Health Care Prior to Medicare?

[stumblinhorse]

I am being sent into retirement here in a couple of weeks. Insurance options around me for a high deductible plan for me and my wife start at $1800 a month. I am just gonna go without. At the end of the day a plan like that is about $26k single or $33k married, out of pocket before they pay for really anything. That math doesn’t add up for me.

 

[airbiscuit]

Interesting post. I have to decide this very thing by Friday as I retired last week at 57.

I think I've narrowed down to Christian Health Ministry (CHM) or Philadelphia American.

A lot of the smaller stuff we'll just pay for which works out to be about what my deductibles were costing me anyway with insurance through work, such as prescriptions, eye exams, and dental cleanings.

These plans are really just to cover major illness or hospitalization.

Cobra for us was way too expensive and the Insurance with the school system my wife works for is as well.

Watch the fine print on Christian Health Ministry, speed of payment or lack of payment.

 

[dmccarty]

I am being sent into retirement here in a couple of weeks. Insurance options around me for a high deductible plan for me and my wife start at $1800 a month. I am just gonna go without. At the end of the day a plan like that is about $26k single or $33k married, out of pocket before they pay for really anything. That math doesn’t add up for me.

The wifey and I have been talking about going without as well.

Unfortunately, our family had quite a few hospitalizations and surgeries a couple of decades ago. This lasted for say 10-15 years, but thankfully, this has eased up quite a bit in the last decade or so. I don't know what my company was paying for healthcare that far back in time, but I think a good, low guess would be $15K for their contribution and our premiums. Adding our out of pocket would certainly have been another $5K per year. Easy.

I know the company contribution and our contribution are now around $30K.

So a minimum, low number of how much we have spent on health care of the last 25 years is between $375,000 to $500,000! I think the number is closer to $500K than $375.

Even with all of surgeries and hospitalizations, I don't think we spent anywhere near that amount of money.

To pull that back to today, your numbers are similar to what we are seeing though a high deductible plan is not as expensive. Which then begs the question, does one roll the dice and go without?

We have negotiated prices down with health care providers so maybe that is what one should do. We have shopped around for services, like MRIs and found HUGE price differences.

 

[stumblinhorse]

Most people will tell you that most clinics will negotiate their fee with you if you are paying cash. That is my plan. I won’t sign up to pay $26k in premiums and then $10k out of pocket just in case. And then get really nothing in return. I am 57yo this year…. I have been to the doctor 1 time in the last 24 months…

 

[dmccarty]

Most people will tell you that most clinics will negotiate their fee with you if you are paying cash. That is my plan. I won’t sign up to pay $26k in premiums and then $10k out of pocket just in case. And then get really nothing in return. I am 57yo this year…. I have been to the doctor 1 time in the last 24 months…

I would suggest getting blood work done including having your vitamin D level checked. It is not expensive and provides a clue as to future health problems. Adequate levels of vitamin D will lower one's risk for respiratory illnesses. I was exposed to the pandemic virus multiple times and never got sick. Getting the second vaccination kicked my a.....s.

Visit to the dermatologist are every 12-18 months to make sure there aren't any problems, and if so, to catch them early. Way too much sun exposure, especially when I was a kid and younger so getting things check is cheap, well, insurance.

I wish I had gotten a cardiac calcium scan years ago to establish a base line. Mine is ok but I wish I had the scan years ago. I had to pay out of pocket since insurance would not cover it......

 

[stumblinhorse]

I would suggest getting blood work done including having your vitamin D level checked. It is not expensive and provides a clue as to future health problems. Adequate levels of vitamin D will lower one's risk for respiratory illnesses. I was exposed to the pandemic virus multiple times and never got sick. Getting the second vaccination kicked my a.....s.

Visit to the dermatologist are every 12-18 months to make sure there aren't any problems, and if so, to catch them early. Way too much sun exposure, especially when I was a kid and younger so getting things check is cheap, well, insurance.

I wish I had gotten a cardiac calcium scan years ago to establish a base line. Mine is ok but I wish I had the scan years ago. I had to pay out of pocket since insurance would not cover it......

Did all that as soon as I found out I was getting laid off. That was my one visit. Still with health coverage the bill was almost $1k. So should be good till 2026.

 

[CloverKnollFarms]

Depending on your income, you may be put on Medicaid.

 

[Bearsixty7]

Watch the fine print on Christian Health Ministry, speed of payment or lack of payment.

I have a classmate that uses them and they have been really happy with them.

 

[bigtiller]

Be thoughtful when deciding to go without health insurance. Below is a December and yearend report from our insurer for just Mrs.tiller. Note the dollar difference between columns titled billed and plan paid.

She had a dislocated shoulder this year but everything else was mostly for maintenance and Chronis treatment. Ageing brings medical surprises, stay prepared.

 

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and don't be surprised if some future changes bring back denial of coverage due to preexisting conditions (prohibited with the ACA, but some people hate that), so assuming you can always get insurance later isn't necessary a truth because that "later" insurance may not cover the big ticket issues plaguing you then.

 

[dmccarty]

Be thoughtful when deciding to go without health insurance. Below is a December and yearend report from our insurer for just Mrs.tiller. Note the dollar difference between columns titled billed and plan paid.

She had a dislocated shoulder this year but everything else was mostly for maintenance and Chronis treatment. Ageing brings medical surprises, stay prepared.

View attachment 2834680

And that bill is part of the health care cost problem. How can the Providers billed plan be so much higher that the allowed total cost? If the billed plan cost is real, the provider took and $100,000 loss? That is hard to believe. Some providers in some states will not accept Medicade patients because what the government pays for service does not cover the costs.

That first column cost is would seem to be why one can negotiate down the bill. The health care provide can have a huge margin.

