Question for pre-ACA Early Retirees and pre-ACA solo folks

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AlwaysWannaLearn
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Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by AlwaysWannaLearn » Thu Jul 12, 2018 12:36 pm

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Last edited by AlwaysWannaLearn on Wed Jul 18, 2018 9:44 pm, edited 2 times in total.

Chris K Jones
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Re: Question for pre-ACA Early Retirees

Post by Chris K Jones » Thu Jul 12, 2018 12:46 pm

I am not a retiree, but I have had non group health policies for about 10 years. Before ACA, people with preexisting conditions in my state could get insurance under most circumstances, but there were riders attached. For example, a coworker's wife had a rider where insurance would not cover skin cancer for her for a year or two because she had a previous diagnosis of skin cancer. Ditto for controlled hypertension. Premiums were also higher for people with certain conditions. I don't remember what the rules were, but I am sure people with some more serious preexisting conditions could not get insurance at all. Hope this helps.

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Cyclesafe
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Re: Question for pre-ACA Early Retirees

Post by Cyclesafe » Thu Jul 12, 2018 1:40 pm

I retired in 2000 at age 45 and promptly applied for medical insurance. My wife and I were grilled over the phone for quite a while about our past medical procedures and lifestyle. As I recall, they didn't like that we were scuba divers, but in the end they sold us a policy. As the years went by, and we remained healthy (quit diving btw) our premium actually WENT down as did our deductible. In fact in the last year of our non-ACA policy we paid only about $10k IIRC with a deductible of $3k. For reference now at 63/64 yo, we pay a non-subsidized $21k with a $10k deductible. We also pay NIIT.) Age 65 can't come soon enough.

Prior to ACA, medical insurance was like auto insurance. Auto insurance doesn't pay if one already has had an accident; prior to ACA medical insurance didn't pay if one was already sick. If there were managed preexisting conditions, the insurance provider offered policies that cost more - sometimes alot more. The customer could reject these higher offers and try again with another company. Eventually, the customer found a compromise policy that somewhat met their needs, or not. I suppose that in the latter case the customer becomes indigent and Medicaid eligible. People went bankrupt, but nobody was dying in the streets either.

DetroitRick
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Re: Question for pre-ACA Early Retirees

Post by DetroitRick » Thu Jul 12, 2018 1:50 pm

I retired from a large, slowly-failing corporation at age 50, end of 2005, well before ACA. At that time, my state had an agreement with Blue Cross where they had mandatory-issue health insurance for all those no longer cobra or employer eligible. Decent coverage, but not cheap. It had been in place for years then, and was expected to continue. As I recall, they had no pre-existing condition exclusions if you could provide evidence of continuous coverage. And I believe they even waived pre-existing for everybody after a 6 month or 1 year period (can't recall which).

So THAT was part of my pre-aca planning process - picking that insurance up after my 2-year cobra ended. I had some mild concern about the pre-existing condition issues, but knew that either continuous coverage or that short exclusion period would suffice for us. Plus, my employer had lousy medical coverage for a big employer anyway (good insurer, mediocre premium rates, lots of coverage restrictions). So, we actually looked forward to the end of the cobra period, knowing I could get better coverage for very close to the same cost. This was obviously not typical, even back then. And during my last years of corporate employment, my employer paid exactly 50% of the full, actual premium - so I was always cognizant of the exact financial impact of going solo.

So, I was fortunate to live somewhere where I knew coverage would be available. And was able to reasonably forecast a few years out beyond the cobra process. I was never naive enough to think I could accurately forecast health coverage costs out beyond that (I can recall assuming around 15% annual rate increases out to Medicare). But I'm adaptable and knew that some options would always exist. ACA made a clear improvement in our situation, and I am grateful for it, but it was never in my original plans. Oddly enough, we're still with the same insurance provider today, as when I was employed. Again, this is not particularly typical, but it worked for us.

