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Jacks60

Health insurance is stopping us

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Hi everyone, Frank and I are new members and excited to learn all we can.  We would really love to take off next year when Frank can officially retire.  However, one big dilemma!

 I not old enough for Medicare, we have checked into it and paying for Medicare and the supplement is bad enough, but what it would cost for me, who is not 65 for 2 and 1/2 years yet is ridiculous!  We never expected it to be this much.  Advice from anyone who is in our situation would be so welcome.  Thank you.   

Edited by Jacks60
Grammar

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I have no idea what advice you expect.  You have priced insurance and found it to be very expensive.  I had the same issue and put off retirement until I was at least within a few months of age 65.  

If you think medical insurance is expensive now, you might want to think about delaying retirement anyway.  Costs can get really high even when Medicare kicks in.  You will need to pay for supplemental insurance and a prescription plan.  They may still leave a great many expenses uncovered.  In your early 60s that might not seem to be much of a concern but that will change.  Also remember dental and hearing is not covered.  Those can also generate major expenses as you age.

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18 minutes ago, JimK said:

You will need to pay for supplemental insurance and a prescription plan.  They may still leave a great many expenses uncovered. 

With all due respect, if you choose the correct Medicare supplemental plan you will have essentially no exposure regardless of what your medical condition.  Prescription plans do have co-pays, but if you analyze your plan each year using a calculator, like what you can find on the Medicare website, you can minimize those costs.

When we started full-timing my wife had ~18 months without Medicare coverage.  We bit the bullet and bought her a plan at the limit of what we could afford and we kept our fingers crossed.  We lucked out and nothing serious happened until after she was on Medicare.

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In Minnesota, you would probably qualify for Minnesota Care. Minnesota Care has no asset tests and the premiums are based on income. It could be $100 month. If income is too high, ACA is the next option, with a potential premium subsidy. Not sure how Michigan works. With the elimination of the mandate, another option is the "short term plans" introduced by the new administration.

My point is that there are options...and they vary to some degree from state to state. Some of it comes back to your own financial situation and whether or not you are willing to take on some risk.

I'm not advocating for one option or another.

Get with a health insurance expert in your area and someone willing to do some work looking at all options.

 

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1 hour ago, docj said:

With all due respect, if you choose the correct Medicare supplemental plan you will have essentially no exposure regardless of what your medical condition.  Prescription plans do have co-pays, but if you analyze your plan each year using a calculator, like what you can find on the Medicare website, you can minimize those costs.

When we started full-timing my wife had ~18 months without Medicare coverage.  We bit the bullet and bought her a plan at the limit of what we could afford and we kept our fingers crossed.  We lucked out and nothing serious happened until after she was on Medicare.

My wife and I have Medicare with full Plan F supplemental.  For the past several years when I assemble the data for tax time, we have consistently been over $20K per year.  That includes a couple of thousand for dental insurance and dental costs not covered.  We are trying to do the minimum.  My dental bills could easily go beyond the $20K by themselves.  Anyway, discounting the dental, we are still over $20K/year.  That includes the supplemental and drug coverage and LTC insurance, drugs not covered by insurance,  PT my wife needs that is not covered, transportation costs, etc.  Out of pocket drug costs are one of the biggest expenses and total many thousands.  It is no joke that people talk about not being able to take their drugs because the costs are too high.  What has happened to drug prices is incredible and the coverage is not keeping up.

 

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10 minutes ago, JimK said:

My wife and I have Medicare with full Plan F supplemental.  For the past several years when I assemble the data for tax time, we have consistently been over $20K per year.  That includes a couple of thousand for dental insurance and dental costs not covered.  We are trying to do the minimum.  My dental bills could easily go beyond the $20K by themselves.  Anyway, discounting the dental, we are still over $20K/year.  That includes the supplemental and drug coverage and LTC insurance, drugs not covered by insurance,  PT my wife needs that is not covered, transportation costs, etc.  Out of pocket drug costs are one of the biggest expenses and total many thousands.  It is no joke that people talk about not being able to take their drugs because the costs are too high.  What has happened to drug prices is incredible and the coverage is not keeping up.

That why many full-timers go to Mexico for dental and medicine.

