COBRAs and Elephants, Oh My! Navigating the Healthcare Zoo in Early Retirement

Healthcare in Early Retirement has to be one of the most thorny, yet least discussed problems that the aspiring early retiree can come across. It’s often referred to as ‘the elephant in the room’ because everyone knows it’s there looming in the background yet few seem to want to acknowledge it, or even know what to do about it.

That’s entirely understandable, and Mr. PIE and I are as guilty of this as the next person of kicking the can down the road when it comes to addressing the problem. Here we are, just 6 months away from pulling the plug on our jobs and only just starting to figure out some options. It’s a huge issue, yet we at least feel like deer in the headlights when trying to confront it. There are so many moving parts and unknowns. The media touts the high cost, our current administration is trying to rewrite the healthcare rules, and we as consumers are left confused, angry and unsure of our options.

We have a two part problem to solve. The first is that we are planning on quitting our jobs and leaving behind company healthcare in July 2018. That leaves us with 6 months of healthcare to find and fund for 2018. The second part of the problem is understanding the ACA income limits and finding a healthcare plan for our family for 2019 onward. If I could add a third problem it would be figuring out dental insurance for our family, but for now that elephant will have to stay in the dentist’s waiting room. Maybe there will be a whole post on that in the future!

The first problem could be easily solved if we were to work a full calendar year and quit our jobs in December 2018. The simple reason we are not doing that is the kids and school. With our half year plan the small PIE’s can finish their respective school years before moving on to their new school in NH. Our oldest son will be finishing 5th grade and due to start Middle school, so this is a great time to make the move. We aim to minimize disruption for them by doing this, and hopefully this will help them to settle in quickly to their new school.

Problem 1: Partial Year Healthcare Coverage

Let’s take a look at the first problem to begin with. We will be eligible to sign up for ACA when we quit our jobs in July 2018. This is because losing our family health insurance that I carry through my employer is a Qualifying Life Event which makes us eligible for a Special Enrollment Period. That enrollment period lasts for 60 days from the date of the qualifying event. Remember that number. You’ll need it later.

The problem with signing up for ACA in July 2018 is that we will have 6 months of income from our employers which will put us well over the limits imposed by the ACA for receiving Premium Tax Credits or Cost Sharing Reductions.  Even if Mr. PIE were to defer a large percentage of his regular salary in 2018 we still both get bonuses and restricted stock unit (RSU) pay-outs in the first half of the year. The cost of unsubsidized health insurance for our family of four is not insignificant. I’ll share some numbers later.

Let me take a moment to address the other elephant in the room. We are highly compensated people and yet here I am bemoaning the cost of full price health insurance. Shouldn’t we just suck it up and be grateful that we can afford it when many others can’t? Probably. However, like many other parts of our financial lives, we will be finding ways to minimize costs within the rules. Until the U.S. figures out how to provide healthcare for its citizens in a reasonable manner that most of the rest of the developed world has figured out, we’ll be working within the system we are given to minimize our costs.

So lets look at options and what the rules are for those options.

I’ve already mentioned that we can sign up for the ACA within 60 days of quitting work. We will also have the option to use COBRA through my company. COBRA is a law that allows continuation of group health coverage that otherwise might be terminated. This coverage is at full company group rates which are significantly more expensive than health coverage for active employees. COBRA participants generally pay the entire premium themselves. COBRA coverage can be used for a maximum of 18 months, and can be terminated by the holder at any time in that period.

Here’s key point number 1 to remember: once COBRA is terminated the holder is then NOT eligible to sign up for the ACA unless they have another Qualifying Life Event. You have to wait until the next ACA open enrollment period.

Key point number 2: If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days after losing coverage to choose whether or not to elect continuation coverage. If you elect to take coverage within those 60 day, coverage is retroactive and the retroactive premiums must be paid.

Key point number 3: If you waive COBRA coverage during the election period, you must be permitted later to revoke your waiver of coverage and to elect continuation coverage as long as you do so during the election period. Then, the plan need only provide continuation coverage beginning on the date you revoke the waiver.

So lets take a look at the premium payments for the ACA and COBRA and figure out what we could be paying for 6 months of coverage for our family of four.

OUCH! Those ACA premiums are for the cheapest bronze plan and come with a hefty deductible. This is for 6 months of insurance for a very healthy family who are very unlikely to even use any services in those 6 months!  Remember I said that unsubsidized healthcare was expensive?

