ACA plan vs employer retiree plan

[leftcoaster]

My employer offers retirees 55+ the option to purchase insurance. It’s pretty different from the plan for active employees and for COBRA.

It’s a high deductible plan - 8k in network deductible for the family. 13k out of network. 80/20 coinsurance. Cost is $2,100/ month for a couple. Prescriptions are free. I don’t have any exotic ones.

Meanwhile the same money would get me a Gold PPO or Platinum HMO on the ACA marketplace without subsidies. A silver PPO is $200 less.

Why would anyone go for the employer plan? I feel like I must be missing something.

[neb2020]

My employer offers retirees 55+ the option to purchase insurance. It’s pretty different from the plan for active employees and for COBRA.

It’s a high deductible plan - 8k in network deductible for the family. 13k out of network. 80/20 coinsurance. Cost is $2,100/ month for a couple. Prescriptions are free. I don’t have any exotic ones.

Meanwhile the same money would get me a Gold PPO or Platinum HMO on the ACA marketplace without subsidies. A silver PPO is $200 less.

Why would anyone go for the employer plan? I feel like I must be missing something.

What's the deductible and specs of the the ACA plans? Off the top the employer retiree plan looks bad... high cost and high premium.

Also, you didn't look at max OOP.

[FiveK]

ACA deductible? OOP max for each? HSA contribution: marginal tax saving rate?

Might be worth putting your numbers into a couple of comparison tools, e.g., Health Savings Account (HSA) vs. Traditional Health Plan and the 'HDHP Analysis' tab of the personal finance toolbox in Excel.

[Bungo]

I view my employer's retiree health insurance as Plan B in case ACA goes away. It's the only reason I'm planning to remain employed until 53 1/2 (retirees are eligible if they turn 55 before retiring or while on COBRA) instead of retiring now at age 52.

[marcopolo]

On the surface the ACA option looks better.
A few things i would consider:

1) Max Out out of Pocket for each plan

2) The network size and coverage out of area for the two plans

3) Usually, once you turn down an employer plan, you can't get back into it. Is that the case for your plan? If so, consider that offered plans on the ACA market place can change dramatically from year to year. With some insurers pulling out completely, other modifying offered plans. Some states are more stable than others. So, this may be a consideration depending on how long you have until medicare age.

[furwut]

ACA plans are age rated (to a degree) so become more expensive as you get older. If you want a subsidy you have to limit your income.

EDIT to add: Generally speaking employer plans insure a younger, healthier population and may be subject to less premium inflation over time. Also, employers who self-insure can offer a cost savings as there is no profit incentive.

[leftcoaster]

My employer offers retirees 55+ the option to purchase insurance. It’s pretty different from the plan for active employees and for COBRA.

It’s a high deductible plan - 8k in network deductible for the family. 13k out of network. 80/20 coinsurance. Cost is $2,100/ month for a couple. Prescriptions are free. I don’t have any exotic ones.

Meanwhile the same money would get me a Gold PPO or Platinum HMO on the ACA marketplace without subsidies. A silver PPO is $200 less.

Why would anyone go for the employer plan? I feel like I must be missing something.

What's the deductible and specs of the the ACA plans? Off the top the employer retiree plan looks bad... high cost and high premium.

Also, you didn't look at max OOP.

ACA Blue California Silver 70 PPO

Deductible
$8000 (Family) NETWORK

$13000 (Family) OUT OF NETWORK

Separate Drug Deductible
$600 (Family)

Out-of-Pocket Max
$16400 (Family) NETWORK
$40000 (Family). OUT OF NETWORK

Maximum Cost per Prescription
$250

Primary care copay
$40

Generic drugs
$16




ACA Blue California Gold 80 PPO

Deductible
$0 (Family) NETWORK

$10000 (Family) OUT OF NETWORK

Separate Drug Deductible
$0 (Family)

Out-of-Pocket Max
$16400 (Family) NETWORK
$20000 (Family). OUT OF NETWORK

Maximum Cost per Prescription
$250

Primary care copay
$35

Generic drugs
$15

[leftcoaster]

Employer plan through Aetna

No out of network figures are given

Managed Choice POS HDHP - Network Option Low

Annual Plan Year Deductible In-Network - Individual
$3950
Annual Plan Year Deductible In-Network - Family
$7900
Annual Out-of-Pocket Maximum In-Network - Individual
$6650
Annual Out-of-Pocket Maximum In-Network - Family
$13300

Drug copay is $0

Preventative coinsurance is 0%. All others are 20%

[chw]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

[leftcoaster]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

Qualifies for HSA - can you contribute if not working?