Linda Sand

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We have a major medical only plan in sd knowing we will pay out of pocket for things but we usually only go to dr once a year. We are 51 and 57. Check aca we understand if you only claim 17000 as your estimated income for the following year you qualify, so it might make sense to defer retirement income

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On 9/14/2020 at 1:23 PM, Jacks60 said:

I not old enough for Medicare, we have checked into it and paying for Medicare and the supplement is bad enough, but what it would cost for me, who is not 65 for 2 and 1/2 years yet is ridiculous!  We never expected it to be this much.

Reminds me of the Monty Python routine.

Anyway, my wife and I were in similar situation when we started full timing in 2013 -- I was 63 and she was 61. Both of us had to purchase our own health insurance for several years. Also, we started full timing a year before the ACA was even available.

Luckily, for the first 18 months, I had a good BCBS COBRA plan (national-wide network, dental & vision, $1000 deductible) for about $1000/month. On the other hand, the "closest" private health insurance at that time was about $860 with $5k deductible and plenty of restrictions.

COBRA got me to Medicare age. My wife went on an AZ ACA plan ($1100/month) for about 2 years after that. Then she went on Medicare in 2016.

If we were thinking about full timing now, we would wait until we both could get Medicare. The ACA is too expensive if you have to pay full cost. However, if you can "adjust" your income level, you can qualify for an ACA subsidy, which could greatly lower the premium cost of your health insurance plan.

Edited by Zulu

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10 hours ago, ToddF said:

In Minnesota, you would probably qualify for Minnesota Care.

She is from Michigan, but may be considering a change of state for domicile. It is possible that MI has something similar so she should definitely look into that. 

9 hours ago, JimK said:

For the past several years when I assemble the data for tax time, we have consistently been over $20K per year.  That includes a couple of thousand for dental insurance and dental costs not covered.  We are trying to do the minimum.  My dental bills could easily go beyond the $20K by themselves.  Anyway, discounting the dental, we are still over $20K/year.  That includes the supplemental and drug coverage and LTC insurance, drugs not covered by insurance,  PT my wife needs that is not covered, transportation costs, etc. 

Medicare does not cover dental and never has. The same is true for Long Term Care insurance. Once you have Medicare, we find that drug plans are a major headache as choosing the wrong one can cost you a great deal. 

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10 hours ago, JimK said:

That includes the supplemental and drug coverage and LTC insurance, drugs not covered by insurance, 

Our experience has been that if we carefully analyzed the drug plans (Part D) each year relative to the medications we used, we have always been able to get all of our meds covered.  My wife takes several high-priced meds, but we've always been able to shop for plans that covered them.

What many people aren't aware of is that different Part D plans from the same insurance carrier can often have significantly different formularies.  For example, this year my wife and I both have AARP Part D plans through United Healthcare.  Since we always have our Rx filled at Walgreens, I wondered why I was on the "Walgreens AARP plan" and she was not.  Sure enough, one of her expensive meds wasn't covered under the Walgreens plan.  Yet the premiums for both our plans are in the ~$30/mo range.   But her total costs would have been a lot higher on my plan.

Changing Part D plans is very easy and acceptance is guaranteed as long as you had coverage in the previous year by another carrier.  We've probably changed Part D plans in ~5 out of the 8 years we've both had Medicare.  When selecting plans we only focus on the total annualized cost of the plan, including premiums and co-pays.  Focusing only on premium costs can sometimes result in a faulty analysis.

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1 hour ago, Kirk W said:
11 hours ago, ToddF said:

In Minnesota, you would probably qualify for Minnesota Care. Minnesota Care has no asset tests and the premiums are based on income. It could be $100 month.

She is from Michigan, but may be considering a change of state for domicile. It is possible that MI has something similar so she should definitely look into that.

Whether Michigan or Minnesota, the OP said they want to "take off next year," which presumably means travel.  I highly doubt that a plan funded by a particular state for its residents would provide coverage outside that state.

