Health Care Options Until Age 65?

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dale8087
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Health Care Options Until Age 65?

Post by dale8087 » Sat Jul 13, 2019 11:27 pm

I am 58 years old and thinking about retiring in the next year or so. I have heard horror stories about how much health care costs for a family plan. Right now I have an employer-sponsored retirement plan with a HSA but I don't know what the best options are after retirement but before Medicare. Any advice would be helpful.

bluquark
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Re: Health Care Options Until Age 65?

Post by bluquark » Sun Jul 14, 2019 12:41 am

You can go on healthcare.gov and type in your information as if you are about to buy a private plan (at least Silver), but stop short of actually buying it. That's a good way of getting realistic quotes for your state and family situation.

mhalley
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Re: Health Care Options Until Age 65?

Post by mhalley » Sun Jul 14, 2019 1:58 am

The main way to do it is using an aca plan at healthcare.gov. You might be able to get a subsidy if you can manipulate your income so it is not too high or too low.
Another option is the healthcare sharing ministry. Some advocate them as being a cheaper alternative. I am somewhat leary of them myself.
You might be eligible for Cobra for 18 months.
The cost of the plans can be quite high. This is mainly governed by your zip code. Just as an example, My wife and I are 64. This year an HSA plan that pays nothing until $6500 deductible costs us $2845 a month. No subsidy due to Roth conversions.

Trader Joe
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Re: Health Care Options Until Age 65?

Post by Trader Joe » Sun Jul 14, 2019 7:00 am

dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
I am 58 years old and thinking about retiring in the next year or so. I have heard horror stories about how much health care costs for a family plan. Right now I have an employer-sponsored retirement plan with a HSA but I don't know what the best options are after retirement but before Medicare. Any advice would be helpful.
Yes, my advice is to not confuse health care with health insurance. This is very important. Best of luck.

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Sandtrap
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Re: Health Care Options Until Age 65?

Post by Sandtrap » Sun Jul 14, 2019 7:15 am

dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
I am 58 years old and thinking about retiring in the next year or so. I have heard horror stories about how much health care costs for a family plan. Right now I have an employer-sponsored retirement plan with a HSA but I don't know what the best options are after retirement but before Medicare. Any advice would be helpful.
Also: search/google the forum archives/past threads for "ACA Subsidy Cliff".
The penalties can be painful.

The "pre-65" period can be a costly time for health care premiums and coverage.
It is good that you're looking into this "Before" you leave work. The horror stories are real.

Look into your employee sponsored retirement HSA plans. It may be great, or not so, or terrible. Perhaps it is very low cost but covers nothing with high deductable. Or, it might be great.

Explore alternative coverages. Likely you will find them sorely lacking in coverage and not worth the lower premiums from HSA.

The folks at HSA are extremely helpful and knowledgeble when you call them. Well worth exploring this.

j
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Sandtrap
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Re: Health Care Options Until Age 65?

Post by Sandtrap » Sun Jul 14, 2019 7:21 am

mhalley wrote:
Sun Jul 14, 2019 1:58 am
The main way to do it is using an aca plan at healthcare.gov. You might be able to get a subsidy if you can manipulate your income so it is not too high or too low.
Another option is the healthcare sharing ministry. Some advocate them as being a cheaper alternative. I am somewhat leary of them myself.
You might be eligible for Cobra for 18 months.
The cost of the plans can be quite high. This is mainly governed by your zip code. Just as an example, My wife and I are 64. This year an HSA plan that pays nothing until $6500 deductible costs us $2845 a month. No subsidy due to Roth conversions.
Besides Cobra, the ACA may give you the best coverage at . . . still high premiums? :oops: and high deductables :oops:
Encourage you to not only go to the healthcare.gov site but to give the folks there a call. They can help you far beyond the info on the site.

I would be leary of health insurance "alternatives". DW and I have looked into most everything out there in the past and there's a lot of things that "sound good", great "sales tactics" but low on delivery, and "hard to cancel or costly to cancel".

So. . . beeeee careful before you sign up for anything.

The HSA might often cost more premium wise but be worth it in the long run. Just hang on until 65.

The other alternative is to continue working part time to retain your health care coverage.

j
Last edited by Sandtrap on Sun Jul 14, 2019 7:21 am, edited 1 time in total.
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MikeG62
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Re: Health Care Options Until Age 65?

Post by MikeG62 » Sun Jul 14, 2019 7:21 am

bluquark wrote:
Sun Jul 14, 2019 12:41 am
You can go on healthcare.gov and type in your information as if you are about to buy a private plan (at least Silver), but stop short of actually buying it. That's a good way of getting realistic quotes for your state and family situation.
^This, although I would not say you need to purchase a policy “at least Silver”. My DW has a Silver plan and I have a Bronze HSA. Depends on how much you typically go to the doctor and how healthy you are.

