Early Retirement Healthcare

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
kerplunk
Posts: 652
Joined: Sun Apr 17, 2011 9:58 pm

Early Retirement Healthcare

Post by kerplunk » Sun Oct 29, 2017 9:22 pm

My dad is 58 and has retired. What are some things he should be looking into for healthcare? ACA? Medicaid? He has seven figures in his retirement accounts, but has been living off of cash for the past year. This would make his income close to $0, correct? Should he sell (or withdraw) some investments so that his realized capital gains are over the magic $12,000 amount to get the ACA subsidies? Any advice on what to look into would be very helpful. Thank you!

I'm assuming once he is 62 he can sign up for Medicare, but until then, what should he do?

Zott
Posts: 208
Joined: Fri Jul 31, 2015 10:21 pm

Re: Early Retirement Healthcare

Post by Zott » Sun Oct 29, 2017 9:40 pm

He should get on his state ACA Marketplace website starting November 1 and see what's available, and what amount of income would give him the best deal for what he wants. Don't forget to check the networks available with each policy. Did your state adopt Medicaid expansion? Could be an option but probably not the best choice.

Check his tax returns to see what his MAGI is (line 37 of Form 1040, plus any tax-exempt interest and untaxed Social Security). Doesn't he have any taxable savings at all? Creating income as you indicated would be an option to get to the point where he can have a policy with subsidies.

And Medicare starts at age 65. not 62.

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 12:18 am

You generally want to have a high enough ACA MAGI to qualify for a plan off of the exchange. This will most often, but not always allow you to find a plan with the medical providers you use to be in-network.

In most states, you don't want to go on Medicaid. The Medicaid reimbursement rates and restrictions keep most of the decent doctors away. You will almost certainly have to find new medical providers.

The minimum numbers depend on the number of persons in the household and whether it is Medicaid expansion state or not. They are based on the Federal Poverty Level (FPL)

The 2018 numbers for a one person household: Medicaid expansion = $16,643, FPL = 138%; not = $12,060, FPL = 100%

I'm targeting $17,500 in a Medicaid Expansion state = 145% FPL. This gives me margin to stay under 150% for maximum cost sharing reduction (CSR) and margin to stay above 138% to stay away from Medicaid.

User avatar
Watty
Posts: 11594
Joined: Wed Oct 10, 2007 3:55 pm

Re: Early Retirement Healthcare

Post by Watty » Mon Oct 30, 2017 1:59 am

kerplunk wrote:
Sun Oct 29, 2017 9:22 pm
what should he do?
You might encourage him to post here himself to help figure out what to do.

I am in a somewhat similar situation but I am married so the income levels to get the subsidy are higher.

The situation changes from year to year so he can't really make any long term plans unless he can get retirement medical insurance through his prior employer or something like veterans benefits.

He may be able to get insurance for 18 months(longer in some states) through his prior employer through what is called COBRA insurance and that is likely his best choice for as long as he can use that. When that runs out he will have a special enrollment period where he can get an ACA policy in the middle of the year. There are very strict deadlines for when you can sign up for COBRA so he does not want to miss those deadlines. If he is eligible for COBRA then he should get paperwork on how to sign up for that or he can call the HR department at his old employer to find out the details.

When I retired and used COBRA my experience was that you really needed to be proactive in getting the paperwork and premium payments in on time since the deadlines are strict and the employer/insurance company would love to drop your coverage so they will do the minimum that is legally possible help you.

After that he will need to figure out if he can keep his income low enough to get a subsidy on the ACA insurance or not and then and get quotes through his state's healthcare exchange which is healthcare.gov for the states that did not set up their own exchanges. If he does not get the subsidy. If he does not get a subsidy then he should also look at individual policies that he can buy directly from the insurance companies since those may be less expensive than what he can buy on the exchange.

If he will get a subsidy then it is very important for him to watch his income numbers very carefully since if he earns one dollar more than the income limit he will lose the entire subsidy. He may want to do dummy tax returns for 2018 to check his income numbers for getting the subsidy.

If he cannot get COBRA then he may need to sign up now to get an ACA policy for the rest of 2017 and he will be eligible to do that based on when his employers healthcare coverage ends. The open enrolment period for 2018 starts November 1st and goes through December 15th but he does not want until the end of the period since there could be problems with the systems being swamped as it gets close to December 15th.

mnnice
Posts: 233
Joined: Sat Aug 11, 2012 5:48 pm

Re: Early Retirement Healthcare

Post by mnnice » Mon Oct 30, 2017 7:43 am

Redundant comment oops

kerplunk
Posts: 652
Joined: Sun Apr 17, 2011 9:58 pm

Re: Early Retirement Healthcare

Post by kerplunk » Mon Oct 30, 2017 8:08 am

Thanks for the responses, everyone.