To the OP:  Go to this thread and at the bottom of page 3, starting in August, there is a series of posts from people dealing with your situation:  

https://www.rvnetwork.com/topic/138198-rver-insurance-exchange-health-insurance/page/3/

 

33 minutes ago, docj said:

Changing Part D plans is very easy and acceptance is guaranteed as long as you had coverage in the previous year by another carrier.  We've probably changed Part D plans in ~5 out of the 8 years we've both had Medicare.  When selecting plans we only focus on the total annualized cost of the plan, including premiums and co-pays.  Focusing only on premium costs can sometimes result in a faulty analysis.

I will be on Medicare in the not too distant future, so I vaguely follow discussions about it.  One thing I've come away with is that for prescription coverage, you get a plan that covers the medications you're on.  But the medications you're on right now could change, and you could suddenly find yourself on a super-expensive one that isn't covered by your plan but would have if you'd picked another plan. 

And maybe I uniquely notice this because I'm not on any medications, so the usual method of picking a plan wouldn't apply to me.  If you are on medications, then it seems like a no-brainer to pick the plan that will pay the most toward the medications you're on, and more sophisticated people will use your more thorough analysis.  But none of that has anything to do with medications you don't know you'll be on later, and insurance is traditionally used to protect against unexpected events.

Am I misunderstanding this?  Because it seems to me to be a ridiculous way for people to pick plans.

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35 minutes ago, Blues said:

Am I misunderstanding this?  Because it seems to me to be a ridiculous way for people to pick plans.

Yes, you appear to not understand that there is an annual "open season" for Medicare supplements every year in the Nov-Dec timeframe.  So the worst that can happen is that, in the middle of the year, you start taking a medication that isn't on your current plan.  If that happens you have to limp along until you get to open season when you will, hopefully, find a plan that covers it.  If you change plans, your new coverage will start on January 1.   We've done this multiple times.   That's why I said that you can't just focus on premium costs; one year we both switched to plans with higher premiums in order to get coverage of all our meds.

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6 minutes ago, hemsteadc said:

I switched both part D and supplemental in July.

Did you have a major life change, life moving?

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In regards to medications,  always ask if a GENERIC is available.  There are loads of "new and improved" medications out there, but if your needs can be addressed by an older, proven medication that has generic equivalents available, you should also look into that first.   Physicians tend to prescribe whatever the  drug detail person has shown them recently.   Also always ask about possible interactions with drugs you are currently taking.    A lot of the "new and improved" are simply new combination of older generic drugs - and taking 2 pills each day at pennies per pill can save a lot when the "new and improved" 1 pill only is $10+ per pill.  😎

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3 hours ago, Barbaraok said:

Did you have a major life change, life moving?

When I changed my part D address to different state, they promptly cancelled me, although their rules didn't indicate I'd done anything 'wrong.'  Best I could figure they expected me to tell them when I went south for the winter, although they'd been paying my prescriptions just fine for 10 years in different states.

I found a broker on the 'net who got me into a cheaper plan. At the same time he got me out of an expensive Plan N supplemental, which had nothing to do with changing an address.

You never know what will happen when you disturb a sleeping insurance company.

Edited by hemsteadc

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1 hour ago, hemsteadc said:

When I changed my part D address to different state, they promptly cancelled me,

That would qualify as a life change event for Medicare.

2 hours ago, docj said:

That's why I said that you can't just focus on premium costs; one year we both switched to plans with higher premiums in order to get coverage of all our meds.

Last year my wife changed to a lower premium part D, to what I have had. The result has been that it pays less for several of her medications and our out of pocket has more than doubled. We look forward to the next renewal.  I have found that many people discover that they have much to learn when they start to use Medicare. It has been quite an education. 

Edited by Kirk W

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4 hours ago, docj said:

Yes, you appear to not understand that there is an annual "open season" for Medicare supplements every year in the Nov-Dec timeframe.  So the worst that can happen is that, in the middle of the year, you start taking a medication that isn't on your current plan.  If that happens you have to limp along until you get to open season when you will, hopefully, find a plan that covers it.  If you change plans, your new coverage will start on January 1.   We've done this multiple times.   That's why I said that you can't just focus on premium costs; one year we both switched to plans with higher premiums in order to get coverage of all our meds.