The amusing part to this is that when I requested the COBRA costs from my HR department, they sent me a PDF designed to lay out COBRA benefits for employees who have been laid-off. It turns out that the costs for laid-off employees are subsidized and the premiums are only $234 a month! If I could just figure out how to get laid-off sometime in the next 6 months…….

Minimizing Healthcare Costs for Partial Year Coverage

So how can we minimize these costs using the rules I laid out above? Here’s our current plan. this comes with the caveat that we will check and double check the rules for COBRA and the ACA to ensure that they really truly can be used as I will show below:

The ‘need health insurance’ question has some flexibility in it’s answer. I can imagine that if any one of our family needs some kind of minor health care service, we would be better off paying out of pocket if the cost is anything up to $1,448 – the difference between overall ACA costs and the overall COBRA costs.

So that’s our first problem solved, let’s move onto the second problem: understanding coverage levels and how they relate to income in 2019.

Problem 2: What Can We Expect to Pay for Healthcare in 2019?

This is not such a thorny problem, and to be honest I have been encouraged by the results I have found for the cost of healthcare and the amount of flexibility we have in choosing our income. As is the case for many early retirees, the majority of our income will be from dividends and capital gains, and as such our actual taxable income will be significantly lower than the cash flow we gain from our investment portfolio. Any additional income we choose to create will be from Roth conversions and Capital Gains Harvesting.

What I sought to understand from this investigation was what income levels trigger changes in Premium Tax Credits and Cost Sharing Reductions. What is the maximum income we can have and still be eligible for some subsidies? I also found that I needed to know what income levels triggered the possibility of the small PIE’s being eligible for CHIP (Childrens’ Health Insurance Program) and that I also needed to know whether the kids being covered by CHIP was a good idea. The Healthcare.gov website has this handy table to help to understand the ACA income limits for a family of four in New Hampshire

When looking into CHIP income limits I came across this information from the Kaiser Family Foundation. It seems to be 2017 figures, and I can’t find any 2018 figures:

The bottom line is that CHIP eligibility for our kids starts with an income below 323% of the Federal Poverty Level. For 2017 the Federal Poverty Level for a family of 4 was $24,600, making CHIP kick in at an income of $79,458.

But would we want the kids covered on CHIP? We’re leaning towards no for a couple of reasons. The first is simplicity. Although CHIP coverage appears to be pretty comprehensive, there are still issues around finding providers and some instances of care requiring pre-approval. The second is that we don’t want to rely on a program that may well change in terms of coverage and eligibility levels. CHIP funding expired at the end of September 2017 and has yet to be reinstated.

Armed with the numbers from these two tables, I was then able to put some sample numbers into Healthcare.gov and take a look at what types of premiums we would be paying at each income level

For each example I chose the Silver plan with the lowest monthly premiums. These are the plans that maximize Cost Sharing Reductions. We’re also happy to have a High Deductible Plan due to the fact that we’re all pretty healthy and we generally don’t use anything close to our deductible each year. Also note that for CHIP I’m working with 2017 numbers for the 2018 plan, although there shouldn’t be large differences in the results. The final caveat is that these are 2018 estimates. Our first full year of ACA coverage will be 2019. Who knows what the state of healthcare will be at that point? Maybe by then all these numbers will be irrelevant? However, we’ve got to work with the information that is available to us, and this is the information we have right now.

These sample numbers only look at the ‘one dollar more or one dollar less’ scenario, showing the extremes of each income level. The monthly premiums and deductibles rise gradually between the income levels shown in the table. It’s also worth noting that while I have chosen to compare the cheapest Silver plans, once the Cost Sharing Reductions have disappeared and the deductibles rise to close to their highest allowed level of $12,600, buying a Silver plan would no longer be the best choice for us. For example, with an income of $98,399 we could buy a Bronze plan for $470 a month with $12,700 deductible.

Final Thoughts

What this investigation tells us is that we can increase our income with Roth conversions and tax Gain harvesting up to a limit of $98,399, and still have somewhat palatable monthly costs that fit in with our planned withdrawal strategy. In any one year we must be able to pay the deductible of close to $13,000, and also be ready to increase that to around $14,000 due to the out of Pocket Maximums for these plans.

