Under 60 Health Care Coverage

[Wawa92]

Will be retiring on December 31st and be relocating full time to The Villages. My wife and I will need Health Care coverage and was hoping someone would have guidance/recommendation on where we could get coverage based on past or current experiences. Both my wife and I are under the age of 60.

[villagetinker]

I would call Villages Health, but if I understand the current situation, you are on your own to get health coverage (aka Obamacare) until you are 65. If I understand it correctly, VHS will accept your insurance (please call them to confirm), until you are 65, then you MUST convert to one of the accepted MEDICARE ADVANTAGE plans, or leave your Primary care doctor in VHS. You can also call SHINE, here is the link: SHINE - Home (http://www.floridashine.org/) they may be able to help you. If you have an employer heath plan, call VHS (Villages Health system) and confirm it is accepted, as I recall they accept most health coverage plans for people under 65.
Hope this helps.

[bagboy]

IF you are going on the open market to buy health insurance, I highly recommend you call Ken Laws, Benco Insurance Agency in Leesburg Fl. He represents Florida Blue, which is your only option for health insurance. They have several plans, benefit ranges, and premium prices. I believe him to be quite knowledgeable, he can answer your questions and guide you in the right direction. Good Luck and Welcome to The Villages! !!!

352-728-0050

[billybye]

Check with ACA policies and hope it is not done away with. Good luck with going on your own for individual policies. We found ACA was only affordable policy available for people over 55, healthy or not.
On Medicare now, but feel sorry for those not 65 yet. If you didn't vote, blame yourself if ACA is gone.

[spring_chicken]

Thank your lucky stars Obamacare is on the way out. My premiums have doubled over the last 2 years. Thank God help is on the way!

[Kahuna32162]

OK, pretty much same boat, moved here at 59 and had to purchase our own health care insurance. Unless you want the absolute bare bones, it's expensive, to the tune of about $1,400/month for 2. We started with Florida Blue, but changed to United Health care for last year (they seem to be the preferred provider in The Villages). as of Jan 1, 2017, UHC will no longer be issuing individual policies in the State of Florida. So, for us, it's back to Florida Blue at about the same rate with a higher deductible than last year.

You can try going through the exchange, while it still lasts, but if you don't qualify for a subsidy, it's really not worth it. BTW, we used Mid Florida Agencies in the Palm Ridge Plaza and Renata Cockburn 352 259-0666. Good Luck!

[Nucky]

Thank your lucky stars Obamacare is on the way out. My premiums have doubled over the last 2 years. Thank God help is on the way!

So if the ACA is gone you will pay less? Maybe I'm just doing the math wrong?

[RickeyD]

So if the ACA is gone you will pay less? Maybe I'm just doing the math wrong?



Don't bother Nuckster, it ain't worth it. [emoji53]

[billybye]

Don't bother Nuckster, it ain't worth it. [emoji53]

So true

[valuemkt]

My wife works in this area and told me some facts about ACA

1. Because you are buying a fully insured individual policy, the ACA requires every person to be covered for the 13 essential health categories they designated under ACA. This includes maternity. So even if you're past child bearing, you're paying for this coverage. There are other coverages you may not want but I'll forego the boring details. Elimination of ACA means you can go back to policies where you didn't purchase coverages you didn't need.

2. ACA provides subsidies for lower income individuals so some pre-65 retirees may be able to get a government subsidy and pay less than the full price. As the prices rise, the government is increasing subsidies. For those folks, they think Obamacare is great because they now have affordable health care. For people who don't get subsidies, the prices have been going up significantly and they get to pay the huge increases.

3. On top of all this, the government requires insurance companies to underwrite people who enroll in the public exchanges (the sickest) and in the individual market as a single risk pool. The government initially agreed to reimburse insurance companies for their losses for taking on the sicker people. The feds have only been paying carriers for about 14 - 16% of their losses and so the carriers are losing their shirts - that's why they are exiting.