Rupert
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Re: Question for pre-ACA Early Retirees

Post by Rupert » Thu Jul 12, 2018 1:54 pm

OP, if you Google the term "job lock," you'll find lots of news stories (and even some studies -- Google "job lock" and "Austin Frakt") containing information about the insurance situation for early retirees pre-ACA. There's fairly robust evidence that pre-existing condition exclusions locked people in jobs longer than they would have liked. Note that HIPAA alleviated the job lock phenomenon somewhat for people looking to change jobs, as opposed to retire early, but only somewhat, as HIPAA permitted pre-existing condition exclusions in employer-sponsored plans for a period of time after a job change under certain conditions. One notable success of the ACA is the extent to which personal bankruptcies have declined since its implementation. See https://www.consumerreports.org/persona ... ankruptcy/ . That tells a story, too. Note also that, pre-ACA, some states did a better job of guaranteeing the insurability of their citizens than others.

One thing that strikes me as I read health insurance threads here at Bogleheads is the fact that people seem to have forgotten this stuff already.

robebibb
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Re: Question for pre-ACA Early Retirees

Post by robebibb » Thu Jul 12, 2018 2:05 pm

Rupert wrote:
Thu Jul 12, 2018 1:54 pm
One notable success of the ACA is the extent to which personal bankruptcies have declined since its implementation (by 50%!). See https://www.consumerreports.org/persona ... ankruptcy/ . That tells a story, too. Note also that, pre-ACA, some states did a better job of guaranteeing the insurability of their citizens than others.

One thing that strikes me as I read health insurance threads here at Bogleheads is the fact that people seem to have forgotten this stuff already.
Correlation does not imply causation. The first 6 months of 2016 were the last months of the Great Recession and IIRC the economy had a very slow recovery from said recession. Implying that the ACA was the cause for the reduction in bankruptcies over this time span is misleading at best.

People with pre-existing health conditions were definately locked into jobs pre ACA but young healthy people responsible enough to purchase individual plans were paying prices multiple times lower than they are now paying under the ACA due to legislated pricing constraints.

Rupert
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Re: Question for pre-ACA Early Retirees

Post by Rupert » Thu Jul 12, 2018 2:06 pm

robebibb wrote:
Thu Jul 12, 2018 2:05 pm
Rupert wrote:
Thu Jul 12, 2018 1:54 pm
One notable success of the ACA is the extent to which personal bankruptcies have declined since its implementation (by 50%!). See https://www.consumerreports.org/persona ... ankruptcy/ . That tells a story, too. Note also that, pre-ACA, some states did a better job of guaranteeing the insurability of their citizens than others.

One thing that strikes me as I read health insurance threads here at Bogleheads is the fact that people seem to have forgotten this stuff already.
Correlation does not imply causation. The first 6 months of 2016 were the last months of the Great Recession and IIRC the economy had a very slow recovery from said recession. Implying that the ACA was the cause for the reduction in bankruptcies over this time span is misleading at best.

People with pre-existing health conditions were definately locked into jobs pre ACA but young healthy people responsible enough to purchase individual plans were paying prices multiple times lower than they are now paying under the ACA due to legislated pricing constraints.
Yes, I amended my comment to remove the 50% figure, as the ACA is only one of three possible causes for the decline in bankruptcies. Experts do attribute a substantial portion of that decline to the ACA however. There are lots of articles on that. Judge for yourself.
Last edited by Rupert on Thu Jul 12, 2018 2:07 pm, edited 1 time in total.

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Re: Question for pre-ACA Early Retirees

Post by Peter Foley » Thu Jul 12, 2018 2:07 pm

Both my wife and I retired a couple years before the ACA took affect. We both had options to continue with employer plans and, although a bit expensive we did so. The plan I am on also offered supplemental plans once one reached Medicare eligibility. I continued with that plan. It is not the cheapest plan but because of my being in the plan long term it is unlikely I could be kicked out for a pre-existing condition if the laws were to change.

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Re: Question for pre-ACA Early Retirees

Post by mrgeeze » Thu Jul 12, 2018 2:24 pm

I worked as an independent contractor for 15 years before I retired at 57.
During those years my one man band company paid healthcare premiums to the tune of about 10k per year.
I could just have easily purchased the same coverage as an individual in the states I lived during this period (VA,NC,MD)

Since retirement I have manage income to stay below the ACA limit.
I have a bronze level ACA plan that serves as my catastrophic insurance.
The $2k/month this plan is apparently valued at is covered by all of us taxpayers.
I pay no premium.

