Health Care in retirement before age 65....Exchanges or Private.

[Craig Vernon]

My financial planner mentioned looking into health care exchanges instead of locking in subsidized coverage through my existing employer. The coverage available to my wife and I is around 900 per month for Anthem PPO. What is your experience? Deal or No Deal?

[rustyp]

My financial planner mentioned looking into health care exchanges instead of locking in subsidized coverage through my existing employer. The coverage available to my wife and I is around 900 per month for Anthem PPO. What is your experience? Deal or No Deal?

Your income until Medicare will determine if exchanges can beat your employer deal. The exchange has you project your income for the upcoming year. The key here is definition of income. If you have a pile of after tax cash that you can live off of you can look very poor on paper but have millions in before tax accounts. I think your adviser was trying to convey this to you. Try him/her again for a more detailed explanation.

I planned for this with early retirement and went from 1800/month employer plan to 200/month from age 62 to 65. In my case the employer plan was so bad if I missed my projection the penalty I would need to pay to the exchange would be a wash.

[Craig Vernon]

Your income until Medicare will determine if exchanges can beat your employer deal. The exchange has you project your income for the upcoming year. The key here is definition of income. If you have a pile of after tax cash that you can live off of you can look very poor on paper but have millions in before tax accounts. I think your adviser was trying to convey this to you. Try him/her again for a more detailed explanation.

I planned for this with early retirement and went from 1800/month employer plan to 200/month from age 62 to 65. In my case the employer plan was so bad if I missed my projection the penalty I would need to pay to the exchange would be a wash.

Hey Rusty, Assuming the 200 month is an exchange medical. Any opinion on the quality of coverage or availability of doctors on these plans?

[Cupcake57]

My financial planner mentioned looking into health care exchanges instead of locking in subsidized coverage through my existing employer. The coverage available to my wife and I is around 900 per month for Anthem PPO. What is your experience? Deal or No Deal?

I am very happy with AARP United. I paid $900/month the first couple of years (age 62-65) now my income is less and I pay $280. Very happy. Other than prescriptions, I've only paid 2 doctor bills in the past 4-5 years totaling less than $100. Prescription coverage is very good, but I'm on some pricey meds so I pay a little. So very happy.

[rustyp]

Hey Rusty, Assuming the 200 month is an exchange medical. Any opinion on the quality of coverage or availability of doctors on these plans?

In my case the coverage from the ACA exchange was better than my employers plan. Don't quote me but I believe you must get the insurance from your state of residence. Google ACA and your state and you should be able to find the plans offered and a financial calculator. You can't make that big of a mistake:

1 if you compare your employer plan to the exchange plan you pick
2 You still have a clean slate to pick at age 65

Given you haven't moved to TV yet my assumption is you are not a Florida resident. You must get insurance from your state of residence. Once you become a FL resident you will be able to switch plans. Your biggest decision right now will be are you willing to give up the employer insurance. There is usually a clause if you leave you cannot go back. This becomes important if your employer plan is providing you a supplemental for life once you hit 65.

[Plinker]

Your income until Medicare will determine if exchanges can beat your employer deal. The exchange has you project your income for the upcoming year. The key here is definition of income. If you have a pile of after tax cash that you can live off of you can look very poor on paper but have millions in before tax accounts. I think your adviser was trying to convey this to you. Try him/her again for a more detailed explanation.

I planned for this with early retirement and went from 1800/month employer plan to 200/month from age 62 to 65. In my case the employer plan was so bad if I missed my projection the penalty I would need to pay to the exchange would be a wash.


Here is the link to how millionaires can get zero deductible policies and pay less than $100 a month using this tactic prior to qualifying for Medicare. It’s due to the fact that income is the only factor determining what your subsidy will be. If you sold your home and bought a less expensive one in retirement and used the cash to live on until Medicare, it’s very doable.

Access Denied (https://www.cnbc.com/2016/01/27/theyre-millionaires-and-they-get-obamacare-subsidies.html)

[PoolBrews]

Here is the link to how millionaires can get zero deductible policies and pay less than $100 a month using this tactic prior to qualifying for Medicare. It’s due to the fact that income is the only factor determining what your subsidy will be. If you sold your home and bought a less expensive one in retirement and used the cash to live on until Medicare, it’s very doable.

Access Denied (https://www.cnbc.com/2016/01/27/theyre-millionaires-and-they-get-obamacare-subsidies.html)

The only kicker here is that if your employer offers you a plan, you don't qualify for ACA. That question is asked during the initial sign up. If you have an available retirement health plan available from your employer, you are automatically disqualified from ACA.

