Any Current Healthcare Solutions for Pre 65 healthcare?

[ScenicRoute_Kate]

I'll share our experience. We are not a typical case as this year we decided to spend 6 months outside the US. We went full time in June 2014. We domiciled in Texas for 2015 and like many enjoyed a (relatively) affordable nationwide BCBS plan on exchange. Faced with our plan being withdrawn for 2016, the only real nationwide ACA-compliant choice in Texas was an off-exchange option costing >$1K a month. Instead we opted for Short Term Medical Insurance from the IHC Group (found through Kyle). They had plans at various prices. For $350 a month we got a nationwide mid-level plan. We are 47 and 51 years old. The main issues are that the plan is not ACA compliant so we will have to pay the fine, but it is still much cheaper than the Texas plan and the other consideration is that they don't cover pre-existing conditions and can refuse coverage (hence non ACA-compliant). Fortunately we are healthy and could live with that. These plans are definitely not for everyone.

 

While outside the US we did a full healthcare screening and we bought any prescriptions we needed. We pay out of pocket which is very inexpensive compared to home. So we actually can't comment on the coverage provided by the STM because we have never used it. We treat the insurance as protection for our savings should we get seriously ill, rather than proactive healthcare.

 

Who knows what the 2017 plan offering will bring but we are slowly coming to the conclusion that for us spending more time outside the US is a better financial decision if we want to make the early retirement / entrepreneurial scenario work.

[Blues]

OK - So what? And do I have any conclusion. Yes, I've concluded that the clowns in DC have really screwed up the coverage for the Pre 65 retired group. Ironic, as this group is usually the ones that 'Had done the right things.' along their lives, to be financially capable to retire at Pre 65. Now they seem to be penalized.

 

But the main problem facing fulltimers under 65 is having access to a nationwide network of doctors. For the vast, vast majority of people under 65, that's not a consideration. I certainly never gave it a thought before I became a fulltimer.

 

For almost everybody else, an HMO or a local-network PPO works fine, and it's the same for people whether they work in a job that doesn't provide health insurance or they're retired. I don't think retired people under 65 are in a unique position in that respect.

 

We're "special" creatures in that regard, and I'm not really surprised that our unusual situation isn't being addressed.

[ScenicRoute_Kate]

 

We're "special" creatures in that regard, and I'm not really surprised that our unusual situation isn't being addressed.

Yes I do agree that we are a special case, but I think a lot of non-nomadic people don't realize how their healthcare coverage is also declining. We may be the canary in the coalmine. Imagine you are a non-nomadic entrepreneur or an early retiree or anyone else who buys a personal healthcare plan. You opt for an HMO or a local PPO, then you travel out of state for vacation, to visit family or to do business and you become ill. Your insurance may have very strict limitations as to what is covered in an emergency. If you are admitted from the emergency room or are not well enough to get back to your home state for a follow up treatment you may be left completely uncovered and open to huge bills. I don't think many people give this a second thought, I know I didn't when I wasn't nomadic.

[Kirk W]

If you are admitted from the emergency room or are not well enough to get back to your home state for a follow up treatment you may be left completely uncovered and open to huge bills. I don't think many people give this a second thought, I know I didn't when I wasn't nomadic.

Even the old school HMO plans did have some sort of coverage for the vacation traveler but they usually had absolute limits on how much and how long you were covered and required you to move back into their network as soon as medically possible. From what I read that is still pretty much the case, I suspect that the more difficult problem for most fulltimers is the need to return to the network for any non-emergency medical needs and also the limit on out of network care since most are seldom in network for long. With the many changes that have come to health care laws in the past few years, the trend of increasing prices and fewer choices is probably going to continue, even if the political power should change as it will be difficult or impossible to ever return to the system we once had. I suspect that the most constant thing in our health care future is going to be constant change in the near term.

 

While we RV folks are not a significant part of the population at large or to the voting dynamics, it would seem to me that it must be also impacting the retirees who have seasonal homes, living in the north summers and south winters? And what do truck drivers, construction workers, and other working folks who never sit still for long do? Perhaps it is time to make some effort to join forces with all who travel extensively and look beyond the RV community for support in the effort to cover the constant traveler?

[Jim & Wilma]

Kirk, On the advice to consult Kyle, I thought we had previously determined he did not want tobe consulted for the under-65 crowd. If you go to the link you posted, you will see that he specifically states he is not consulting on these issues.

 

The ACA plans have discontinued paying commissions which is driving the insurance agents away. Kyle is trying to make a living and you can't blame him.