It also shows us that we have a lot of flexibility in choosing what our income level is and how much we are willing to pay for healthcare. In any one year we could choose to have an extremely low income and low healthcare costs, or increase our income with Roth conversions and tax gain harvesting and choose to pay more for our healthcare as a result.

That’s until it all changes again!

Have you addressed the elephant in the room yet? Do you know what healthcare will look like for you and are you happy with the result? Any ideas how I could manage to get laid-off in the next 6 months? (kidding!….)

 

 

 

 

 

46 comments

  1. Have you considered any of the healthshare ministries? Like Liberty? They qualify you as exempt from ACA. I believe Holly at clubthrifty.com has written about her experience. Also, Steve from Think Save Retire is using Liberty.

    Right now the cost sharing subsidies are still in play for the consumer BUT the insurers are not being reimbursed for them. I believe more or even most insurers will drop out of ACA in 2019.

    Some points about COBRA – you have 60 days to elect it and then another 30 to pay. Also you can sign on for dental and or vision separate from medical COBRA. Keep in mind if you obtain dental coverage that’s not via COBRA, and had a break in coverage (I believe 60 days or more) you may be subject to a waiting period. So you may pay for dental insurance but may not be able to use it for six months.

    The high cost of health insurance is inflated right now. Mr. Groovy and I are being subsidized by almost $20K for premiums, but in a free market, I seriously doubt that the same coverage would cost more than 8 or 10K.

    Off the top of my head, in your situation, I’d probably do the COBRA just for the 4 months and then look to switch to ACA (if it’s still viable) for 2019 with a reasonable deductible. Otherwise if you’re all relatively healthy and have no pre-existing conditions, a healthshare ministry might be a good option.

    1. Hi Mrs. Groovy, thanks for coming by!
      We have looked into and discussed healthshare ministries. Overall they leave us nervous. We are mainly concerned that an unregulated system like healthshare ministries can make whatever decisions they like about your reimbursements. Also given our totally religion agnostic household, we’d have a hard time agreeing to whatever belief system they require. I’ll watch them with interest though. Maybe as they become more established and show their worth and stability we may change our tune.
      Thanks for reminding me about the dental etc through COBRA. I have the costs for that in hand and I believe I can continue the dental part without the medical part, which is what we will probably do. Itsn’t it nuts that they can impose a waiting period? There SOOOO much wrong with SOOOO much of our healthcare system!
      I think we will go the COBRA route, I was intrigued to see that we can waive coverage then reinstate it and not have to pay the retroactive premiums. I have more digging around to do on that front!
      a

      1. Check out Q9 here. https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-consumer.pdf
        Also, I’m pretty certain that the Bogelheads and Mr. Money Mustache forums have covered some in depth COBRA issues.

        It seems you can save yourself a month or two of payments, but make sure you know in advance how formal/informal the process is. My former employer serves as administrator of COBRA. I can ask questions or request a change with a quick email. Mr. G’s COBRA goes through an administrator called Discovery Benefits and EVERYTHING requires formal paperwork. And the customer service phone number is not tied to the mailing address. So you call one number to ask questions and just hope someone from another office filed the correct form electronically.

        1. Thanks for that! This PDF was actually what I was working from for my research. It’s interesting to hear that COBRA administration may actually be the stumbling block. I’ll be sure to quiz HR about that when the time comes
          Thanks for the advice!

  2. Great post! We’ll retire in early 2018 and face some of the same tough choices. Most likely, we’ll pick the cheapest version of the health-share ministries (~$500/month) and then pack as much international travel into the rest of 2018 (Asia and Europe, 2-3 months each). Then sign up for a bronze plan in 2019 and hope that our taxable income will be low enough to qualify for a small O-care subsidy.
    Best of luck!
    ERN

    1. Hi ERN! thanks for visiting my little post!
      As I mentioned to Mrs. Groovy, we have concerns about Healthshare ministries. We’re willing to keep our mind open to the idea though. I’d be interested to hear how it works out for partial year coverage for you. I was very encouraged to see how much control we will have over income and the subsequent costs for healthcare, and we can change that from year to year if our needs change. That’s if it all stays the same for 2019 onward of course, and who knows where it’s going even now!

      1. There are also short term policies available , but not ACA compliant. They do not cover pre-existing conditions, pregnancy, and you have to pay the penalty. (If it is still there).