No doubt, given recent news, the rates will go up yet again

AlphaPilot
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Re: Question for pre-ACA Early Retirees

Post by AlphaPilot » Thu Jul 12, 2018 2:41 pm

AlwaysWannaLearn wrote:
Thu Jul 12, 2018 12:36 pm
If you retired in your 50s/early 60s (or younger) in the days before the exchanges, and did so without access to retiree health insurance:

At that time, what were your thoughts/plans re. health insurance coverage until Medicare-eligible? In those pre-ACA years, what did you do and how did it work out? Did pre-existing condition limitations enter into the calculus in the pre-retirement planning and/or affect you in the post-retirement period?

My purpose in asking is not to get into speculation about what will happen with healthcare policy in the future. No one knows, and I hope the thread doesn't go there. Rather, I'd like to learn from the past experiences of those who faced somewhat similar circumstances to just one possible future scenario of many. Thank you in advance for sharing your wisdom.
This is probably how I should have worded my previous thread topic. ;)

I'd also be curious to know what the pattern was in terms of each year thereafter up until ACA. Meaning premium rates and how much they raised or lowered in that non-employee-covered-pre-medicare era. Interesting to hear some were lowering as it approached ACA timeline!

J295
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Re: Question for pre-ACA Early Retirees

Post by J295 » Thu Jul 12, 2018 3:02 pm

Retired early. One option we had in the tool kit if needed was to go into the state high risk insurance pool if we couldn’t get coverage. Ended up that Supreme Court opinion opened up ACA for us.

Will adjust as needed in future. Life and health care are fluid. That’s ok with us.

jalbert
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Re: Question for pre-ACA Early Retirees

Post by jalbert » Thu Jul 12, 2018 3:18 pm

I think the real issues were lurking beneath. Before ACA, if you developed an incurable long-term and/or expensive condition, the insursance company would just not renew your policy. You could get a new policy, but pre-existing conditions would not be covered say for 12 months. That was enough time for the insurance company to receive enough of your medical claims data to make an underwriting decision of whether to continue coverage without the preexisting condition rider. For expensive conditions, they would just cancel you when the preexisting condition rider expired.

If you (correctly) viewed health insurance as covering the tail risk of catastrophic and major expenses, then individual health insurance did not actually exist for most people before ACA. Group insurance through employers was better but created a false sense of health insurance security. If you had to give up a job because of disability, you might well lose the employer's group health coverage just when you most need health insurance to cover health-related expenses. (If you qualify for SS disability, you would get medicare, but I think that is the higher bar of "disability for any employment" not "disability for employment similar to career employment"). Some states had high risk pools to help with the problem.

Many employer-based plans also were inadequate before the essential health benefits requirements of ACA. One example would be employer-based plans with a $1M lifetime benefit cap.

Before ACA anyone who did not qualify for medicare or medicaid was taking health expense tail risk.
Last edited by jalbert on Fri Jul 13, 2018 12:03 pm, edited 1 time in total.
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Re: Question for pre-ACA Early Retirees

Post by scrabbler1 » Thu Jul 12, 2018 3:50 pm

I retired at the end of 2008 and bought a reasonably priced individual HI plan for 2009. But its premiums rose 20% in 2010 and nearly 25% in 2011; combined that's nearly 50% compared to 2009. In the middle of 2011, after the ACA had already been passed, I dropped the now-expensive policy and switched to a cheaper, bare-bones, hospital-only policy which got me through to the end of 2013. In 2014, I returned to a broader policy, just in time because I had some health issues in 2015 and was in the hospital for 12 days.

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Re: Question for pre-ACA Early Retirees

Post by goaties » Thu Jul 12, 2018 4:37 pm

jalbert wrote:
Thu Jul 12, 2018 3:18 pm
I think the real issues were lurking beneath. Before ACA, if you developed an incurable long-term and/or expensive condition, the insursance company would just not renew your policy.
Yes, yes, yes, this is what used to keep me up at night. And still does, since the future of the ACA is so uncertain. If you want information which is better than anecdotal, go to the Kaiser Family website. They've been collecting data about healthcare for years: https://www.kff.org/

Spirit Rider
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Re: Question for pre-ACA Early Retirees

Post by Spirit Rider » Thu Jul 12, 2018 4:52 pm

It is incorrect to say there were no protections for pre-existing conditions prior to the ACA.

