Health Insurance for those under 65
 

Moving in a few weeks to my new home in TV from another state. I am under 65, so too young to qualify for Medicare. My earnings last year exceeded the cap for Obamacare. I will need to get insurance through the Florida exchange. Is this something I should try to navigate on my own through Florida’s healthcare website, or are their brokers I could go to help me choose a plan. I don’t even have a doctor yet in Florida, and need to make sure that the eventual plan I get will be honored by my primary care provider as well as a few specialists (dermatologist and cardiologist) I will see a few times a year.

I would contact SHINE and see if they can help you. They offer free, unbiased advice.

SHINE - Home

Ouch, get ready for some serious financial pain (I share your pain). Unfortunately, somebody has to pay for all the people getting free and highly subsidized insurance. I’m not in any hurry to get older, with the exception that I am highly anticipating becoming eligible for Medicare.

You’re right - in a bizarre sort of way I’m looking forward to turning 65 to become Medicare eligible (still 4 years off). I retired at 59, and my former employer reimburses me each month for a good chunk of my medical premium, so that helps, but I have to find my own coverage on the open market.

Also moving to the Village of Richmond and under Medicare age. Hi neighbor.

Unable to help with the question of where to source plans but can share our experience over the last 3-months.

We were rejected by the Villages Healthcare System because the few primary care doctors that accept non-Medicare patients have a full patient load. We pleaded our case to a “Villages Healthcare Coordinator” but only qualified for one primary care doctor who eventually rejected us anyway because he does not treat patents under age 60.

Exploring in a 5 mile radius outside VHS, we found a few primary care practices that accept new non-medicare patients and we are on a 6-month first appointment waitlist. Until then, we will drive to Lady Lake or use the Urgent Care in Wildwood. For specialty docs, same issues so we will drive outside the 5 mile radius to Lady Lake or Clermont (2 and 3 month waitlists)

We were advised by helpful local sources that United Health is widely accepted but, as luck would have it, one of our preferred docs rejected same. Blue Cross/Shield PPO plans are more costly (for us) but appear to provide greater access to local primary care and specialty doctors accepting non-medicare patients.

Best of luck in your search. I hope you find excellent healthcare.

Also a Michael, age 61!

Luckily the company I retired from supplies insurance at $145 a month. I retired at 56, turning 59 soon so I have a few years before I need to worry about it. Good luck finding something.

1. There's no such thing as "Villages Healthcare System." There is The Villages Health, which is a large group with several locations in The Villages and includes GPs, Internal Medicine doctors, specialists, PAs, their own lab and x-ray machines, and access to other specialists at The Villages Regional Hospital.

2. I just did a quick search on their website and see that Dr. Hugo Boise is welcoming new patients with individual insurance plans.

You can probably also call them directly, since sometimes those websites aren't 100% accurate or up to date.

My wife and I are in the same boat (60 and 63 years old). We logged into healthcare.gov and we eligible for 11 pages of various plans. Thankfully, we were referred to Robert Buckmann with Mid-Florida Agencies. He asked questions about our particular needs and quickly narrowed it down to two plans. You can Google both Robert Buckmann and Mid-Florida Agencies to read what others have to say about them. His number is: (352) 630-9996. He’s only taking referrals now during open enrollment so feel free to use our names (Jerry & Carol Hambley) as an introduction. Good luck!

If he's not available you can ask for Leonel Barron - he just helped me figure out which of the Florida Blue options were best for us. Turns out we've been paying WAY too much for a Silver plan that doesn't cover as much as a cheapo Bronze plan covers. That's on the exchange with our tax credit, based on our income.

Thank you for these referrals - I’ll be transitioning between Colorado and Florida for the next several months, so hanging onto my Colorado coverage until March or so - but want to get the ball rolling now (finding both coverage as as well as a doctor) - Since moving is a life-altering event, I’ll be able to switch out my insurance to Florida when the time comes.

Obamacare eligibility is based upon next year's projected income. Thus looking for insurance for 2023 you project your income for 2023. The risk is if you go over your projection you will owe a penalty. The benefit is based upon "earned income". You should read the definition of earned income in the Obamacare rules. There are ways to limit your next year's income. For example if you are planning on drawing from a retirement account next year consider drawing it out this year. Compare Obamacare benefit to what extra tax will be this year Vs next year which you are going to pay on it anyways but perhaps in a different tax bracket.

Unfortunately, what is considered earned income is not limited to wages and drawing from a taxable retirement account. It also includes interest (including interest from tax exempt municipal bonds), dividends, and realized capital gains (which can be offset by only $3 K in realized capital losses for a couple filing jointly). So as usual, responsible people who saved their money for retirement are penalized by the Obamacare definition of earned income. Many under 65 retirees now have a new dilemma, they should be happy that they can finally earn some interest on their savings, but then learn that the increased interest will be more than offset by the loss of Obamacare tax credits
because the increased interest puts them over the eligibility cap.

