Short Term Health Insurance regulation changes - good for age 62 retirement?

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David Jay
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Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

Revisions in the short term health care program look like they may plug the age 62 retirement - age 65 Medicare gap. The revised regulations allow policies to be a year long and allow 2 renewals (I.e. 36 month coverage). They are not required to cover pre-existing conditions but if you are coming off of a company provided health care plan it should be easy to provide to document your current state of health.

Details here: https://www.nytimes.com/2018/08/01/us/p ... rance.html
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by anonenigma »

Ask yourself, "Do I feel lucky?"

There's a reason that premiums are much higher for people in their 50s and 60s than in their 30s and 50s.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by adamthesmythe »

As you get older it becomes more likely that you will develop an expensive medical condition. My understanding is that these plans have limits on coverage. I also thought there was no guaranteed renewal- an important consideration if you develop an expensive chronic condition.

In my opinion, these plans are for those who are severely financially challenged and don't have any other choices. And presumably have little in the way of savings to lose.

And maybe for those who just feel lucky. Do you?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

Stepping outside the ACA means going back to the buyer-beware days. Check your policy carefully for the coverage required by the ACA
https://familiesusa.org/blog/10-essenti ... must-cover

Lifetime maximum benefits?

Please check to be sure that outpatient treatments and procedures are covered (chemotherapy? radiation therapy? surgery?). Oftentimes people do not realize until they're in the situation, how much is done on an outpatient basis, and that the cost of these treatments can bankrupt you very quickly.

At your own risk, aka, do you feel lucky?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

InMyDreams wrote: Wed Aug 22, 2018 12:24 amStepping outside the ACA means going back to the buyer-beware days.
I loved the "buyer beware" days when one could purchase exactly the insurance coverage they sought. I need a "Major Medical" (as they used to be called) policy to protect against a catastrophic illness for 3 years.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by magazinewriter »

Good luck if you go that route. I’d be afraid that my policy would not be renewed if I got sick.

If you feel that you can’t afford the ACA premiums, maybe take another look at whether you are ready to retire. Might be better to stick with your company policy.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

David Jay wrote: Wed Aug 22, 2018 7:57 am I need a "Major Medical" (as they used to be called) policy to protect against a catastrophic illness for 3 years.
Just make sure that what you consider "Major Medical" is what the policy says. I've mentioned on another thread (which might be good for you to read if you haven't already) - a man who was about to start his first day of cancer treatment, on the phone with the financial assistance department, saying, yeah, I just found out that my insurance doesn't cover outpatient chemo or radiation treatment. I'll need to work out a payment plan.

In the good ol' days, most people didn't realize what wasn't covered until they needed it.

Major medical doesn't kick in if the treatment is not covered.

This is the other thread
viewtopic.php?f=2&t=256436

I think that thread may also mention the affiliation-based funding? Often associated with a religious group. Something else to look at.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

InMyDreams wrote: Wed Aug 22, 2018 9:41 am I think that thread may also mention the affiliation-based funding? Often associated with a religious group. Something else to look at.
I've looked at that, I am just exploring all the options.

Michigan has the Medicaid expansion, so I can get coverage for hundreds of dollar a year if I take living expenses out of our Roth accounts and show less than $1800 a month in income. The problem is that my long term (30+ years) employer would like me to consult after retirement and I am looking at ways to do that.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

BTW - HC insurance post FIRE is a frequent topic of conversation on MrMoneyMustache.com. You might want to look at their site, as well. These peeps are usually on ACA, but concerned about its demise. Solutions include moving to a state that offers guaranteed issue or moving to a country with affordable health care.

Seems like you're most likely to get consulting work in the first year or so post-retirement. Maybe after that you could switch to the medicaid option - and cash out from taxable retirement accounts during this year and the first year to build up a cash reserve to live off of in subsequent years.

