Health insurance and where to live when retiring early?

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CFM300
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Health insurance and where to live when retiring early?

Post by CFM300 »

Thinking of retiring early and moving to a new area. When choosing a new location, it seems prudent to factor in health insurance options. (We're about a decade away from Medicare.) Looking at various locations on the ACA website, some markets only have HMOs. Other markets only have PPOs. Some markets are more or less expensive than others.

Are current plans and prices in a market the best predictors of what will be available in that market in the future? Are some states or cities more likely to be better than others? How do we determine that? (For example, are more affluent areas more likely to have better plans?)

Are health insurance options so unknown that they shouldn't even factor into our decision of where to move?

Thoughts and advice appreciated.
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mrmass
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Re: Health insurance and where to live when retiring early?

Post by mrmass »

If healthcare is the top factor, MA has very good health care. Our state connector has been in place for a long time and from what I read, the feds looked at how MA implemented it when they developed the federal plan

plan https://www.mahealthconnector.org/
jebmke
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Re: Health insurance and where to live when retiring early?

Post by jebmke »

Price variation may be more a function of local competition and state regulation.

As far as HC and retirement location, I'd recommend focusing on availability and quality first and cost second - unless your financial situation is really close to the edge of feasibility. As well, keep in mind that quality and availability can be very local. I live within an hour of major cities and an hour and a half of DC but the local HC is primitive. An hour is a long time if you are in a health crisis or as you get older and longer drives are onerous for yourself or your spouse. We like the area where we retired but for this reason and a couple of other factors we will likely abandon it before long if I can just get us organized.
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OnTrack2020
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Re: Health insurance and where to live when retiring early?

Post by OnTrack2020 »

CFM300 wrote: Thu Jan 27, 2022 11:21 am Thinking of retiring early and moving to a new area. When choosing a new location, it seems prudent to factor in health insurance options. (We're about a decade away from Medicare.) Looking at various locations on the ACA website, some markets only have HMOs. Other markets only have PPOs. Some markets are more or less expensive than others.

We have an EPO for our ACA plan. The HMO is, I believe, more restrictive than the PPO.

Are current plans and prices in a market the best predictors of what will be available in that market in the future? Are some states or cities more likely to be better than others? How do we determine that? (For example, are more affluent areas more likely to have better plans?)

In my opinion, I would not rely on current plans and prices as future predictors of a health care plan. I do believe that if you retire to a location with more population that you will have more plans being offered from what I've seen. We live in a state that, until recently, only had two insurance carriers in the ACA marketplace. Our gold plan was under $300 for 4 of us in 2021. In 2022, more insurance carriers came on board; therefore, more competition. Even with less estimated income in 2022, our gold plan, if we had continued with it, would rise to close to $1,500 from $300. I just don't think you currently have a way to predict future prices. I have heard people on this board talk about the plans in California and seem to be happy with them??

Are health insurance options so unknown that they shouldn't even factor into our decision of where to move?

I think you can try to do your best to factor them in, but they simply aren't set in stone. Some carriers may drop out, while new ones will be added, etc.

Thoughts and advice appreciated.
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MP123
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Re: Health insurance and where to live when retiring early?

Post by MP123 »

The states that sided with Texas in the recently settled California vs Texas were trying to get rid of ACA. They might not be the best choice if one was dependent on having an ACA plan, or at least those states aren't supportive of ACA at a high level.

https://www.kff.org/health-reform/issue ... g-the-aca/
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mrmass
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Re: Health insurance and where to live when retiring early?

Post by mrmass »

MP123 wrote: Thu Jan 27, 2022 1:30 pm The states that sided with Texas in the recently settled California vs Texas were trying to get rid of ACA. They might not be the best choice if one was dependent on having an ACA plan, or at least those states aren't supportive of ACA at a high level.

https://www.kff.org/health-reform/issue ... g-the-aca/
Helpful link. Thank you
Cali4en
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Re: Health insurance and where to live when retiring early?

Post by Cali4en »

MP123 wrote: Thu Jan 27, 2022 1:30 pm The states that sided with Texas in the recently settled California vs Texas were trying to get rid of ACA. They might not be the best choice if one was dependent on having an ACA plan, or at least those states aren't supportive of ACA at a high level.

https://www.kff.org/health-reform/issue ... g-the-aca/
Fair point in theory and perhaps in the long run, but pragmatically it may be a null issue unless Congress takes up changing the ACA again. We've been using the ACA in the Austin metro for eight years now and it has been a completely great experience. State support doesn't particularly matter as long as the ACA remains intact at the federal level. Of course, you need to live in a healthy ACA market/county, but that's true everywhere.
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Re: Health insurance and where to live when retiring early?