As someone else said, if you can manage your income below the cutoffs, you may qualify for subsidies - which can substantially reduce the cost of the premiums. We are not able to so we pay full freight. Annual premiums for our two polices in 2019 are around $17K per year (+ OOP’s).
Real Knowledge Comes Only From Experience

McGilicutty
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Re: Health Care Options Until Age 65?

Post by McGilicutty » Sun Jul 14, 2019 9:10 am

I'm also looking into the ACA. According to the following article, the ACA subsidy cliff is at 400% of the Federal Poverty Level.

https://thefinancebuff.com/stay-under-o ... cliff.html

100% of FPL for 2020 appears to be $12490 for a single person like myself. See the following article for more details on FPL:

https://thefinancebuff.com/federal-pove ... acare.html

So, 400% of FPL for me is $49960. My income will probably be around $30K next year and I plugged that into the Healthcare.gov Web site and it looks like my premium will be $560/month for a bronze plan with a $530/month subsidy. So, it looks like I would only have to pay $30/month for health insurance. Not a bad deal.

Also, be aware that there is a floor (138% of FPL, I think) where earning below that you would not get ACA subsidies. You might qualify for Medicaid if you are below the floor, but I think Medicaid takes into account your assets or something (not sure about that), so it's probably best to stay above the income floor.

As a retiree, there is a lot you can do to control your income. As one of the articles linked above states, if you think you are going to be below the floor, you can just do a Roth conversion to raise your income above the floor. Additionally, if you will be living off your portfolio and need income that will take you above the ACA ceiling, you can choose assets to sell that haven't appreciated much in order to keep your income below the ceiling.

Good luck with your retirement!

doneat53
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Re: Health Care Options Until Age 65?

Post by doneat53 » Sun Jul 14, 2019 9:18 am

100% of FPL for 2020 appears to be $12490 for a single person like myself. See the following article for more details on FPL:
Yabut you should use 100% FPL for the previous year for your calculations for current year. ie for 2019 use FPL for 2018

informal guide
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Re: Health Care Options Until Age 65?

Post by informal guide » Sun Jul 14, 2019 9:21 am

Do look carefully at your employer's COBRA cost and coverage.(I believe offering COBRA coverage is required by law) It will give you an 18 month window to shop, along with the comfort of knowing the details of your coverage (mine was the same as my employee coverage, for under $1000 per month total for my spouse and me). My employer also offers a "retiree plan," at a higher price than COBRA because the average age of participants is higher than COBRA participants, until reaching Medicare age.

Topic Author
dale8087
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Re: Health Care Options Until Age 65?

Post by dale8087 » Sun Jul 14, 2019 10:18 am

I will definitely look into the COBRA angle. Thank you all for your time!

InMyDreams
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Re: Health Care Options Until Age 65?

Post by InMyDreams » Sun Jul 14, 2019 11:56 am

HealthSherpa provides an easy user interface to get prices for your specific marketplace:
https://www.healthsherpa.com/

I'm in a similar boat, and am planning on using the (expensive) retiree health insurance benefit rather than the (less expensive) ACA option in 2020. I feel too much uncertainty about the ACA (e.g., the current court case wending its way up the appellate system) to go to the ACA right now.

cacophony
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Re: Health Care Options Until Age 65?

Post by cacophony » Sun Jul 14, 2019 12:14 pm

mhalley wrote:
Sun Jul 14, 2019 1:58 am
The main way to do it is using an aca plan at healthcare.gov. You might be able to get a subsidy if you can manipulate your income so it is not too high or too low.
Another option is the healthcare sharing ministry. Some advocate them as being a cheaper alternative. I am somewhat leary of them myself.
You might be eligible for Cobra for 18 months.
The cost of the plans can be quite high. This is mainly governed by your zip code. Just as an example, My wife and I are 64. This year an HSA plan that pays nothing until $6500 deductible costs us $2845 a month. No subsidy due to Roth conversions.
What state you live in definitely makes a big difference. I just priced your same situation in California and the cheapest plan ($6,300 deductible) is only $1291/month.

It's also worth noting that certain states allow more than 18 months of Cobra. For example California has Cal-Cobra which covers up to 36 months in almost all cases.

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Flobes
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Re: Health Care Options Until Age 65?