Not that I haven't been thinkin' about this...
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

InMyDreams wrote: Wed Aug 22, 2018 10:31 am BTW - HC insurance post FIRE is a frequent topic of conversation on MrMoneyMustache.com. You might want to look at their site, as well. These peeps are usually on ACA, but concerned about its demise. Solutions include moving to a state that offers guaranteed issue or moving to a country with affordable health care.

Seems like you're most likely to get consulting work in the first year or so post-retirement. Maybe after that you could switch to the medicaid option - and cash out from taxable retirement accounts during this year and the first year to build up a cash reserve to live off of in subsequent years.

Not that I haven't been thinkin' about this...
Yea, I am thinking through those issues, the MMM crowd typically wants more than 3 years of coverage. I can get into Medicaid expansion within a month of ending W-2 income, so my choices while working part time look like: COBRA, ACA, Short Term or Medi-Share. ACA enrollment doesn't line up well with preferred my retirement date.

I probably need a contract with employer to assure enough income to more than offset the cost of insurance. Don't want to work for free (or worse).
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by Rupert »

David Jay wrote: Wed Aug 22, 2018 10:47 am
InMyDreams wrote: Wed Aug 22, 2018 10:31 am BTW - HC insurance post FIRE is a frequent topic of conversation on MrMoneyMustache.com. You might want to look at their site, as well. These peeps are usually on ACA, but concerned about its demise. Solutions include moving to a state that offers guaranteed issue or moving to a country with affordable health care.

Seems like you're most likely to get consulting work in the first year or so post-retirement. Maybe after that you could switch to the medicaid option - and cash out from taxable retirement accounts during this year and the first year to build up a cash reserve to live off of in subsequent years.

Not that I haven't been thinkin' about this...
Yea, I am thinking through those issues, the MMM crowd typically wants more than 3 years of coverage. I can get into Medicaid expansion within a month of ending W-2 income, so my choices while working part time look like: COBRA, ACA, Short Term or Medi-Share. ACA enrollment doesn't line up well with preferred my retirement date.

I probably need a contract with employer to assure enough income to more than offset the cost of insurance. Don't want to work for free (or worse).
Pretty sure retirement is a qualifying event that would allow you to enroll in ACA outside the open enrollment period.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

Rupert wrote: Wed Aug 22, 2018 10:58 am Pretty sure retirement is a qualifying event that would allow you to enroll in ACA outside the open enrollment period.
Yup, just discovered that a few minutes ago.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by bhsince87 »

You should be able to get COBRA for 18 months. I'd be tempted to go that route, and bank up cash/bonds in taxable during that time. Even pull from 401k/IRA if need be.

Then at least you have Medicare as an option. WHo knows what ACA might look like by then, but it might be an even better option at that point.

Worst case, the short term plans for another 18 months might not be bad. As others have said, just read the fine print.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

bhsince87 wrote: Wed Aug 22, 2018 3:14 pm ...the short term plans for another 18 months might not be bad. As others have said, just read the fine print.
hmm, I didn't mean to give that impression. To be blunt - I do think it's a bad choice. I thought that other posts also had the same underlying tone (do you feel lucky?) , but they need to speak for themselves.

I haven't checked it out, but my assumption has been that retirement did not qualify you for COBRA. I don't think that would make a difference for my plans, but does anyone know for certain?

However, if you remain an employee, but work under benefited hours, I believe that will qualify for COBRA. I think that's where I'm headed.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by RickBoglehead »

Edit -

So you feel it is ok for Michigan Taxpayers to supplement your medical costs (expanded Medicaid) despite having at least $700k in assets per your other posts?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by nisiprius »

David Jay wrote: Tue Aug 21, 2018 9:16 pm...if you are coming off of a company provided health care plan it should be easy to provide to document your current state of health...
What happens if you have an asymptomatic pre-existing condition that is not diagnosed or treated, until you a) go onto the short-term plan and it b) becomes symptomatic and c) gets discovered, diagnosed, and treated?

Prostate cancer would be one obvious example of a condition that can exist for over a decade with no symptoms at all.

