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Healthcare for us under Medicare age...


CathyinMB

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My husband who is 67 and I, who am 53 are looking to hitting the road full time in September. We are wondering how Obamacare will help me out as far as health insurance goes and can we count on the cost not rising to unaffordable. Are there others out there that have taken advantage of the Affordable Care Act?

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We have not as we do not need it however we have helped several people apply due to curiosity on our part and lack of knowledge on their part. It is complicated and requires you do the homework. There are variables and qualifications.

 

The people we helped out had no or could not afford adequate healthcare. In each case because of the subsidy they received affordable health care that met their needs.

 

Do the homework as it applies to your financial situation. Remember the actual name is the Affordable health care act designed for those who can not afford adequate health care. As for rising cost we have had the same health care policy for over 35 years and it increases nearly every year.

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You can go on the exchange and see if your income levels quality you for a subsidy. It is pretty easy to figure out.

 

Even with the subsidy it is not what I would call cheap, and the coverage is not really very good unless you have a catastrophic illness. And there is no prescription coverage before deductibles are met. At least not in my plan or any plan I can find in my home state. There ARE some very good free preventative health care benefits, though. So that is good.

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Also you will need to use a PPO plan, as that as far as I can deduct, that allows nation wide coverage. We had this and dropped it due to high cost and high deductible, 12k. We now have a health share plan instead of insurance. Liberty Health Share.

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We have our insurance through the Marketplace. Not fulltimers but we do live in Texas, and insurance rates/plans/etc. are going to be state dependent.

 

It is not cheap but it is less expensive than the COBRA plan I had when I lost my job in 2006 and coverage, particularly pharmacy, is better than I had. Unlike Jack's experience we have no pharmacy deductible. We are on a PPO through BCBSTX and do not receive a subsidy.

 

Might I suggest you take a look at Kyle's site since they specialize in RVers? http://rverhealthinsurance.com/

 

 

Michelle

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Michelle would you share your plan number specifically. I'm also on BCBS through the Exchange and have no prescription coverage unless the deductible is met.I do get a small discount on the scripts due to the plan. I saw no plan that I was willing to pay for in TX that covered prescriptions that was a PPO.

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Jack we were getting a discount on drugs somewhat. One place said had to meet deductible first and another took it. The Womens Clinic in Houston, there pharmacy did not. In Winnie the local pharmacy did. I think we had same plan. PPO Bronze 12k deductible, 100% after ded meat

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As others said go to the ACA site for your state. Remember, nothing is for sure with the ACA as a Supreme Court case is still pending so if you qualify for subsidies you should also understand they may go away and plan accordingly. Qualifications for ACA subsidies depend on you income, not your assets. Since you are under 65 the ACA would make the most sense for you but you may in conjunction want to consider ways to defer or limit income.

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Just as an example of the above, you can increase your ability to qualify for subsidies or increase subsidies by not selling any stocks to take capital gain or by offsetting any gain with loss or fully funding an IRA or health savings account.

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Sometimes your prescription coverage depends on the pharmacy. Dave and I have the same plan. The Target in Durham, NC, would not give me the insurance price since I had not yet met my deductible. The Target at home gave Dave the negotiated price in spite of not having met his deductible. That difference cost me a few hundred dollars.

 

Linda Sand

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Every county in every state is different in terms of choices if any for HMO or other plans with high deductibles.

My coverage has gotten worse with the ACA and a subsidy. I had a $10,000 deductible plan with Humana that gave me coverage most places I travel and annual preventive services covered. I now have the highest deductible allowed (somewhere around $6,500) but it will not cover me out of my state, except hopefully in an emergency. Any followup (for example setting a broken leg) I would need to travel back to my state (for example getting the cast off). Some plans will not cover emergencies in Canada. My broker felt the insurer I went with had a good payment history for emergencies in the US and Canada. Some plans will claim the fees for emergency care are unreasonable and unnecessary and still you with at least part of the bill when you are out of your state and network.

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I guess I have a lot of research ahead of me. My biggest concern is prescriptions as I'm on some expensive inhalers but other then that in pretty good shape. Thanks for all the insight and info! I definitely will check out Liberty Health Share.

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I saw no plan that I was willing to pay for in TX that covered prescriptions that was a PPO.

 

 

Jack,

 

Many of the Silver plans and up (Gold, Platinum) have a separate or no deductible for prescription drug benefits. Some of them use a co-pay structure without a deductible. Most Bronze plans only cover prescriptions after the medical deductible is met.

 

EDIT: Also...if you qualify for a Cost Sharing Reduction subsidy (CSR) then Silver plans are the way to go since they are the only ones you can use the CSR with. I have many subsidy-eligible clients on Silver plans that have $0 deductible for prescriptions.

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I guess I have a lot of research ahead of me. My biggest concern is prescriptions as I'm on some expensive inhalers but other then that in pretty good shape. Thanks for all the insight and info! I definitely will check out Liberty Health Share.

If you are concerned about getting coverage for expensive inhalers you will want to be careful with any "ministry share programs". I am not opposed to these plans in general, but they will not cover pre-existing conditions medications for the first 12 months.

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If you are concerned about getting coverage for expensive inhalers you will want to be careful with any "ministry share programs". I am not opposed to these plans in general, but they will not cover pre-existing conditions medications for the first 12 months.

That is false. Need to do some research before posting. Liberty does but it is limited coverage in steps. If you go on "provisional" coverage all preexisting conditions are covered.

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That is false. Need to do some research before posting. Liberty does but it is limited coverage in steps. If you go on "provisional" coverage all preexisting conditions are covered.

 

I got this straight from their website:

 

"These are the kinds of expenses we do not share together:
  • Pre-existing conditions for the first 12 months of participation"
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And you said no coverage. First year no, second $20kish, third more, etc. But Liberty will put you on "provisional" coverage if their is a problem. Did for my wife. They are paying for her surgery which is pre existing. Lots of people on forums will criticize anything to do with "religious" roots. No accusing anyone but this is the norm and it happens on this forum. One needs to check this out for themselves. Tons of false info on forums

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HSA accounts don't allow you enough money. We had a 12k ded but only allowed 7k deposit.

While it is true that you can only contribute $7650 (couple over 55) to your HSA account in one year, you can do it again the following year.

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While it is true that you can only contribute $7650 (couple over 55) to your HSA account in one year, you can do it again the following year.

True but not anymore. I no longer qualify. Just believe this is not fair but it is all about taxes. But we don't want to go there.

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