[Blues]

While we RV folks are not a significant part of the population at large or to the voting dynamics, it would seem to me that it must be also impacting the retirees who have seasonal homes, living in the north summers and south winters? And what do truck drivers, construction workers, and other working folks who never sit still for long do? Perhaps it is time to make some effort to join forces with all who travel extensively and look beyond the RV community for support in the effort to cover the constant traveler?

 

But remember, this concerns only the under-65 demographic. People under 65 who are retired, don't have retirement-related health insurance, and live in the north summers and south winters (or are fulltime RVers) are not terribly numerous. And working folks who travel for their work often have health insurance through their job.

 

The solution is, and has always been, to have good health insurance through your employer, preferably with a substantial contribution to the premium by your employer so you don't realize how much it actually costs. Until that changes, which probably won't be until the millennials who are rejecting traditional jobs get old enough to really face the health insurance music, the outliers will continue to have an impact proportionate to their numbers.

 

People are irrational--they buy lottery tickets but don't worry about the odds of getting sick while on vacation and having their insurance company balk at covering it. And that's not going to change.

[GlennWest]

Never bought a lottery ticket ever. Personally consider it gambling.

[jloux2012]

We are in the same boat. Grew up here in California. Registration and income tax way to high. We started looking into SD, but then the ACA caused them not to have PPO, so no problem, TX. With the announcement of United Health pulling out, not sure where we will set up domicile.

My job limits me to work only 29 hours a week, so no insurance there, and I make too much for subsidy. Hubby is retired, per workman's comp accident. Was hoping to cut back on my hours so I can take advantage of ACA helping us out, since our insurance premium is more than $1k a month. ( My company is pretty flexible as I am able to work 3 months of the year in other centers throughout the year, and was hoping to only work 6 months at my new domicile state).

 

When we do change domicile, I will eventually have to transfer my job also, so we have been looking in different counties, that are close to where my job centers are located.

It is so complicated!

Not sure why the government couldn't make it illegal for insurance companies to deny because of pre-existing and keep a limit on how much they charge.

 

Sorry I will get off my soapbox

[Daveh]

Thanks for clarifying that Jim. I certainly did not mean criticism of Kyle.

[Daveh]

So this is timely but not good news for those utilizing short term insurance as an option. http://www.modernhealthcare.com/article/20160608/NEWS/160609920/breaking-hhs-cracks-down-on-short-term-plans-tweaks-risk-adjustment

[ScenicRoute_Kate]

So this is timely but not good news for those utilizing short term insurance as an option. http://www.modernhealthcare.com/article/20160608/NEWS/160609920/breaking-hhs-cracks-down-on-short-term-plans-tweaks-risk-adjustment

 

Thanks for sharing Daveh. Well that looks like another potential option for us disappearing. I understand the rationale for closing the loophole. It isn't fair to have STM available at a lower cost to people who don't have pre-existing conditions, and for those without a fortunate health background having to pay more.

[Kirk W]

Not sure why the government couldn't make it illegal for insurance companies to deny because of pre-existing and keep a limit on how much they charge.

There are several reasons why but the key one is that there would be no insurance companies in the market at all if they were to do that. The reason that so few companies are left in many areas is the very financial impact of the current regulations on the companies. It is not possible for any business to constantly pay out more in benefits than they take in from their customers. Only government gets to do that and if the government does so for too long, it too will fail, much as has happened in Greece. Insurance companies work much like your home where they must limit their spending to less than the amount that they take in.

[Smitty77_7]

My wife and I did quite a bit of business traveling in our careers, so we always paid the extra for PPO coverage vs HMO type. So for us, no real change on our expectations of insurance coverage. And yes, many corporations used to provide as part of the 'total employee compensation' partially subsidized (Some even fully.) Retirement Group Health Insurance. However ACA also made these contributions go away from the majority of Fortune 500 companies retirement packages. (And no time to make up 'total employee compensation' with higher wages to prepare for these higher individual costs, once your retired, that paycheck and wages flow is cut off:)!

 

I've mentioned in other threads, that I personally know of people I worked with that retired. Sometimes doing so to save jobs of younger employees. That are now back in the work force as either contractors (If they job skills have remained current, not always the case.), or at local retails such as Costo, Trader Joes, etc. - working just enough to cover health insurance. All still Pre 65. They're not out traveling, or playing golf, or building kit cars, or 'name your hobby' here. And that revenue now directed to Health Insurance costs, is not going into the economy in other sectors. How much? Probably a drop in the bucket, but those drops do count. One former mentor of mine, was at first bitter about this. It was almost all he talked about, so much so that people started avoiding him a social gatherings - to not want to hear about it again. (Not that he was wrong about how it was unfair to him and his wife. As they earned the subsidized Group Retirement as part of their compensations over 30-35 years. Just as much as any teacher, city/county/federal/public safety, etc. person had done too.) It was refreshing to run into him at a retiree function, and see him back to his normal great attitude about life. Seems his daughter and son took him to lunch, and pointed out how he was letting this set back 'get to him'. They were worried about his health, sort of ironic, and he said at first he pushed back a bit. But then had a 'Heck, they're right, I'm getting an ulcer over this.' moment, and made it a point to do what he had always done in his life before. Figure out what he and his wife needed to do to address this problem. He works at Costco now, and they have put their travel plans on hold until they reach 65. (He's 63 and his wife is 62.)