And when found, the insurer could easily say that, based on the stage it is in, every doctor would agree that it must have been a pre-existing condition at the time you bought the policy?

Do you know of laws that would make this scenario impossible, or do you assume that an insurer would never do anything like that?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by JBTX »

RickBoglehead wrote: Wed Aug 22, 2018 6:18 pm Edit -

So you feel it is ok for Michigan Taxpayers to supplement your medical costs (expanded Medicaid) despite having at least $700k in assets per your other posts?
While what you are saying is technically true, Medicaid expansion is primarily funded by federal govt. I think they fund 90% and state funds 10%. But your point remains valid. However the same can be said, maybe to a lesser degree, if you get ACA subsidies.

With the removal of the individual mandate we will be seeing more of these types of threads.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

RickBoglehead wrote: Wed Aug 22, 2018 6:18 pm Edit -

So you feel it is ok for Michigan Taxpayers to supplement your medical costs (expanded Medicaid) despite having at least $700k in assets per your other posts?
The governor and the state legislators determined that Michigan should offer the Medicaid expansion under the ACA. Would you be equally offended if I took a subsidy for a policy through the ACA exchange? It appears that I can get a great deal on a “Bronze” policy.

Do you overpay your state and federal taxes or do you take all of the exemptions and deductions that the law allows? Do you feel it is okay for other taxpayers to underwrite your deductions?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

This thread has become really fascinating.

I should not purchase a short term, high deductible policy with my own money - too much risk. I should not have other taxpayers subsidize my ACA access to health care. I didn’t work for a Megacorp or Government that provides continued health care in retirement. COBRA doesn’t last for 3 years. I’m open to suggestions as to how I get from 62 to Medicare without risking my retirement portfolio due to a catastrophic health care event.
Last edited by David Jay on Wed Aug 22, 2018 7:52 pm, edited 1 time in total.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by samsoes »

RickBoglehead wrote: Wed Aug 22, 2018 6:18 pm Edit -

So you feel it is ok for Michigan Taxpayers to supplement your medical costs (expanded Medicaid) despite having at least $700k in assets per your other posts?
Why shouldn't he?

I take every possible legal deduction and tax break my magnanimous state and federal governments make available to me, don't you? I also carefully track and pay my Use Tax.

But not a dollar more, in either case.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by TravelGeek »

David Jay wrote: Wed Aug 22, 2018 7:57 am I loved the "buyer beware" days when one could purchase exactly the insurance coverage they sought.
Except that my recollection is that not (every)one could simply purchase exactly the insurance coverage they sought prior to ACA.

The key problem with short term insurance plans is that they are more limited in their coverage and you have no guarantee of renewal. I don’t know if it would work for you, but I don’t think it is an option I will likely consider (I want iron clad pre-existing conditions coverage, and 3 years isn’t enough for me anyway; my gap to Medicare is much larger).
InMyDreams wrote: Wed Aug 22, 2018 6:13 pm I haven't checked it out, but my assumption has been that retirement did not qualify you for COBRA. I don't think that would make a difference for my plans, but does anyone know for certain?
Voluntary termination (incl. retirement) is a qualifying event for COBRA if your employer is required to provide COBRA. See for example:

https://www.dol.gov/agencies/ebsa/about ... compliance
Q4: Who is entitled to benefits under COBRA?
There are 3 elements to qualifying for COBRA benefits. COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:

Plan Coverage - Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction on an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full-time.

...

Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.

The qualifying events for employees are:

- Voluntary or involuntary termination of employment for reasons other than gross misconduct


...
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by JoeRetire »

David Jay wrote: Wed Aug 22, 2018 7:57 am
InMyDreams wrote: Wed Aug 22, 2018 12:24 amStepping outside the ACA means going back to the buyer-beware days.
I loved the "buyer beware" days when one could purchase exactly the insurance coverage they sought.
Unless you couldn't due to pre-existing conditions, lack of affordability, or lack of products tailored to your specific desires.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by John88 »

RickBoglehead wrote: Wed Aug 22, 2018 6:18 pm Edit -

So you feel it is ok for Michigan Taxpayers to supplement your medical costs (expanded Medicaid) despite having at least $700k in assets per your other posts?
In California assets are not considered for magi Medicaid only for pre ACA Medicaid
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by adamthesmythe »

David Jay wrote: Wed Aug 22, 2018 7:03 pm This thread has become really fascinating.