4. Health care never really gets cheaper unless you buy less coverages or have higher deductibles and then use less care because you are healthy. That's because the higher the deductible, the lower the premium.

ACA required you to buy more coverages than you may need and then they failed to reimburse insurance companies for millions in losses, so everyone suffered.

On the whole, ACA swizzled monies to different places and didn't improve the overall quality of care. And reductions in Medicare reimbursements to doctors and hospitals only end up having them charge more to the non-Medicare people. Have you ever seen a doctor or hospital take a pay-cut?

[Paper1]

Will be retiring on December 31st and be relocating full time to The Villages. My wife and I will need Health Care coverage and was hoping someone would have guidance/recommendation on where we could get coverage based on past or current experiences. Both my wife and I are under the age of 60.

Brace yourself. My wife and I are both 64 and have a $1550 monthly premium for 2017 with a big deductable. We have Florida Blue and I don't think you'll find coverage for less. Never thought I'm not looking forward to 65 but my out of pocket costs will drop 75%. If you find something better please post.

[ColdNoMore]

It seems to me that a lot of people have either forgotten how fast health insurance costs were rising before ACA...or were protected by their company picking up the increases.

Blaming ACA is the easy scapegoat, but I'm still waiting for some specifics as to what will take its place...if in fact it actually gets changed.

Obamacare Premiums Are Lower Than You Think (http://healthaffairs.org/blog/2016/07/21/obamacare-premiums-are-lower-than-you-think/)


Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.

What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.

While certain aspects of ACA are very popular by a majority (no preexisting conditions, older children qualifying, etc.), what a lot of folks seemed to have forgotten is that it's the provision that younger, and therefore more healthy participants, are required to participate...which offsets those bottom line negatives to health insurance providers.

Just a note of caution for the ACA/Obamacare haters...be careful of what you wish for.

[spring_chicken]

My wife works in this area and told me some facts about ACA

1. Because you are buying a fully insured individual policy, the ACA requires every person to be covered for the 13 essential health categories they designated under ACA. This includes maternity. So even if you're past child bearing, you're paying for this coverage. There are other coverages you may not want but I'll forego the boring details. Elimination of ACA means you can go back to policies where you didn't purchase coverages you didn't need.

2. ACA provides subsidies for lower income individuals so some pre-65 retirees may be able to get a government subsidy and pay less than the full price. As the prices rise, the government is increasing subsidies. For those folks, they think Obamacare is great because they now have affordable health care. For people who don't get subsidies, the prices have been going up significantly and they get to pay the huge increases.

3. On top of all this, the government requires insurance companies to underwrite people who enroll in the public exchanges (the sickest) and in the individual market as a single risk pool. The government initially agreed to reimburse insurance companies for their losses for taking on the sicker people. The feds have only been paying carriers for about 14 - 16% of their losses and so the carriers are losing their shirts - that's why they are exiting.

4. Health care never really gets cheaper unless you buy less coverages or have higher deductibles and then use less care because you are healthy. That's because the higher the deductible, the lower the premium.

ACA required you to buy more coverages than you may need and then they failed to reimburse insurance companies for millions in losses, so everyone suffered.

On the whole, ACA swizzled monies to different places and didn't improve the overall quality of care. And reductions in Medicare reimbursements to doctors and hospitals only end up having them charge more to the non-Medicare people. Have you ever seen a doctor or hospital take a pay-cut?


Good analysis.

[bagboy]

My wife works in this area and told me some facts about ACA

1. Because you are buying a fully insured individual policy, the ACA requires every person to be covered for the 13 essential health categories they designated under ACA. This includes maternity. So even if you're past child bearing, you're paying for this coverage. There are other coverages you may not want but I'll forego the boring details. Elimination of ACA means you can go back to policies where you didn't purchase coverages you didn't need.

2. ACA provides subsidies for lower income individuals so some pre-65 retirees may be able to get a government subsidy and pay less than the full price. As the prices rise, the government is increasing subsidies. For those folks, they think Obamacare is great because they now have affordable health care. For people who don't get subsidies, the prices have been going up significantly and they get to pay the huge increases.