 

I've also shared here, and other threads, that this has changed the way my wife and I are spending our Pre 65 retirement years. So far we've not had to go back to work. But, who knows what 2017, 2018 may bring. And we too, are just dealing with it the best we can. If my wife's Mom was not living with us in our 'Vacation Home' full time - we'd put our stuff in storage, and lease the house out until age 65... That would cover our mortgage, taxes, and then some.

 

All any of us can do, is look at the options available for us. Make our best decision at that time. And IMO, continue to write and prompt our DC gang to start the process of fixing some of the problems in ACA, balance them out a bit more fairly. May not be in time of for us, but it could help others in the future...

 

One step forward, and now two steps backwards - on this one. But, we're stepping forward again as best as we can:)!

 

Best to all, be safe, have fun,

Smitty

[bja1234]

Smitty,

 

Well said

[Kirk W]

One step forward, and now two steps backwards - on this one. But, we're stepping forward again as best as we can:)!

That problem doesn't completely go away when you reach 65 as the ACA did impact many of the corporate retiree health care plans' Medicare supplement programs. While it wasn't as serious in many ways, it has increased the cost to many retired folks and it demonstrates the fact that no part of the health care issue is immune to the effects of government & laws. Thus it is important to realize that all of it is changing and all we can do is to stay informed and deal with what we must. The key is to move ahead with your plans but keep flexible to deal with changes, no matter your age at retirement.

 

I endorse Smitty's point that we must not allow these things to ruin our plans or to divert us from enjoying our lifestyle!

[Smitty77_7]

And Kirk - I admit freely, that for about 18-24 months, I let the impact on ACA to our plans - divert us from enjoying our lifestyle!'... I really had to take a 'do better', and just readjust the sail trim for the current conditions - and enjoy the ride.

 

I've joked before in the threads about 'Bota wine, vs "Name Your Vintage Here" (Or even beer, if that is your reference.) (Or in the case of my sister, exotic chocolates!)... I admit that while I certainly prefer the taste of a good bottle wine (And I have many Vintages I could place here:)!) - I do find that the stacking of one box to equal four bottles of wine, to be much easier for transport! (And as long as know one buys the last one off the shelf, the Loft Cab is better then any other Box wine we have bought so far...).

 

And Kirk, I've followed many threads on the Medicare impacts of ACA. I decided to turtle this one, duck my head into my shell, and come out at 64 1/2 to see which way the Medicare winds were blowing then... And as you mentioned, while for sure a financial impact to the Medicare gang - much less then the ACA impact on some Pre 65... I'll look forward to this discount, on paying to many higher Medicare related costs:)! But noted and appreciate the heads up to myself, and all...

 

Best,

Smitty

[whj469]

As for us Medicare folks, we have it because of the government! That fact I don't forget.

I am interested in how the ACA caused the Forturn 500 Companies to lower the health coverage for their retirees.

I must have missed something. I was under the impression that the companies that reduced the health care expense for

their retirees did so to save money?

[Kirk W]

I am interested in how the ACA caused the Forturn 500 Companies to lower the health coverage for their retirees.

I must have missed something. I was under the impression that the companies that reduced the health care expense for

their retirees did so to save money?

Remember the debates when it was stated that companies with "gold plated" healthcare would be a source of revenue to support coverage for those not insured? My former employer was one of the first 10 companies who were assessed for the crime of "excess coverage" which was the basis of the fee, meaning that they paid for too much. In my employer's case, the retiree plan was charged $87 million that year. Those fees forced most of them out of many coverage offerings, including Medicare supplements. According to the retiree news bulletin of my former employer last October, of the 25 highest rated private company Medicare supplemental plans at the time of enactment of the ACA, 22 no longer exist. The newsletter included a list of those companies, but I didn't keep it. The company that I retired from was 3M Company.

[Daveh]

The issue is much more complicated than that Kirk and in your example it was indeed the corporation deciding to not pay the cost. In essence they will not provide the benefit if the federal government refuses to subsidize the benefit.