I should not purchase a short term, high deductible policy with my own money - too much risk. I should not have other taxpayers subsidize my ACA access to health care. I didn’t work for a Megacorp or Government that provides continued health care in retirement. COBRA doesn’t last for 3 years. I’m open to suggestions as to how I get from 62 to Medicare without risking my retirement portfolio due to a catastrophic health care event.
The ACA with subsidy is a legal and valid option, although its continued existence is somewhat uncertain. It may in fact be the only possible option for some.

I don't buy the argument that there is something wrong with taking advantage of this legal option. Indeed, one reason why it is highly subsidized is that a relatively well thought out plan to require most to people to buy insurance was removed. This, to be blunt, was a transparent attempt to make things look worse than they needed to be.

The fact is, most of the options available are bad (in the sense of being risky). You (we) are not guaranteed access to good health care at reasonable cost- at least not until 65. Given the uncertainties of the ACA, the best option for the truly risk-averse is to work to 63.5 or 65, depending.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by OnTrack »

magazinewriter wrote: Wed Aug 22, 2018 7:59 am Good luck if you go that route. I’d be afraid that my policy would not be renewed if I got sick.

If you feel that you can’t afford the ACA premiums, maybe take another look at whether you are ready to retire. Might be better to stick with your company policy.
If it is not renewed, couldn't he enroll in ACA? I'm assuming the renewal would be once each year and coincide with ACA open enrollment (which might not be valid assumptions?).
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

adamthesmythe wrote: Wed Aug 22, 2018 10:04 pm ...the best option for the truly risk-averse is to work to 63.5 or 65, depending.
I am risk averse to dying with my boots on, as my father did...
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

In looking at short-term policies available, some seemed so cheap. Then when you read the details, they don't cover any prescriptions, have 10k limits, etc. I am curious (if they exist) what a short-term plan that actually covers things costs. I am also curious how strict they are about pre-existing conditions (or what constitutes one).
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by HueyLD »

My actual experience with short term insurance was not good.

I went to a specialist for a new condition but the insurance company insisted that I should have known the issue and declared it a pre-existing condition not covered by the insurance.

Fortunately, my physician documented the condition as "new" and I was able to fight the insurance company for the rightful coverage. The insurance company ignored me until I filed a complaint with their state's insurance regulatory agency.

In other words, the so-called short term insurance with very limited and no pre-existing coverage is worthless to me.

YMMV.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

michaeljc70 wrote: Thu Aug 23, 2018 10:18 am In looking at short-term policies available, some seemed so cheap. Then when you read the details, they don't cover any prescriptions, have 10k limits, etc. I am curious (if they exist) what a short-term plan that actually covers things costs. I am also curious how strict they are about pre-existing conditions (or what constitutes one).
The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

David Jay wrote: Thu Aug 23, 2018 11:44 am
michaeljc70 wrote: Thu Aug 23, 2018 10:18 am In looking at short-term policies available, some seemed so cheap. Then when you read the details, they don't cover any prescriptions, have 10k limits, etc. I am curious (if they exist) what a short-term plan that actually covers things costs. I am also curious how strict they are about pre-existing conditions (or what constitutes one).
The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
Does that cover prescription drugs? I noticed when looking a lot of the cheaper plans don't. I'm not on any prescriptions, but certain things you can get can have extremely high drug costs. None of the plans I looked at under $500 (for 2 people in their 40s) covered prescriptions.

