# Health Care Insurance



## bogey21 (Aug 16, 2017)

I buy a Health Care policy for my oldest Son who is 39 years old.  I have been in the habit of buying 360 day Short Term Policies and replacing them with new ones at maturity.  Historically Short Term Policies written by Golden Rule (now part of United Healthcare) could be purchased for terms between 30 and 360 days.  

The big negative between them and ACA Compliant Policies is that they don't cover pre-existing conditions and are non renewable.  Each year you have to apply for a new policy which will be denied if something which can be defined as a pre-existing condition happened during the prior year.

The benefit to me who is paying the premiums is that even after taking into account the penalty for not having an ACA Compliant Policy the cost of a 360 day Short Term Policy is about half that of an ObamaCare Policy and the deductible is not as high.

Well in order to push people like my Son into ACA Compliant Obama Care Policies the prior Department of Healthcare and Human Services passed a rule limiting Short Term Policies to 89 days and will no longer allow one Short Term Policy to replace a maturing one.  Naturally I don't like it as I like the lower deductible and cheaper premium.

I understand that rescinding this rule and allowing for 360 day policies and allowing new ones to once again be allowed is now under review.  Since my Son's policy doesn't mature until December 14th, I have hope.  

George


----------



## davidvel (Aug 16, 2017)

This won't get political.


----------



## DeniseM (Aug 16, 2017)

If Tuggers would like to discuss health insurance - great, but if we start discussing the *politics of health insurance*, we will have to close this thread.


----------



## Passepartout (Aug 16, 2017)

DeniseM said:


> If Tuggers would like to discuss health insurance - great, but if we start discussing the *politics of health insurance*, we will have to close this thread.


Impossible. The two are too closely linked.


----------



## DeniseM (Aug 16, 2017)

I know...


----------



## VacationForever (Aug 16, 2017)

Not political.  I have Anthem BCBS through the exchange and they just announced that they are pulling out of our state for next year. Our choices are getting fewer...


----------



## PamMo (Aug 16, 2017)

Yep. Humana is pulling out of our state at the end of the year (after others already left). Only one insurer is stepping in to fill the need.


----------



## bogey21 (Aug 16, 2017)

DeniseM said:


> If Tuggers would like to discuss health insurance - great, but if we start discussing the *politics of health insurance*, we will have to close this thread.



No intent to make this political.  The primary purpose of my post is to point out that there was a little known alternative to the ACA which as of now has been shut down.  The secondary purpose of my post is to make Tuggers aware that if Short Term Health Insurance can again be written for up to 360 days, it may be a less costly alternative for some who understand what they have to give up in exchange for substantial saving.

George


----------



## Panina (Aug 16, 2017)

Not political, just facts....We have only one insurer in our state in the ACA and our rates went up about 40% this year . All the other years we were allowed to use doctors in other states when on vacation. This year only select doctors in our state and not able to use other states unless emergency.  Just got denied an emergency ambulance bill saying out of network that was needed when we were vacationing in another state. Husband was bleeding heavy from glass injury.    Use to have catastrophe coverage,  and even with the deductible cost was less then now.


----------



## Sugarcubesea (Aug 16, 2017)

I was on a conference call today with our broker for our company and our company insurance is going up 8.9%.  That is with a reduced benefit policy. Ugh.  I feel so bad for those folks that have to self insure.


----------



## VacationForever (Aug 17, 2017)

My issue with Anthem BCBS's withdrawal is that many of the specialists that I am seeing right now do not take the other Exchange insurances.  I also checked one drug that I am taking against their drug lists, and it is listed as Tier 4 by the other plans, and it also states that other drugs need to be tried out first as it is non-formulary.  I have an illness that I have had for decades and finally found a specialist this year who prescribes a drug that works, unlike the many drugs that I was on before.  I am getting stressed over this.  It really stinks.


----------



## vacationhopeful (Aug 17, 2017)

MANY, MANY YEARS AGO ... when I had a solo medical insurance policy, a friend/business peer called and asked WHAT I did for health insurance (had a solo policy). She and her husband plus her daughter were looking for coverage; she had a property management company ... had to hold a REAL ESTATE BROKER's license with office and had been pricing to add a group medical coverage policy (for better rates & coverage). All the business policies had a minimum number of workers for any group policy. I joined. And every payment due cycle (it might have been quarterly then), I dropped off a check to her office. And I would throw ALMOST all that type of business to her as a "you help me, I help you" smart move. Then she sold her business to a larger concern and retired ... and that benefit went away.

I found a solo health insurance policy ... cost more but not an ugly amount above my prior arrangement. Ugly came some years later.


----------



## Passepartout (Aug 17, 2017)

Back in the day- before ACA, but before DW & I aged into Medicare, we had little choice but to buy these short-term policies. We would buy one for (iirc) 6 months from Blue Cross, and 6 months later from Blue Shield. Alternating back and forth. But to call them 'health insurance' was a stretch. They didn't 'insure' anything- no preventative care coverage, no prescription coverage, we had to pay the first (thou$and$) before this started picking up perhaps half. And the half was of the full priced hospital or provider billed amount- not the negotiated lower price for the covered in REAL insurance! It was a joke that we sure didn't laugh at. We bought this just as a stop-gap until Medicare kicked in, and boy, I can tell you, we let out a great big sigh of relief when we finally qualified for Medicare!