[NotWhoYouThink]

Our employer retiree plan has a much larger network of providers. We'll use it after COBRA runs out. It only has to cover us for 3 years.

[Escapevelocity]

The cost of your employer plan seems to indicate that your employer is not subsidizing any portion of the cost. In my case, I have a similar decision to make, but fortunately the cost for married couple with our without dependents is around $1200 per month due to the employer providing approx. 40% subsidy of the cost (they don't disclose the exact subsidy) and this is not for a high deductible plan. I will have an annual deductible below $1k and an annual out of pocket max of around $6500.

We will go with this employer plan rather than ACA mostly due to the employer subsidy and attractive coverage features, but there is another disadvantage of ACA plans depending on your state. If you plan to do extensive traveling as we do, the ACA plans are generally much less likely to provide real coverage outside of your state.

[yohac]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

Qualifies for HSA - can you contribute if not working?

Yes, but make sure the plan is an HSA-qualified HDHP.

[leftcoaster]

Our employer retiree plan has a much larger network of providers. We'll use it after COBRA runs out. It only has to cover us for 3 years.

So you retired, went on cobra, and will go to the retiree plan next?

I’m trying to figure out if my state cobra extension can be used for that too.

Retire -> cobra -> cal-cobra -> retiree -> Medicare

To get the retiree plan, you have to be 55 when you retire OR on Cobra. So you can retire at 53.5. If cal-cobra counts, then it’s just 52…

[leftcoaster]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

Qualifies for HSA - can you contribute if not working?

Yes, but make sure the plan is an HSA-qualified HDHP.

If you aren’t working what’s the source of pretax contributions?

[marcopolo]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

Qualifies for HSA - can you contribute if not working?

Yes, but make sure the plan is an HSA-qualified HDHP.

If you aren’t working what’s the source of pretax contributions?

You contribute out of your portfolio and then take the deduction when you file your taxes.

[Watty]

Why would anyone go for the employer plan? I feel like I must be missing something.

The free prescription part is huge deal for people who have expensive prescriptions.

A big question is how it will compare to an ACA plan two or more years from now and there is no telling what will actually be available then.

We can't get into politics here but if things had played out differently the ACA might not have lasted much longer.

[chw]

It sounds like your company is trying to direct retirees to ACA plans. Your analysis is correct. Depending on your level of yearly medical expenses, the Bronze level ACA plan will likely do well for you, and usually qualifies for HSA contributions.

Qualifies for HSA - can you contribute if not working?

Yes, you can contribute to an HSA with no earned income.

[InMyDreams]

In the medical world, it is wise to consider all possibilities, even if you don't need them right now. Your drug costs may not include an "exotic" right now, and hopefully never will, but considering what benefit you could be walking away from may form your opinion.

One thing to consider, whether it's ACA or retiree - what management is there of your care, including your prescriptions? What are the reputations of the companies that are administering the plans?

Unfortunately, crystal balls are useless, and it's a bit of a crap shoot. Good luck.

[musicmom]

You have a real decision to make.
DH and I didnt.
My megacorps no longer offered retiree plan is almost identical to active employee plan. Extremely low monthly premium.
Most in network PPO docs and services covered at 100%. OOP max per year is 3000 per year I think. Generic drugs have $5 copays. No dental, vision.

I agree that your employer is helping you to consider ACA.

[FIREchief]

Meanwhile the same money would get me a Gold PPO or Platinum HMO on the ACA marketplace without subsidies. A silver PPO is $200 less.

Why would anyone go for the employer plan? I feel like I must be missing something.

I don't think you're missing anything. I started out on Megacorp retiree coverage after FIRE. It was high deductible plus a very hefty premium (which went up a LOT). I learned that Megacorp can provide such coverage at cost with something like an additional 2% administrative fee. In other words, it became a profit center for them. That's Megacorp for you.

There is competition in most/all ACA areas. Megacorp has a captive audience and somewhat of a monopoly on you. I've even suspected at times that they're juicing the premiums for all employees with likely perks for executive retirees.