Another thing is, do you get a discount like you do with regular insurance (before the plan kicks in after deductible)? I haven't really heard of any of these short-term companies names before. I don't know if they have networks and if so, how the discounts are. I had a minor outpatient procedure last month. The billed cost was $30k but after the BCBS discount it was $6.5k.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

michaeljc70 wrote: Thu Aug 23, 2018 12:44 pm
David Jay wrote: Thu Aug 23, 2018 11:44 am
michaeljc70 wrote: Thu Aug 23, 2018 10:18 am In looking at short-term policies available, some seemed so cheap. Then when you read the details, they don't cover any prescriptions, have 10k limits, etc. I am curious (if they exist) what a short-term plan that actually covers things costs. I am also curious how strict they are about pre-existing conditions (or what constitutes one).
The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
Does that cover prescription drugs? I noticed when looking a lot of the cheaper plans don't. I'm not on any prescriptions, but certain things you can get can have extremely high drug costs. None of the plans I looked at under $500 (for 2 people in their 40s) covered prescriptions.

Another thing is, do you get a discount like you do with regular insurance (before the plan kicks in after deductible)? I haven't really heard of any of these short-term companies names before. I don't know if they have networks and if so, how the discounts are. I had a minor outpatient procedure last month. The billed cost was $30k but after the BCBS discount it was $6.5k.
The policy I looked at is with a major benefits company in this part of the state (Priority Health), so I sure that they have networks and discounts.

The policy basically covers NOTHING until you spend $2500 out-of-pocket. This is true, classic insurance (like fire insurance) where I hope to never file a claim.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

David Jay wrote: Thu Aug 23, 2018 11:44 am The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
Is it online? Can you give a link to it?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by Rupert »

David Jay wrote: Thu Aug 23, 2018 2:18 pm
The policy I looked at is with a major benefits company in this part of the state (Priority Health), so I sure that they have networks and discounts.

The policy basically covers NOTHING until you spend $2500 out-of-pocket. This is true, classic insurance (like fire insurance) where I hope to never file a claim.
The problem I would have with that policy is this language: "This plan does not cover pre-existing conditions. Benefits will be excluded for each illness, injury or condition for which, during the five year period prior to your effective date, medical advice, diagnosis, care or treatment was recommended or received." It also doesn't cover transplants or any preventive services. What happens if you enroll in the 3-month plan, have a major heart attack near the end of the 3-month period, need heart surgery, and can't enroll in the ACA because it isn't open enrollment?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by Rupert »

InMyDreams wrote: Thu Aug 23, 2018 2:40 pm
David Jay wrote: Thu Aug 23, 2018 11:44 am The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
Is it online? Can you give a link to it?
Yes, it's online. Here's a link: https://www.priorityhealth.com/plans/in ... term-plans

You have to click through the pricing link and enter some data (I made some up) to get the plan details.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by boomer »

David Jay, I am also looking at a policy like this. I have already retired and have been on my spouse's policy. However, he will be retiring soon and I will need two year's coverage. I can't meet the income requirement for a discount on ACA insurance. I just need worse case scenario coverage as I feel very healthy.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

Rupert wrote: Thu Aug 23, 2018 2:42 pm
InMyDreams wrote: Thu Aug 23, 2018 2:40 pm
David Jay wrote: Thu Aug 23, 2018 11:44 am The policy I am looking at has a $2M cap and a 2500 deductible per spouse. I am only concerned about not being bankrupted by a major illness or injury, not looking for first dollar coverage so this is a good fit.

Cost is about $300 a month. By comparison, a "Bronze" plan with a $6000 deductible (each) is about $1200 a month.
Is it online? Can you give a link to it?
Yes, it's online. Here's a link: https://www.priorityhealth.com/plans/in ... term-plans

You have to click through the pricing link and enter some data (I made some up) to get the plan details.
"Members get the Priority Health discount which is significantly lower than retail."

I wonder what the discount is on a drug that costs $30,000 a year?

