Understood. But over $2500 they cover your prescriptions? Seems like a fantastic deal.David Jay wrote: ↑Thu Dec 06, 2018 6:56 pmNo prescription coverage below the deductible. The first $2500 you pay regardless. Like a HDHP, where you pay from your HSA.michaeljc70 wrote: ↑Thu Dec 06, 2018 6:40 pmWith 2 people that are retired paying $300 a month, there has to be so many holes in the policy you can drive a truck through it. Are prescriptions covered?David Jay wrote: ↑Thu Dec 06, 2018 5:39 pm As I prepared to retire, I looked at the following possibilities (prices are for married couple):
1. COBRA
2. ACA
3. Medicaid Expansion
4. Short term policy
5. Medishare
1. $8000 a year. Pretty steep for a moderate income person in LCOL area.
2. My retirement payout (sick bank, vacation) exceeds ACA subsidy level (64K) so that is out for 2019, it will likely work for next year.
3. Would require that I live mostly out of my Roth accounts, depleting them.
5. About $400 a month with $10,000 out-of-pocket before start of coverage
Which leaves #4 - a short term policy (6mo, renewable) for 2019. $300 a month with a $2500 deductible per person. $2M max coverage. Policy is offered by the largest hospital network in out-state Michigan. If something came up that prevented renewal at mid-year, options 3 and 5 are available.
I will likely use ACA for 2020 and 2021 because I can keep income below $64K next year.
Health insurance for FIRE [Financial Independence Retire Early]
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Re: Health insurance for FIRE
Re: Health insurance for FIRE
No pre-existing conditions. So this only covers things that arise during the coverage period.michaeljc70 wrote: ↑Thu Dec 06, 2018 7:32 pmUnderstood. But over $2500 they cover your prescriptions? Seems like a fantastic deal.David Jay wrote: ↑Thu Dec 06, 2018 6:56 pmNo prescription coverage below the deductible. The first $2500 you pay regardless. Like a HDHP, where you pay from your HSA.michaeljc70 wrote: ↑Thu Dec 06, 2018 6:40 pmWith 2 people that are retired paying $300 a month, there has to be so many holes in the policy you can drive a truck through it. Are prescriptions covered?David Jay wrote: ↑Thu Dec 06, 2018 5:39 pm As I prepared to retire, I looked at the following possibilities (prices are for married couple):
1. COBRA
2. ACA
3. Medicaid Expansion
4. Short term policy
5. Medishare
1. $8000 a year. Pretty steep for a moderate income person in LCOL area.
2. My retirement payout (sick bank, vacation) exceeds ACA subsidy level (64K) so that is out for 2019, it will likely work for next year.
3. Would require that I live mostly out of my Roth accounts, depleting them.
5. About $400 a month with $10,000 out-of-pocket before start of coverage
Which leaves #4 - a short term policy (6mo, renewable) for 2019. $300 a month with a $2500 deductible per person. $2M max coverage. Policy is offered by the largest hospital network in out-state Michigan. If something came up that prevented renewal at mid-year, options 3 and 5 are available.
I will likely use ACA for 2020 and 2021 because I can keep income below $64K next year.
Last edited by David Jay on Thu Dec 06, 2018 7:42 pm, edited 1 time in total.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
Re: Health insurance for FIRE
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
Re: Health insurance for FIRE
So a medical issue in month 5 that needed ongoing care would be a major problem for example.
In the bad old days (pre-ACA) insurers used to go through applications after the fact and look for reasons to deny claims. I'd be pretty nervous about that still with plans that exclude pre-existing conditions.
It might be good to time it so the short-term policy expires (after 12 months) while open enrollment for ACA plans is open just in case. The open enrollment window isn't very long...
Re: Health insurance for FIRE
In a lot of ways the unpredictability is worse than actual cost.
If you had enough to retire today except for the healthcare cost and you also knew that it would cost $25K a year and you are making $75K a year then you know that working another year will make you enough to cover your health care expenses for a few years.
With no idea of what it will cost, or if it will even be available, retiring becomes a lot more difficult to plan.
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Re: Health insurance for FIRE
If you are under the ACA subsidy cap, it is ideal. Of course, there can be changes to the law. Nobody can predict that.Watty wrote: ↑Thu Dec 06, 2018 8:11 pmIn a lot of ways the unpredictability is worse than actual cost.
If you had enough to retire today except for the healthcare cost and you also knew that it would cost $25K a year and you are making $75K a year then you know that working another year will make you enough to cover your health care expenses for a few years.