We needed an MRI but we had time to shop around. One hospital wanted $3,000. We found a place that only does MRIs and they told us it would be $750 but ended up being $500.

One has more visibility in pricing when buying a vehicle than one does when getting health care. Something very wrong with that fact.

 

[dmccarty]

and don't be surprised if some future changes bring back denial of coverage due to preexisting conditions (prohibited with the ACA, but some people hate that), so assuming you can always get insurance later isn't necessary a truth because that "later" insurance may not cover the big ticket issues plaguing you then.

Yep. One also needs to be aware of to have creditable coverage. My understanding is that this is for Medicare part D drug coverage. I have seen other discussions where people say it mean something else but the only thing I can find is something like this, https://www.cms.gov/medicare/prescr...verage/downloads/whatiscreditablecoverage.pdf

WHAT IS CREDITABLE COVERAGE?
Beginning January 1, 2006, Medicare beneficiaries will have the opportunity to receive subsidized
prescription drug coverage through the new Medicare Part D program. Beneficiaries who choose not to
sign up at the first opportunity may have to pay more if they wait to enter the program later after the open
enrollment period.

Beneficiaries who have other sources of drug coverage - through a current or former employer or union, for
example - may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage
is at least as good as the new Medicare drug benefit (and therefore considered "creditable coverage" ), then
the beneficiary can continue to get the high quality care they have now as well as avoid higher payments if
they sign up later for the Medicare drug benefit....

 

[hslogger]

When you got nothing you got nothing to lose.

 

[part-time-Farmer-NC]

I too am facing this decision. From what I looked on marketplace, I can drop my income to my SSI level and use savings and qualify for a lower premiums. I didn't know about the 1099 surprise that would come due.

Didn't know that the amount my employer pays for med is listed, never really paid attention to that. Gonna go back and see what that is. I always heard COBRA was about 110 pct of that number.

Wife is about 18 months behind me in age but in better health. i am exploring my options so it's good to read the experiences of others, see what may work for us.

 

[dmccarty]

I too am facing this decision. From what I looked on marketplace, I can drop my income to my SSI level and use savings and qualify for a lower premiums. I didn't know about the 1099 surprise that would come due.

Yep, if you can lower your income you get lower premiums with ObamaCare. Or if you have dependents. The 1099 was a nasty surprise.

Didn't know that the amount my employer pays for med is listed, never really paid attention to that. Gonna go back and see what that is. I always heard COBRA was about 110 pct of that number.

Wife is about 18 months behind me in age but in better health. i am exploring my options so it's good to read the experiences of others, see what may work for us.

The health care payment is code DD on your W2.

The cost of COBRA depends on the company. From what I can tell, my company ONLY charges 103% of the cost.

 

[part-time-Farmer-NC]

I just checked my W2 no DD entry there. In 12A on W2 I see AA which is my Roth 401k contribution amount. I think that is where it is supposed to be listed. I do see a Med Pre Tax item on my paystub that shows a YTD. I believe that is my contribution amount though.

I saw the IRS indicating it supposed to be listed there on the W2 on 12 (see below). It doesn't state in 12 A, B C etc. I only have the 12A box filled out and according to the codes listed below its Roth 401K.

Reporting Employer-Provided Health Coverage on Form W-2 | Internal Revenue Service

Jan. 27, 2014 - Employers may need to report employer-sponsored health care coverage amounts on W-2 forms being issued this January 2014. Individuals do not have to pay taxes on these coverage amounts and should not report it as income.

www.irs.gov

 

[dmccarty]

I just checked my W2 no DD entry there. In 12A on W2 I see AA which is my Roth 401k contribution amount. I think that is where it is supposed to be listed. I do see a Med Pre Tax item on my paystub that shows a YTD. I believe that is my contribution amount though.

I saw the IRS indicating it supposed to be listed there on the W2 on 12 (see below). It doesn't state in 12 A, B C etc. I only have the 12A box filled out and according to the codes listed below its Roth 401K.
...

The back of the W2 describes the fields with the health care coverage amount being "DD—Cost of employer-sponsored health coverage. The amount reported with code DD is not taxable."

Odd that DD is not showing up if you have company supplied health care.

 

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The back of the W2 describes the fields with the health care coverage amount being "DD—Cost of employer-sponsored health coverage. The amount reported with code DD is not taxable."

Odd that DD is not showing up if you have company supplied health care.

Mine shows almost $24k this year
I pay about $4k (med) + $250 (dental) on top of that

 

[dmccarty]

Mine shows almost $24k this year
I pay about $4k (med) + $250 (dental) on top of that

Shocking, isn't it.

Now that the company health care cost is documented, or should be documented, in the W2, imagine what would happen if companies did not get a tax break for paying for health care, and that money was paid directly to the employee. That health care expense IS paid for by the employee, they just don't always see/know how much they are paying...

If people KNEW how much their health care insurance was costing them, both the company paid amount and what the employee pays in premium and out of pocket, me thinks there would be a change in the system.

My health care expense, what I pay out of pocket, premiums and what the company pays for in my name, is almost TWICE what I pay for a mortgage, house insurance and property tax.....

 

[QRTRHRS]

I took SS at 62 only because I felt that I was being taken advantage of and I had a house that I wanted time to paint, etc. to get on the market.

I got on with my counties school district driving a school bus. I stayed on after I got on Medicare at age 65. After I got on Medicare, under the district's plans, I got $175/month for medical issues not covered under my Medicare plan. Original Medicare and the "F" plan supplement; vison, dental, prescriptions extra so that $175 covered that.

Eventually, I resigned and went back twice to help them out when they were short on drivers.

Being just over an hour away from UK in Lexington, KY was helpful in that they have a lower cost dental clinic. The students whom are in their last year(s) work under licensed dentist's and do a good job.