Post by Flobes » Sun Jul 14, 2019 12:39 pm

dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
I have heard horror stories about how much health care costs for a family plan. Any advice would be helpful.
Depending on where you live, costs are very widely variable. Ditto laws and regulations. Different regions within the same state can have very different insurance availabilities and pricetags. Start your research with local details.
dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
options are after retirement but before Medicare
Another option is to get a part-time job that gives access to benefits. Companies that reportedly offer health insurance to part-timers: Starbucks, Whole Foods, REI, Costco, Lowes. Plus some jobs with some governments.
dale8087 wrote:
Sun Jul 14, 2019 10:18 am
I will definitely look into the COBRA angle.
Caveat: If you end your COBRA mid-year, then when you shift to other insurance, you will have to restart all of your annual deductibles, etc that year.

My retirement health insurance journey from age 57: COBRA (ending 12/31) => private high-deductible individual insurance, with HSA (starting 1/1) => ACA Silver, with maximum subsidies and cost-sharing => Medicare.

Random Poster
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Re: Health Care Options Until Age 65?

Post by Random Poster » Sun Jul 14, 2019 12:43 pm

cacophony wrote:
Sun Jul 14, 2019 12:14 pm
What state you live in definitely makes a big difference. I just priced your same situation in California and the cheapest plan ($6,300 deductible) is only $1291/month.
Anyone know of a resource that identifies which states have the cheapest health insurance premiums?

Or, alternatively, which zip codes within each state have the cheapest health insurance premiums?

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Watty
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Re: Health Care Options Until Age 65?

Post by Watty » Sun Jul 14, 2019 12:56 pm

A few things I have found out about COBRA that might not be obvious;

A few states have extended COBRA from 18 months to 36 months but it may be called something else for the additional 18 months. I think it was California and one or two other states. Be sure to look at what it is for your specific state.

If the employee who qualifies for COBRA goes on Medicare before COBRA ends, then the other family members on COBRA, like a spouse, qualify for an additional 18 months of COBRA so they could have up to 36 months.

When comparing COBRA to an ACA policy look at the details closely. My COBRA was with Blue Cross and when I switched to an ACA policy there was also a Blue Cross option. When I looked at the details though the ACA Blue Cross network of doctors was very limited and none of the doctors that I had been using with my Blue Cross COBRA policy were in the ACA Blue Cross network. Very few primary care doctors in the ACA Blue Cross Network were taking new patients. I ended up going with a Kaiser ACA policy just to get good access to doctors.

If you go with COBRA be proactive with making sure the bills are paid on time. My COBRA was administered by a third party company and they did the bare minimum that they legally had to as far as notifications and billing. It was obvious that they would have loved for me to have missed a payment so they could drop me from COBRA. Be sure that someone will make the COBRA payments if both you and your spouse are in a hospital and cannot pay the bills.

dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
Any advice would be helpful.
You need to be careful about thinking that you can do any reliable planning since the health insurance laws change from year to year. I have about two years until I can get on Medicare and I cannot predict what will be available for the next two year so I am planning on just following it closely.

As other have said be sure to understand the ACA subsidy cliff. I have a paid off house but one thing I have done is to set up a home equity line of credit that I can draw on so that I do not need to do things like IRA withdrawals that might put me over the cliff.

In addition to the cliff the amount of subsidy also varies depending on how far below the cliff you are. In my situation I get an an additional 9.8% subsidy for each dollar below the cliff. That means that if I am $10,000 below the cliff then I get an additional $980 subsidy.

Another post mentioned the minimum income that is needed to get the subsidy. That is also very important but I have not been at all close to that so I don't know all the details. Apparently below that income level you lose the subsidy, but the state I am in has not expanded Medicare so I could not get that either. It sounds like it can be a real "catch 22" situation.

lt1_vette
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Re: Health Care Options Until Age 65?

Post by lt1_vette » Sun Jul 14, 2019 1:56 pm

You can try Medishare, reviews and YouTube videos giving feedback. Not insurance but faith based cost share arrangement for members.

https://www.medishare.com/

Supposedly economical alternative to ACA and healthcare.gov

Would be interested if others have experience with MediShare.

informal guide
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Re: Health Care Options Until Age 65?

Post by informal guide » Sun Jul 14, 2019 5:40 pm

Watty wrote:
Sun Jul 14, 2019 12:56 pm
A few things I have found out about COBRA that might not be obvious;

A few states have extended COBRA from 18 months to 36 months but it may be called something else for the additional 18 months. I think it was California and one or two other states. Be sure to look at what it is for your specific state.

If the employee who qualifies for COBRA goes on Medicare before COBRA ends, then the other family members on COBRA, like a spouse, qualify for an additional 18 months of COBRA so they could have up to 36 months.

I thought this was the case when going on Medicare, but the COBRA insurance company and my employer denied it when I hit the Medicare time.