Other than that, it looks okay. I'd also be worried about pre-existing conditions. Usually the policy says something that it isn't only things you have been treated for but things that a reasonable person would have sought treatment for.
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boomer
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by boomer »

Am I missing something? Why wouldn't it cover a heart attack?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
I think they are saying it is the end of your policy (you cannot renew these short-term plans forever) and you have the heart attack. Say your policy ends on 9/30 and the heart attack (or whatever) occurs on 9/29. You missed ACA enrollment for October (typically 15th of the prior month if you have a qualifying event) and will have no coverage 10/1-10/31.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by Rupert »

boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
No, I asked about heart surgery after a heart attack occurring near the end of the coverage period. But that's just an example. It could just as easily be chemotherapy that you need following a cancer diagnosis that occurred during the coverage period. The way these policies usually work is you have to renew them every month, 2 months or 3 months. If you develop a condition during one of those coverage periods, then you now have a pre-existing condition that won't be covered during the next coverage period. So you sign up for 3 months, are diagnosed during the 3 months, and now that condition won't be covered if you renew for 3 more months.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

somehow I managed to skip entering any details, and downloaded what I believe is details of a ACA compliant plan, and a comparable non-ACA plan, each documents' title:
mypriority-silver-3200-spectrum-health-partners-sbc.pdf
mypriority-silver-3200-sbc.pdf

So, it's interesting to look at the items that are specifically mentioned in the first plan (which I think is ACA compliant) that are not mentioned in the second, such as
Home Health Care
Rehab (not just drug rehab, but OT/PT)
Skilled Nursing Care (in a facility)
DME (Durable Medical Equipment)

Not mentioned in either document is the outpatient (or home) treatment for cancer.

I'd suggest asking the insurer for details about all of the above.

And, altho you might think you would never need an extended stay in a Rehab facility/Skilled Nursing Facility - remember, you're looking at protecting yourself from catastrophic situations. If you are involved in a motor vehicle accident (your fault) or other personal injury (you fell off your roof) or you have a stroke (face it, we're entering an age range that is at increased risk) - then you could land in one of these facilities. And if the insurer simply doesn't have benefit for that kind of care, it's all your to pay.
Last edited by InMyDreams on Thu Aug 23, 2018 3:11 pm, edited 1 time in total.
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David Jay
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

michaeljc70 wrote: Thu Aug 23, 2018 2:57 pm
boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
I think they are saying it is the end of your policy (you cannot renew these short-term plans forever) and you have the heart attack. Say your policy ends on 9/30 and the heart attack (or whatever) occurs on 9/29. You missed ACA enrollment for October (typically 15th of the prior month if you have a qualifying event) and will have no coverage 10/1-10/31.
Three points:
1. One year plans are coming, per a conversation with Priority Health today. They expect to have them available by the end of the year (before my retirement date). The revised HHS rule allows for 2 renewals (3 years total). That was the original point of my post.
2. In Michigan they have the Medicaid expansion, you qualify after 30 days. Show <$1800 income (a good reason to have a nice Roth balance) and you are in.
3. In my case (not necessarily in Boomer's case), I am eligible for Medicare by the end of the final renewal.
Last edited by David Jay on Thu Aug 23, 2018 3:08 pm, edited 1 time in total.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

David Jay wrote: Thu Aug 23, 2018 3:05 pm
michaeljc70 wrote: Thu Aug 23, 2018 2:57 pm
boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
I think they are saying it is the end of your policy (you cannot renew these short-term plans forever) and you have the heart attack. Say your policy ends on 9/30 and the heart attack (or whatever) occurs on 9/29. You missed ACA enrollment for October (typically 15th of the prior month if you have a qualifying event) and will have no coverage 10/1-10/31.
Two points:
1. One year plans are coming, per a conversation with Priority Health today. They expect to have them available by the end of the year (before my retirement date). The revised HHS rule allows for 2 renewals (3 years total). That was the original point of my post.
2. In Michigan they have the Medicaid expansion, you qualify after 30 days. Show <$1800 income (a good reason to have a nice Roth balance) and you are in.
If your income can be made that low, why not just get an ACA plan with a subsidy?
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