  3. This is so interesting (in not a good way!) It is scary to see those numbers and scarier how confusing purchasing medical insurance is. As Mrs. G said above, I also wondered if you’ve considered the healthshare ministries. And I wonder if dental is a part of those plans too… I have to get a crown this week and it is going to cost $1000+. I’ll be interested to follow what you do over the next year. We have insurance for the next 5 years, and hopefully by then – some of the madness will be figured out.

    1. Hey Vicki, good to hear from you!
      AS I mentioned to Mrs. Groovy, we have concerns about healthshare ministries, but we’re willing to keep our eyes open to see how they pan out. Dental is certainly an ongoing issue. Mr. PIE is a big spender on dental (he’s so frivolous! ;-), and with two kids coming up to orthodontics age it really is the next thing we have to get our heads around.
      It’s great that you have a buffer of 5 years – something has to be figured out by then – doesn’t it?!

  4. You may have already looked at this, but Both Go Curry Cracker and Root of Good have some good info on ACA health insurance, including some thoughts on CHIP in Root of Good’s case, I think.

    1. Hi, thanks for stopping by!
      I have read about ACA on both of those sites, but must have missed stuff about CHIP – I’ll head over and take a look.
      I was glad to do this analysis for our personal situation. The cost vary so much from state to state and year to year. Let’s just hope my 2019 analysis is at least somewheer close to what we’ll actually face, or lower – that would be good too!

  5. Hello,
    I just discovered your site. I look forward to reading more of your posts.

    I also live in NH and will likely FIRE in March 2018. I’m 44, wife is 39. My two biggest concerns are health care and sequence of returns. Our plan is to buy a silver plan on the ACA in 2018. With our projected income in 2018, the premium after subsidies is only $127 per month. This is very affordable but the thing that scares me is future of these subsidies and the ACA in general. Who knows what this will look like in 2019. We can certainly cut back on our non-essential spending to spend more on health insurance premiums but we wouldn’t be able to do much. I guess this is where “flexibility” during a long retirement is critical. We don’t mind getting part time jobs if necessary, working 2-3 days a week but would prefer to not work at all.

    Early retirement into a the 2nd longest bull market in history, the ACA in peril and tax reform on the horizon has caused some sleepless nights but we’re not letting this uncertainty deter our early retirement plans. If it all hits the fan then we still enjoyed a long vacation.

    1. Hi Jonas! so happy to hear from a fellow New Hampshire-ite (even if we’re not NH residents yet!)
      Congrats on getting so close to your FIRE date. It sounds like you’ve got a lot of this figured out, and that’s great you get such a low cost plan for 2018 even with working part of the year. I completely hear you about the things that keep us up at night. I’ve even talked about getting a small job if it would help with Healthcare down the road. It’s unfortunate that we have to have so many contingencies to cover something simple like healthcare. We’ve really got to hope that this gets sorted out in a positive way soon!
      As for SoR risk, we hear you about that too. If there was ever a time to have that as a major concern, this is it. We’ve got a few plans in mind to mitigate that risk as best we can that include creating an income flow from a lump sum pension payment via a bond ladder, and using a post retirement Glide path as described by Big ERN at EarlyRetirementNow
      all the very best with your ER plans!

  6. Great analysis, and very applicable to my situation!! I’m also retiring in summer 2018, and have a meeting scheduled with our HR folks next week to discuss COBRA details. I, like you, will have too much income in 1H of 2018 to qualify for any subsidies. While I’ll be deferring the start of my pension through 2019, I will have some employer RSU’s/Options I’ll be cashing in throughout 2019 which will also likely kill any subsidies.

    I’ve been considering Health Sharing, but also have some of your concerns. As a conservative person, I’ll likely grin and bear it with COBRA for 18 months to let the market settle. It’ll be expensive ($16k/year), but I know we’ll be well covered for sufficient time to fully understand our longer term options.

    I hate elephants in our house, especially when they defecate. This elephant has a bad case of diarrhea, and I’m afraid I haven’t found the cure…..

    1. Someone needs to medicate that elephant – fast!
      COBRA certainly brings some peace of mind, even if it comes with a price tag. If we were bothered about keeping our current doctors we may be more excited about paying for that peace of mind, but as we’re moving anyway, that benefit is gone.
      Let’s hope 2019 brings some more certainty.
      Thanks for stopping by Fritz!

  7. Have you looked into nearby geo-arbitrage? Could Massachusetts offer some better options (and if nothing else, more stability) than the federal plans?