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Watty
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Re: Health Care Options Until Age 65?

Post by Watty » Sun Jul 14, 2019 5:51 pm

informal guide wrote:
Sun Jul 14, 2019 5:40 pm
Watty wrote:
Sun Jul 14, 2019 12:56 pm
A few things I have found out about COBRA that might not be obvious;

A few states have extended COBRA from 18 months to 36 months but it may be called something else for the additional 18 months. I think it was California and one or two other states. Be sure to look at what it is for your specific state.

If the employee who qualifies for COBRA goes on Medicare before COBRA ends, then the other family members on COBRA, like a spouse, qualify for an additional 18 months of COBRA so they could have up to 36 months.


I thought this was the case when going on Medicare, but the COBRA insurance company and my employer denied it when I hit the Medicare time.
That seems odd, did they say why?

Here is what it says on the CMS website about the conditions that you need to meet.

https://www.cms.gov/CCIIO/Programs-and- ... sheet.html
18 to 36-Month Period (Second Qualifying Event): A spouse and dependent children who already have COBRA coverage, and then experience a second qualifying event, may be entitled to a total of 36 months of COBRA coverage. Second qualifying events may include the death of the covered employee, divorce or legal separation from the covered employee, the covered employee becoming entitled to Medicare benefits (under Part A, Part B or both), or a dependent child ceasing to be eligible for coverage as a dependent under the group health plan. The following conditions must be met in order for a second event to extend a period of coverage:

The initial qualifying event is the covered employee's termination or reduction of hours, of employment, which calls for an 18-month period of continuation coverage;

The second event that gives rise to a 36-month maximum coverage period occurs during the initial 18-month period of continuation coverage (or within the 29-month period of coverage if a disability extension applies);

The second event would have caused a qualified beneficiary to lose coverage under the plan in the absence of the initial qualifying event;

The individual was a qualified beneficiary in connection with the first qualifying event and is still a qualified beneficiary at the time of the second event; and

The individual meets any applicable COBRA notice requirement in connection with a second event, such as notifying the plan administrator of a divorce or a child ceasing to be a dependent under the plan within 60 days after the event. See "Notices Required of Qualified Beneficiaries,"

If all conditions associated with a second qualifying event are met, the period of continuation coverage for the affected qualified beneficiary (or beneficiaries) is extended from 18 months (or 29 months) to 36 months.

furwut
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Re: Health Care Options Until Age 65?

Post by furwut » Sun Jul 14, 2019 6:58 pm

dale8087 wrote:
Sat Jul 13, 2019 11:27 pm
I am 58 years old and thinking about retiring in the next year or so. ...
You should also be aware that continuance of ACA is uncertain. So that’s a point in favor of starting off with COBRA or Employer Retirement Health Insurance - at least until things become clearer. Once you reject COBRA or employer insurance you may not be able to get back on.

informal guide
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Re: Health Care Options Until Age 65?

Post by informal guide » Sun Jul 14, 2019 7:41 pm

"That seems odd, did they say why?

Here is what it says on the CMS website about the conditions that you need to meet....."

My employer and the COBRA insurance company stated that my voluntary retirement (rather than an employer termination or reduction of hours) was not a qualifying event. I believe this was checked at high levels, as it was different than what was initially orally communicated.

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Watty
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Re: Health Care Options Until Age 65?

Post by Watty » Sun Jul 14, 2019 8:31 pm

informal guide wrote:
Sun Jul 14, 2019 7:41 pm
"That seems odd, did they say why?

Here is what it says on the CMS website about the conditions that you need to meet....."

My employer and the COBRA insurance company stated that my voluntary retirement (rather than an employer termination or reduction of hours) was not a qualifying event. I believe this was checked at high levels, as it was different than what was initially orally communicated.
Yikes, the link I posted does not say anything about voluntary or involuntary termination.

StealthRabbit
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Re: Health Care Options Until Age 65?

Post by StealthRabbit » Sun Jul 14, 2019 11:35 pm

Pre-medicare age HC would be a good wiki / sticky (Especially if someone researches the best state!)
BTDT myself (Age 49 retiree, no HC, no Pension)
Many viable options.
Initially COBRA $1200 ..!(24 months was free for me via 'trade-act', as long as I was a FT college kid @ age 49 (no problem... did a weekend MBA for 2 yrs) (also free))
Some college (student) medical coverages accept people older than age 40 (some do not).
Self pay.. . Lived in Thailand ~10% USA rate for services but VERY efficient, fast, excellent (EXCELLENT) care.. https://patientsbeyondborders.com/
Took a one yr RTW trip and used 'Travel Insurance', ~$100 / month (each) not meant to be primary, but they (reluctantly) covered issues. Travel insurance ENDS the minute you return home... DON'T go HOME!!! (that is easy!)
Used CHM (USA Healthcare sharing) $300 . month for (2) ... Not insurance, but has covered myself and many relatives, including several cancer treatments, births, and a 6 month ICU / Brain Tumor surgery for niece.