If he is in a Medicaid expansion state, which he is, does he need to actually go beyond $16k in income even though around $12,000 is the minimum for ACA? Or what is the maximum for Medicaid? It sounds like he should try to have the smallest amount of income to qualify for ACA, but not small enough to qualify for Medicaid.

I am also worried he won’t have enough income. Is converting, for example, $16,000 from his IRA to Roth IRA a good way to raise his income?

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 9:32 am

The maximum to qualify for Medicaid and the minimum to receive an ACA subsidy are based on the same amount.

They are based solely on whether it is a Medicaid expansion state, persons in the household and I should add for completeness, whether you live in Alaska or Hawaii.

Medicaid expansion state, 1 person household and 48 contiguous states: Medicaid < $16,643, ACA subsidy >= $16,643.

You do not want to cut it too close. Another import MAGI level is 150% of 2018 FPL = $18,090. Less that this amount and you get the highest ACA subsidy and the Highest Cost Sharing Reduction (CSR).

The latter can be very valuable. For example, at $17,500, while I receive a subsidy > $1,000/month, CSR result in a $6,125/year lower deductible and a $6,750/year lower OOP maximum.

User avatar
Pajamas
Posts: 2780
Joined: Sun Jun 03, 2012 6:32 pm

Re: Early Retirement Healthcare

Post by Pajamas » Mon Oct 30, 2017 9:38 am

kerplunk wrote:
Mon Oct 30, 2017 8:08 am
Thanks for the responses, everyone.

If he is in a Medicaid expansion state, which he is, does he need to actually go beyond $16k in income even though around $12,000 is the minimum for ACA? Or what is the maximum for Medicaid? It sounds like he should try to have the smallest amount of income to qualify for ACA, but not small enough to qualify for Medicaid.

I am also worried he won’t have enough income. Is converting, for example, $16,000 from his IRA to Roth IRA a good way to raise his income?
You have to look at the particular state to see what is available and what the income requirements are.

If he qualifies for Medicaid, he should at least look at it before manufacturing income so as to be able to reject it for a different type of coverage. Many academic medical centers have excellent doctors that accept Medicaid. At least in my area, the same doctors may have patients at an academic medical center associated with a respected university (NYU, Colombia) and also at a public hospital. Sometimes the patient seen at the clinic at a public hospital may even have surgery at the academic medical center.

Health care in the U.S. is complicated.

jkrm
Posts: 43
Joined: Wed Oct 08, 2008 8:20 am

Re: Early Retirement Healthcare

Post by jkrm » Mon Oct 30, 2017 1:15 pm

I have an additional question that relates to this discussion. What happens if you get ACA insurance, and then ACA goes away? At the age of 58 most of us have some sort of pre-existing condition - do you lose your insurance? Find yourself unable to renew for the next year?

I am 63 and would like to retire, but have a minor pre-existing condition (sleep apnea). I can get coverage for 2018, but don't know if I will still be able to do so in 2019.

Rupert
Posts: 2670
Joined: Fri Aug 17, 2012 12:01 pm

Re: Early Retirement Healthcare

Post by Rupert » Mon Oct 30, 2017 1:31 pm

jkrm wrote:
Mon Oct 30, 2017 1:15 pm
I have an additional question that relates to this discussion. What happens if you get ACA insurance, and then ACA goes away? At the age of 58 most of us have some sort of pre-existing condition - do you lose your insurance? Find yourself unable to renew for the next year?
No one knows the answer to this question. That's what makes early retirement so scary these days.

randomguy
Posts: 4890
Joined: Wed Sep 17, 2014 9:00 am

Re: Early Retirement Healthcare

Post by randomguy » Mon Oct 30, 2017 1:38 pm

Rupert wrote:
Mon Oct 30, 2017 1:31 pm
jkrm wrote:
Mon Oct 30, 2017 1:15 pm
I have an additional question that relates to this discussion. What happens if you get ACA insurance, and then ACA goes away? At the age of 58 most of us have some sort of pre-existing condition - do you lose your insurance? Find yourself unable to renew for the next year?
No one knows the answer to this question. That's what makes early retirement so scary these days.
I think most states mandate guaranteed renewal and if your plan is canceled they have to offer an alternative. Thats the good news. The bad news is that your new plan might be drastically more expensive. Of course no more subsidies.