    1. We’re actually going to be moving from MA to NH as our ER destination! MA certainly has healthcare figured out better than a lot of the country has. NH isn’t too bad though. There is still a good selection of insurance providers, and costs are lower than many other parts of the country.
      Thanks for stopping by!

  8. Medical insurance and care in this country is a disaster. It’s awful. It almost makes us want to leave.

    It’s confusing and expensive. Don’t get me started on it.

    Anyway, I’m glad you’re paving the way on this so we can just follow your lead.

    1. Ha! I’m with you! You don’t want to know how many paragraphs of rant I deleted from this post as it was being written. I’m taking a deep breath even now so I don’t get started on it. Let’s just say the situation in the US is ridiculous, embarrassing, and lacking conscience.
      Phew, off to go meditate and try to calm down!

  9. Right before I left, our company put out an announcement for voluntary layoffs. I immediately went to my boss and asked about it. Turned out the offer was open to everyone except our subsidiary. I would have had full pay with benefits through the entire summer. So close it was painful!

    With regard to healthcare, we’re guilty of kicking the can down the road. About a year before I left, Mrs CK gave up her corporate job for a position teaching at our local community college. The pay was less than half, but the benefits through the state are second to none. The summer and winter breaks aren’t bad either. Having benefits covered made it very easy for me to leave.

    While she loves her students, and enjoys working to expand their engineering program, I do think she will want to move on at some point. We’re considering moving abroad, but right now we do enjoy living in New England. I’ve been hesitant to even look at the numbers if we stay since everything seems to constantly be in flux.

    Thanks for sharing you’re analysis. It looks like we’ll have to carefully adjust our income when the time comes.

    Cheers!

    1. Hi there, and thanks for stopping by to comment! Missing out on those lay offs must have been super frustrating. We recently had lay offs (which is obviously why HR was ready with the package information they sent me!) but not my department this time. I must admit, it’s a peculiar feeling when you’re rooting to be laid off, but you know that those around you are panicking.
      Having healthcare covered through a job is a huge deal that must be hard to walk away from. It’s amazing how engrained this system is in our psyche her in the US. Take a step back and even job linked healthcare is ridiculous!
      I understand the allure of New England. Good luck with your plans!

  10. Worrying about accessing insurance and healthcare are very big for me. However, I get most of my effective care from non-traditional practitioners, who aren’t covered by my insurance anyway. As a pretty healthy person, I *may* win out if I forgo insurance. But as a person who just lost a father to early cancer, I think it’s best to keep paying.

    1. I’m so sorry for your recent loss, ZJ. We’re thinking of you.
      Even ACA healthcare is edging towards a version of catastrophic insurance one those deductibles get high. It really is coverage in case of a worst case scenario. Which totally sucks. We may have to wait three years or so for any chance of a change to the current system, but given what our current administration has been trying to do, I’ll settle for keeping what we have for a while!

  11. I do not look forward to looking into this in the next year or two. I haven’t dwelled on it too much, since I’ll probably be working through the summer of 2019. After that, though, it’s up to us to figure out how to cover the costs for the next twenty-some years!

    I will be looking into health care sharing ministries, for sure. A number of self-employed doctors and bloggers I know are using them. There are some limitations and reasons to be hesitate, but money talks and I’ll be listening.

    Thank you for the detailed look at your not-so-great options.

    Cheers!
    -PoF

    1. Hi there and thanks for stopping by. It’s just a bad set of options at the moment isn’t it?! I recently took another look at healthshare and had non of my concerns assuaged. It’s slowly starting to sink in that for the second half of next year at least, we will simply have to suck it up.

  12. I like your strategy of waiving COBRA and later continuing coverage. My question is will you be responsible for medical cost during the interim (the date waived to the date you continued coverage) if a major health issue occurs? Congratulations on your pending FIRE.

