to soldier on in its current form for the next 30 years?  (sorry, your explanation of insurance was severely lacking in magical solutions, and was even less impressive than a pathetic Ponzi scheme, given that new policy buyers would actually have to pay higher premiums :)
« Last Edit: February 13, 2015, 08:30:09 PM by EscapeVelocity2020 »

Exflyboy

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Re: Health insurance in ER - what are y'all doing?
« Reply #48 on: February 23, 2015, 11:32:40 AM »
So I have started to look at this a bit more closely as the Wife will retire next Summer and I can then (in theory) go on my pt employers plan and work for the remainder of 2016. After that we got..

Option 1: Use the ACA. We get about $15k in rent plus about $8k in dividends.. so thats a MAGI (whatever the heck MAGI actually is) of around $23k so that will be close to max subsidies. Other spending will come from after tax savings.

Option 2: Go back to the UK. According to the UK National health Service website we will both get free HC from day 1 providing we can prove we are planning to live there permanently (shipping of personal goods, rental agreements are all valid documents to prove intent). My American Wife can apply for permanent residency (about $2500 one time fee), but take 5 years.. The downside.. the weather sucks!

Option 3: Go somewhere else with low cost HC.

UnleashHell

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Re: Health insurance in ER - what are y'all doing?
« Reply #49 on: February 23, 2015, 01:25:22 PM »

Option 2: Go back to the UK. According to the UK National health Service website we will both get free HC from day 1 providing we can prove we are planning to live there permanently (shipping of personal goods, rental agreements are all valid documents to prove intent). My American Wife can apply for permanent residency (about $2500 one time fee), but take 5 years.. The downside.. the weather sucks!

Devon / Cornwall isn;t too bad. too many tourists for the best four months of the year though.