[Kjbatl]

The only kicker here is that if your employer offers you a plan, you don't qualify for ACA. That question is asked during the initial sign up. If you have an available retirement health plan available from your employer, you are automatically disqualified from ACA.

You are not automatically denied if you are offered a plan from employer. I am retired and my employer plan requires I pay the premiums in retirement with no employer subsidies. If the plan meets high cost to income ratio, you qualify for the reduced premiums of the exchange. I have Blue Cross and employee premiums were 800 so I qualified and premiums are about 450 with credits.

[Caymus]

You are not automatically denied if you are offered a plan from employer. I am retired and my employer plan requires I pay the premiums in retirement with no employer subsidies. If the plan meets high cost to income ratio, you qualify for the reduced premiums of the exchange. I have Blue Cross and employee premiums were 800 so I qualified and premiums are about 450 with credits.

The exchangers would "probably" never find out if you were offered a company plan. In my case I received a lump sum for health care premiums that expired when I reached 65. The only issue with it was that I was not allowed to receive a subsidy in order to use the credits.

[SusanStCatherine]

Most people I know keep their employer plans and often keep them into their Medicare supplement plans. We did not have an employer plan available to us, so we use the ACA Healthcare exchange where you cannot be denied coverage. We are full-time Florida residents so we use Healthcare.gov site. It's the only place you can get an ACA plan and be considered for subsidies. If you are another state's resident, it may be different and the plans may not be accepted around here. We selected one of the least expensive Florida Blue Select Bronze plans. The premium per person on this plan for ages in the The low sixties is approx $900 per month per person. There is very little choice besides Florida Blue - there is Ambetter and there might be another plan like Kaiser strict HMO.
I have found that the Florida Blue Select plan is not accepted around here. I have not found one place that accepts it. It apparently pays providers less than other Florida Blue plans. But we are pretty healthy and self pay for our office visits since our deductible is extremely high like $6K. It helps a little with Rx and bloodwork.
Changes occur regularly like income limits, subsidies, etc so be careful.
Good luck!

[Rainger99]

I planned for this with early retirement and went from 1800/month employer plan to 200/month from age 62 to 65.

What was the $200 a month plan? Who was it with? What was the deductible, etc.?

[Dlbonivich]

I have Florida Blue Anthem $350 for both of us. We use The Villages health system no problems. We show low income to qualify. As others said we live off of cash saved. My husband retired at 53 and he is currently 62 aand I’m 57.

[CoachKandSportsguy]

We kept our company sponsored private plan, the high deductible version, to maximize the HSA savings option, which was never offered prior to this year. We will keep it as long as CoachK is employed, and the HSA contributions are available. Lots of ignorant comments when it was offered by those who couldn't do the financial analysis of spending versus savings. They were intimidated by the concept of high deductible.

Can't get HSA contributions in the government plans.

good luck in your decision.

[kkingston57]

Your income until Medicare will determine if exchanges can beat your employer deal. The exchange has you project your income for the upcoming year. The key here is definition of income. If you have a pile of after tax cash that you can live off of you can look very poor on paper but have millions in before tax accounts. I think your adviser was trying to convey this to you. Try him/her again for a more detailed explanation.

I planned for this with early retirement and went from 1800/month employer plan to 200/month from age 62 to 65. In my case the employer plan was so bad if I missed my projection the penalty I would need to pay to the exchange would be a wash.

Did the same thing. Problem is that I had a fund which reported higher than anticipated capital gains(income) and I went from $200 a month to $800 a month. Next year was on Medicare and best insurance I have ever had.

[edtherock]

I am 63- married On ACA now. As long as our yearly income stays below around 30,000 per year I get 100% govt subsidies to pay my monthly medical fee! We pay 0 dollars per month. We selected Florida blue select plan. 40 dollar doctor deductible and 85 dollar specialist deductible. That’s it. So the lower you can keep you income- the less you pay with ACA or Obamacare or whatever you want to call it. It works really welll. This is the second year we have been on it. Totally happy. But the key is that yearly income ! If you don’t have cash then this may not work for you.

[Michael 61]

I am 63- married On ACA now. As long as our yearly income stays below around 30,000 per year I get 100% govt subsidies to pay my monthly medical fee! We pay 0 dollars per month. We selected Florida blue select plan. 40 dollar doctor deductible and 85 dollar specialist deductible. That’s it. So the lower you can keep you income- the less you pay with ACA or Obamacare or whatever you want to call it. It works really welll. This is the second year we have been on it. Totally happy. But the key is that yearly income ! If you don’t have cash then this may not work for you.