With no idea of what it will cost, or if it will even be available, retiring becomes a lot more difficult to plan.
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Re: Health insurance for FIRE
I don't know where you live, but I'd look at the policy closely. Some only cover prescription if you are inpatient. I looked at short term policies, and we are in our 40s, and for under $300 nothing covered prescriptions generally. There are many holes in these plans. I would look very closely. There is no free lunch. Being healthy and in our 40s, I wish there was.David Jay wrote: ↑Thu Dec 06, 2018 7:36 pmNo pre-existing conditions. So this only covers things that arise during the coverage period.michaeljc70 wrote: ↑Thu Dec 06, 2018 7:32 pmUnderstood. But over $2500 they cover your prescriptions? Seems like a fantastic deal.David Jay wrote: ↑Thu Dec 06, 2018 6:56 pmNo prescription coverage below the deductible. The first $2500 you pay regardless. Like a HDHP, where you pay from your HSA.michaeljc70 wrote: ↑Thu Dec 06, 2018 6:40 pmWith 2 people that are retired paying $300 a month, there has to be so many holes in the policy you can drive a truck through it. Are prescriptions covered?David Jay wrote: ↑Thu Dec 06, 2018 5:39 pm As I prepared to retire, I looked at the following possibilities (prices are for married couple):
1. COBRA
2. ACA
3. Medicaid Expansion
4. Short term policy
5. Medishare
1. $8000 a year. Pretty steep for a moderate income person in LCOL area.
2. My retirement payout (sick bank, vacation) exceeds ACA subsidy level (64K) so that is out for 2019, it will likely work for next year.
3. Would require that I live mostly out of my Roth accounts, depleting them.
5. About $400 a month with $10,000 out-of-pocket before start of coverage
Which leaves #4 - a short term policy (6mo, renewable) for 2019. $300 a month with a $2500 deductible per person. $2M max coverage. Policy is offered by the largest hospital network in out-state Michigan. If something came up that prevented renewal at mid-year, options 3 and 5 are available.
I will likely use ACA for 2020 and 2021 because I can keep income below $64K next year.
- DWesterb2iz2
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Re: Health insurance for FIRE
In Texas you can get great coverage cheaply as a community college student. One class will make you eligible. Not so in my state, maybe in yours?
Re: Health insurance for FIRE
If you re-read my original post, you will see that I have (2) alternatives for the renewal period (6 months in this case). Then for 2020 I add ACA as our income will qualify for the credit.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
Re: Health insurance for FIRE
I would look at whether there is a cap on what insurance will pay. For most people, covering prescription drugs for the period of the short term policy wouldn't be a deal breaker, but if the policy only paid up to the first $X,XXX,XXX, and then stopped paying? There used to be lots of policies that had caps.michaeljc70 wrote: ↑Thu Dec 06, 2018 8:45 pmI don't know where you live, but I'd look at the policy closely. Some only cover prescription if you are inpatient. I looked at short term policies, and we are in our 40s, and for under $300 nothing covered prescriptions generally. There are many holes in these plans. I would look very closely. There is no free lunch. Being healthy and in our 40s, I wish there was.David Jay wrote: ↑Thu Dec 06, 2018 7:36 pmNo pre-existing conditions. So this only covers things that arise during the coverage period.michaeljc70 wrote: ↑Thu Dec 06, 2018 7:32 pmUnderstood. But over $2500 they cover your prescriptions? Seems like a fantastic deal.David Jay wrote: ↑Thu Dec 06, 2018 6:56 pmNo prescription coverage below the deductible. The first $2500 you pay regardless. Like a HDHP, where you pay from your HSA.michaeljc70 wrote: ↑Thu Dec 06, 2018 6:40 pm
With 2 people that are retired paying $300 a month, there has to be so many holes in the policy you can drive a truck through it. Are prescriptions covered?
gasdoc
Re: Health insurance for FIRE [Financial Independence Retire Early]
Reading this stuff makes me want to move to a country with universal health care.
Stocks-80% || Bonds-20% || Taxable-VTI/VXUS || IRA-VT/BNDW
Re: Health insurance for FIRE
See above, $2Mgasdoc wrote: ↑Fri Dec 07, 2018 7:48 am I would look at whether there is a cap on what insurance will pay. For most people, covering prescription drugs for the period of the short term policy wouldn't be a deal breaker, but if the policy only paid up to the first $X,XXX,XXX, and then stopped paying? There used to be lots of policies that had caps.
gasdoc
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
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Re: Health insurance for FIRE [Financial Independence Retire Early]
"Don't be downhearted, I can fit it for you sonny. It won't take too long. It'll just take money."