In 1996 ERISA was amended to include the Health Insurance Portability and Accountability Act (HIPAA). A group plan could not exclude pre-existing conditions if the individual had at least 12 months of previous coverage with no gap > 63 days.

However, as noted this did not help if you could not get coverage or lost coverage. Individual policies were not covered under HIPPA.

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Re: Question for pre-ACA Early Retirees

Post by Sandtrap » Thu Jul 12, 2018 5:06 pm

AlwaysWannaLearn wrote:
Thu Jul 12, 2018 12:36 pm
If you retired in your 50s/early 60s (or younger) in the days before the exchanges, and did so without access to retiree health insurance:

At that time, what were your thoughts/plans re. health insurance coverage until Medicare-eligible? In those pre-ACA years, what did you do and how did it work out? Did pre-existing condition limitations enter into the calculus in the pre-retirement planning and/or affect you in the post-retirement period?

My purpose in asking is not to get into speculation about what will happen with healthcare policy in the future. No one knows, and I hope the thread doesn't go there. Rather, I'd like to learn from the past experiences of those who faced somewhat similar circumstances to just one possible future scenario of many. Thank you in advance for sharing your wisdom.
You've brought up a good issue.
Thanks for posting.

Retiring early, or any date before Medicare eligibility, can invite financial pressures (sometimes severe) if one does not have a pension that includes medical coverage, COBRA, or other "gap" coverage available. Even with an ACA policy, the financial impact of sudden health issues, (whether catastrophic, chronic, or otherwise), can break the bank. (example below)

Those who are under the ACA Subsidy Cliff and who have a great plan will survive well until Medicare.
Others who do not have pension medical, Cobra, or who's incomes do not qualify for an ACA Subsidy, will feel the impact.

As an actionable example: In year 2 of retirement, I went over the ACA Subsidy Cliff, and also had a nasty health disaster to the tune of $30,000 or more. As a result. I was "dinged" $30,000 for ACA back premiums. And, to make matters worse, a large portion of the $30,000 out of pocket medical expenses were not covered by the AVA policy. This was a "double whammy", or "perfect storm" to the tune of $50,000 !!!. It would have been a financial disaster if not for a very substantial EF.

Actionably: Medical expenses between "early retirement" and Medicare eligibility/coverage can be severe and it would do well to be prepared for it. It goes without saying that for some folks, post age 60 is when we seem to age in "dog years". :shock: so health is a great concern.

aloha
j :D

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Re: Question for pre-ACA Early Retirees

Post by klg » Thu Jul 12, 2018 7:20 pm

I left a Fortune 500 company (oil & gas) with fabulous employee health insurance in 1992 at age 45 since I wanted to see if I would like being on my own as a CPA. I did not and so effectively retired. At the time I shopped hard for coverage similar to what I had while an employee and concluded such coverage was insane; the "auto insurance for oil changes" metaphor is apt in my opinion. I then looked into 'major medical' policies which were common and affordable but I decided that in the event of a catastrophic problem that it was more likely than not that I would not be a "fighter." Thus, I went bare for 20 years until 2012 when I signed up for Medicare mostly as a way to protect my estate from the medical/industrial system during my final years to come. No regrets and I'd make the same decision again.

AlwaysWannaLearn
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by AlwaysWannaLearn » Thu Jul 12, 2018 8:34 pm

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Last edited by AlwaysWannaLearn on Wed Jul 18, 2018 9:45 pm, edited 1 time in total.

bhsince87
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Re: Question for pre-ACA Early Retirees

Post by bhsince87 » Thu Jul 12, 2018 8:40 pm

goaties wrote:
Thu Jul 12, 2018 4:37 pm
jalbert wrote:
Thu Jul 12, 2018 3:18 pm
I think the real issues were lurking beneath. Before ACA, if you developed an incurable long-term and/or expensive condition, the insursance company would just not renew your policy.
Yes, yes, yes, this is what used to keep me up at night. And still does, since the future of the ACA is so uncertain. If you want information which is better than anecdotal, go to the Kaiser Family website. They've been collecting data about healthcare for years: https://www.kff.org/
I have a cousin who was wiped out by this after an auto accident. But I'm pretty sure that practice was outlawed in 1996.
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by marcopolo » Thu Jul 12, 2018 8:47 pm

This is an interesting discussion as a recent early retiree.
With 13+ years to Medicare age, ongoing access to health insurance is probably the biggest risk to my retirement.