Post by quantAndHold »

Healthcare in general is a moving target. I would expect healthcare, in general, to get more expensive rather than cheaper, and as we age, healthcare gets more expensive, but the ACA itself has stabilized a lot in the last few years. As a generalization, populated areas will have more plan choices than less populated areas.

As far as price, though, if you can qualify for a subsidy, it doesn’t much matter where you live, because the price is controlled by your income. If you don’t qualify for a subsidy, there are significant differences in how much your premium is going to be, depending on where you live. You’ll need to research that.
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Re: Health insurance and where to live when retiring early?

Post by dink2win »

I live in CA so only really know about Covered CA, but I heard the Silver HMO plans are pretty decent and very low copay and deductibles. However to get the best plans (94 tier) for free you need to make less than $26k a year as a married couple.

However, depending on how much your taxable income (or Roth conversions) will be in retirement, considering a state with no income tax and lower cost of living may be worth more money savings (even if you have to pay a bit more for a medical insurance premium).

Also, medical options and programs are subject to change in the future, while its a lot less likely that a state would start suddenly collecting income tax. Like its possible that in the future there will be a national health plan like every other developed nation in the world.
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Re: Health insurance and where to live when retiring early?

Post by twh »

Have you checked to see if your company has a retiree plan you can buy into? Some do. Typically this is with a larger and self-insured company and they may offer this to people who are over a certain age and worked at the company for a certain number of years. The advantage of this is the administrator is probably a big insurer like UHC or Cigna and the options and plan are as good or better as any on the ACA. They probably charge full price, but still it is a good and safe deal unless you qualify for ACA subsidies.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

jebmke wrote: Thu Jan 27, 2022 11:37 am I'd recommend focusing on availability and quality first and cost second
I get what you're saying about choosing a location that has quality healthcare options, but one's health insurance plan will dictate more specifically whether those are accessible. I could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

MP123 wrote: Thu Jan 27, 2022 1:30 pm The states that sided with Texas in the recently settled California vs Texas were trying to get rid of ACA. They might not be the best choice if one was dependent on having an ACA plan, or at least those states aren't supportive of ACA at a high level.

https://www.kff.org/health-reform/issue ... g-the-aca/
Something to consider, for sure. Thanks!
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

Cali4en wrote: Thu Jan 27, 2022 1:53 pm you need to live in a healthy ACA market/county
How does one identify those? Currently (without simply checking each location using the ACA site) and predictively?
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

quantAndHold wrote: Thu Jan 27, 2022 2:03 pm As far as price, though, if you can qualify for a subsidy, it doesn’t much matter where you live, because the price is controlled by your income.
I searched for comparable PPO plans in two different cities. Same income, same subsidy, same out of pocket max, both BCBS, etc.

The plan in one city cost $41/month. The plan in the other city cost $687/month. Both prices are after applying the subsidy.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

dink2win wrote: Thu Jan 27, 2022 2:16 pm depending on how much your taxable income (or Roth conversions) will be in retirement, considering a state with no income tax and lower cost of living may be worth more money savings (even if you have to pay a bit more for a medical insurance premium).
Good point!
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

twh wrote: Thu Jan 27, 2022 2:25 pm Have you checked to see if your company has a retiree plan you can buy into?
We have, and they don't. Thanks for the suggestion though.
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Re: Health insurance and where to live when retiring early?

Post by chw »

mrmass wrote: Thu Jan 27, 2022 11:29 am If healthcare is the top factor, MA has very good health care. Our state connector has been in place for a long time and from what I read, the feds looked at how MA implemented it when they developed the federal plan

plan https://www.mahealthconnector.org/
+1. Retired 4 years ago, and have had access to good quality healthcare networks thru the Connector plans. We were a bit nervous a few years ago when the ACA was nearly abolished, but felt that MA would continue their public healthcare plans, as they were in place before ACA. We were late 50s in age when we signed up, and premiums have actually gone down marginally during this time.
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quantAndHold
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Re: Health insurance and where to live when retiring early?