    1. Hi Ken, thanks for the question. It’s a really important concern. I guess it comes down to how much certainty do we want to pay for. I can imagine two different health situations if we waive coverage and plan to reinstate it according to need. The first could indeed be costly, and that’s the case of an unexpected and sudden event requiring healthcare. Another situation would be if it becomes obvious that one of needs medical care but it’s not extremely urgent. In that case we could reinstate coverage before making an appointment to see a doctor.
      As for how much certainty do we want to pay for? Well, I’m not sure we have the answer to that yet! The other factor in our decisions about COBRA will be based on how much of our deductible we have used in the first half of next year. If we’ve made any significant payments towards it, then continuing with COBRA would make more sense as we already have skin the the game with that particular plan.
      Bottom line is that’s it’s complicated. But I think you knew that!
      Thanks for the congrats! 😊

      1. I’m 66 and still working due to the uncertainty in the health care market. I hope to work to the end of 2018 which would put my wife 18 months from Medicare enrollment. So I will be following your blog to see how you work through the uncertainty. Wishing the Pie’s well on your road to FIRE.

      2. Glad you mentioned the deductible issue in your reply. Although not mentioned in your excellent post (major kudos to you for the summarizing intricacies of the COBRA election period vs. ACA choices by the way) you have to consider that if you switch to an ACA or other plan mid-year, a new plan comes with a new deductible and new OOPM so if you’ve had significant accumulation towards either of those in the first 1/2 of the year, you are walking away from that build up. Not a concern if the family is generally healthy and unlikely to need significant care in the 2nd half of the year. The 2nd consideration would be switching to a brand new network. Since your family is relocating, you are probably going to be seeking out new docs anyway, so maybe not a concern for you guys to shop around but for a family staying in the same area, a change in insurance provider may force them to switch docs to stay in-network.

        Look forward to hearing about your final decisions next year. We are probably going to be quitting in the April/May timeframe (not in 2018 though sadly) and will have similar decision on what to do with the end of that year. Do we COBRA? Do we ACA it (if it survives)? Do we self-insure? Do we do health ministries?

        1. Thanks for your thoughtful comment. To be honest, this is such a complex issue that the intricacies are still revealing themselves to me. i.e. when I wrote the post the idea of already having paid towards a deductible for the year affecting our decision, hadn’t occurred to me!
          You’re correct about us not having to worry about keeping our current doctors, but I’ve read several comments and posts that mention choosing plans based on country wide acceptance for when travel is part of your plans. More nuance to factor into our decisions.
          Congrats on your plans! Who knows what the insurance world will look like in even a year or two?!

  13. I retired in 2015 with four months of insurance to cover. I took the 60 days with the option to pay coverage if a significant health issue arose.
    (Actually 61, since Oct had 31 days (I wasn’t sure what would happen if we had an accident on Oct 31).
    Also don’t call ACA on day 59. They only start coverage on the first of the month, and I think I had to call in sept to start Nov 1.

    1. This is great advice, thanks so much for sharing. I think that working the COBRA rules like this is a common thing, and I’m glad to her that it can work out. Whether we actually waive coverage or simply delay paying will remain to be seen.
      Thanks for stopping by!

  14. Hello, have you asked any of your self-employed friends what they do? I’m a dentist and my husband owns a small business (and also have 2 young kids).We found it to be significantly cheaper to work with an insurance broker than go through the ACA (due to the income level we are at). We are all (thankfully) healthy and pay $745/month but have a $8k deductible. We live in Wisconsin where healthcare costs are significantly higher, so I’m not sure if this is a fair suggestion (?). Regarding dental insurance- I’d recommend using money from an HSA to pay for dental care. Dental “insurance” is kind of a misnomer for a few reasons- 1) a majority of plans only give you a max of $1000-$1500/year to spend on dental treatment and 2) unless you’re doing elective treatment, it is nearly impossible to rack up thousands upon thousands of dollars of necessary dental treatment (one of the reasons we need medical insurance). Many of my retired/self-employed patients have found it be either a wash or they “lose” money because they didn’t need enough dental treatment to utilize their full dental plan that they purchased. My office offers a discount to my non insured patients and I know it’s pretty common amongst most offices since they don’t have to deal with an insurance company to get reimbursed.
    Anyway, congrats on your upcoming retirement and good luck finding insurance.

    1. Hi Jen!
      You raise some very interesting points. This is why I love the comments section!
      I looked into private insurance for next year and found the same plan at the same price as through the ACA. This was direct from the insurance company. I hadn’t looked into a broker though. How do you go about finding one?
      Dental is very frustrating, and to be honest I haven’t done a deep dive into it. Even while we have company dental insurance right now, so much isn’t covered. It really is a joke.
      I’m interested to hear that discounts can be negotiated, and I’ll certainly look into that.
      Thanks for all the info!