[random_walker_77]

One of the biggest differences between ACA plans and employer plans is the network size. On an ACA plan, travel insurance might be necessary as there may be no coverage once you leave your home region or state. If the good cancer centers aren't nearby and aren't in your network on the ACA plan but are accessible through the employer plan, that may become a consideration.

[nguy44]

One of the biggest differences between ACA plans and employer plans is the network size. On an ACA plan, travel insurance might be necessary as there may be no coverage once you leave your home region or state. If the good cancer centers aren't nearby and aren't in your network on the ACA plan but are accessible through the employer plan, that may become a consideration.

I agree. If you like your current healthcare providers, check if they take the ACA plans you are interested in. When we looked at it, none of our current providers did (even though the state health exchange listed them as providers). When our son aged out our insurance onto the ACA, even though the then administrator of the employee plan (Blue Cross) also had ACA plans in our area, our providers would not accept it, with the line "We only accept Blue Cross plans from employers, not from the government).

[chw]

One of the biggest differences between ACA plans and employer plans is the network size. On an ACA plan, travel insurance might be necessary as there may be no coverage once you leave your home region or state. If the good cancer centers aren't nearby and aren't in your network on the ACA plan but are accessible through the employer plan, that may become a consideration.

I agree. If you like your current healthcare providers, check if they take the ACA plans you are interested in. When we looked at it, none of our current providers did (even though the state health exchange listed them as providers). When our son aged out our insurance onto the ACA, even though the then administrator of the employee plan (Blue Cross) also had ACA plans in our area, our providers would not accept it, with the line "We only accept Blue Cross plans from employers, not from the government).

I have an ACA plan with a network that is actually has a better network than my previous Megacorp plan. I did discover that if I was utilizing ACA subsidies, and on a Medicaid type plan, the Doctor/facility network did shrink significantly in lower income tiers. We discovered that the ACA plan in our state for incomes between 52-69K (2 person household) had the same or better doctor network, when compared to our previous workplace plans.

[SnowBog]

One other consideration could be Roth conversions.

My spouse should have access to retiree medical coverage (for our family) when we retire. I haven't compared the plans in detail (lots can change in the next 7+ years). But my working assumption is we'll use spouse plan during Roth conversion years, as we wouldn't qualify for an ACA subsidy.

After that, we'll see what options make sense...

[Escapevelocity]

Another consideration is that most employer provided retiree health plans can only be elected at the time of retirement. You can't go on ACA for a couple years and then switch back.

[leftcoaster]

Another consideration is that most employer provided retiree health plans can only be elected at the time of retirement. You can't go on ACA for a couple years and then switch back.

And there’s no medical underwriting.

[random_walker_77]

One of the biggest differences between ACA plans and employer plans is the network size. On an ACA plan, travel insurance might be necessary as there may be no coverage once you leave your home region or state. If the good cancer centers aren't nearby and aren't in your network on the ACA plan but are accessible through the employer plan, that may become a consideration.

I agree. If you like your current healthcare providers, check if they take the ACA plans you are interested in. When we looked at it, none of our current providers did (even though the state health exchange listed them as providers). When our son aged out our insurance onto the ACA, even though the then administrator of the employee plan (Blue Cross) also had ACA plans in our area, our providers would not accept it, with the line "We only accept Blue Cross plans from employers, not from the government).

I have an ACA plan with a network that is actually has a better network than my previous Megacorp plan. I did discover that if I was utilizing ACA subsidies, and on a Medicaid type plan, the Doctor/facility network did shrink significantly in lower income tiers. We discovered that the ACA plan in our state for incomes between 52-69K (2 person household) had the same or better doctor network, when compared to our previous workplace plans.

Good to know. This must be region-specific. In my region, the ACA plans cover a limited geographical area.
I see there are articles describing the majority of ACA plans as having limited networks in order to contain costs: https://www.modernhealthcare.com/articl ... ow-network

[chw]

One of the biggest differences between ACA plans and employer plans is the network size. On an ACA plan, travel insurance might be necessary as there may be no coverage once you leave your home region or state. If the good cancer centers aren't nearby and aren't in your network on the ACA plan but are accessible through the employer plan, that may become a consideration.