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CFM300 wrote: Thu Jan 27, 2022 8:53 pm
quantAndHold wrote: Thu Jan 27, 2022 2:03 pm As far as price, though, if you can qualify for a subsidy, it doesn’t much matter where you live, because the price is controlled by your income.
I searched for comparable PPO plans in two different cities. Same income, same subsidy, same out of pocket max, both BCBS, etc.

The plan in one city cost $41/month. The plan in the other city cost $687/month. Both prices are after applying the subsidy.
My bad. Practically everyone I know is on a bronze HMO because they want the HSA. Your subsidy is calculated using the second cheapest silver plan. There are differences in price, but the differences between bronze plans are not that large.

You also need to consider the size and quality of the networks. The copays are regulated, but there are large differences in the quality of the networks. BCBS is actually one of the worst here. Prices can also get skewed by how competitive the market is for silver plans.
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Re: Health insurance and where to live when retiring early?

Post by Cali4en »

CFM300 wrote: Thu Jan 27, 2022 8:47 pm
Cali4en wrote: Thu Jan 27, 2022 1:53 pm you need to live in a healthy ACA market/county
How does one identify those? Currently (without simply checking each location using the ACA site) and predictively?
That's the only way I am aware of, sadly.
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

quantAndHold wrote: Thu Jan 27, 2022 9:57 pm You also need to consider the size and quality of the networks.
I agree, but that seems even more difficult -- perhaps even impossible -- when considering possible retirement locations where we don't currently live.
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

quantAndHold wrote: Thu Jan 27, 2022 2:03 pm Healthcare in general is a moving target. I would expect healthcare, in general, to get more expensive rather than cheaper, and as we age, healthcare gets more expensive, but the ACA itself has stabilized a lot in the last few years. As a generalization, populated areas will have more plan choices than less populated areas.

As far as price, though, if you can qualify for a subsidy, it doesn’t much matter where you live, because the price is controlled by your income. If you don’t qualify for a subsidy, there are significant differences in how much your premium is going to be, depending on where you live. You’ll need to research that.
This is not true at all.

The amount of the subsidy is determined by the difference between the SLCSP in your area and your expected contribution based on income. That then get applied to whatever plan you choose. You pay the difference.

The amount you end up paying is VERY much dependent on the local market factors that set both the SLCSP pricing, as well as the relative pricing between them and other plans.

The states that did the "Silver Switcheroo" a few years ago generally have expensive Silver plans that drive up the amount of the tax credit so that other metal plans become cheaper.

In general, states that are friendly towards ACA have better options and pricing than states that have tried to fight adoption of the ACA.
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Re: Health insurance and where to live when retiring early?

Post by TheHiker »

Going through similar thoughts as OP.
I think prices are only part of the picture and these are relatively easy to figure out. But doctor networks are as important.

We use healthcare a lot (unfortunately). Many specialist visits, specialty medication, hospital stays etc. Self-insuring would not be an option for us.
Looking at the ACA plans in our county (San Francisco bay area).
Most of the ACA plans are HMO and most of our current specialist doctors are not in network of any of these plans.
There is just one expensive PPO plan with poor out-of-network coverage and a very high out-of-pocket max.

I know we are spoiled with the group plans from work which pay for anything no questions asked.
Looks like with ACA navigating the system is going to be quite complicated and finding the doctors may be difficult.
My employer-provided plan pays for any drugs doctors prescribe (brand name, off label, experimental drugs etc). Does drug coverage work differently with ACA?

When looking at other areas, I see very different lists of plans from different insurers (many I never heard of).
How do you tell which of the plans has a network that is good/adequate?

Kaiser offers plans in many areas around here. Are Kaiser ACA plans similar to their employer group plans? Or are they also limited in some ways?
OnTrack2020
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Re: Health insurance and where to live when retiring early?

Post by OnTrack2020 »

TheHiker wrote: Fri Jan 28, 2022 1:47 am Going through similar thoughts as OP.
I think prices are only part of the picture and these are relatively easy to figure out. But doctor networks are as important.

We use healthcare a lot (unfortunately). Many specialist visits, specialty medication, hospital stays etc. Self-insuring would not be an option for us.
Looking at the ACA plans in our county (San Francisco bay area).
Most of the ACA plans are HMO and most of our current specialist doctors are not in network of any of these plans.
There is just one expensive PPO plan with poor out-of-network coverage and a very high out-of-pocket max.