  15. Great Post. I came over from Physician on Fire. I am still working part time because of this ridiculous situation. I am a doctor also. At 60 the ACA premiums are even worse. I have too much passive income to quality for subsidies. A good problem I know. By continuing to own a small business (my medical practice) I can stay insured on the cheap. It is costing about $650/mo with a $500 deductible. There are lots of fees if you anything done. I am counting down the time to Medicare. I see no light at the end of the tunnel.

    1. Welcome! And thanks for coming on over from PoF.
      It truly is a ridiculous situation we find ourselves in. I like to hope that there is some light at the end of the tunnel, but I also believe that the tunnel could be very long!

  16. Thank you for the thoughtful analysis, this also applies to me whether I pull the plug in the summer of 2018 or after Q1 of 2019, either way we will have to pay full price for ACA coverage for 18-21 months.

    How is your availability of heath plans? The biggest shock to me outside of the price was this year was the city I wanted to domicile my address in while we travel (in-laws house) only has one health plan on the exchange with the local hospital system. The last remaining plan with the Big 4 exited the market and it doesn’t help me at all when traveling. There’s some specific follow-up care and I may have to figure out how to move my state/county of residence around just because of health insurance. My father is considering Barista FI because that one plan available back home is $2,800/mo with a $14,000 deductible. He’s better off to take a large pay cut and sign back onto a Fortune 500 company.

    I fear its not going to get better as the mandate to purchase health insurance was never really a mandate and continues to be weakened.

    1. Hi, and it’s good to see you here!
      There’s a lot to be said for finishing at the end of a calendar year if possible. Mr. PIE and I consider that for seconds at a time then shake our heads and say no, kids and school wins!
      We actually have pretty good availability. Enough that I haven’t compared between each company for each level, beyond prices. I know that we’re are very lucky in that respect, given that many states and counties have no choice at all.
      It’s not funny but Barista FI made me smile – is that the official name for those who get Starbucks jobs for benefits? If so, I love it 😊
      The whole healthcare situation has the potential to get worse before it gets better, but I keep asking myself just how bad it will be allowed to get? Maybe I’m naive, but I find it hard to imagine that it will be truly terrible for any length of time. We can hope!

      1. Yes, Barista FI is my go-to term for anyone who gets a job just for the benefits. I spent seven years in a commute that took me by a local school district’s bus depot, they advertised benefits for their position pre-ACA and it was a very popular job with early retirees, drive a bus for 5-6 hours a day for half the days in the year. I’m sure it ran their insurance pool numbers up. I’ve personally said I am willing to move to Hawaii and work at Costco hauling carts in, benefits eligible after six months.

        The thing specifically appealing about Starbucks is all of the large companies self insure, so your insurance cost is the company contribution plus the employee contributions divided by the total cost of insurance. Work in a place with generally young and healthy employees, your insurance costs are fairly cheap. I know the other side of this, since I work for a company with an average employee age of 48…

        1. Ok, Barista FI will certainly make it into my vocabulary now that’s an awesome phrase!
          And an interesting insight into why Starbucks is a good choice for benefits. I’ll have to bear that in mind!

  17. I retired to Medicare, but my wife and kids use Liberty Health Share and My Direct MD as major medical and primary care. ACA compliant and for the 3 about $450per month. We don t use much health care but so far it’s working fine. We are in FL but this is supposed to work nationwide.

    1. Hi Gasem, thanks for stopping by.
      We’ve taken a look at the healthshare as and there is a lot that leaves us uncomfortable with the idea. While I realize they are gaining traction and working out for many folks, the unregulated nature of health shares, the ‘religious’ requirement, and the limits on types of coverage don’t jive for us. Having said that I will continue to watch them with interest. We’re not striking down any ideas when it comes to reasonable costs!

  18. Not sure what you mean about “religious” aversion. They are clear about their roots but there is no proselytizing I’ve seen. The physician we’ve dealt with is well qualified and established good rapport.

    1. My concerns are only based on the healthshare group requirements themselves, not the healthcare providers.
      Investigating the small print I see requirements to “ observe Christian standards, accept shared beliefs, maintain a godly lifestyle, and worship regularly with others”
      My ethics don’t allow me to pretend that any of these apply to me, and I’m concerned that if I did, they could revoke any claim at any time.
      That’s the extent of my desire to get into religious debate here!😊

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