 

To discuss the issue fairly we must remember that employer provided health care is tax deductible and thus subsidized by the federal government. The ACA has somewhat leveled the playing field but large corporate employers still get preferential tax treatment. You state the ACA penalizes the corporations for "the crime of "excess coverage" but they were actually attempting to stop abuse by corporations in passing through compensation as exceptional health care packages, rather than simply paying the employees income and letting individuals decide what healthcare they needed, for the sole purpose of tax evasion.

 

I suspect once we get a reasonable congress the cadillac tax mechanism will be revisited but no discussion of the issue is fair unless we start with the premise that large corporate employer health insurer plans have enjoyed tax payer subsidies for decades.

[Kirk W]

The issue is much more complicated than that Kirk and in your example it was indeed the corporation deciding to not pay the cost. In essence they will not provide the benefit if the federal government refuses to subsidize the benefit.

I didn't say it was not complicated, but you should also go back and read the part of the link about the penalty levied. They lost that subsidy because of the change made in the laws added to the penalty. I was there and directly involved, but you may believe whatever you wish.

[Daveh]

I did read the link but as I said this was a cost saving move by 3M, they were not forced to make changes, and what they like to characterize as a penalty is in large part setting off a tax subsidy they were getting not available to individuals and was also a mechanism used for tax avoidance. That is the rest of the story.

[Daveh]

The other question is why are all these corporations cutting benefits when the Cadillac tax is not even in effect and very well may never take effect. I submit itis because they are screwing there employees and blaming the ACA. How were 3M costs impacted by an excise tax that does not exist?

[Kirk W]

I did read the link but as I said this was a cost saving move by 3M, they were not forced to make changes, and what they like to characterize as a penalty is in large part setting off a tax subsidy they were getting not available to individuals and was also a mechanism used for tax avoidance. That is the rest of the story.

............................. No point in arguing or allowing any facts to get in the way of opinions.

 

The fact is that they have found another way to get us the same type of benefits as we had before, via a health care reimbursement account for each of us an our dependents and so have kept our out of pocket expenses to about the same level or below from what it was before. If you want to attack business and blame them, nothing I can supply will change your mind.

 

Since you are expert, document your statements that none of those taxes are in effect. "the Cadillac tax is not even in effect and very well may never take effect"

[Daveh]

Kirk, you are always kind to people asking questions and provide excellent information but on this issue you seem to come in with an agenda. You, and at least one other over 65 individual, periodically stop by to do some ACA bashing which always includes opinion informed by politics rather than facts.

 

The law is what it is and your comments do not further the search for solutions. I respond not to argue but to prevent misinformation from spreading.

 

This kind of talk especially bothers me as a former nurse since I have seen people avoid medical care and/or make poor medical decisions based on things they heard when people were attempting to make a political point rather than provide sound accurate advice.

 

Numerous companies, and especially insurance companies, used the ACA as a foil to blame for changes to accomplish their own cost savings.http://www.washingtonpost.com/wp-dyn/content/article/2009/09/15/AR2009091501175.html?hpid=topnews http://www.mintpressnews.com/why-are-health-insurance-policies-being-cancelled/171302/

 

You said the ACA caused havoc in the supplemental market. WHJ asked you how that could be. You responded that it was the cadillac tax. Here is the information: "This notice is intended to continue the process of developing regulatory guidance regarding the excise tax on high cost employer-sponsored health coverage under § 4980I of the Internal Revenue Code (Code). Section 4980I, which was added to the Code by the Affordable Care Act,1 applies to taxable years beginning after December 31, 2017." https://www.irs.gov/pub/irs-drop/n-15-52.pdf

 

Most recently, the 2018 date was moved back to 2020. "On December 18, 2015, Congress passed and the President signed a two-year delay of the 40 percent excise tax on high-cost employer-sponsored health plans, also known as the “Cadillac Tax.” This delay was part of a year-end government funding package and changes the effective date from 2018 to 2020. While the tax was originally non-tax deductible, the December 2015 changes make it tax deductible for employers who pay it." .

 

http://www.cigna.com/health-care-reform/cadillac-tax https://www.irs.gov/pub/irs-drop/n-16-04.pdf

[Zulu]

I think post #22 was the last on-topic comment. Most of the other posts are just pros & cons of the ACA. Could we stop beating that dead horse?

This under 65 healthcare issue for RVers deserves better attention than this.

However, I think what I find more disturbing is the lack of information on the topic from Escapees itself. If you check out Escapees insurance portal www.rverinsurance.com, the under 65 health care options given (telemedicine, health sharing ministries, etc) do not include much information on changing your domicile to get better ACA insurance . . what states have BCBS PPO plans? Specifics on domiciling in these states?

 

While ACA plans are very subject to change, I find this lack of ACA healthcare domicile info from an organization whose mission is "to provide a total support network for RVers" myopic.