I know we are spoiled with the group plans from work which pay for anything no questions asked.
Looks like with ACA navigating the system is going to be quite complicated and finding the doctors may be difficult.
My employer-provided plan pays for any drugs doctors prescribe (brand name, off label, experimental drugs etc). Does drug coverage work differently with ACA?

In order to determine the cost prior to picking a plan, you are able to input any prescription meds you take to see if they are covered. If you are looking at the plan benefit information, you will be able to see how much the monthly co-pay will be for those medicines. Something I didn't realize at the time we went on the ACA, but the prescriptions meds were less expensive when we were on a gold plan versus us now being on a bronze plan where they are higher. But really need to look at overall cost of plans when deciding.

When looking at other areas, I see very different lists of plans from different insurers (many I never heard of).
How do you tell which of the plans has a network that is good/adequate?

This is a tough one because you want a plan with an insurer that actually pays out on a claim. Prior to picking a plan, you also can type in your current doctors/hospital/pharmacy to see if they are in network. We also read some of the reviews on the different carriers. Also know that once you pick a plan that, if you are not happy with your plan, you will be able to switch in a year.

Kaiser offers plans in many areas around here. Are Kaiser ACA plans similar to their employer group plans? Or are they also limited in some ways?

Can't answer this one.
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JoeRetire
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Re: Health insurance and where to live when retiring early?

Post by JoeRetire »

mrmass wrote: Thu Jan 27, 2022 11:29 am If healthcare is the top factor, MA has very good health care. Our state connector has been in place for a long time and from what I read, the feds looked at how MA implemented it when they developed the federal plan
The same person helped craft both - Jonathan Gruber, economist from MIT.

The area does indeed have terrific healthcare.
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JoeRetire
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CFM300 wrote: Thu Jan 27, 2022 11:21 amAre current plans and prices in a market the best predictors of what will be available in that market in the future?
Depends on the length of "the future".

In the short term, you can only go with what exists today. But things can and do change. The culture of an area changes over time. And state and federal laws change. The ACA caused a huge change, for example.
Are some states or cities more likely to be better than others?
Yes.
How do we determine that?
You probably don't. But you can look to the political leanings of a state or area to help gauge the kind of government assistance for things like healthcare that is provided or avoided.
(For example, are more affluent areas more likely to have better plans?)
More affluence tends to lead to more healthcare.
Are health insurance options so unknown that they shouldn't even factor into our decision of where to move?
It was a factor for us. Not the top factor, but it was comforting to know that great healthcare was close and affordable.
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JoeRetire
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Re: Health insurance and where to live when retiring early?

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CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
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JoeRetire
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Re: Health insurance and where to live when retiring early?

Post by JoeRetire »

CFM300 wrote: Thu Jan 27, 2022 8:53 pm
quantAndHold wrote: Thu Jan 27, 2022 2:03 pm As far as price, though, if you can qualify for a subsidy, it doesn’t much matter where you live, because the price is controlled by your income.
I searched for comparable PPO plans in two different cities. Same income, same subsidy, same out of pocket max, both BCBS, etc.

The plan in one city cost $41/month. The plan in the other city cost $687/month. Both prices are after applying the subsidy.
And if that difference in cost is too expensive for a few years until Medicare kicks in, then perhaps retiring is cutting things too closely.
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Re: Health insurance and where to live when retiring early?

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CFM300 wrote: Thu Jan 27, 2022 8:43 pm
jebmke wrote: Thu Jan 27, 2022 11:37 am I'd recommend focusing on availability and quality first and cost second
I get what you're saying about choosing a location that has quality healthcare options, but one's health insurance plan will dictate more specifically whether those are accessible. I could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
How true. We have a world famous cancer hospital in our state, and it wont take any ACA plans. They made a point of emphasizing the fact on the hospital website, not an oversight in their list of insurance plans accepted.
Last edited by beyou on Fri Jan 28, 2022 9:45 am, edited 3 times in total.
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Re: Health insurance and where to live when retiring early?

Post by beyou »

JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
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Re: Health insurance and where to live when retiring early?

Post by twh »

Just for reference, the actual, non-subsidised, cost of medical coverage in a PPO type plan including drug coverage is something like $1,300/month. That's with some not-outrageous deductibles and not-outrageous maximum out-of-pocket limits and reasonable drug co-pays. Of course, this may vary geographically, but this is it plus or minus.
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Re: Health insurance and where to live when retiring early?

Post by fortunefavored »

TheHiker wrote: Fri Jan 28, 2022 1:47 am Going through similar thoughts as OP.
I think prices are only part of the picture and these are relatively easy to figure out. But doctor networks are as important.

