UPDATED: Health Insurance, before Medicare

[Engineer1911]

I am appreciative of the knowledge and expertise of members of this Forum. My wife is retiring in September 2019 at age 62. She is in excellent health with no medications or significant health issues. The bad news is she has 40+ years working in medical offices dealing with health insurance payments to doctors and facilities.

We are trying to find an "affordable plan" to cover her insurance needs until she turns 65 and has Medicare. She has heard all the stories about $1,000 per month premiums with $6,000 + deductibles. Her current employer 401K would cover that premium for 3 years, but is there a better solution?

If you don't want to post your response, please send a private message or an email to me. I am seeking information or advice from the members and their personal solution to this problem. Please don't attack the current system or the government, we are well aware of the cost versus short comings of the health insurance industry today.

Thank you,
Bob

UPDATE: My wife took the COBRA company insurance until January 1, 2020 for the bargain price of ~$750 per month. Beginning January 1, 2020 she joined a "cost sharing plan" for about $450 per month with 'reasonable' deductibles. The biggest plus was the comprehensive, low cost annual physical. She is in good health, so it is a "low risk" option.

I thank all of you for your responses and PMs. It is true, "There is no affordable health insurance now." I had essentially the same coverage as COBRA insurance for 16 months for $280 per month from my last employer.

 

[Bullet Bob]

Bob, I don't have a definitive answer for you, but in this type of situation I almost always recommend your state's State Health Insurance Assistance Program (SHIP) office. I've never dealt with Georgia, but the three states I do have some familiarity with are excellent.

There's no cost, and since it's a state office they're not trying to sell you anything. Usually you can set up an in-person appointment with a representative near you.

Good luck.

 

[HOUSTON RICK]

The rules for individual healthcare (effectively self insurance with a premium) after the Obama debacle are draconian. The government exchanges were a complete joke when it comes to preventative care to me. That is what we used to call hospitalization insurance, not health insurance. Maybe good for a quadruple bypass, but nothing for the care and pills to prevent it ever being necessary. You will receive zero respect at any medical provider, your "insurance" will not cover anything, everything even things that they obviously will cover eventually will be denied several times to keep your money, and the doctors do not want to bother and will bill you directly. Perhaps most importantly, you can only change to new plans during certain enrollment dates. You cannot just go with whatever you want to buy. I have found so far that many persons involved in selling and providing individual health insurance are simply liars if not completely ignorant. I cannot accurately phrase it more kindly. If you do not read it in the contract, you do not get it, and only then with a lawyer. The song "money for nothing" comes to mind. If I have not made this clear, if there is any way to stay in a group plan, including COBRA, it will be infinitely better at twice the price. The time that I spent on individual health insurance was the single worst, bar none, consumer experience of my life. There are good plans out there, but as said you must have a qualifying life event or be within a (brief) enrollment period to get in. Know what you are getting, know how and when you can get it. If Cobra is available, and your coverage has been good, that might be your best plan. Please let me know if I have been ambiguous. Good luck!

 

[LoboGunLeather]

Unfortunately there are no good options. Your wife's employer plan mentioned is probably the best alternative; at least with the retirement plan picking up that basic policy coverage it leaves you folks exposed only for the deductible and co-pays, probably some prescription costs. Those costs are potentially high, but when compared to another 3 years (until Medicare eligibility at 65) of private insurance premiums the risk may be relatively small.

My brother-in-law and his wife (age 63) live in a state where there is only one participating insurance company in the approved exchange. They have been quoted a premium of $3100 monthly for a basic major medical policy with 30% co-pay and $10,000 deductible. They are now completely "self-insured" (100% at risk).

My wife was able to do a Cobra conversion of her employer plan when she was suddenly "retired" due to downsizing. Cost us about $350 per month. Then the Affordable Care Act kicked in and we were paying $1342 per month (one person) for 70/30 major medical with $8000 deductible. When she had surgery about 3 years ago I took a check for $31,000 to the hospital business office, then spent several months writing checks to surgeons, anesthesiologists, oncologists and other providers on top of everything else (cost us right at $40,000 overall). When she turned 65 and qualified for Medicare ($123 per month premium) we added a good supplemental policy ($357 per month), and we felt the weight of the world taken off our retirement savings plans!

Again, no really good options. Just have to get the best you can and hope you can afford the deductible and co-pays, at least until Medicare enrollment time.

 

[johngalt]

Consider looking at off-exchange plans, they may be slightly better (or more accurately, less terrible). They aren't eligible for any subsidies though.

I get mine through an insurance company that is owned by the local hospital. The provider network is narrow, but it is probably the best hospital in the area. The insurance has been honored without difficulty for the minor issues I've had so far.