User avatar
dm200
Posts: 13777
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Early Retirement Healthcare

Post by dm200 » Mon Oct 30, 2017 1:38 pm

jkrm wrote:
Mon Oct 30, 2017 1:15 pm
I have an additional question that relates to this discussion. What happens if you get ACA insurance, and then ACA goes away? At the age of 58 most of us have some sort of pre-existing condition - do you lose your insurance? Find yourself unable to renew for the next year?
I am 63 and would like to retire, but have a minor pre-existing condition (sleep apnea). I can get coverage for 2018, but don't know if I will still be able to do so in 2019.
Nobody can predict the future. However, if you have insurance - and you continue in that plan, I would say you do not have an excludable "pre-existing" condition. As best I recall, as well, even before the ACA, if you had evidence of continuous coverage, and went to a new plan - the new plan would not invoke the pre-existing condition exclusion.

You are also only two years away from Medicare qualification.

Shallowpockets
Posts: 260
Joined: Fri Nov 20, 2015 10:26 am

Re: Early Retirement Healthcare

Post by Shallowpockets » Mon Oct 30, 2017 1:48 pm

Doesn't matter is ACA goes away. Pretty much every year there are so many changes in medical insurance you have to review and change as needed. Do not plan on anything going away or not changing.
Take the ACA if it works for you. Reevaluate next year.

On ACA you would want to put in your prospective taxable income and see where you stand. Try and stay within those parameters. It is not too hard.
GF is doing this. Stays above the lower number and out of Medicaid by converting what dollars are necessary into a ROTH from a no taxable investment. This generates some taxable income. She takes it up to the limit of that line.
If the line is 18k you put that in for your income going forward and then in December you realize enough taxable income to reach that figure. Capitol gains realized, ROTH conversions. At the 18k limit you also reduce the taxes you might have to pay.

Rupert
Posts: 2670
Joined: Fri Aug 17, 2012 12:01 pm

Re: Early Retirement Healthcare

Post by Rupert » Mon Oct 30, 2017 1:49 pm

dm200 wrote:
Mon Oct 30, 2017 1:38 pm

As best I recall, as well, even before the ACA, if you had evidence of continuous coverage, and went to a new plan - the new plan would not invoke the pre-existing condition exclusion.
I think this was only true for employer-sponsored plans subject to HIPAA, and I think HIPAA doesn't apply if the employer has fewer than 20 employees. I don't think this rule applied in the individual market at all (someone correct me if I'm wrong).

User avatar
dm200
Posts: 13777
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Early Retirement Healthcare

Post by dm200 » Mon Oct 30, 2017 2:00 pm

Rupert wrote:
Mon Oct 30, 2017 1:49 pm
dm200 wrote:
Mon Oct 30, 2017 1:38 pm
As best I recall, as well, even before the ACA, if you had evidence of continuous coverage, and went to a new plan - the new plan would not invoke the pre-existing condition exclusion.
I think this was only true for employer-sponsored plans subject to HIPAA, and I think HIPAA doesn't apply if the employer has fewer than 20 employees. I don't think this rule applied in the individual market at all (someone correct me if I'm wrong).
You may very well be correct; I cannot recall. No matter what happens with ACA, though, I really doubt that if you are on a plan (such as BCBS) and now not subject to pre-existing exclusion, that it would be invoked retroactively. All the more reason, it seems to me, to try to stay with the same plan. I also recall that years ago, some plans did not universally invoke a pre-existing condition exclusion.

kerplunk
Posts: 652
Joined: Sun Apr 17, 2011 9:58 pm

Re: Early Retirement Healthcare

Post by kerplunk » Mon Oct 30, 2017 2:15 pm

Isn’t Medicaid way more expensive ($6,000/year) versus ACA with best subsidy ($600/year)? I used one of those quick healthcare calculators and it said that would be the difference.

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 2:35 pm

This are some misconceptions about pre-existing conditions worked. Even before there was Obamacare, there was HIPPA. HIPPA has been in existence for over twenty (20) years. Pre-existing conditions were covered as long as you had continuous coverage. Continuous coverage was defined as not having a gap of more than 63 days.

While some people were caught because of being denied coverage in the private marketplace. The vast majority of people who were subject to pre-existing condition tests, were because they voluntarily decided not to obtain coverage until they had major medical expenses.