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The Sensible Steward
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Re: Health insurance for FIRE [Financial Independence Retire Early]
Do these short-term plans have networks that entitle you to discounted rates before you meet your deductible? In looking at them I haven't heard of any of these companies (Independence American Insurance Company and LifeShield National Insurance Company). That can make a big difference. Currently I get around 50% off doctors and 80%-90% off lab work when going in network.
Last edited by michaeljc70 on Fri Dec 07, 2018 10:11 am, edited 1 time in total.
Re: Health insurance for FIRE
Maybe I'm not seeing something. If someone had enough to retire today "except for X" (whether that's health care, housing, post-retirement plans like travel, whatever), then they don't have enough to retire. There's not much to discuss.
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Re: Health insurance for FIRE
The ones I have read are either in foreign countries or managing their income to get subsidies. And the ones with subsidies are frank that if the subsidies go away they will either relocate to a foreign country or go back to work.
Re: Health insurance for FIRE
Thank you for your message. In this particular item, "unpredictability" comes as more "expensive" than the actual cost might be.Watty wrote: ↑Thu Dec 06, 2018 8:11 pmIn a lot of ways the unpredictability is worse than actual cost.
If you had enough to retire today except for the healthcare cost and you also knew that it would cost $25K a year and you are making $75K a year then you know that working another year will make you enough to cover your health care expenses for a few years.
With no idea of what it will cost, or if it will even be available, retiring becomes a lot more difficult to plan.
All of your comments are giving me some anchor points, so thank you for that.
Re: Health insurance for FIRE [Financial Independence Retire Early]
Would that actually make it less costly, or is it just trading insurance premiums for higher taxes?
"To achieve satisfactory investment results is easier than most people realize; to achieve superior results is harder than it looks." - Benjamin Graham
Re: Health insurance for FIRE
Thanks. Now I see it. That would be the deal breaker for me. If the insurance company can't handle a bill over $2M, I sure can't! Seriously, a catastrophic, long term illness hospitalization could exceed $2m.David Jay wrote: ↑Fri Dec 07, 2018 8:11 amSee above, $2Mgasdoc wrote: ↑Fri Dec 07, 2018 7:48 am I would look at whether there is a cap on what insurance will pay. For most people, covering prescription drugs for the period of the short term policy wouldn't be a deal breaker, but if the policy only paid up to the first $X,XXX,XXX, and then stopped paying? There used to be lots of policies that had caps.
gasdoc
gasdoc
Re: Health insurance for FIRE
The problem is that when it comes to health insurance on the individual market the X is undefined, unknown, and almost certainly different next year and the year after.
Should you plan on $10k, $20k, $50k a year? Maybe it's free to you? Maybe it's not available at all leaving you exposed to unlimited costs?
Agreed you need to cover it but how do you plan?
Re: Health insurance for FIRE [Financial Independence Retire Early]
My policy will. Priority Health is a large hospital network and you get in-network discounts on the deductible amounts.michaeljc70 wrote: ↑Fri Dec 07, 2018 10:03 am Do these short-term plans have networks that entitle you to discounted rates before you meet your deductible? In looking at them I haven't heard of any of these companies (Independence American Insurance Company and LifeShield National Insurance Company). That can make a big difference. Currently I get around 50% off doctors and 80%-90% off lab work when going in network.
It works the same way with my work insurance HDHP now - I get the Blue Cross discounted price for, say, my ophthalmologist visits even though I pay with HSA money.
It's not an engineering problem - Hersh Shefrin | To get the "risk premium", you really do have to take the risk - nisiprius
Re: Health insurance for FIRE
I completely agree that it is a large and unpredictable expense.MP123 wrote: ↑Fri Dec 07, 2018 9:47 pmThe problem is that when it comes to health insurance on the individual market the X is undefined, unknown, and almost certainly different next year and the year after.
Should you plan on $10k, $20k, $50k a year? Maybe it's free to you? Maybe it's not available at all leaving you exposed to unlimited costs?
Agreed you need to cover it but how do you plan?
But, is that really all that much different than a lot of other retirement planning?
What will the market return over the next 10 years, is it 10% CAGR, 5% CAGR, -5% CAGR?
Maybe we will will have a Japan style decade or two, or three. Or maybe another historical bull market.