currently ACA
($3.31/ month for (2) $6500 HSA (income tax free WA State (Free FT college instead of wasting time in HS also!!! (if you still have kids at home))) < $65800 required or premium jumps to $2300 (not currently doing Roth Rolls, they can wait :mrgreen: )
ACA will not likely go away immediately due to so many people on it

If I needed to in the future... (No ACA?) I would certainly go back to one of (4) USA Healthcare Sharing Ministry programs. .... or move overseas. Both worked out fine.

Other options...
Small business group (need 3 employees to get group), Start an LLC and generate some emplyment (if you don't already have several LLC's)
J-o-b... :oops:
https://ptmoney.com/the-ten-best-part-t ... -benefits/
(Costco or USPS or UPS would be OK for me, as I ONLY work night shift (Can't tolerate any 'day-shift-cry-babies')
Since I keep my CDL current, I can also get a pretty high paying night shift gig if I must W-O-R-K... (BTDT...3 jobs at a time since age 15 (Dairy Farm Boarding School), so no longer seeking employment, I'm beat!)

Good luck, there are certainly many more options!
Have a good time! Life can come to a close tomorrow (or sooner).
Retire Early, Retire often!
Last edited by StealthRabbit on Sun Jul 14, 2019 11:46 pm, edited 1 time in total.

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AerialWombat
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Re: Health Care Options Until Age 65?

Post by AerialWombat » Sun Jul 14, 2019 11:45 pm

lt1_vette wrote:
Sun Jul 14, 2019 1:56 pm
You can try Medishare, reviews and YouTube videos giving feedback. Not insurance but faith based cost share arrangement for members.

https://www.medishare.com/

Supposedly economical alternative to ACA and healthcare.gov

Would be interested if others have experience with MediShare.
I have been a member of CHM (chministries.org) for a year and a half, and have had no problems with them. I've actually used it (to cover an urgent care visit and followup care), and found the reimbursement process to be straightforward. You have to follow a process, and it takes 3-4 months to get reimbursed, but they tell you that up front, so it has met my expectations.

Lost my health insurance in 2011, been kickin' it with alternatives ever since!
“Life doesn’t come with a warranty.” -Michael LeBoeuf

lstone19
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Re: Health Care Options Until Age 65?

Post by lstone19 » Wed Jul 17, 2019 9:05 am

informal guide wrote:
Sun Jul 14, 2019 7:41 pm
"That seems odd, did they say why?

Here is what it says on the CMS website about the conditions that you need to meet....."

My employer and the COBRA insurance company stated that my voluntary retirement (rather than an employer termination or reduction of hours) was not a qualifying event. I believe this was checked at high levels, as it was different than what was initially orally communicated.
I'm curious how large an employer this is. I wonder if it's a small company with a HR department that is just someone's collateral duty. I see nothing in the rules about the termination needing to be involuntary (a retirement is a form of employment termination). It's been years (in the 90s) since my wife or I voluntarily left an employer but I recall getting COBRA paperwork at the time.

I was getting ready to post a question that fits with this so rather than start a new topic, here goes. My wife is 16 months older than me and health care is through her employer. I retired (non-voluntary) from my full-time job two years ago and have been doing self-employment work since. So despite the issue informal_guide is having, I wanted to verify that if my wife leaves anytime after she turns 63.5, then we both initially should have 18 months of COBRA coverage and then when she reaches 65 and goes on Medicare, I get an additional 18 months (to 36 months total) which will get me to 65 and Medicare. We don't plan to cut the dates too fine - while her employer does not offer retiree medical, they do have service awards (based on billable hours - she's a contractor) that we project hitting no sooner than 63 and 10 months. After receiving that, there's less reason for her to keep working.

informal guide
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Re: Health Care Options Until Age 65?

Post by informal guide » Wed Jul 17, 2019 1:43 pm

This employer is a large financial services company with around 15,000 employees and the issue surfaced for me around two years ago. I speculate that the COBRA vendor -- -one of the largest insurers - - was involved in the decision. At least on the medical side, I believe the employer self-insured, paying the large insurer to administer claims (possibly with a "stop loss" backstop for catastrophic experience).

The employer also offers the same medical plans, albeit at a higher cost than COBRA, to retirees and their dependents until they reach 65.

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