User avatar
dm200
Posts: 13777
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Early Retirement Healthcare

Post by dm200 » Mon Oct 30, 2017 2:41 pm

Spirit Rider wrote:
Mon Oct 30, 2017 2:35 pm
This are some misconceptions about pre-existing conditions worked. Even before there was Obamacare, there was HIPPA. HIPPA has been in existence for over twenty (20) years. Pre-existing conditions were covered as long as you had continuous coverage. Continuous coverage was defined as not having a gap of more than 63 days.
While some people were caught because of being denied coverage in the private marketplace. The vast majority of people who were subject to pre-existing condition tests, were because they voluntarily decided not to obtain coverage until they had major medical expenses.
I also wonder (do not know) how rigidly pre-existing conditions were excluded from coverage for medical care. Does anyone have any examples - in either direction? Might there be ways (without being fraud) of reducing the chances of exclusion?

I also (very vaguely) recall that sometimes the exclusion for pre-existing conditions only would or could be invoked during the beginning (such as a year) of coverage.

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 2:59 pm

I don't think fraud was required, just the pre-existing condition, but I'm with you on your second point. I think it might have been something like six months.

randomguy
Posts: 4890
Joined: Wed Sep 17, 2014 9:00 am

Re: Early Retirement Healthcare

Post by randomguy » Mon Oct 30, 2017 3:39 pm

Spirit Rider wrote:
Mon Oct 30, 2017 2:59 pm
I don't think fraud was required, just the pre-existing condition, but I'm with you on your second point. I think it might have been something like six months.
A lot of the HIPPA stuff was group plan to group plan where if you could show coverage, you didn't have a 6-18 month exclusion period for pre existing conditions. In my experience that didn't allow you to transfer to an individual plan. For those you filled out a huge form detailing all your medical care for your whole life and then they decided if they would cover you or not and for how much. Preexisting conditions were not an automatic exclusion. Some things like HIV (or anything else where you are looking at 50k+ for 20+ years) ment you were not getting coverage. If you lied or omitted stuff, your coverage could be revoked. You can google "health insurance rescission" for all the stories that came out when ACA was getting passed for stores of companies reviewing all the files of cancer patients looking for a reason to cancel coverage.

Going forward, if you have insurance today it seems likely that there will be some outlet. But it might cost a ton.

Rupert
Posts: 2670
Joined: Fri Aug 17, 2012 12:01 pm

Re: Early Retirement Healthcare

Post by Rupert » Mon Oct 30, 2017 3:49 pm

randomguy wrote:
Mon Oct 30, 2017 3:39 pm
Spirit Rider wrote:
Mon Oct 30, 2017 2:59 pm
I don't think fraud was required, just the pre-existing condition, but I'm with you on your second point. I think it might have been something like six months.
A lot of the HIPPA stuff was group plan to group plan where if you could show coverage, you didn't have a 6-18 month exclusion period for pre existing conditions. In my experience that didn't allow you to transfer to an individual plan. For those you filled out a huge form detailing all your medical care for your whole life and then they decided if they would cover you or not and for how much. Preexisting conditions were not an automatic exclusion. Some things like HIV (or anything else where you are looking at 50k+ for 20+ years) ment you were not getting coverage. If you lied or omitted stuff, your coverage could be revoked. You can google "health insurance rescission" for all the stories that came out when ACA was getting passed for stores of companies reviewing all the files of cancer patients looking for a reason to cancel coverage.

Going forward, if you have insurance today it seems likely that there will be some outlet. But it might cost a ton.
+1. The exclusion periods applied only to group plans. When you shifted from one group plan to another, assuming your employers were both large enough to fall under HIPAA (it's "HIPAA" by the way, not "HIPPA"), there was a sort of complicated rule that kicked in whereby your pre-existing conditions were excluded for some period of time (usually months, not more than a year or so) if you did not maintain "continuous coverage." None of that stuff applied in the individual market, where insurance companies were notorious (tons of news stories about it pre-ACA) for denying people coverage for pre-existing conditions. Yes, I suppose you might be able to avoid being denied coverage if you maintain precisely the same coverage post-ACA (assuming your existing plan continues to exist post-ACA, which is doubtful), but you'd be at the mercy of the insurance company on pricing. That's not a good plan at all if you're considering early retirement.

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 4:01 pm

HIPPA only applied to group employer plans, but prior to Obamacare most states, even my laissez-faire state, had extended that protection to individual plans. I just did a quick scan of the HIPPA regulations
  • Only pre-existing conditions treated in the six months prior to entry into the plan could be subject to exclusion.
  • If you had credible coverage for >= 12 months with any gap < 63 days, no exclusion could apply. Credible coverage did not have to be from an employer group plan. It could be from just about any full healthcare coverage E.g. COBRA, individual, Medicaid, etc...
  • The maximum exclusion was 12 months, 18 months for a late enrollee.