michaeljc70 wrote: Thu Aug 23, 2018 3:08 pm
David Jay wrote: Thu Aug 23, 2018 3:05 pm
michaeljc70 wrote: Thu Aug 23, 2018 2:57 pm
boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
I think they are saying it is the end of your policy (you cannot renew these short-term plans forever) and you have the heart attack. Say your policy ends on 9/30 and the heart attack (or whatever) occurs on 9/29. You missed ACA enrollment for October (typically 15th of the prior month if you have a qualifying event) and will have no coverage 10/1-10/31.
Two points:
1. One year plans are coming, per a conversation with Priority Health today. They expect to have them available by the end of the year (before my retirement date). The revised HHS rule allows for 2 renewals (3 years total). That was the original point of my post.
2. In Michigan they have the Medicaid expansion, you qualify after 30 days. Show <$1800 income (a good reason to have a nice Roth balance) and you are in.
If your income can be made that low, why not just get an ACA plan with a subsidy?
You may have missed some details earlier in the thread. I could qualify for either ACA with subsidy or ACA Medicaid expansion if I choose not to work at all. My company wants me to do some consulting (and I would like to have a gentle entry into retirement) and it will bump my total income over $64,000 (ACA subsidy max) for 2019. I am looking at options that will allow me to work.

Medicaid expansion is the fallback (worst case, stop working 30 days before the 1 year policy expires if they are unwilling to renew due to a condition developing during the 12 months). This solves Rupert's issue (above) of being uninsured at the end of the first (or second) policy term because they won't renew.
Last edited by David Jay on Thu Aug 23, 2018 3:21 pm, edited 1 time in total.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by michaeljc70 »

David Jay wrote: Thu Aug 23, 2018 3:14 pm
michaeljc70 wrote: Thu Aug 23, 2018 3:08 pm
David Jay wrote: Thu Aug 23, 2018 3:05 pm
michaeljc70 wrote: Thu Aug 23, 2018 2:57 pm
boomer wrote: Thu Aug 23, 2018 2:53 pm Am I missing something? Why wouldn't it cover a heart attack?
I think they are saying it is the end of your policy (you cannot renew these short-term plans forever) and you have the heart attack. Say your policy ends on 9/30 and the heart attack (or whatever) occurs on 9/29. You missed ACA enrollment for October (typically 15th of the prior month if you have a qualifying event) and will have no coverage 10/1-10/31.
Two points:
1. One year plans are coming, per a conversation with Priority Health today. They expect to have them available by the end of the year (before my retirement date). The revised HHS rule allows for 2 renewals (3 years total). That was the original point of my post.
2. In Michigan they have the Medicaid expansion, you qualify after 30 days. Show <$1800 income (a good reason to have a nice Roth balance) and you are in.
If your income can be made that low, why not just get an ACA plan with a subsidy?
You may have missed some details earlier in the thread. I could qualify for either ACA with subsidy or ACA Medicaid expansion if I choose not to work at all. My company wants me to do some consulting (and I would like to have a gentle entry into retirement) and it will bump my total income over $64,000 (ACA subsidy max) for 2019. I am looking at options that will allow me to work.

Medicaid expansion is the fallback (worst case, stop working 30 days before the 1 year policy expires if they are unwilling to renew due to a condition developing during the 12 months). This solves Rupert's issue (above) of being uninsured at the end of the policy term.
Okay. The original post and title say retirement. It sounds like you'll still be working.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by curmudgeon »

Personally, I would avoid short term insurance in ER scenario unless I was sure of the renewal regulations/requirements. I wouldn't want to be in the middle of an expensive issue and have the insurance refuse to renew. Of course, many of the options are on somewhat shaky ground. ACA holds together with massive taxpayer subsidies; take those away and the risk pool would fall apart. The medicaid expansion stuff removes the asset tests of the old medicaid, but I've know folks who use it here in California, and the reality (vs the paper coverage) leaves a lot to be desired. We've gone with a bronze HSA ACA plan, which ends up being largely like a major medical ($6K deductible) for us; we don't try to use the "free" services. By keeping our MAGI under the cliff, our premiums are minimal, so we buy this big complex policy that's more than we would choose otherwise, but we don't actually pay for it (directly). I don't necessarily expect the ACA subsidy gravy train to last forever, but I live with what's here now.