3. On top of all this, the government requires insurance companies to underwrite people who enroll in the public exchanges (the sickest) and in the individual market as a single risk pool. The government initially agreed to reimburse insurance companies for their losses for taking on the sicker people. The feds have only been paying carriers for about 14 - 16% of their losses and so the carriers are losing their shirts - that's why they are exiting.

4. Health care never really gets cheaper unless you buy less coverages or have higher deductibles and then use less care because you are healthy. That's because the higher the deductible, the lower the premium.

ACA required you to buy more coverages than you may need and then they failed to reimburse insurance companies for millions in losses, so everyone suffered.

On the whole, ACA swizzled monies to different places and didn't improve the overall quality of care. And reductions in Medicare reimbursements to doctors and hospitals only end up having them charge more to the non-Medicare people. Have you ever seen a doctor or hospital take a pay-cut?


The OP has a very real dilemma. They will both need to purchase health insurance. Other than aquiring insurance with Florida Blue, through the ACA Marketplace, what do you or your wife suggest they do?

[villagetinker]

OP, My wife and I are out of this market (aka over 65) but I thought there were other options then the "exchanges". As stated previously, there are some included options that old people do not need, so private insurance with just the coverages you need might be less costly. As I stated before, SHINE may be able to help, that would be followed by a Google search on private insurance options, do you have an option of COBRA coverage, we had that for the 18 months after I retired, and before I hit 65. Finally, as suggested before (I think), contact a local health insurance firm, and see if there are other options that have not been mentioned so far.
Good luck, hope this helps.

[USCFCAT1]

The OP has a very real dilemma. They will both need to purchase health insurance. Other than aquiring insurance with Florida Blue, through the ACA Marketplace, what do you or your wife suggest they do?

Simplest solution - decide if the "fine" is lower than the cost of coverage. If you need a major medical policy so be it.

From there, keep an address in the home state if there is coverage there...and keep it.

Anyone who is so hoodwinked to think that ACA is a good thing needs to really catch up with reality. Just because you have a card that says BCBS or United does not mean that any provider needs to accept it.

Remember, with ACA if you cut your thumb at home...that is NOT a health insurance claim, that is a Home Owners claim.


If you cut your thumb at your neighbors, that is a claim on THEIR home owners/renters policy.

If you hurt your thumb at work...that is a Comp injury.

If you hurt your thumb in the car...Auto claim.

COBRA is never ever not even slightly a good idea for 99% of the population.

[bagboy]

Simplest solution - decide if the "fine" is lower than the cost of coverage. If you need a major medical policy so be it.

From there, keep an address in the home state if there is coverage there...and keep it.

Anyone who is so hoodwinked to think that ACA is a good thing needs to really catch up with reality. Just because you have a card that says BCBS or United does not mean that any provider needs to accept it.

Remember, with ACA if you cut your thumb at home...that is NOT a health insurance claim, that is a Home Owners claim.


If you cut your thumb at your neighbors, that is a claim on THEIR home owners/renters policy.

If you hurt your thumb at work...that is a Comp injury.

If you hurt your thumb in the car...Auto claim.

COBRA is never ever not even slightly a good idea for 99% of the population.

I hope you are not under the impression that I support the ACA. I'm simply replying to the OP who as I see it will not have the opportunity to keep their current health plan. To my knowledge in the state of Florida, there isnt an open market for the OP to shop for health insurance. There is one company, Florida Blue, and one way to purchase coverage, through the ACA Marketplace. To not have some type of coverage to cover unexpected catastrophic events would really be a huge risk.
The OP should contact a local, experienced agent and get the facts of coverage availability, and get guidance on proceeding.

[USCFCAT1]

And reductions in Medicare reimbursements to doctors and hospitals only end up having them charge more to the non-Medicare people. Have you ever seen a doctor or hospital take a pay-cut?