One item on my wishlist is a plan that includes the Mayo clinic. Bad news - there isn't any, at any price. I have to pay cash to go there.

Another option is one of the sharing ministries. I signed up with Christian Care Ministry as a backup plan. I have not used it for anything, so I don't know how well it actually works. I did a lot of research before joining, and near as I can tell it isn't a scam. They do NOT cover pre-existing conditions though. On the plus side they are much less expensive and have a far greater choice of providers, on par with a big company group plan.

But if she has a choice, don't retire until eligible for Medicare. That is the sad reality of life in the U.S.

 

[df06]

I retired at 61. Had to pay $1000 plus per month till Medicare kicked in. But before Medicare kicked in, obama care came about. Contrary to what was stated, I did not get to keep my policy, it was cancelled. My premium on a new policy went up a couple hundred dollars a month, the deductibles tripled.
I wish you luck in finding an affordable policy.

 

[H Richard]

Normally the "COBRA" from her group plan would be the best plan, but I would recommend a good Senior Insurance Specialist. Having worked in a Dr.'s office she may know of some in her area. These agents have access to numerous plans and may have one that will fit you best.

 

[Salty RI]

When I retired at age 58 I kept the Ins from my employer, we had one of the best BC plans, all it cost me was 386 .00 a year, but it cost me 600.00 a month for my wife and went up over a 100.00 a month every year. [emoji46]

Sent from my LGL52VL using Tapatalk

 

[4barrel]

These folks all have good advice and I suggest you look into all the options available to you. Just because your wife is in excellent health now definitely doesn't mean she will stay that way. I can't recommend any particular coverage per se but I highly recommend you do not gamble and go without coverage until she gets Medicare. Get the best coverage you can afford even if you have to grit your teeth and dip into her 401K.

The reason I say this is what we ran into with my wife. She retired extremely early at age 50 and was also in excellent health. At the time we were lucky in that her employer still paid for full coverage until she reached Medicare age. At around 60 she began having health issues that were extremely costly. There is no way we could have paid for them.

When she reached Medicare age her employer dropped her coverage so we chose a Plan F supplement even though it was more expensive. However, with it we are out no expense save for the coverage itself which now runs about $200 a month (but rises a little every year). The point is, it's all a **** shoot so what is appropriate for one is not necessarily right for the next guy.

 

[hoc9sw]

I took my company's COBRA offering. Yes, expensive (but less than anything in the public market), but it had exactly the same coverage as I had before, and my in-network providers / records continued (I am a cancer patient, and see at least one specialist a week even in the good times). I timed my retirement to have enough COBRA to get me to Medicare. COBRA is generally good for 18 months in most cases.

You might also want to look at picking up some AFLAC coverage. I have the cancer policy, and it has been a real blessing.

 

[hoc9sw]

Also remember that although she won't have to pay a penalty, she will (potentially) have to pay regular income tax on the 401K withdrawals.

 

[Grayfox]

Find yourself an independent insurance agent who specializes in health insurance. They'll shop around and get you the best deal.
Not sure if it will help in your situation, but mine got me a great deal on Medicare supplements. If nothing else, they are the experts and time spent talking to one will be well spent.

 

[Golddollar]

I retired at 63 1/2 at the end of 2015. Upon the good counsel of the office manager, I made sure to get a private policy to maintain continuity of coverage. The deductible was 0, and it got me through the two heart surgeries I had right after I retired. But then that policy was cancelled, and the replacement policy that was offered had a deductible of $4500.00. So in 2017, a mere 3 months before Medicare kicked in, I basically paid for my arthroscopic knee surgery by myself. It cost enough to, for the first time, qualify me for a medical expense deduction on my Federal income tax. That's all I feel I can say.

 

[H Richard]

Another thing to keep in mind, is a COBRA plan is a continuation of yur existing plan, and pre-existing conditions remain covered. If you take out an entirely new plan, any pre-existing may not be covered.

As you get on to Medicare, and your Supplement plan goes up some every year, don't overlook "shopping" for plans every year in the Oct 15 to Dec 15 open enrollment period. All Supplement plans have exactly the same coverage (under Government Regulations) but the premiums aren't the same. I just changed my supplement last fall, and it saved me nearly $800 per year in premium costs.

 

[pharmer]

Unfortunately there are no good options. .

That about sums it up. I'm almost 66 and working full time. "Health Plan" is "self-insured." They pay a "name brand" insurance co to deny just about everything. $700 yr personal, almost $7K hospital deductible. I'm paying the $135.50/mo out of pocket for Medicare A&B. Can't afford to use provided "Health insurance." I had a $16K, 6 hr trip to the ER last year that costs me $78/ mo until almost 2021 and no, none of it counts toward this year's deductible. Best advice is shop around, you can pay less for the same coverage. Joe