I agree. If you like your current healthcare providers, check if they take the ACA plans you are interested in. When we looked at it, none of our current providers did (even though the state health exchange listed them as providers). When our son aged out our insurance onto the ACA, even though the then administrator of the employee plan (Blue Cross) also had ACA plans in our area, our providers would not accept it, with the line "We only accept Blue Cross plans from employers, not from the government).

I have an ACA plan with a network that is actually has a better network than my previous Megacorp plan. I did discover that if I was utilizing ACA subsidies, and on a Medicaid type plan, the Doctor/facility network did shrink significantly in lower income tiers. We discovered that the ACA plan in our state for incomes between 52-69K (2 person household) had the same or better doctor network, when compared to our previous workplace plans.

Good to know. This must be region-specific. In my region, the ACA plans cover a limited geographical area.
I see there are articles describing the majority of ACA plans as having limited networks in order to contain costs: https://www.modernhealthcare.com/articl ... ow-network

I am in MA, which had a public health plan before ACA, so perhaps due to that, the non Medicaid networks are more robust. I had qualified for a Medicaid type plan (Silver) this year with very low premiums and copays, but decided to declare a higher income this year to obtain a non- Medicaid subsidized plan (Bronze) to access the better medical network in case it’s needed. The Medicaid plan was a good option, especially for someone younger and in good health, but I didn’t want to get stuck with the limited network as I am older and possibly may need access to a better network.

[Eagle33]

I view my employer's retiree health insurance as Plan B in case ACA goes away. It's the only reason I'm planning to remain employed until 53 1/2 (retirees are eligible if they turn 55 before retiring or while on COBRA) instead of retiring now at age 52.

Before retiring, be sure that retiree health insurance is still available to you to purchase after 18 months leaving employment. I was considering doing what you are planning, but found out a week after leaving that my retiree health insurance had to be purchased within 30 days of end of employment. Decided to purchase over COBRA because of distance from 65 greater than 18 months and retiree medical was less than ACA w/o subsidies.

[Bungo]

I view my employer's retiree health insurance as Plan B in case ACA goes away. It's the only reason I'm planning to remain employed until 53 1/2 (retirees are eligible if they turn 55 before retiring or while on COBRA) instead of retiring now at age 52.

Before retiring, be sure that retiree health insurance is still available to you to purchase after 18 months leaving employment. I was considering doing what you are planning, but found out a week after leaving that my retiree health insurance had to be purchased within 30 days of end of employment. Decided to purchase over COBRA because of distance from 65 greater than 18 months and retiree medical was less than ACA w/o subsidies.

Absolutely, I'll double and triple check this with HR and read all the fine print before pulling the trigger. The HR internal website says that retirees can opt into/out of the plan at any time if they are eligible for the plan (5 years with the company before retiring, and age 55 achieved either before retiring or while on COBRA post-retirement).

I interpret this to mean that retirees don't lose eligibility if they don't sign up immediately after retirement, and are free to switch back and forth between ACA and the employer plan as desired. But of course the devil may be in the details, and moreover these terms could change between now and my potential retirement date. I'll also want to get up-to-date details about the monthly premiums, deductibles, network, coverage, annual out of pocket maximum, etc.

How's your retiree plan working out? Any unexpected issues, regrets, etc.?

[Eagle33]

The insurance provider is typical insurance issues, but trying to communicate with the megacorp side is another story.

Last year was a pain trying to findout about what changes when retiree plan becomes secondary to Medicare. Main reason is that megacorp has HR functions so distributed globally & part are outsourced to 3rd parties, that is difficult to know who to call and the different entities do not share info with no one there taking ownership for an answer to my questions. I finally gave up trying to explain Medicare and secondary insurance to someone in India! Glad to switch to US based customer service when spouse turns 65 and we go off this retiree plan.

And people on this forum complain about Vanguard customer service!

[InMyDreams]

And another thought - I believe retiree health insurance premiums are not a qualified medical expense that can be pulled from your HSA. It can, however, be deducted via itemization if you can overcome the threshold.

[FiveK]

And another thought - I believe retiree health insurance premiums are not a qualified medical expense that can be pulled from your HSA. It can, however, be deducted via itemization if you can overcome the threshold.

Depends on your age. From HSA withdrawals,
"Furthermore, once reaching age 65,...premiums for employer-sponsored retiree health insurance can be paid from an HSA."