#139 | Medical insurance in early retirement (part 3 of 5)

March 7, 2022

Episode Summary:

 

In this week’s episode, Maggie shares her plan for medical insurance in early retirement.  The reality is insurance is expensive, and either your employer is subsidizing the cost for you, or you’re paying the higher price tag in exchange for your freedom and flexibility. First, we discuss some factors to understand about medical insurance during early retirement and the various types of insurance options you can choose from.  Maggie then shares her specific approach and plan and a detailed cost breakdown of what it will cost her family with and without ACA subsidies.  

 

Episode Notes:

 

Insurance is the number one question we get when we tell people we are retiring.  Also, everything we’re sharing on insurance is specifically relevant to those living in the United States.  

 

Key considerations and thoughts on insurance during early retirement:

  •  Insurance is just a product you buy. It’s not some special club only for people who work for established businesses. You put in more than you get out on average, which is how insurance companies make money.
  • It’s going to be more expensive than what you currently pay as part of a W2 job.  We now appreciate how much our employer has been paying all these years!  Either you’re paying the expense, or your employer is. 
  • Think of it as the cost of your freedom.  You can get frustrated and feel trapped because of it, or you can do your research, plan, and budget for it, choose the best options, and move on with your plans and dreams.  Just accept it.  
  • You should budget for this and include it in your annual cost of living estimates in retirement.  You also need to budget for medical expenses in addition to the cost of insurance.
  • Do your research and ask a lot of questions. Healthcare.gov outlines several roles that can help you; they have navigators, certified application counselors, and agents/brokers that can help you.  
  • Remember, once you get insurance, there are many other ways to save on medical expenses.  We did a previous episode on creative ways to save on medical expenses.  

 

There are several paths you can go for insurance:

 

  • Cobra for up to 18 months.  Warning, it’s expensive.  Your company HR person can share the rates with you for your company.  You’re paying your portion of the cost and then also what your company has been subsiding for you all these years. 
  • Healthcare.gov / ACA plans.  This is what Maggie plans to use, so we’ll share more on this later.  
  • Private health insurance.  Yes, you can go directly to private insurance companies to buy insurance.  The big downside here is these don’t allow you to qualify for marketplace subsidies.  
  • Healthcare sharing ministries such as medi-share.  We’re not experts on these, and we’re not going down this path as we don’t ideologically qualify.  
  • Newer models like sidecar health.  The biggest negative is there is a max of what they cover for specific types of care, which they call a benefit amount (e.g., average joint replace the should cost this much, so that’s the most we’ll cover).  They cover you up to a certain amount, but you could be in trouble if you have something really expensive.  We feel comfortable covering the small stuff, but we want insurance for the big crazy stuff, and that’s where SideCar health lacks, in our opinion, so it’s not for us right now.  And it’s new and doesn’t have enough history for me to feel comfortable relying on it.  
  • You could enter into some sort of part-time employment arrangement to get insurance.
  • You could technically go without insurance.  It’s no longer a legal requirement in the US.  We would never recommend this. 
  • If you’re traveling full-time, other types of insurance like travel insurance medical coverage.  Some of these only work if you also have a traditional plan for it to sit on top of, so do your research and read the fine print!
  • Move to another country and get resident status or qualify for medical coverage there.  We’re not experts on this, but it’s possible, though not easy, and there is a lot of content out there if you’re curious about this path. 

 

What is Maggie’s plan? 

  • We’re putting our kids on our ex-spouse’s plans.  That’s a nice benefit we each have that will make the cost significantly lower.  We’re NOT doing cobra.  It’s too expensive and not worth the incremental cost to us.
  • We’re going to do a plan through healthcare.gov.  We’ll do a high-deductible plan so we can participate in HSAs because HSAs are awesome!  There are many plan options on the healthcare.gov marketplace, so you’ll want to spend some time comparing the different plans.  The site is straightforward to use, and you can put in your doctors and medicines and see which plans cover which things.  We will have to switch some doctors, but it’s a tradeoff we’re willing to make. 
  • We’ll augment it with travel insurance when traveling in the US or abroad.
  • Specific offices and practices have plans for dental and visual, or you can just go without and pay cash as you need services.  We plan to sign-up for the dental plan at our existing dentist’s office, and we’ll pay cash for vision needs as we have them.  

 

What is medical insurance going to cost us in early retirement?  

All of these numbers are for two adults.  

  • Current premiums through our employers: $201 a month, $2416 a year. 
  • Cobra would cost us: $1,251 per month; $15,018 per year
  • Without subsidy healthcare.gov plans:  Range of options from $1,032 per month; $12,384 per year TO $1,993 per month; $23,916 per year.  That’s a big range, $6K a year per person to $12K a year per person, but it shows you the range of options available.  We’re not yet in our 60-day window, but we’re likely going to land closer to the bottom end due to going with a high-deductible plan so we can do an HSA:  $1252 per month; $15,018 per year (Aetna CVS Bronze)
  • With Subsidy, healthcare.gov plans: The $15K a year option noted above will cost us full-price if our annual salary is $190K or higher.  If our salary gets below $80K, we will be eligible for a subsidy of $11K+ a year, and our annual insurance cost will come down to $3,750 per year.  

 

Top 3 takeaways:

  1. You need medical insurance, but there are various options and tradeoffs to consider.
  2. Budget for it and do your research in advance.
  3. Explore the subsidies as it makes the cost of insurance significantly more affordable for the average family or person. Then, plan strategically to leverage them.  

 

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