I think the best that you can do is try to make reasonable estimates based on the current situation and trends, build in some conservative wiggle room, and realize that you will need to be flexible.
Some might advocate working forever (or at least till medicare), but if one of your scenarios is 50k/yr (in today's dollars?), how much longer can employers continue to absorb that cost?
Once in a while you get shown the light, in the strangest of places if you look at it right.
Re: Health insurance for FIRE
The current system did mandate insurance for all (until next year), and while we have no idea what prices would have been had it not been, it didn't bring down prices.StopIroningShirts wrote: ↑Sat Dec 08, 2018 6:27 am... I would personally rather see health insurance mandated for all, which would bring down prices and allow people to buy into the ACA for the same rates as group plans. Until then, the current system is what we've got...
"To achieve satisfactory investment results is easier than most people realize; to achieve superior results is harder than it looks." - Benjamin Graham
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Re: Health insurance for FIRE
I would argue the list of waivers and minor penalty wasn't a mandate. If they refused to issue drivers licenses, passports, or accept tax returns until proof of insurance was provided, that would be a mandate. Here were the list of exemptions in 2017, which included just not paying a utility bill until the point they sent you a shutoff noticeJoMoney wrote: ↑Sat Dec 08, 2018 6:58 amThe current system did mandate insurance for all (until next year), and while we have no idea what prices would have been had it not been, it didn't bring down prices.StopIroningShirts wrote: ↑Sat Dec 08, 2018 6:27 am... I would personally rather see health insurance mandated for all, which would bring down prices and allow people to buy into the ACA for the same rates as group plans. Until then, the current system is what we've got...
****
For coverage year 2017, HealthCare.gov listed the following as hardship exemptions:
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Re: Health insurance for FIRE [Financial Independence Retire Early]
I removed an off-topic post conjecturing on single-payer insurance. This requires a change in legislation, which makes this a political discussion and is off-topic (proposed legislation). As a reminder, see: Politics and Religion
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Re: Health insurance for FIRE
Only around 3% of the people in the US have an exchange plan. Most people get their health insurance from their job or Medicare/Medicaid. In reality, few people are on the ACA and it focused on getting people covered and giving them a subsidy rather than really addressing why healthcare costs so much. With the Medicaid expansion in the ACA you had some people go on that (around 5% of the population). ER visits actually went up after the ACA compared to before.JoMoney wrote: ↑Sat Dec 08, 2018 6:58 amThe current system did mandate insurance for all (until next year), and while we have no idea what prices would have been had it not been, it didn't bring down prices.StopIroningShirts wrote: ↑Sat Dec 08, 2018 6:27 am... I would personally rather see health insurance mandated for all, which would bring down prices and allow people to buy into the ACA for the same rates as group plans. Until then, the current system is what we've got...
- DWesterb2iz2
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Re: Health insurance for FIRE
the individual insurance market is much bigger than the exchange. I buy compliant individual policies that are not on the exchanges, and so do many other people. Moreover, The coverage mandates (no caps, no exclusion for pre existing conditions, etc) changed every insurance policy, not just individual policies. Unless you have government program insurance, you are “on” ACA. (And people on Medicaid because of the expansion are on ACA, too.) The exchanges were part of aca, but not the point of it.michaeljc70 wrote: ↑Sat Dec 08, 2018 10:21 amOnly around 3% of the people in the US have an exchange plan. Most people get their health insurance from their job or Medicare/Medicaid. In reality, few people are on the ACA and it focused on getting people covered and giving them a subsidy rather than really addressing why healthcare costs so much. With the Medicaid expansion in the ACA you had some people go on that (around 5% of the population). ER visits actually went up after the ACA compared to before.JoMoney wrote: ↑Sat Dec 08, 2018 6:58 amThe current system did mandate insurance for all (until next year), and while we have no idea what prices would have been had it not been, it didn't bring down prices.StopIroningShirts wrote: ↑Sat Dec 08, 2018 6:27 am... I would personally rather see health insurance mandated for all, which would bring down prices and allow people to buy into the ACA for the same rates as group plans. Until then, the current system is what we've got...