It seems like there may also be some options around association-based health plans; you might do some more research on those. I've been holding the "health sharing ministry" plans as my potential fallback, but I suspect if ACA falls apart there may be more bridge options available to someone who has maintained a full coverage policy in the past, so I've stuck with the exchange so far. Right now I'm thinking I may use a short term plan for the part year when I turn 65, but we'll see what things look like when I get there.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by InMyDreams »

Do you need to retire? Can you stay on as a part time employee? There is a less-well-known clause in the ACA that says that an employee that has worked an average of 30hrs/week in the previous Measurement Period, must be allowed to continue to buy health insurance as tho they were still a benefited employee.

"The employee’s status as full time or part time, based on the measurement period, governs the employee’s status for the subsequent stability period, even if the employee’s hours change during the stability period."


https://www.shrm.org/resourcesandtools/ ... riods.aspx

and your employer must have more than 100 employees
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by BarbK »

I'm interested in these new policies also. I haven't found any that quote for a year. I've found United Health Care plans which cost about 1/3 the premium cost of a full pay Bronze ACA plan. Max Benefit is $2M, $10K deductible.

When we both had our crappy ACA bronze plan, our deductible was $12.6K. No one mentioned that that they combine the deductible for a couple. After getting burned the first year, we had individual plans. We paid over $50K for premiums for 2015-2017. Only one year used the negotiated rates but didn't meet the $12.6K deductible anyway. No claims for 2016 or 2017.

Yes, they are crappy insurance, but so are the ACA bronze plans with such limited coverage.

2018 I went on Medicare (Yeah - haven't used that either), but DH is still on ACA and his premium went up a lot in 2018.

---
David Jay - If you are self employed, you are able to deduct all of your Health Care Premiums from your income (provided that your income is more than your premiums).

Does anyone find that taking the subsidy is not cost advantageous vs Roth conversions? In 2018, it seemed possible that we could get a subsidy, but for one it was $400 per month, vs $75-$80K of Roth conversion at 12% tax rate vs later RMDs at assumed 25-28% tax rate.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by David Jay »

BarbK wrote: Thu Aug 23, 2018 3:44 pm I'm interested in these new policies also. I haven't found any that quote for a year. I've found United Health Care plans which cost about 1/3 the premium cost of a full pay Bronze ACA plan. Max Benefit is $2M, $10K deductible.
I called the provider to find out if they would be issuing the new, one year policies (HHS just changed to allow the 1 year policies within the last month or two, most providers haven't got the new policies on their websites).

Deductions aren't a big benefit when your marginal rate is 12%.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by boomer »

Three points:
1. One year plans are coming, per a conversation with Priority Health today. They expect to have them available by the end of the year (before my retirement date). The revised HHS rule allows for 2 renewals (3 years total). That was the original point of my post.
2. In Michigan they have the Medicaid expansion, you qualify after 30 days. Show <$1800 income (a good reason to have a nice Roth balance) and you are in.
3. In my case (not necessarily in Boomer's case), I am eligible for Medicare by the end of the final renewal.
This would work for me, because I need coverage for two years. I may need coverage before the end of the year, though, so I may have to do another plan for a few months.
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Re: Short Term Health Insurance regulation changes - good for age 62 retirement?

Post by nisiprius »

One other detail. Can you actually get to see the contract--not a "summary of benefits" but the actual contract--before you buy the policy?
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