I agree about keeping your income low (on paper). I’m still several years away from 65 and retired. I receive a monthly medical benefit from my former employer of $550 per month, but then I’m required to find my own health insurance. My only income on paper is a monthly pension and interest income from investments. For other income, I just withdraw from my savings accounts each month, so on paper, my yearly income is way less than when I was working. I qualify for ACA, and signed up with the Gold plan through Florida Blue - the monthly premium is $700 (so after the benefit from my former employer is only $150 out of pocket each month). $20 copay for dr visits / $60 for specialists - with no deductible to meet. I’m pleased.

[OrangeBlossomBaby]

Most people I know keep their employer plans and often keep them into their Medicare supplement plans. We did not have an employer plan available to us, so we use the ACA Healthcare exchange where you cannot be denied coverage. We are full-time Florida residents so we use Healthcare.gov site. It's the only place you can get an ACA plan and be considered for subsidies. If you are another state's resident, it may be different and the plans may not be accepted around here. We selected one of the least expensive Florida Blue Select Bronze plans. The premium per person on this plan for ages in the The low sixties is approx $900 per month per person. There is very little choice besides Florida Blue - there is Ambetter and there might be another plan like Kaiser strict HMO.
I have found that the Florida Blue Select plan is not accepted around here. I have not found one place that accepts it. It apparently pays providers less than other Florida Blue plans. But we are pretty healthy and self pay for our office visits since our deductible is extremely high like $6K. It helps a little with Rx and bloodwork.
Changes occur regularly like income limits, subsidies, etc so be careful.
Good luck!

Florida blue select is accepted almost everywhere here. I have The Villages Health for my regular doctor and audiologist, and the specialists for my skin cancer, my colonoscopy, and whatever else, are all /not/ TVH and they all participate with FloridaBlue Select PPO.

They're not all participating providers with the HMO, but the PPO provider list is pretty vast and diverse.

The one I have is also a bronze plan. I'm paying around $150/month just for me now that hubby is on medicare. I have a $9700 out of pocket max, and 0 deductible. I have to pay $85 every time I go to a specialist's office or need lab work other than my yearly CBCs and thyroid panel, and if I need my doctor for anything other than a yearly checkup.

So far I've paid around $2000 since January 1 for skin cancer treatments and surgery. The good news, is that if I get my hip replacement this year, I'll only have to pay $7000 out of pocket for the whole shebang, which normally costs $25,000 for people who have no insurance.

[Justputt]

I retire later this month, and our hospital's COBRA plan is $2,266/mo for the highest deductible. I can get Medicare, but my wife will be too young for Medicare for six more years. No way will I get any subsidy, so the question now shifts to ACA or market. We've found the ACA can be higher when there's no subsidy. Curious what others have found when one spouse needs pre-Medicare insurance and ACA "need tests" fail.

[Craig Vernon]

Wow, Thanks all for the input. I am following!!!

[SusanStCatherine]

I retire later this month, and our hospital's COBRA plan is $2,266/mo for the highest deductible. I can get Medicare, but my wife will be too young for Medicare for six more years. No way will I get any subsidy, so the question now shifts to ACA or market. We've found the ACA can be higher when there's no subsidy. Curious what others have found when one spouse needs pre-Medicare insurance and ACA "need tests" fail.

The "market" is the "ACA". The "ACA is the Affordable Care Act otherwise reffered to as Obamacare. You purchase an ACA plan from the marketplace. In Florida it is through Healthcare.gov. Other states could be different. The reason to use an ACA plan is because you can obtain coverage no matter your health. You can also possibly qualify for a subsidy. I believe employer plans are ACA plans.
You can try obtaining health insurance from other sources but they are not regulated the same way and I would not trust them personally.
Since the ACA has been enacted, we have paid very large premiums with very large deductibles. Basically we have catastrophic coverage, but the premium price is extremely high. We feel we need the coverage in case of a major accident or illness. Someone has to pay for the sicker people who cannot afford it.

[Justputt]

The "market" is the "ACA". The "ACA is the Affordable Care Act otherwise reffered to as Obamacare. You purchase an ACA plan from the marketplace. In Florida it is through Healthcare.gov. Other states could be different. The reason to use an ACA plan is because you can obtain coverage no matter your health. You can also possibly qualify for a subsidy. I believe employer plans are ACA plans.
You can try obtaining health insurance from other sources but they are not regulated the same way and I would not trust them personally.
Since the ACA has been enacted, we have paid very large premiums with very large deductibles. Basically we have catastrophic coverage, but the premium price is extremely high. We feel we need the coverage in case of a major accident or illness. Someone has to pay for the sicker people who cannot afford it.