We use healthcare a lot (unfortunately). Many specialist visits, specialty medication, hospital stays etc. Self-insuring would not be an option for us.
Looking at the ACA plans in our county (San Francisco bay area).
Most of the ACA plans are HMO and most of our current specialist doctors are not in network of any of these plans.
There is just one expensive PPO plan with poor out-of-network coverage and a very high out-of-pocket max.

I know we are spoiled with the group plans from work which pay for anything no questions asked.
Looks like with ACA navigating the system is going to be quite complicated and finding the doctors may be difficult.
My employer-provided plan pays for any drugs doctors prescribe (brand name, off label, experimental drugs etc). Does drug coverage work differently with ACA?

When looking at other areas, I see very different lists of plans from different insurers (many I never heard of).
How do you tell which of the plans has a network that is good/adequate?

Kaiser offers plans in many areas around here. Are Kaiser ACA plans similar to their employer group plans? Or are they also limited in some ways?
If you consume a lot of complicated medical care, I would stay on your corporate plan indefinitely or make the switch to Kaiser. Switching to Kaiser you would have all new doctors/specialists/etc. but since Kaiser controls both sides (insurance & providers) - there are far fewer surprises. Kaiser is an HMO, so will still be nothing like your corporate plan and you may have to argue occasionally to get something covered you want.

I would not want to navigate the never-ending changes to ACA plans/networks if I had a complicated mesh of various 3rd party providers. You're just asking for headaches and never ending surprise bills or providers being dropped randomly, etc.
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Re: Health insurance and where to live when retiring early?

Post by fortunefavored »

beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Same in my area. The top hospitals only accept medicare/medicaid(!) and corporate megacorp plans. No metal plans include them.
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Re: Health insurance and where to live when retiring early?

Post by TheHiker »

fortunefavored wrote: Fri Jan 28, 2022 9:54 am If you consume a lot of complicated medical care, I would stay on your corporate plan indefinitely or make the switch to Kaiser. Switching to Kaiser you would have all new doctors/specialists/etc. but since Kaiser controls both sides (insurance & providers) - there are far fewer surprises. Kaiser is an HMO, so will still be nothing like your corporate plan and you may have to argue occasionally to get something covered you want.

I would not want to navigate the never-ending changes to ACA plans/networks if I had a complicated mesh of various 3rd party providers. You're just asking for headaches and never ending surprise bills or providers being dropped randomly, etc.
Thanks for the suggestion. I am (reluctantly) coming to the same conclusion.
Changing all the doctors when switching to Kaiser won't be ideal, of course. But the alternatives look much more complicated and will require to change the doctors anyway...
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JoeRetire
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Re: Health insurance and where to live when retiring early?

Post by JoeRetire »

beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
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Re: Health insurance and where to live when retiring early?

Post by SuzBanyan »

JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
Here is what the MD Anderson website says:

“MD Anderson and our physicians are not included as a “Participating Provider” for any “Individual” insurance plans on or off the marketplace in Texas (i.e., ACA plans). Certain individual plans available outside of Texas may allow in network access to MD Anderson, but you must verify that information with the insurance plan. Plans that offer out-of-network benefits may be accepted at MD Anderson if they meet our requirements. If not, enrollees would be responsible for all charges (i.e., self-pay).”

Although the hospital does accept traditional Texas Medicaid, it is unlikely many early retirees will qualify for that program because Texas has not expanded Medicaid.
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JoeRetire
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Re: Health insurance and where to live when retiring early?

Post by JoeRetire »

SuzBanyan wrote: Fri Jan 28, 2022 3:40 pm
JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
Here is what the MD Anderson website says:

“MD Anderson and our physicians are not included as a “Participating Provider” for any “Individual” insurance plans on or off the marketplace in Texas (i.e., ACA plans). Certain individual plans available outside of Texas may allow in network access to MD Anderson, but you must verify that information with the insurance plan. Plans that offer out-of-network benefits may be accepted at MD Anderson if they meet our requirements. If not, enrollees would be responsible for all charges (i.e., self-pay).”

Although the hospital does accept traditional Texas Medicaid, it is unlikely many early retirees will qualify for that program because Texas has not expanded Medicaid.
Got it. So either don't move to an MD Anderson-only city, or don't retire early.
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WapelloHawk
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Re: Health insurance and where to live when retiring early?