Having said that, I am not sure how much the pre-ACA world will be applicable to the future. There are like to be a lot of changes in the future, probably some good, and some bad for those in a similar situation. But, it seems unlikely to me that we will simply revert back to where we were previously. Perhaps, I am being naive.
Once in a while you get shown the light, in the strangest of places if you look at it right.

AlwaysWannaLearn
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by AlwaysWannaLearn » Thu Jul 12, 2018 9:09 pm

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Last edited by AlwaysWannaLearn on Wed Jul 18, 2018 10:07 pm, edited 1 time in total.

marcopolo
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by marcopolo » Thu Jul 12, 2018 9:24 pm

AlwaysWannaLearn wrote:
Thu Jul 12, 2018 9:09 pm
marcopolo wrote:
Thu Jul 12, 2018 8:47 pm
This is an interesting discussion as a recent early retiree.
With 13+ years to Medicare age, ongoing access to health insurance is probably the biggest risk to my retirement.

Having said that, I am not sure how much the pre-ACA world will be applicable to the future. There are like to be a lot of changes in the future, probably some good, and some bad for those in a similar situation. But, it seems unlikely to me that we will simply revert back to where we were previously. Perhaps, I am being naive.
Thank you, marcopolo. I appreciate your perspective. We appear to be in similar boats with a dozen or so years to Medicare. I agree that, to use your words, "ongoing access to health insurance is probably the biggest risk to my retirement." Same here. I also agree that there will be many changes in the future. That said, just because there won't be an exact match to the past doesn't mean the experiences of those who did "tweener time" between group coverage and Medicare coverage in the pre-ACA days don't have TREMENDOUS value to others facing that situation in the current day. I respect that you might have a different view. If you find no value in others' experiences from the past, I respect that, and I invite you to stop following this thread.
I think you may have mis-understood my comments. I think there is tremendous value in understanding how people who have tread this path before have dealt with it, as that will provide possible solutions that can be adapted as necessary to the sutuation going forward. I was simply saying that the future is quite likely to be different than the past. Flexibility in planning, I think, is going to be the key.
Once in a while you get shown the light, in the strangest of places if you look at it right.

AlwaysWannaLearn
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Re: Question for pre-ACA Early Retirees

Post by AlwaysWannaLearn » Thu Jul 12, 2018 9:26 pm

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AlwaysWannaLearn
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by AlwaysWannaLearn » Thu Jul 12, 2018 9:35 pm

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Last edited by AlwaysWannaLearn on Wed Jul 18, 2018 10:06 pm, edited 1 time in total.

marcopolo
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by marcopolo » Thu Jul 12, 2018 9:41 pm

AlwaysWannaLearn wrote:
Thu Jul 12, 2018 9:35 pm
marcopolo wrote:
Thu Jul 12, 2018 9:24 pm
I think you may have mis-understood my comments. I think there is tremendous value in understanding how people who have tread this path before have dealt with it, as that will provide possible solutions that can be adapted as necessary to the sutuation going forward. I was simply saying that the future is quite likely to be different than the past. Flexibility in planning, I think, is going to be the key.
I agree, marcopolo. I'm glad we're on the same page. As I indicated in my OP, I fully recognize that none of us knows what the future holds, so there's no point in discussing it. Perhaps the issue wasn't in my misunderstanding but in how you communicated your perspective? Meh, no matter. The point is to learn from others' past experiences. It will help us all on the go-forward, knowing full well that the future won't "match" identically what's happened in the past. Thank you for your input.
Yeah, reading back over my post, I agree with you that I did not communicate my meaning clearly. I should have said something like "directly applicable". I think we agree on the main point.
Once in a while you get shown the light, in the strangest of places if you look at it right.

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Re: Question for pre-ACA Early Retirees

Post by jalbert » Fri Jul 13, 2018 3:23 pm

Spirit Rider wrote:
Thu Jul 12, 2018 4:52 pm
It is incorrect to say there were no protections for pre-existing conditions prior to the ACA.