By market I meant retail market and not the marketplace. My son found insurance cheaper on the retail market than the ACA. IMO, ACA is a rip unless you qualify for a lot of subsidies. Otherwise, I agree with your observations.

[PoolBrews]

I am 63- married On ACA now. As long as our yearly income stays below around 30,000 per year I get 100% govt subsidies to pay my monthly medical fee! We pay 0 dollars per month. We selected Florida blue select plan. 40 dollar doctor deductible and 85 dollar specialist deductible. That’s it. So the lower you can keep you income- the less you pay with ACA or Obamacare or whatever you want to call it. It works really welll. This is the second year we have been on it. Totally happy. But the key is that yearly income ! If you don’t have cash then this may not work for you.

You also have to show a minimum income to qualify (never understood that...). For a couple it's around $18K. So if you're living off of cash, you still need to show income to qualify.

[Caymus]

You also have to show a minimum income to qualify (never understood that...). For a couple it's around $18K. So if you're living off of cash, you still need to show income to qualify.

I think you would be put on Medicaid without a minimum income.

[OrangeBlossomBaby]

I think you would be put on Medicaid without a minimum income.

Medicaid exists to provide health care for people who are poor, disabled, or children of poor people.

Medicare is for senior citizens, without consideration of their income.

[OrangeBlossomBaby]

You also have to show a minimum income to qualify (never understood that...). For a couple it's around $18K. So if you're living off of cash, you still need to show income to qualify.

ACA is not Medicaid. ACA is a health care program that provides subsidies to help offset the costs of premiums, to people who fall under a certain income level. If you fall below a certain income level, you qualify for Medicaid - which is MUCH more comprehensive than regular health insurance, and has no premiums, deductibles, or maxes.

If your income is at a certain minimum, you don't qualify for Medicaid - but you DO qualify for subsidies on the regular health insurance market, which is the "Healthcare Marketplace" with ACA subsidies.

Your subsidy, if any, will depend on your income. Up north my subsidy covered 100% of my premium, and I was able to get a really great health care plan with it.

Down here, it covered all but $200 of my monthly premium, but the best plan I could find wasn't all that great. It changes every year, our income has changed every year. This year the premium was only $17/month. Until hubby went on Medicare because he turned 65. Now, not only does he have to pay HIS $170 premium out of his social security check, I have to pay $150 for the same plan I had last month for only $17.

So this year, he gets a much better plan, comprehensive, with fitness center membership, a quarterly deposit into an OTC payment card, and so on. And I'm stuck with sub-par health care for almost 10x as much as we paid only a month ago.

[wayneman]

I have to kindly disagree. I have Florida Blue select and every one of my MD's are on it. It is a local plan which can also be used at shands. My cobra from UF health was $925/month. Got gold plan for $450. Being in healthcare for 40yrs i don't go cheap on healthcare. Medical bills can bankrupt you in a hurry. Also realize if you have a spouse, their income also counts. So you have to figure that in when you do your calculations. Most people I know keep their employer plans and often keep them into their Medicare supplement plans. We did not have an employer plan available to us, so we use the ACA Healthcare exchange where you cannot be denied coverage. We are full-time Florida residents so we use Healthcare.gov site. It's the only place you can get an ACA plan and be considered for subsidies. If you are another state's resident, it may be different and the plans may not be accepted around here. We selected one of the least expensive Florida Blue Select Bronze plans. The premium per person on this plan for ages in the The low sixties is approx $900 per month per person. There is very little choice besides Florida Blue - there is Ambetter and there might be another plan like Kaiser strict HMO.
I have found that the Florida Blue Select plan is not accepted around here. I have not found one place that accepts it. It apparently pays providers less than other Florida Blue plans. But we are pretty healthy and self pay for our office visits since our deductible is extremely high like $6K. It helps a little with Rx and bloodwork.
Changes occur regularly like income limits, subsidies, etc so be careful.
Good luck!

[Craig Vernon]

Following...

[rustyp]

Following...

Craig FYI - respondents keep advising you of how well they like their Florida XYZ plan. Just a reminder again you cannot get a Florida plan unless you are a resident.

[Laura Pintar]

My financial planner mentioned looking into health care exchanges instead of locking in subsidized coverage through my existing employer. The coverage available to my wife and I is around 900 per month for Anthem PPO. What is your experience? Deal or No Deal?

If your under 65 like me, the premium is based on your income so be careful, more you make, more it costs. I would compare your existing employer costs for you both to the Florida blue plan and see what is cheaper, but once you discontinue your employer plan, usually you can't go back to it.