Post by WapelloHawk »

In Tennessee, we buy non-ACA health insurance through Farm Bureau. For the 55-59 age group, the cost is $610/month. $3000 deductible. Has served us well since the penalty for not purchasing ACA insurance (ie, mandate) went away a few years back. Farm Bureau is a big insurer in TN for pre-Medicare retired people.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

SuzBanyan wrote: Fri Jan 28, 2022 3:40 pm
JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
Here is what the MD Anderson website says:

“MD Anderson and our physicians are not included as a “Participating Provider” for any “Individual” insurance plans on or off the marketplace in Texas (i.e., ACA plans). Certain individual plans available outside of Texas may allow in network access to MD Anderson, but you must verify that information with the insurance plan. Plans that offer out-of-network benefits may be accepted at MD Anderson if they meet our requirements. If not, enrollees would be responsible for all charges (i.e., self-pay).”

Although the hospital does accept traditional Texas Medicaid, it is unlikely many early retirees will qualify for that program because Texas has not expanded Medicaid.
Here is what I wrote in response to a similar question on another thread recently

"I just checked, our ACA plan covers MD Anderson as an in-network facility. We pay $19.67/mo for my wife, myself, and our college age son."

We have a PPO that is tied into the BlueCard Network.
MD Anderson is a preferred provider in that network.

The quote you posted says they are not participating provider for any ACA plans in Texas. Other states have better plan offerings.

So, it seems you just need to move out of Texas and to a place where they have access to wider networks.
Once in a while you get shown the light, in the strangest of places if you look at it right.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

beyou wrote: Fri Jan 28, 2022 9:42 am We have a world famous cancer hospital in our state, and it wont take any ACA plans.
fortunefavored wrote: Fri Jan 28, 2022 9:57 am Same in my area. The top hospitals only accept medicare/medicaid(!) and corporate megacorp plans. No metal plans include them.
SuzBanyan wrote: Fri Jan 28, 2022 3:40 pm “MD Anderson and our physicians are not included as a “Participating Provider” for any “Individual” insurance plans on or off the marketplace in Texas (i.e., ACA plans).
Thank you all for confirming that access can indeed be a problem with ACA and even non-ACA plans.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

CFM300 wrote: Fri Jan 28, 2022 4:06 pm
beyou wrote: Fri Jan 28, 2022 9:42 am We have a world famous cancer hospital in our state, and it wont take any ACA plans.
fortunefavored wrote: Fri Jan 28, 2022 9:57 am Same in my area. The top hospitals only accept medicare/medicaid(!) and corporate megacorp plans. No metal plans include them.
SuzBanyan wrote: Fri Jan 28, 2022 3:40 pm “MD Anderson and our physicians are not included as a “Participating Provider” for any “Individual” insurance plans on or off the marketplace in Texas (i.e., ACA plans).
Thank you all for confirming that access can indeed be a problem with ACA and even non-ACA plans.
Not for all ACA plans.
As has been said numerous times, the cost and quality of plans vary greatly by state and county. There really is no was to generalize.
Once in a while you get shown the light, in the strangest of places if you look at it right.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

WapelloHawk wrote: Fri Jan 28, 2022 3:58 pm In Tennessee, we buy non-ACA health insurance through Farm Bureau. For the 55-59 age group, the cost is $610/month. $3000 deductible. Has served us well since the penalty for not purchasing ACA insurance (ie, mandate) went away a few years back. Farm Bureau is a big insurer in TN for pre-Medicare retired people.
Very helpful. Thank you. We will be sure to explore non-ACA plans as well.
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CFM300
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Re: Health insurance and where to live when retiring early?

Post by CFM300 »

marcopolo wrote: Fri Jan 28, 2022 4:09 pm As has been said numerous times, the cost and quality of plans vary greatly by state and county.
That's the entire premise of my post -- and the information problem I'm trying solve.
sport
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Re: Health insurance and where to live when retiring early?