Regarding looking for a primary care physician, I don't claim to be better than google. But over time, I have created a list of primary care groups in this area. Maybe this will help a little.

If under 65, you pretty much need to buy a plan listed on Healthcare.gov, which lists the ACA plans, meaning no preexisting conditions and the like. You can buy them off the exchange, but might as well buy them on the exchange in case you qualify for a subsidy. Income limit for subsidy was pretty high lately due to Covid. A broker can help you and will not affect your cost. Expect to pay a high premium (due to age) with an extremely high deductible.

You also have the option of a non-obamacare compliant plan for catastrophic coverage at a lower cost.

Should getting healthcare be this complicated?? Whether it is pre-Medicare or Medicare??

Absolutely not, but you know what happens when the Government gets involved with anything.

Florida blue via healthcare.gov. Decided to take social security early and pay the premium for 2 years. Deferring lots of taxable income was no longer an option. Accepted by villages health without issues

Oh boy, do you speak the truth! I'm having a hard time going for a Bronze plan for my wife but the facts are, the plan is much better than the Silver Plan that they seem to push on us every year. The Silver plan is about double what it was last year. That's a no go for us. It's been smooth sailing for us since this coverage was available. This is the first year I'm struggling to decide. They text and email and now call daily. I guess it's better than letting me forget. I'm not rushing into this decision.

Thanks for sharing OBB. I'm not the only one in the Bronze Boat vs Silver Boat.

I got my butt handed to me back in the day when the Political Forum was up and running. I was always honest about what was going on and others felt the need to criticize instead of helping. It was a long time ago and the ones who buried me are mostly not around anymore for whatever reason. The ones who helped us became good friends. Life is good. We'll figure this out. :mademyday:

Don't miss the Political Forum. The smartest thing they ever did was let it go by the wayside. It was BRUTAL! :faint:

I am on Medicare but wife is not eligible. Can someone give me a ballpark estimate of how much insurance would cost for her? She is in good health. Thanks.

When we lived up north we qualified for free health care via the medicare expansion, after beloved spouse's department closed down, he was out of work and no one would hire him as a new employee for even close enough to what we needed to make ends meet. I was working two part time jobs. His social security wouldn't come for another two years.

Same situation, one year closer to his social security check but not there yet, and we were here in The Villages, having to pay for health insurance for the first time ever in our adult lives (since we both had our own employer-provided health insurance before we met, and between the two of us we always had employer-provided benefits for both of us while we were married). Florida doesn't participate in medicare expansion, so we had to pay for the privilege. So much for a lower cost of living here compared to the north.

Fast forward to this past year, and his SS checks started, and our premiums have been $436/month. We earn less than $40,000 after taxes between social security, pension, and one of us working part time. I can no longer work due to arthritis and bursitis. But neither of my illnesses are considered "disabilities" so I'm also not eligible for social security disability.

I'm due for a hip replacement which will set me back $15,000 AFTER I satisfy the deductible and out of pocket max. PLUS $436/month premium.

So I'll go with the bronze plan, get the 0 deductible, $9100 out of pocket max, 900 pay for ambulance, 1000 for emergency room, and tiddly winks of copays that go toward the out of pocket max for usual and customary visits to doctors. And then I'll get my hip replacement. My total cost will be around $10,000 out of pocket in total, instead of $15,000. Plus my premiums will only be around $150/month. Which gets off-set by the Florida Blue rewards program where you plug in how many days you ate vegetables or got enough sleep or exercised or whatever, and get points toward dollars off the premiums. And then - MY social security will start next year, so my premiums wil go up again. I did some math, estimating tht my premiums wil go up to around $500/month once get my first check. The MdStategroup are pretty terrific though. Very happy to receiieve help from them and recommend them to anyone else seeking information agojt florida BLure. i realze my typing might not be o good right now, sleep meds are kickng in. so goognidht!

I've been paying my own medical insurance since moving here in 2011. It is expensive and with the expansions healthcare professionals will be very in short supply.
I will be happy to be getting Medicare soon.
I have Florida Blue Cross Bronze.
Good Luck.

I'm under medicare age and found Dr's easily in the area, with not the greatest insurance company. Premiere Medical has numerous offices in TV. Believe me TV HC isn't that special, and there is lots of offices with primary care MDs just outside TVs I found a wonderful one in Belleview, being on the Northside, on the South end there is several in Sumterville, Leesburg, and Wildwood. I'm a 29 yr retired nurse and I'm very picky and I've managed to find Drs and have major surgery without much trouble. Just don't focus on TV healthcare.