Rupert
Posts: 2670
Joined: Fri Aug 17, 2012 12:01 pm

Re: Early Retirement Healthcare

Post by Rupert » Mon Oct 30, 2017 4:51 pm

Spirit Rider wrote:
Mon Oct 30, 2017 4:01 pm
HIPPA only applied to group employer plans, but prior to Obamacare most states, even my laissez-faire state, had extended that protection to individual plans. I just did a quick scan of the HIPPA regulations
  • Only pre-existing conditions treated in the six months prior to entry into the plan could be subject to exclusion.
  • If you had credible coverage for >= 12 months with any gap < 63 days, no exclusion could apply. Credible coverage did not have to be from an employer group plan. It could be from just about any full healthcare coverage E.g. COBRA, individual, Medicaid, etc...
  • The maximum exclusion was 12 months, 18 months for a late enrollee.
It was a little more complicated than that. Take a look at the Wikipedia entry on pre-existing conditions. For someone with a pre-existing condition, this is the alarming part (how long each state permitted pre-existing conditions to be excluded from coverage bought on the individual market pre-ACA):

12 months: California, Idaho, Kentucky, Maine, Michigan, New Jersey, New York, Vermont; Colorado*, Connecticut*, Maryland*, Mississippi*, Montana*, North Carolina*, North Dakota*, Ohio*, Pennsylvania*, Rhode Island*, South Dakota*, Utah*, Virginia*, West Virginia*, Wyoming*
18 months: Minnesota
2 years: Alabama*, Florida*, Georgia*, Illinois*, Iowa*, Kansas*, South Carolina*, Tennessee*, Texas*, Wisconsin*
3 years: Hawaii*
10 years: Indiana
unlimited: Alaska*, Arizona*, Arkansas*, Delaware*, District of Columbia*, Louisiana*, Missouri*, Nebraska*, Nevada*, Oklahoma*
Elimination riders permanently excluding pre-existing conditions
prohibited: California, Idaho, Indiana, Kentucky, Maine, Massachusetts, Michigan, Minnesota, New Jersey, New York, Oregon, Vermont, Washington
permitted*: 37 other states and DC

https://en.wikipedia.org/wiki/Pre-existing_condition

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Mon Oct 30, 2017 4:55 pm

Yes, HIPPA was 20 years ago. Many states had expanded provisions. In fact, much if what was in Obamacare had been already been added in one state or another.

jim234
Posts: 45
Joined: Wed Feb 11, 2015 9:52 am

Re: Early Retirement Healthcare

Post by jim234 » Mon Oct 30, 2017 6:07 pm

To the OP.

You can't generalize as to whether Medicaid is better or worse than a ACA metal plan. In my area the doctor network is the same in both so there is no advantage using a metal plan, which will be more expensive.

Factors to consider, how healthy? Someone with ongoing health issues will save a huge amount by being in Medicaid.

You need to do some homework since every state, and even every county can differ.

User avatar
LadyGeek
Site Admin
Posts: 41109
Joined: Sat Dec 20, 2008 5:34 pm
Location: Philadelphia
Contact:

Re: Early Retirement Healthcare

Post by LadyGeek » Mon Oct 30, 2017 6:32 pm

I removed an off-topic post. With regards to earlier comments on what "might happen" if ACA goes away, please see this post: Subject: ACA, Medicare and possible changes

The important points: Discussions about proposed legislation (what will happen to implement the changes) are off-topic to "keep investors from making bad decisions. Proposed regulations change many times between the time they're introduced and signed into law."

Health care is no exception. Acting now because of what "might" happen can be worse than doing nothing at all. Let's wait until things settle out and have clear intent (formal changes to law / regulations).
To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

User avatar
samsoes
Posts: 408
Joined: Tue Mar 05, 2013 9:12 am

Re: Early Retirement Healthcare

Post by samsoes » Mon Oct 30, 2017 6:34 pm

jim234 wrote:
Mon Oct 30, 2017 6:07 pm
To the OP.

You can't generalize as to whether Medicaid is better or worse than a ACA metal plan. In my area the doctor network is the same in both so there is no advantage using a metal plan, which will be more expensive.

Factors to consider, how healthy? Someone with ongoing health issues will save a huge amount by being in Medicaid.

You need to do some homework since every state, and even every county can differ.
I used to work for Mega Multi-State Hospital system. When the ACA Medicaid plans became available, we were told by the local hospital CEO that they lost money for every ACA Medicaid patient who was treated due to the extremely low reimbursement rates. For inpatients, the reimbursement amount was capped a a fixed amount, like $12,000, IIRC. That means the maximum the hospital received was $12,000 regardless if it was complex cardiac surgery followed by weeks of recovery, or overnight IV therapy for a minor dehydration episode. Somehow I suspect that the ACA Medicaid patient was "pushed along" to expedite discharge, perhaps sooner than a non-ACA-Medicaid patient.

