Health Insurance before Medicare

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GridironGems
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Health Insurance before Medicare

Post by GridironGems »

I have a co worker who turns 60 in April, but is ready to retire. Works for the state and has enough points to retire for the pension. Only thing keeping him is health insurance. Is healthcare.gov the best option for him to examine? Any other thoughts or ideas?
Thanks!
twh
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Re: Health Insurance before Medicare

Post by twh »

Does the state have some provision where he can buy into the state program as a retiree? It may be full price, but it is probably a better option than ACA and similar cost.
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Kenkat
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Re: Health Insurance before Medicare

Post by Kenkat »

The buy-in idea is a good one, but if that is not an option, ACA plans can actually be affordable depending on your state and overall income level. It is pretty easy to get an idea of plans and prices here:

https://www.healthcare.gov/see-plans/#/

I will add that if you are used to a workplace plan that covers everything, the ACA plans may have higher deductibles than he is used to.
fortunefavored
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Re: Health Insurance before Medicare

Post by fortunefavored »

Make sure he spends the time to thoroughly research the ACA plans if he cannot buy into the state plan. In most areas, the ONLY individual plans available are via ACA - so you're unlikely to find anything else.

ACA plans have similar names to corporate/private plans ("Blue Cross of North Dakota") but have WILDLY different network of doctors, coverage levels, etc. Pay particular attention to which hospitals are in-network. Many top hospitals are excluded from ACA plans. Don't assume Blue Cross ACA is the same as Blue Cross private. Another big gotchya with ACA plans is most have zero out of area coverage - and the "area" can be very small.. like 10 miles.

Then there's the max out of pocket and deductibles, which can be a shocker to those used to a government or private plan.
Last edited by fortunefavored on Tue Nov 30, 2021 5:57 pm, edited 1 time in total.
fposte
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Re: Health Insurance before Medicare

Post by fposte »

Agreeing that he should check to see whether the pension provides him access to insurance. Mine is basically the same insurance as when I was working, so long as I'm getting the pension and am under 65.
livesoft
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Re: Health Insurance before Medicare

Post by livesoft »

COBRA may be another option, but not for the next 5 years.

We have friends who have created a path for us to follow, so does this person have friends who worked with them and retired before Medicare eligibility? What did they do?
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twh
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Re: Health Insurance before Medicare

Post by twh »

What some places do is allow you to buy into their program at full price. When you turn 65, they may continue to do that, but they are secondary to Medicare and the price goes down. The after-65 plan may or may not be as good as a Medicare Advantage or Medicare+Medigap plan. If you are making any significant income, ACA price will not be significantly different from an employer retiree plan, but the employer plan probably has better numbers and a better network.
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JoeRetire
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Re: Health Insurance before Medicare

Post by JoeRetire »

GridironGems wrote: Tue Nov 30, 2021 5:24 pmIs healthcare.gov the best option for him to examine? Any other thoughts or ideas?
Healthcare.gov is definitely the first place to start. And if his state has their own health portal, it will redirect him there. It might take some time to get used to the process, but it's time well spent.

Depending on where he lives, he may find many great plans, or not. We were able to get great plans from the same insurance company we had when I was working, covering all the same doctors, hospitals and prescriptions, with far lower deductibles, and at less cost. Obviously, that depends on income and locale.

COBRA may be worth looking into for the short term, if ACA plans prove expensive, or if he wants to continue with his existing plan for some reason.
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marcopolo
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Re: Health Insurance before Medicare

Post by marcopolo »

fortunefavored wrote: Tue Nov 30, 2021 5:54 pm Make sure he spends the time to thoroughly research the ACA plans if he cannot buy into the state plan. In most areas, the ONLY individual plans available are via ACA - so you're unlikely to find anything else.

ACA plans have similar names to corporate/private plans ("Blue Cross of North Dakota") but have WILDLY different network of doctors, coverage levels, etc. Pay particular attention to which hospitals are in-network. Many top hospitals are excluded from ACA plans. Don't assume Blue Cross ACA is the same as Blue Cross private. Another big gotchya with ACA plans is most have zero out of area coverage - and the "area" can be very small.. like 10 miles.

Then there's the max out of pocket and deductibles, which can be a shocker to those used to a government or private plan.
This may be your experience, but i honestly don't know how general that is.
You use terms like "many" and "most", do you know that to be true? There are literally thousands of local markets (availability of plans is done at a county level), I have no idea what "most" plans do with regard to network design.

What i can say is it definitely varies greatly by state and county. We are fortunate to have access to a PPO plan that has nationwide coverage, and covers all our doctors and all the major hospital in our state. In our area, you can also buy the same individual plans outside the ACA as well, although I am not sure what the advantage of that would be to an individual.
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mhalley
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Re: Health Insurance before Medicare

Post by mhalley »

The cost of ACA insurance is determined by zip code, and goes up every year. I elected to forego the subsidy for Roth conversions, and it was very expensive by age 64, plus would not pay a cent till a 6k deductible. Some have had good results with the religious health sharing plans, but they always felt iffy to me. I would look on healthcare.gov at the ACA plans for your area, and then see what they would be at age 64 and go from there.
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mhc
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Re: Health Insurance before Medicare

Post by mhc »

Here are some common options:

1. insurance through previous employer
2. ACA exchange
3. cost sharing ministries (maybe coupled with direct primary care physician) (this is not insurance)
4. buy non-exchange insurance
5. move to another country
6. no insurance
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mkc
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Re: Health Insurance before Medicare

Post by mkc »

fortunefavored wrote: Tue Nov 30, 2021 5:54 pm Make sure he spends the time to thoroughly research the ACA plans if he cannot buy into the state plan. In most areas, the ONLY individual plans available are via ACA - so you're unlikely to find anything else.

ACA plans have similar names to corporate/private plans ("Blue Cross of North Dakota") but have WILDLY different network of doctors, coverage levels, etc. Pay particular attention to which hospitals are in-network.
Cannot emphasize researching the specific provider network details of ACA plans enough.

In our county, a new option showed up on the Marketplace for 2022, with premiums lower than BCBS (previously the only company on ACA). Digging into it, there are no in-network hospitals or specialists (including pediatricians, OB/GYN, and cardiologists) within a hour's drive and only 2 in-network PCP family medicine physicians in the county for that insurance company. Pretty much all local providers will be out-of-network for anyone choosing this option, they do not have out-of-network coverage, and the lower premiums means everyone's premium tax credit is much lower for 2022.
livelovelaugh00
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Re: Health Insurance before Medicare

Post by livelovelaugh00 »

Recently I realized that different zip code have different set of ACA insurance plans available to choose from in my little state. The insurance I like is not in my zip code. However it is available in my brother's zip code which is less than half an hour away. I am thinking if I should change my address to his address and use my address as mailing address. What do you think??

Edit:
I called the insurance company and asked if the plan only serve certain zip code in the state. The rep said the plan is available for entire state.
Last edited by livelovelaugh00 on Thu Dec 02, 2021 9:06 am, edited 3 times in total.
PaunchyPirate
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Re: Health Insurance before Medicare

Post by PaunchyPirate »

livelovelaugh00 wrote: Thu Dec 02, 2021 8:34 am Recently I realized that different zip code have different set of ACA insurance plans available to choose from in my little state. The insurance I like is not in my zip code. However it is available in my brother's zip code which is less than half an hour away. I am thinking if I should change my address to his address and use my address as mailing address. What do you think??
I think you'd be running afoul of the rules and, if caught, you'd possibly be facing some form of penalties for such things as insurance fraud.
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