Author Topic: US Health Insurance Circa 2018  (Read 3550 times)

Ajb147

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US Health Insurance Circa 2018
« on: August 03, 2018, 09:11:38 PM »
Hey everyone! Well, more specifically, hey people in the US! (hi to worldwide people, but this probably doesnt apply to you much lol). 

What are you doing for health insurance post RE?!  I tried searching the forums and everything that I found was pre-trump era (i.e., Obama care) and I don't think it applies anymore.  Or maybe I'm way off base?  Anyway, if I did miss a post or MMM article about this, or if older advice is still valid, please let me know!  I know I could google this, and I did, but the group here is my most reliable source for current info from like minded people and this seemed to be the most efficient route.  btw, I am 31, single, no kids, with no prior conditions(if any of that matters).  I'm still employed but will be out before 32.  I currently have an HSA high deductible type plan and was hoping to do something similar, but really wondering about what other people in similar situations are doing these days.

Thanks so much for everything!

rantk81

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Re: US Health Insurance Circa 2018
« Reply #1 on: August 04, 2018, 07:55:13 AM »
This is probably the million dollar (quite literally) question for me, and many others who are on the cusp of pulling the trigger on FIRE...

Raenia

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Re: US Health Insurance Circa 2018
« Reply #2 on: August 04, 2018, 08:24:19 AM »
I'm not finding it right now, but there was a huge thread on "What comes after the ACA" or something like that.

Possible strategies I've heard people using:
 - pad your FI number to account for increased health expenses (This is our plan A)
 - plan on retiring to a country with better/cheaper healthcare (Our plan B, as DH has dual British citizenship)
 - plan on medical tourism for non-emergency services
 - get income low enough to qualify for Medicaid
 - keep working part time for health insurance, if necessary

DreamFIRE

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Re: US Health Insurance Circa 2018
« Reply #3 on: August 04, 2018, 08:48:07 AM »
Hey everyone! Well, more specifically, hey people in the US! (hi to worldwide people, but this probably doesnt apply to you much lol). 

What are you doing for health insurance post RE?!  I tried searching the forums and everything that I found was pre-trump era (i.e., Obama care) and I don't think it applies anymore.  Or maybe I'm way off base?

It's called the Affordable Care Act (ACA), and it still applies.  They were unsuccessful in repealing it.  There's a lawsuit where many states are trying to get the ACA ruled unconstitutional due to the removal of the mandate penalty beginning in 2019 that was part of the tax bill that passed.  We will see how that shakes out in time.  I'm still counting on the ACA.
« Last Edit: August 04, 2018, 08:56:22 AM by DreamFIRE »

DreamFIRE

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Ajb147

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Re: US Health Insurance Circa 2018
« Reply #5 on: August 04, 2018, 10:12:05 AM »
AWESOME! That ^ was just what I was looking for.  Will follow up if I have questions after reviewing it all and doing more research

radram

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Re: US Health Insurance Circa 2018
« Reply #6 on: August 04, 2018, 10:13:58 AM »
The key for the entire healthcare debate is the phrase "under current law(UCL)".

We must always remember that phrase. Things change as laws change. Please understand I find these figures below to be embarrassing. We get paid to have healthcare. It does not feel right to me. Many people are paying for it, and in fact paying for us. Things WILL change. I also do not pay taxes on my income, since the capital gains tax rate is 0% for my income level. Also embarrassing, also not right, and it will also change someday(hops off soapbox).

UCL- income is EVERYTHING. Net worth is NOTHING. Your healthcare costs will be based on income, not net worth. If you own a billion dollars of Berkshire Hathaway, and own nothing else, you have $0 income(BRK does not pay dividends), and are eligible for ALL programs that only look at income. UCL, you would go onto your state poverty health plan at no cost (in my state of WI).

UCL, as a FIRE person of 3 years, with an 11 year old, a 19 year old, and a wife, our family is best off with income JUST below 250% of poverty level, high enough to stay off of state insurance, while qualifying for a premium reduction AND cost share reductions through ACA. We can buy and sell what we need to keep us in this zone.

When CSR payments were suspended last year, insurance company raised premiums to offset the loss of those payments, resulting in a larger subsidy for me. My monthly premium this year is $1.50 for our family of 4, for a silver plan with a CSR. The payments were suspended. The law requiring the CSR's to be OFFERED was not suspended. That would take a repeal of either that provision, or the ACA as a whole.

It remains to be played out, but now that there is no penalty for not having a compliant ACA plan, logic will imply that healthy people paying high premiums (income too high for subsidies) will leave ACA plans. That will again raise premiums for the rest in the plans. UCL, for ME, my premiums will again rise, and my subsidy will again rise, and I will again pay NOTHING for health insurance for 2019(it might go up about $1 per month).

Also likely would be a larger portion of healthcare claims going unpaid next year, as some of those healthy folks will have rolled the dice, and lost(getting sick and racking up large bills they can not pay). The result? You guessed it: higher premiums, and a higher subsidy for me.

The 1 concern would be if insurance companies stop offering ACA compliant plans. UCL, that seems unlikely, since by removing the penalty, there will be a higher percentage of people getting subsidies, and therefore a greater chance of the insurance company getting paid. The best check is a government check, am I right?

If I was on ACA, and could not control my income, and did not receive a subsidy, you bet I would look into buying one of the catastrophic plans that will be offered again starting next year. We have the cash to handle a few catastrophic events. Unfortunately, we are not insurable at any cost, due to preexisting conditions.

If we get back to full ACA repeal, our family will look at all possibilities, including dropping our income poverty level, or leaving the country.

Also new this year: with the elimination of exemptions and higher standard exemption, it might be beneficial for children to NOT be dependents. I will look into this before I make our final "income" sells of stocks. Maybe it is time for my 11 year old to get a place of her own.

DreamFIRE

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Re: US Health Insurance Circa 2018
« Reply #7 on: August 04, 2018, 05:48:12 PM »

Mr. Green

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Re: US Health Insurance Circa 2018
« Reply #8 on: August 04, 2018, 06:05:38 PM »
Despite what the current Administration would like you to think, the ACA is still the law of the land. It's what we use and we've been very happy with our experience.

Monkey Uncle

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Re: US Health Insurance Circa 2018
« Reply #9 on: August 05, 2018, 08:47:36 AM »
Despite what the current Administration would like you to think, the ACA is still the law of the land. It's what we use and we've been very happy with our experience.

Same here.

If something similar to the last House repeal bill were to pass, our costs would be similar to what we were paying for the employee portion of my premium back when I was working and had employer-provided insurance.  That wouldn't be as good as we have it now with ACA premium tax credits, but it would be doable.

If the ACA gets repealed or declared unconstitutional without any replacement, we likely would need to make some extra money to swing the premiums on private insurance, or I might have to get a job just to get employee health coverage.  That would suck, but not as bad as if I had just kept working without getting any of the FIRE experience at all.

 

Wow, a phone plan for fifteen bucks!