Stay away from ACA Medicaid if you possibly can.
"Happiness Is Not My Companion" - Gen. Gouverneur K. Warren. (Avatar is the statue of Gen. Warren at Little Round Top @ Gettysburg National Military Park.)

User avatar
Watty
Posts: 11594
Joined: Wed Oct 10, 2007 3:55 pm

Re: Early Retirement Healthcare

Post by Watty » Mon Oct 30, 2017 7:11 pm

dm200 wrote:
Mon Oct 30, 2017 2:41 pm
I also wonder (do not know) how rigidly pre-existing conditions were excluded from coverage for medical care. Does anyone have any examples - in either direction? Might there be ways (without being fraud) of reducing the chances of exclusion?
It used to be that when you changed jobs your new employer healthcare would exclude preexisting conditions.

I know someone that changed jobs and a year or so later(I don't remember how long) they had a nose polyp removed from the inside of their nose and it was sent off for a routine biopsy to see if it was cancer. It turned out that a few years before they had a typical sinus infection so the insurance company would not cover the cost of the biopsy since they considered that to be a pre-existing condition. They got lucky and it was not cancer so it only cost them a few hundred dollars but if it had been cancer they would have been facing cancer without any insurance coverage.

I don't have any statistics but it was not uncommon for insurance companies to try to exclude anything that they could and you could then have to fight them to get coverage.

Part of the problem was that they would not review your files when you applied for insurance to identify pre-existing conditions, they would wait until you had some expensive problem and then go through your records looking for a way to exclude coverage for it.

It was often brutal.

mnnice
Posts: 233
Joined: Sat Aug 11, 2012 5:48 pm

Re: Early Retirement Healthcare

Post by mnnice » Mon Oct 30, 2017 7:55 pm

samsoes wrote:
Mon Oct 30, 2017 6:34 pm
jim234 wrote:
Mon Oct 30, 2017 6:07 pm
To the OP.

You can't generalize as to whether Medicaid is better or worse than a ACA metal plan. In my area the doctor network is the same in both so there is no advantage using a metal plan, which will be more expensive.

Factors to consider, how healthy? Someone with ongoing health issues will save a huge amount by being in Medicaid.

You need to do some homework since every state, and even every county can differ.
I used to work for Mega Multi-State Hospital system. When the ACA Medicaid plans became available, we were told by the local hospital CEO that they lost money for every ACA Medicaid patient who was treated due to the extremely low reimbursement rates. For inpatients, the reimbursement amount was capped a a fixed amount, like $12,000, IIRC. That means the maximum the hospital received was $12,000 regardless if it was complex cardiac surgery followed by weeks of recovery, or overnight IV therapy for a minor dehydration episode. Somehow I suspect that the ACA Medicaid patient was "pushed along" to expedite discharge, perhaps sooner than a non-ACA-Medicaid patient.

Stay away from ACA Medicaid if you possibly can.
That certainly was not my experience last summer when my dc (aged12) had an appendicitis. I was just about ready to take him home AMA after six days of inpatient. I have yet to encounter a situation where I felt anyone has altered their care plan as a result of the entity providing coverage.

User avatar
samsoes
Posts: 408
Joined: Tue Mar 05, 2013 9:12 am

Re: Early Retirement Healthcare

Post by samsoes » Mon Oct 30, 2017 8:16 pm

Watty wrote:
Mon Oct 30, 2017 7:11 pm
dm200 wrote:
Mon Oct 30, 2017 2:41 pm
I also wonder (do not know) how rigidly pre-existing conditions were excluded from coverage for medical care. Does anyone have any examples - in either direction? Might there be ways (without being fraud) of reducing the chances of exclusion?
It used to be that when you changed jobs your new employer healthcare would exclude preexisting conditions.

I know someone that changed jobs and a year or so later(I don't remember how long) they had a nose polyp removed from the inside of their nose and it was sent off for a routine biopsy to see if it was cancer. It turned out that a few years before they had a typical sinus infection so the insurance company would not cover the cost of the biopsy since they considered that to be a pre-existing condition. They got lucky and it was not cancer so it only cost them a few hundred dollars but if it had been cancer they would have been facing cancer without any insurance coverage.

I don't have any statistics but it was not uncommon for insurance companies to try to exclude anything that they could and you could then have to fight them to get coverage.