In 1996 ERISA was amended to include the Health Insurance Portability and Accountability Act (HIPAA). A group plan could not exclude pre-existing conditions if the individual had at least 12 months of previous coverage with no gap > 63 days.

However, as noted this did not help if you could not get coverage or lost coverage. Individual policies were not covered under HIPAA.
Individual policies could also have provided the coverage that prevents a gap in coverage. But before ACA, if you lost individual coverage and tried to get a job for group coverage, you had just 63 days to get the job and qualify for the start of coverage to have pre-existing conditions covered during the first 12 months. In health cost tail risk situations, getting or keeping a job may not always be possible.
Risk is not a guarantor of return.

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Re: Question for pre-ACA Early Retirees

Post by Spirit Rider » Fri Jul 13, 2018 3:52 pm

jalbert wrote:
Fri Jul 13, 2018 3:23 pm
Spirit Rider wrote:
Thu Jul 12, 2018 4:52 pm
It is incorrect to say there were no protections for pre-existing conditions prior to the ACA.

In 1996 ERISA was amended to include the Health Insurance Portability and Accountability Act (HIPAA). A group plan could not exclude pre-existing conditions if the individual had at least 12 months of previous coverage with no gap > 63 days.

However, as noted this did not help if you could not get coverage or lost coverage. Individual policies were not covered under HIPAA.
Individual policies could also have provided the coverage that prevents a gap in coverage. But before ACA, if you lost individual coverage and tried to get a job for group coverage, you had just 63 days to get the job and qualify for the start of coverage to have pre-existing conditions covered during the first 12 months. In health cost tail risk situations, getting or keeping a job may not always be possible.
Yes, but if you had an individual policy and significant health problems, your insurance carrier would drop you like a hot potato at the end of the policy term. In most states there was no guaranteed issue and insurance companies could and did refuse to insure or use medical underwriting for policy cost.

Also, HIPPA did not apply, so even if you had no gap, the insurance company could and would deny/delay coverage for pre-existing conditions. I was an independent contractor during this time and knew of professional acquaintances severely impacted during this time. At least at some point my state created a high risk pool. So even though it was expensive, you could still get coverage.

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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by Rupert » Fri Jul 13, 2018 3:54 pm

OP, the effectiveness of the pre-ACA high-risk pools varied significantly by state. People died waiting to get into those pools. Lots of stories on the internet about those pools.

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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by jalbert » Fri Jul 13, 2018 4:18 pm

As an actionable example: In year 2 of retirement, I went over the ACA Subsidy Cliff, and also had a nasty health disaster to the tune of $30,000 or more. As a result. I was "dinged" $30,000 for ACA back premiums. And, to make matters worse, a large portion of the $30,000 out of pocket medical expenses were not covered by the AVA policy. This was a "double whammy", or "perfect storm" to the tune of $50,000 !!!. It would have been a financial disaster if not for a very substantial EF.
I'm trying to understand this. If you get in-network care, your total annual cost should never exceed unsubsidized premium plus out-of-pocket maximum, which can be calculated easily for any plan on an ACA exchange.
Risk is not a guarantor of return.

47Percent
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by 47Percent » Fri Jul 13, 2018 4:21 pm

I know pre-ACA one couple in their early 40's in excellent health were trying to get Individual insurance as the husband was trying to make it on his own.

He was in excellent health and his wife was in even better health. I mean not outwardly, but by all measurable standards.. athlete's heart rate, 115/78, no issue with cholesterol, no sugar, no family history, nothing in their history etc. etc. Except for routine annual they had no reason to visit doctors, and neither had taken anything more than a couple of tylenols now and then over their entire adult life. Blue Shield denied her insurance because she had had a C-section 4 years earlier. No complications.. just routine under doctor advise and the child was healthy. Blue Shield didn't mention the reason, but that's what they figured out later. They had to mention this rejection in other applications, and that was the end of that.

He had to get back into the corporate grind in a hurry.

Yes, this is just one example/anecdote. But this was not atypical at all.