Huh? Lets start with "Fee Schedules". Medicare will pay $X for Procedure "Y". From there, ALL providers create a fee schedule from the known minimum (medicare). This fee is typically Medicare + Z%. So, "cash pay" would essentially be "Medicare+X%". Insurance companies who are contracted to providers will pay "Medicare+Q%" on certain procedures.

So - if your sympathetic joint effusion has a reimbursement of $1.00 from Medicare....

$1.00 (what Medicare pays)
$0.15 (what Medicaid pays - when they get around to it)
$1.30 (what BCBS will pay to an in-network provider)
$2.00 (cash pay fee schedule for WorkComp/PI - knowing it will take years to get paid)

To claim that providers are jacking their price to "cover" Medicare is foolish...they only "cover" Medicaid...and most simply do not accept Medicaid as it never pays a bill let alone a steeply discounted bill.

Have I seen providers take a pay cut? LOL, you have GOT to be kidding. Medicare no longer pays for MANY high level hospital consults. They dont pay for many diagnostic visits nor much of the DME/Supplies used.

[USCFCAT1]

I hope you are not under the impression that I support the ACA.


Not all all.

It is just funny to see people show shock when they get the questionnaire in the mail asking "what, where, how, when" for many issues. Then they fill it out - get a denial and blame the provider. In actuality it is simply underwriting deferring PX billing responsibility to ANYONE other than their own policy.

[USCFCAT1]

The OP has a very real dilemma. They will both need to purchase health insurance. Other than aquiring insurance with Florida Blue, through the ACA Marketplace, what do you or your wife suggest they do?



Christian Healthcare Ministries: Home (https://www.chministries.org/)

[biker1]

Getting a subsidy from the Obamacare exchange is all about your adjusted gross income. If you can structure your finances so as to show a low adjusted gross income then you can get a subsidy. In other words, your net worth is not part of the equation - only what you show as adjusted gross income on your tax return.


OK, pretty much same boat, moved here at 59 and had to purchase our own health care insurance. Unless you want the absolute bare bones, it's expensive, to the tune of about $1,400/month for 2. We started with Florida Blue, but changed to United Health care for last year (they seem to be the preferred provider in The Villages). as of Jan 1, 2017, UHC will no longer be issuing individual policies in the State of Florida. So, for us, it's back to Florida Blue at about the same rate with a higher deductible than last year.

You can try going through the exchange, while it still lasts, but if you don't qualify for a subsidy, it's really not worth it. BTW, we used Mid Florida Agencies in the Palm Ridge Plaza and Renata Cockburn 352 259-0666. Good Luck!

[bagboy]

Maybe the Florida Blue rep can respond and confirm ,it's gross income that is used, not adjusted gross income.

[biker1]

It is actually modified adjusted gross income.

Maybe the Florida Blue rep can respond and confirm ,it's gross income that is used, not adjusted gross income.

[Chi-Town]

It is actually modified adjusted gross income.
That is correct. From HealthCare.gov

Your MAGI is the total of the following for each member of your household who’s required to file a tax return:

Your adjusted gross income (AGI) on your federal tax return
Excluded foreign income
Nontaxable Social Security benefits (including tier 1 railroad retirement benefits)
Tax-exempt interest
MAGI does not include Supplemental Security Income (SSI)

Sent from my SM-N910V using Tapatalk

[rexxfan]

If I understand it correctly, VHS will accept your insurance (please call them to confirm), until you are 65, then you MUST convert to one of the accepted MEDICARE ADVANTAGE plans, or leave your Primary care doctor in VHS.
To my knowledge, VHS stopped taking on new patients with one of their accepted non-Medicare insurances (e.g. Cigna) in mid-October, 2015. I made my initial appointment with VHS before the cutoff and I was allowed in. My wife wanted to wait until after we got here (which was after the cutoff) to learn more about it before deciding and she got frozen out. I'm not aware of any reversal of that policy. We're both in our early 60's so aren't yet eligible for Medicare.
--
Bob C