Part of the problem was that they would not review your files when you applied for insurance to identify pre-existing conditions, they would wait until you had some expensive problem and then go through your records looking for a way to exclude coverage for it.

It was often brutal.
I recall that horrible situation. Oftentimes insurance companies would have staff to dig into the history of a newly diagnosed cancer (or other expensive condition) patient to dig-up anything which can be used as a "pre-existing condition." These staff would receive bonuses calculated as a percentage of the projected cost they saved the insurance company by denying the cancer coverage. Unconscionable.
"Happiness Is Not My Companion" - Gen. Gouverneur K. Warren. (Avatar is the statue of Gen. Warren at Little Round Top @ Gettysburg National Military Park.)

JBTX
Posts: 1522
Joined: Wed Jul 26, 2017 12:46 pm

Re: Early Retirement Healthcare

Post by JBTX » Mon Oct 30, 2017 9:07 pm

samsoes wrote:
Mon Oct 30, 2017 8:16 pm
Watty wrote:
Mon Oct 30, 2017 7:11 pm
dm200 wrote:
Mon Oct 30, 2017 2:41 pm
I also wonder (do not know) how rigidly pre-existing conditions were excluded from coverage for medical care. Does anyone have any examples - in either direction? Might there be ways (without being fraud) of reducing the chances of exclusion?
It used to be that when you changed jobs your new employer healthcare would exclude preexisting conditions.

I know someone that changed jobs and a year or so later(I don't remember how long) they had a nose polyp removed from the inside of their nose and it was sent off for a routine biopsy to see if it was cancer. It turned out that a few years before they had a typical sinus infection so the insurance company would not cover the cost of the biopsy since they considered that to be a pre-existing condition. They got lucky and it was not cancer so it only cost them a few hundred dollars but if it had been cancer they would have been facing cancer without any insurance coverage.

I don't have any statistics but it was not uncommon for insurance companies to try to exclude anything that they could and you could then have to fight them to get coverage.

Part of the problem was that they would not review your files when you applied for insurance to identify pre-existing conditions, they would wait until you had some expensive problem and then go through your records looking for a way to exclude coverage for it.

It was often brutal.
I recall that horrible situation. Oftentimes insurance companies would have staff to dig into the history of a newly diagnosed cancer (or other expensive condition) patient to dig-up anything which can be used as a "pre-existing condition." These staff would receive bonuses calculated as a percentage of the projected cost they saved the insurance company by denying the cancer coverage. Unconscionable.
This function was sometimes outsourced to third parties who specialized in such exercises. You have a new policy, then get diagnosed with cancer. Then they take your application and review it again, thoroughly, and if you failed to report your pre existing acid reflux condition, for instance, they could void the whole policy.

jkrm
Posts: 43
Joined: Wed Oct 08, 2008 8:20 am

Re: Early Retirement Healthcare

Post by jkrm » Tue Oct 31, 2017 8:12 am

Thank you for all of the replies concerning pre-existing conditions, and my apologies to the OP if I hijacked this thread - I thought the topic was germane to someone 58 and needing medical insurance.

The comments about HIPAA and states' extending its provisions to individual health insurance are intriguing to me. It seems that, even if I have a pre-existing condition, I should not be refused coverage as long as I have been continuously insured. Yet that's exactly what happened when I was "between jobs" back in 2013 - I decided to look on the commercial market for health insurance because the COBRA coverage from my former employer was very expensive, but United Healthcare rejected me because of sleep apnea. I am puzzled about how they could have done that legally. (I did get insurance from Aetna, at a minor bump-up in premium.)

I sent a question to the Virginia Bureau of Insurance to try to get clear on this.

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Tue Oct 31, 2017 8:32 am

Individual insurance could be a source of "credible coverage". It has been a long time, but I believe the HIPPA protection against pre-existing condition exclusion only applied to enrollment in employer group plans. Some states extended this to all plans, but many did not.

User avatar
samsoes
Posts: 408
Joined: Tue Mar 05, 2013 9:12 am

Re: Early Retirement Healthcare

Post by samsoes » Tue Oct 31, 2017 8:53 am

jkrm wrote:
Tue Oct 31, 2017 8:12 am
Thank you for all of the replies concerning pre-existing conditions, and my apologies to the OP if I hijacked this thread - I thought the topic was germane to someone 58 and needing medical insurance.