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Re: Health insurance for FIRE
Having an ACA compliant plan (which most plans must be now) to me is different than being on Obamacare, but I guess it is semantics. I had my own individual policy for decades before the ACA. There were few changes after the ACA compared to the plans I had before- except the networks became narrower, deductibles rose and the cost skyrocketed. I never had one of those pre-ACA so-called "junk" plans they talked about. Now I have a plan with a $15k deductible, which I would call a junk plan. My point was addressed toward the idea that the mandate would lower costs. The number of additional people covered was not that great and there are still tens of millions uninsured.DWesterb2iz2 wrote: ↑Sat Dec 08, 2018 10:57 amthe individual insurance market is much bigger than the exchange. I buy compliant individual policies that are not on the exchanges, and so do many other people. Moreover, The coverage mandates (no caps, no exclusion for pre existing conditions, etc) changed every insurance policy, not just individual policies. Unless you have government program insurance, you are “on” ACA. (And people on Medicaid because of the expansion are on ACA, too.) The exchanges were part of aca, but not the point of it.michaeljc70 wrote: ↑Sat Dec 08, 2018 10:21 amOnly around 3% of the people in the US have an exchange plan. Most people get their health insurance from their job or Medicare/Medicaid. In reality, few people are on the ACA and it focused on getting people covered and giving them a subsidy rather than really addressing why healthcare costs so much. With the Medicaid expansion in the ACA you had some people go on that (around 5% of the population). ER visits actually went up after the ACA compared to before.JoMoney wrote: ↑Sat Dec 08, 2018 6:58 amThe current system did mandate insurance for all (until next year), and while we have no idea what prices would have been had it not been, it didn't bring down prices.StopIroningShirts wrote: ↑Sat Dec 08, 2018 6:27 am... I would personally rather see health insurance mandated for all, which would bring down prices and allow people to buy into the ACA for the same rates as group plans. Until then, the current system is what we've got...
Last edited by michaeljc70 on Sat Dec 08, 2018 12:13 pm, edited 1 time in total.
Re: Health insurance for FIRE [Financial Independence Retire Early]
Why not work a few extra years? I always thought that the FIRE mentality was all about financial independence but this thread is convincing me otherwise. If you have to rely on subsidized healthcare you're not really financially independent and are only pushing healthcare costs up for others.
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Re: Health insurance for FIRE [Financial Independence Retire Early]
All, a good audio (15 minutes) on this came out on "This American Life" and an audio will be available Sunday Dec 9, 2018 based on the ACA individual mandate and how NY is dealing with cost increases. I'm not trolling just letting all be aware this is something to be aware for "FIRE".
"Know That You Are Unprecedentedly Negative"
By David Kestenbaum
When health care premiums went up in New York State, a bunch of people got mad and wrote letters to the state. Producer David Kestenbaum takes us into the raw world of these letters.
https://www.thisamericanlife.org/663/ho ... /act-two-0
"Know That You Are Unprecedentedly Negative"
By David Kestenbaum
When health care premiums went up in New York State, a bunch of people got mad and wrote letters to the state. Producer David Kestenbaum takes us into the raw world of these letters.
https://www.thisamericanlife.org/663/ho ... /act-two-0
Re: Health insurance for FIRE [Financial Independence Retire Early]
For some (many?) Early retirees, even those who have budgeted for health insurance, it actually takes going out of your way to avoid the subsidy.wootwoot wrote: ↑Sat Dec 08, 2018 12:08 pm Why not work a few extra years? I always thought that the FIRE mentality was all about financial independence but this thread is convincing me otherwise. If you have to rely on subsidized healthcare you're not really financially independent and are only pushing healthcare costs up for others.
If you retire and are living of a tax-efficent taxable account, you could be spending well north of $100k/yr, and still have MAGI below the subsidy threshold.
Should such a person jump through hoops to avoid, or not take the tax break? What other tax break should they try to avoid?
Once in a while you get shown the light, in the strangest of places if you look at it right.
Re: Health insurance for FIRE [Financial Independence Retire Early]
I removed an off-topic post and a reply. As a reminder, see: General Etiquette
Update: A few more off-topic posts have been removed.We expect this forum to be a place where people can feel comfortable asking questions and where debates and discussions are conducted in civil tones.
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Re: Health insurance for FIRE [Financial Independence Retire Early]
I'm going to bow out of this thread. What this poster said is accurate...and we've done just that.wootwoot wrote: ↑Sat Dec 08, 2018 12:08 pm Why not work a few extra years? I always thought that the FIRE mentality was all about financial independence but this thread is convincing me otherwise. If you have to rely on subsidized healthcare you're not really financially independent and are only pushing healthcare costs up for others.
I'll continue to file my taxes and pay the minimum required like any taxpayer. If that provides a tax credit for health insurance based on my income, I doubt I'll volunteer that money back to the IRS and instead continue to support human services not for profits