Too old to work.. too young for Medicare

[Isaac-1]

All I can say is I know the feeling, though I am a couple of years younger than you are, and my Blue Cross insurance is only $1,200 per month.

[TexasJeff]

Great responses. And yeah, thats a typo. I was born back in the luddite era of 1960. 25 years in high tech made my eye twitch. The wife is the same age so no break there. Also ive got some “pre-existing” stuff so alternative insurance is out.

I think this was a good thread and will look forward to more responses if they come. I guess we’ll suck it up and pay full freight one more year. You’re right though: the system sure is rigged. Crazy rates, sky high deductibles.

[Mr Lars]

Well, I wouldn’t exactly define getting on Medicare as ‘the goal line’.
The government forcing its way into the health insurance industry decades ago is one of the main causes of the horrible situation currently.

[tommar]

Just one other thing: As many folks know, straight Medicare only pays for 80% of your bills. The other 20% is yours to pay. So, there are so-called Medigap or supplemental Medicare insurance policies. You get ONLY ONE CHANCE to get a supplemental Medicare policy which will cover you IF YOU HAVE PRE-EXISTING CONDITIONS! And this happens only at age 65 and only on this one year. So, the window is small. Unfortunately, as you age, the premiums increase. There are several flavors of supplemental policies; and some offer age-stable premiums but most do not. So do your research and the premiums and policies vary from state-to-state.

[the sights]

Must you take that employer money if not let it sit till your 65

[BCam]

Originally Posted by tommar

Just one other thing: As many folks know, straight Medicare only pays for 80% of your bills. The other 20% is yours to pay. So, there are so-called Medigap or supplemental Medicare insurance policies. You get ONLY ONE CHANCE to get a supplemental Medicare policy which will cover you IF YOU HAVE PRE-EXISTING CONDITIONS! And this happens only at age 65 and only on this one year. So, the window is small. Unfortunately, as you age, the premiums increase. There are several flavors of supplemental policies; and some offer age-stable premiums but most do not. So do your research and the premiums and policies vary from state-to-state.

This isn't true with respect to all the Medicare options such as Medicare Advantage plans. I have Kaiser's Medicare Advantage HMO here in Sacramento County. My 2021 premium will be $15/mo, with no supplemental premium (just Part B), no pre-condition limitations, no 20% except for durable medical equipment, no annual deductible, reasonable co-pays etc. Granted it's an HMO and there are restrictions but I've been covered by HMOs for well over 20 years including Kaiser since 2007 (commercial and then Medicare). California is a "mature" HMO market so we went through the growing pains many years ago.

Note that there are travel restrictions that may limit the advisability of such plans for full-timers but for most of us the travel benefits are fine.

Plans vary, not only from state to state but county to county.

For anyone who wonders what a good Medicare Advantage HMO looks like, here's a summary of my 2021 benefits:

https://medicare.kaiserpermanente.or...nia/sacramento

[BCam]

Originally Posted by TexasJeff

I'm wondering if it just makes sense to just pay ourselves the cost of the premium and go cash with our doctors.

Under no circumstances (unless you're unusually wealthy) should you do this. You could be wiped out with one bad health episode. You can save some money premium-wise by choosing a plan with a higher annual deductible, but you need to do the math.

I had a 30+ year career in hospitals, much of which dealt with billing, insurance, health plan contracting, etc. Some of my most heart-rending experiences had to do with people (often self-employed) who chose to consciously forgo health insurance or inadvertently let their coverage lapse.

[TexasJeff]

Kaiser Permanente in CA is a huge system. My mom (97 yo) is part of it and it's been great for her. Though the waiting can be a real issue - I've been there with her sitting for an hour waiting to see a doc.

Regarding letting insurance lapse and just saving/paying ourselves the premium: I don't think I was really serious but instead reflective on how much the rates are going up. $1600/mo in 2020, going up to $1825/mo in 2021. And deductibles are going up another $2000 as well. Some of us understand the command "assume the position" and yelling "thank you sir, may I have another!?!"

The unfortunate thing is that though some of us age-out of our careers for one reason or another between 60-65, it's sometimes unavoidable. I won't whine about it. I had a great career. Then I got older. It is what it is. We'll keep plodding along and try to stay healthy enough. We got our RV and a Jeep so life aint all bad!

[jacwjames]

I made the decision to retire just before my 55th birthday. Health insurance was a concern but we had insurance through BCBS of TN for ~$400/month. The next year my premium doubled so I shopped on the ACA website and went with another carrier, the first year it didn't increase too much. Guess what the next year the premium went up almost double again. So I decided to go with a private carrier but the policy was for catastrophic type event with higher deductibles and out of pocket. The next year the premium went up ~15% but it did not increase last year. I will never go without some sort of coverage to protect my assets in case of a catastrophic event.

[Bamaman]

Being able to get on Medicare with a supplement almost makes you glad you had a 65th birthday. Everywhere we look, we see advertising only about Advantage Plans. They work essentially like a HMO with the doctor getting paid a set amount monthly no matter how many times they see you.

But we've seen some hospital chains and their hundreds of doctor's offices/clinics refuse to even accept Advantage plans. And we've seen individuals in small cities and health markets having to drive long distances to doctors and hospitals in different towns for services because their local hospital and their physician/employees refuse to accept Advantage..

My wife has had 9 surgeries in the last 2 years, and is facing a terrible foot surgery and rehab next month. We choose to go with Medicare and a Plan F medigap supplement because we want to have control of our healthcare and the ability to have superior physicians and hospitals.

Those in early retirement have few options, other than going the ACA route. It's one of those plans you cannot afford deductibles/co-pays on. But there again, you cannot afford to be without coverage either. Any major hospital stay could be a serious drain on your financial resources. I just hope you've saved and saved--until it hurt.

[Isaac-1]

Yeah, sadly there is no good option it seems for so many people. I was just shopping on the ACA exchange yesterday, and can't find any option that works out significantly better than the $1,200 per month in premiums I am spending now. Sure there are some lower level Bronze plans I could buy starting at $700 per month, but the out of pocket deductible / co-pay for Rx and doctors visits kill the advantage as I am on one of those $600+ per month medications if paying out of pocket, and don't get any government subsidy as our household income is above $72,000 per year. So it is either pay up front in higher premiums, and still pay $50 per month Rx co-pay or save on premiums and pay $500+ out of pocket for medication even with discount programs. No matter how you slice it the end result is about $15,000 per year in healthcare cost, which running the numbers and assuming no changes in health or medication I might be able to trim down to $14,000, maybe even $13,500 by finding the sweet spot in co-pay, higher deductibles, etc.



The sad thing about all this is I am relatively healthy, mostly just the usual post 50 year old stuff, see the doctor twice per year for scheduled checkups, have not been in the hospital or emergency room in almost 10 years.