Florida Blue ( blue cross/blue shield) is available. There is a stand alone Florida Blue store on CR101 on the left side in a strip mall down the block from CVS located on 466

Hard to say. If you go to the Florida Blue website, you can get a pretty accurate estimate. Personally, I retired at 56, I'm now 63, and my 2023 premium will be $17,600 for the year with a $7,000 deductible and no pre-existing conditions. (Bronze plan). I was self-employed, so no employer benefits, don't qualify for "Obamacare", and even if I did, I wouldn't accept it.

I am 58 and was fortunate to be able to keep my health insurance (Humana First Local) at the group rate. Finding providers took a long time though. I go to Leesburg, Clermont,
Ocala Family Medical, and still have a couple doctors down in Clearwater.

Ocala family health

Looking at their site, it appears that SHINE only offers medicare assistance.

There are Florida Blue brokers offices located next to many (perhaps) all The Villages Heath locations. Just walk in and they were very helpful finding, reviewing/comparing plans that met our needs. Wonderful experience!

My situation is chicken s&$t compared to the numbers that you laid down.

Paying for medical coverage thru an employer or the exchange is just sickening. The coverage is for my wife and you know what will happen if I go the cheap way. We’ll get bombed with Doctor Bills.

I think I’ve made mistakes over the last two or three years by not giving more than just a glance at the Bronze plans. I know better and could have investigated much deeper. That’s water under the bridge. This new decision is the one that really counts.

When I compare two different Bronze plans a the same Silver plan we’ve had for about 8 years I can’t believe what I’m looking at. Bronze it is……. I think! Lol

I retired at 57. I paid aprox. $16,000/year for health insurance for me and my wife on my first year of retirement. Then I learned about health sharing plans. They are basically catastrophic plans with a few perks and the cost was $500/month (6,000/yr). With the $10k annual savings, I happily paid for any occasional doctors visits. Also, Quest offers services where you can get deeply discounted blood work which you can order yourself on line. Grassroots also offers this lab service. The health sharing plan I used was Medishare until I found Zion health share (http://www.zionhealthshare.org/), which was better. My income was over the limit for any meaningful healthcare.gov tax credit. The health share plans worked out well for us but we had no pre existing conditions and we are in good health. I am happily over 65 now and on medicare. The time goes by quickly!

Cost
 

Isn't over $1,400/mo premium rather high? Especially having to satisfy a $7,000 deductible?

It doesn't sound high to me.

Sure is. I had the same coverage (actually a $6,000 deductible) in NY for $325/ month. When I moved here in 2015 it jumped to $1,050/ mo and has been going up ever since

Not if you have to by insurance through Obamacare and don’t qualify for federal tax credit subsidies. Before Obamacare I was paying about $350 a month for excellent private insurance with a low deductible and max out of pocket. After Obamacare the monthly premiums skyrocketed along with the deductible and max out of pocket. Somebody has to pay for all the people getting free or highly subsidized insurance.

Obamacare went into existence in 2010. In 2010 the median price of a house was $158700. Today's house median price is $379100.

It was passed in 2010, and then slowly implemented. It wasn't fully in effect until 2016

And the increases in prices were immediate and very substantial.

The insurance plan I'm on now (FloridaBlue BlueSelect Silver 1443) retails at just under $2000 per month. Of course no one actually pays that much, but that's the MSRP for it. I'm charged $436/month for that plan.

It's $12,000 deductible (for the two of us) and $17,400 out of pocket (for the two of us). Our copays are 50% for anything that's covered but not preventative maintenance (which has no copay and no additional cost at all). Prescriptions are $30 each for a month's supply, so I don't bother and get mine at Walmart or Publix without going through insurance at all. Of course that also means that what I /do/ pay for my prescriptions doesn't count toward my deductible.

Last year wasn't nearly as bad, the deductible was lower, the out of pocket was lower, the premium was lower, and the copays were lower. But because hubby's social security checks kicked in, we had to deal with a thing called "cost sharing" and that blew us into a different level, which meant that ALL our costs increased. Not just the premiums (which went from a high of $84 to $436 within a window of two months - approximately a 500% increase even though our income level only went up around 40%), but all our medical expenses covered by insurance.

Welcome to the lower cost of living - where instead of just losing a few bucks out of your paycheck every week, you lose a crapton of money every month to pay for all the things that income tax would've covered. As long as you never get sick or injured, you can absolutely save a fortune in Florida. But god forbid you have an unexplained sneeze - hope you have a lot of money invested, in someone else's name, so the hospital can't take it from you.