Post by sport »

CFM300 wrote: Thu Jan 27, 2022 8:43 pm
jebmke wrote: Thu Jan 27, 2022 11:37 am I'd recommend focusing on availability and quality first and cost second
I get what you're saying about choosing a location that has quality healthcare options, but one's health insurance plan will dictate more specifically whether those are accessible. I could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
In the Cleveland area, there are two excellent hospital groups, The Cleveland Clinic and University Hospitals. Almost all of the hospitals are part of one or the other of these groups. Most of the doctors are employees of the hospitals. It is difficult to imagine any network in this area that would not include at least one of those two groups.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

CFM300 wrote: Fri Jan 28, 2022 4:16 pm
marcopolo wrote: Fri Jan 28, 2022 4:09 pm As has been said numerous times, the cost and quality of plans vary greatly by state and county.
That's the entire premise of my post -- and the information problem I'm trying solve.
I wish there was a searchable database of plans.
The information is all available, but short of looking at each individual state, and maybe even county, I am not sure how one would narrow down the good plans.

The only place I could think to start is that states that are hostile (sued to get rid of) to the ACA are less likely to have good ACA plans.

You could also look for states that did either the "Silver loading", or the "Silver Switcheroo" a few years ago. That indicates a willingness of the state and health insurers in that state to work together to provide better/cheaper solutions to consumers.

My main point above was that generalization like "ACA plans don't provide good access" is not necessarily true.
Once in a while you get shown the light, in the strangest of places if you look at it right.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

sport wrote: Fri Jan 28, 2022 4:22 pm
CFM300 wrote: Thu Jan 27, 2022 8:43 pm
jebmke wrote: Thu Jan 27, 2022 11:37 am I'd recommend focusing on availability and quality first and cost second
I get what you're saying about choosing a location that has quality healthcare options, but one's health insurance plan will dictate more specifically whether those are accessible. I could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
In the Cleveland area, there are two excellent hospital groups, The Cleveland Clinic and University Hospitals. Almost all of the hospitals are part of one or the other of these groups. Most of the doctors are employees of the hospitals. It is difficult to imagine any network in this area that would not include at least one of those two groups.
Both of those are also part of the BlueCard network.
Perhaps that is the key, to get coverage that provides access to affiliated networks like BCBS. Are there other similar networks?
Once in a while you get shown the light, in the strangest of places if you look at it right.
AnEngineer
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Re: Health insurance and where to live when retiring early?

Post by AnEngineer »

marcopolo wrote: Fri Jan 28, 2022 4:26 pm The only place I could think to start is that states that are hostile (sued to get rid of) to the ACA are less likely to have good ACA plans.
Why? ACA plans are offered by companies, not the state.
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beyou
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Re: Health insurance and where to live when retiring early?

Post by beyou »

JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
There are people whose ONLY OPTION IS ACA.
And there are hospitals who don’t take ACA.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

beyou wrote: Fri Jan 28, 2022 4:44 pm
JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
There are people whose ONLY OPTION IS ACA.
And there are hospitals who don’t take ACA.
Which ones?
Once in a while you get shown the light, in the strangest of places if you look at it right.
AnEngineer
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Re: Health insurance and where to live when retiring early?

Post by AnEngineer »

JoeRetire wrote: Fri Jan 28, 2022 3:20 pm
beyou wrote: Fri Jan 28, 2022 9:43 am
JoeRetire wrote: Fri Jan 28, 2022 5:41 am
CFM300 wrote: Thu Jan 27, 2022 8:43 pmI could be in a city with an amazing hospital and doctors, but if they're not in-network for any of the ACA plans, then it doesn't really help me unless I'm willing to pay out of pocket.
If you are in a city with an amazing hospital, at least one plan available to you is almost certain to have a network that covers the hospital.
Nope, see my last post.
Not interested in reading your post history.

Note that I didn't say ACA plan network.
What hospital doesn't have a network you can join?
FYI, it was immediately above the post you quoted:
beyou wrote: Fri Jan 28, 2022 9:42 am How true. We have a world famous cancer hospital in our state, and it wont take any ACA plans. They made a point of emphasizing the fact on the hospital website, not an oversight in their list of insurance plans accepted.
marcopolo
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Re: Health insurance and where to live when retiring early?

Post by marcopolo »

AnEngineer wrote: Fri Jan 28, 2022 4:40 pm
marcopolo wrote: Fri Jan 28, 2022 4:26 pm The only place I could think to start is that states that are hostile (sued to get rid of) to the ACA are less likely to have good ACA plans.
Why? ACA plans are offered by companies, not the state.
Perhaps, it is just a coincidence, but I suspect the insurance regulators, and the general attitude have some impact.

The sliver loading and silver Switcheroo approaches to lower costs for consumers were also done by companies and not the state, but mostly only happened in states that were friendly towards the ACA.
Once in a while you get shown the light, in the strangest of places if you look at it right.
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