For context, see the NY Times article entitled aptly enough "Money won't buy you Health Insurance" dated Feb 2011.

https://www.nytimes.com/2011/02/20/opin ... insky.html

47Percent
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by 47Percent » Fri Jul 13, 2018 4:38 pm

jalbert wrote:
Fri Jul 13, 2018 4:18 pm
As an actionable example: In year 2 of retirement, I went over the ACA Subsidy Cliff, and also had a nasty health disaster to the tune of $30,000 or more. As a result. I was "dinged" $30,000 for ACA back premiums. And, to make matters worse, a large portion of the $30,000 out of pocket medical expenses were not covered by the AVA policy. This was a "double whammy", or "perfect storm" to the tune of $50,000 !!!. It would have been a financial disaster if not for a very substantial EF.
I'm trying to understand this. If you get in-network care, your total annual cost should never exceed unsubsidized premium plus out-of-pocket maximum, which can be calculated easily for any plan on an ACA exchange.
I know of no ACA compatible insurance where the out of pocket max is more than about $7.5K/person.
$30K in claw back in PTC also seems very high -- unless it spans two years. Going over the cliff accidentally 2 consecutive years?

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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by curmudgeon » Fri Jul 13, 2018 4:55 pm

47Percent wrote:
Fri Jul 13, 2018 4:38 pm
jalbert wrote:
Fri Jul 13, 2018 4:18 pm
As an actionable example: In year 2 of retirement, I went over the ACA Subsidy Cliff, and also had a nasty health disaster to the tune of $30,000 or more. As a result. I was "dinged" $30,000 for ACA back premiums. And, to make matters worse, a large portion of the $30,000 out of pocket medical expenses were not covered by the AVA policy. This was a "double whammy", or "perfect storm" to the tune of $50,000 !!!. It would have been a financial disaster if not for a very substantial EF.
I'm trying to understand this. If you get in-network care, your total annual cost should never exceed unsubsidized premium plus out-of-pocket maximum, which can be calculated easily for any plan on an ACA exchange.
I know of no ACA compatible insurance where the out of pocket max is more than about $7.5K/person.
$30K in claw back in PTC also seems very high -- unless it spans two years. Going over the cliff accidentally 2 consecutive years?
My area has a relatively robust level of ACA competition (4 insurers, ~20 plans). HOWEVER, if you want to "keep your doctor" (that is, not be tied to a limited network), there are only a few PPO plans and they are quite expensive with large OOP limits for out of network care. For two, they are $35-40K in premiums and $40K family ($20K per person) OOP max. I think Sandtrap hit something along these lines.

jalbert
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Re: Question for pre-ACA Early Retirees and pre-ACA solo folks

Post by jalbert » Fri Jul 13, 2018 5:31 pm

I know of no ACA compatible insurance where the out of pocket max is more than about $7.5K/person.
I've seen some plans with aggregate family oop-max that is 2x individual oop-max, but the plan only recognizes a family oop-max for an individual who is enrolled as part of a married couple or family. Married couples can generally do separate individual enrollments to get around this at no extra cost, but if there are additional family members covered, having a family deductible may be worth more.
Risk is not a guarantor of return.

randomguy
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Re: Question for pre-ACA Early Retirees

Post by randomguy » Fri Jul 13, 2018 6:21 pm

robebibb wrote:
Thu Jul 12, 2018 2:05 pm

People with pre-existing health conditions were definately locked into jobs pre ACA but young healthy people responsible enough to purchase individual plans were paying prices multiple times lower than they are now paying under the ACA due to legislated pricing constraints.
It was very hard to compare plans preACA. There were tons of cheaper plans. Most of them also had big coverage limits. Simple example. Me and my wifes coverage was ~400/month. Pregnancy coverage was 500. If you say I could get a plan for 300, then yeah ACA was a huge increase. If you need pregnancy (and you had to sign up for that at specific periods. The insurance companies aren't idiots and know who is going to buy and keep the coverage), ACA was cheaper right afterwards. You can debate how much letting people select certain levels of coverage makes sense.

To some extent this question is pretty useless as we are unlikely to go back to the same system. We are likely to get an all new one with who knows what type of rules and regulations and you will likely see 50 different set of state regulations. Maybe Massachusetts will become a popular early retirement state:)

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