Agreed.  One needs to compare plans every year.  It's very easy to do on the Medicare web site.  Just plug in your meds and a list will come up with different plans to compare.  Companies will drop med coverage for certain drugs.  Humana dropped a very expensive one for us last year so we did have to 'limp along' until we could get a new plan that covered it.  Instead of using Humana for it we used GoodRX and saved a lot but it was still high.  This year we switched to a different plan (WellCare) and the drug is covered and lowered by hundreds of dollars.  The plan is $13.10/m and some of our meds are free.  It's been excellent for us this year.  Hope they continue covering that expensive drug.  You definitely have to go by what drugs you're taking in choosing plans.

https://www.goodrx.com/?gclid=COCUktPKx7oCFeo9QgodrVAAMg

Edited by 2gypsies

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2 hours ago, Kirk W said:

Last year my wife changed to a lower premium part D, to what I have had. The result has been that it pays less for several of her medications and our out of pocket has more than doubled. We look forward to the next renewal.

Didn't you do an annualized cost analysis before you made the change? Of course, the plan with the lower premiums will charge you more for the Rx.  It's a net zero sum game; it all has to turn out roughly the same in the long run.  The trick is finding the one that is the best one for your particular set of prescriptions.  

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2 minutes ago, docj said:

Didn't you do an annualized cost analysis before you made the change? Of course, the plan with the lower premiums will charge you more for the Rx.  It's a net zero sum game; it all has to turn out roughly the same in the long run.  The trick is finding the one that is the best one for your particular set of prescriptions.  

It's kind of like buying a car with a trade-in. It doesn't matter how much for which part as long as the total is one you can live with.

Linda

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3 hours ago, docj said:

Didn't you do an annualized cost analysis before you made the change? 

Let's put it this way. We have both known that for some time, but we each have our own account via my former employer who supplements the cost for us. She is well aware of the fact that it was a bad decision and I keep my comments to myself.   But I'm pretty sure she knows what I'm thinking.  😏

 

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3 hours ago, Kirk W said:

She is well aware of the fact that it was a bad decision and I keep my comments to myself.   But I'm pretty sure she knows what I'm thinking.  😏

 

You are a wise, wise man.  😉

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All great suggestions.  We have changed plans numerous times looking for the best coverage.  We have even tried to use the pharmacies to help with the selection.  Unfortunately that has not stopped us from paying thousands for drugs due to insufficient coverage.  Every prescription we have had in at least 10 years has been for generics, when available.

Most of our expensive drug costs are due to my wife's prescriptions.  Even the cost of my simple statins and antihypertensive generics has double in the past couple of years.  There are major law cases and investigations which have lead to the conclusion that many drug companies have conspired to avoid competition and raise prices for generics.  Those cases will be in the courts for years if not decades.

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On 9/17/2020 at 8:43 AM, docj said:

Yes, you appear to not understand that there is an annual "open season" for Medicare supplements every year in the Nov-Dec timeframe.  So the worst that can happen is that, in the middle of the year, you start taking a medication that isn't on your current plan.  If that happens you have to limp along until you get to open season when you will, hopefully, find a plan that covers it. 

Oh, I know there's an open season in which you can change plans.  But the worst that can happen is that on January 2, and not in the middle of the year, you are prescribed a very expensive drug that isn't covered by your plan.  Depending on the price, it could be a lot more than just limping along, and possibly financially ruinous.  All because you didn't predict something you have no way of predicting.

 

On 9/17/2020 at 10:50 AM, Kirk W said:

I have found that many people discover that they have much to learn when they start to use Medicare. It has been quite an education. 

This has been my biggest disappointment with Medicare.  I bet the vast vast majority of people who aren't on Medicare have no idea how complicated it is, that there are so many choices you have to make, and that the expected basis for selecting a drug plan is what drugs you're currently on even though that probably won't be the extent of the drugs you are prescribed for the next year, so you're flying blind on those when you pick your plan.

When I hear "Medicare for all," my reaction is now "Watch out what you ask for." 

 

On 9/17/2020 at 1:23 PM, 2gypsies said:

You definitely have to go by what drugs you're taking in choosing plans.

I'll say again that that's a ridiculous system because those drugs can change.  Or if someone isn't on any drugs, but definitely wants to have coverage if he get sick and is prescribed drugs.  Which plan should that person pick?

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