The comments about HIPAA and states' extending its provisions to individual health insurance are intriguing to me. It seems that, even if I have a pre-existing condition, I should not be refused coverage as long as I have been continuously insured. Yet that's exactly what happened when I was "between jobs" back in 2013 - I decided to look on the commercial market for health insurance because the COBRA coverage from my former employer was very expensive, but United Healthcare rejected me because of sleep apnea. I am puzzled about how they could have done that legally. (I did get insurance from Aetna, at a minor bump-up in premium.)

I sent a question to the Virginia Bureau of Insurance to try to get clear on this.
IIRC, HIPAA plans (which allowed preexisting conditions) also required COBRA benefits to be exhausted first. That could be why UHC was able to reject your application based on a pre-existing condition, since you chose to bypass COBRA.
"Happiness Is Not My Companion" - Gen. Gouverneur K. Warren. (Avatar is the statue of Gen. Warren at Little Round Top @ Gettysburg National Military Park.)

jkrm
Posts: 43
Joined: Wed Oct 08, 2008 8:20 am

Re: Early Retirement Healthcare

Post by jkrm » Tue Oct 31, 2017 8:56 am

samsoes wrote:
Tue Oct 31, 2017 8:53 am
jkrm wrote:
Tue Oct 31, 2017 8:12 am
Thank you for all of the replies concerning pre-existing conditions, and my apologies to the OP if I hijacked this thread - I thought the topic was germane to someone 58 and needing medical insurance.

The comments about HIPAA and states' extending its provisions to individual health insurance are intriguing to me. It seems that, even if I have a pre-existing condition, I should not be refused coverage as long as I have been continuously insured. Yet that's exactly what happened when I was "between jobs" back in 2013 - I decided to look on the commercial market for health insurance because the COBRA coverage from my former employer was very expensive, but United Healthcare rejected me because of sleep apnea. I am puzzled about how they could have done that legally. (I did get insurance from Aetna, at a minor bump-up in premium.)

I sent a question to the Virginia Bureau of Insurance to try to get clear on this.
IIRC, HIPAA plans (which allowed preexisting conditions) also required COBRA benefits to be exhausted first. That could be why UHC was able to reject your application based on a pre-existing condition, since you chose to bypass COBRA.
Ah. That would make sense. This is all rather confusing!

Rupert
Posts: 2670
Joined: Fri Aug 17, 2012 12:01 pm

Re: Early Retirement Healthcare

Post by Rupert » Tue Oct 31, 2017 9:06 am

And note that employer group plans that aren't subject to HIPAA (because of size -- fewer than 20 employees) also aren't subject to COBRA. Last time I checked, approximately 30% of people in the country work for employers who aren't subject to HIPAA or COBRA. MegaCorp employees seem to be over-represented here at SatuMedia. So I look for opportunities to remind SatuMedia that many of the points they make re employer benefits and health insurance don't apply to a vast number of people in the country.

randomguy
Posts: 4890
Joined: Wed Sep 17, 2014 9:00 am

Re: Early Retirement Healthcare

Post by randomguy » Tue Oct 31, 2017 11:48 am

Rupert wrote:
Tue Oct 31, 2017 9:06 am
And note that employer group plans that aren't subject to HIPAA (because of size -- fewer than 20 employees) also aren't subject to COBRA. Last time I checked, approximately 30% of people in the country work for employers who aren't subject to HIPAA or COBRA. MegaCorp employees seem to be over-represented here at SatuMedia. So I look for opportunities to remind SatuMedia that many of the points they make re employer benefits and health insurance don't apply to a vast number of people in the country.
Most states have some state level COBRA things for smaller business. https://kff.org/private-insurance/s ... 2asc%22%7D

For more fun, i COBRA goes away if the company offering goes out of bussiness. Not a super common occurence by any means but not exactly a fun thing to learn:)

Spirit Rider
Posts: 6498
Joined: Fri Mar 02, 2007 2:39 pm

Re: Early Retirement Healthcare

Post by Spirit Rider » Tue Oct 31, 2017 12:57 pm

randomguy wrote:
Tue Oct 31, 2017 11:48 am
Most states have some state level COBRA things for smaller business. https://kff.org/private-insurance/s ... 2asc%22%7D

For more fun, i COBRA goes away if the company offering goes out of business. Not a super common occurrence by any means but not exactly a fun thing to learn:)
After some high profile cases of the above, my state extended COBRA by requiring the insurance carrier to provide the employer plan coverage directly to COBRA enrollees at the same price. If that plan was no longer offered they had to offer a plan with the same or greater coverage at the same price.

I had the fortunate or unfortunate experience depending on your point of view. To take advantage of those protections when the startup I was at went belly up. Not to mention that all my wonderful founder shares and options became worthless.

Post Reply