Yes, there is a place for this short term coverage- if you can't get real insurance it will cover some of the cost if you have a sudden catastrophic accident or illness, but to call it 'insurance' for normal, day-to-day medical coverage, it just isn't.

I will stifle my ire about the 'powers that be' not doing what's necessary to make the nation's insurers feel comfortable staying in the marketplace so that we-us- their customers- feel that we have choice in providers. 

Jim


----------



## SmithOp (Aug 17, 2017)

You could roll the dice and go with no insurance, then just pay the ACA penalty if it survives the reform efforts.


Sent from my iPad using Tapatalk


----------



## VacationForever (Aug 17, 2017)

My issue is before ACA came along there were individual markets where one could shop.  Individual markets have disappeared or become invisble.  I am going to need to find a broker here to hunt for individual market plans.  Last year we came across a rather nasty broker whom my husband refused to deal with and this person was going to research the individual market for me.


----------



## rapmarks (Aug 17, 2017)

I have lots of horror stories with insurance, and they go way back to the seventies.  Miscarriage wasn't covered because I hadn't been on the plan nine months.  Hospitalization not covered for my three year old with 106 fever because insurance said not medically necessary.  ER visit not covered because they said if it really was an emergency, you would have been admitted.  The year of hmo hell , when I had h pylori and had to wait several weeks to see the only dr in the system, could not use the nearby hospital and had to drive over an hour, had the dr not give me the medication until my husband was tested and our hmo dr refused the test for him.    All the times we went in for an exam and the dr billed it as preventive and insurance wouldn't pay, wouldn't count toward deductible.    In 1999 we were paying four hundred a month per person, twelve hundred a month for our family.   I feel for the people facing astronomical costs.  My daughter works for a health insurance company and has something like five thousand deductible per person with three little kids.   But I don't think it was so hunky dory in the past either. 


Sent from my iPad using Tapatalk


----------



## bogey21 (Aug 17, 2017)

Passepartout said:


> Back in the day- before ACA, but before DW & I aged into Medicare, we had little choice but to buy these short-term policies. We would buy one for (iirc) 6 months from Blue Cross, and 6 months later from Blue Shield. Alternating back and forth. But to call them 'health insurance' was a stretch.



Not trying to be argumentative here but the short-term policy I bought for my Son from a United Healthcare subsidiary was real insurance.  I agree that it didn't have all the bells and whistles of ACA compliant policies.  In some areas (particularly its deductible) it was better.  Policy holders had access to the entire United Healthcare network.  Sure you had to give up some things.  On the other hand it was a ton cheaper.  In many ways perfect for healthy younger people who were looking for something akin to catastrophic coverage at a *relatively* low cost.

George


----------



## VacationForever (Aug 17, 2017)

bogey21 said:


> Not trying to be argumentative here but the short-term policy I bought for my Son from a United Healthcare subsidiary was real insurance.  I agree that it didn't have all the bells and whistles of ACA compliant policies.  In some areas (particularly its deductible) it was better.  Policy holders had access to the entire United Healthcare network.  Sure you had to give up some things.  On the other hand it was a ton cheaper.  In many ways perfect for healthy younger people who were looking for something akin to catastrophic coverage at a *relatively* low cost.
> 
> George


Does your son qualify for Medicaid?


----------



## vacationhopeful (Aug 17, 2017)

I finally aged into Medicare .... after MONTHs and then YEARS, of counting the days til I turn 65.

For multiple years prior, I had a group policies for medical insurance ... but got into those groups with 2 different deals/setup ... but reasonable rates. Later even got my own personal coverage thru an insurance company after those associations ended... for a rate I didn't like but NEVER as bad as the ACA.

When the Federal Government mandated insurance coverage for the masses ... . via THE MARKETPLACE ... individual coverage on the open market VANISHED. And the insurance companies NEW line was, "they offered NO Individual Policies" ... "go to the Marketplace ...and get a subsidize policy ... if you qualify".

And that is when I PAID and PAID ... counting the MONTHS til I turned 65. $400 per month NOW is chump change verses the montly $1100-1200+ for crap Marketplace policy which was always cancelled each year. With fewer benefits, higher co-pays, higher deductible and different

PS Now I don't have to ask my pharmacist "who is my doctor this year?". Or get the pharmacist to work their magic to get a script extended (again for BP or collesteral). Or call 3 friends to ask "who are you using the year .. for a doctor office but to see a Physician Assistant?. Actually, my pharm tech graduated HS with me ... her pharmacist really relies on her....he treats me like I am her oldest & bestest friend .. we had home room together for 4 years ... no classes ... not really friendly in HS. I just wish ANY doctor had the same office & location from last "ACA business year".

PSS .. Those "Drop In clinics" (which seem to be everywhere) are setup to be rated by the ACA as "emergency rooms" .. not a doctor's office visit. I know for me, my $150 copay for a office visit is NOT acceptable copay for feeling bad ... plus whatever the medical insurance companies are also paying them


----------



## Timeshare Von (Aug 17, 2017)

Not political either . . .

Here in Wisconsin it has been a revolving door of companies in the ACA Exchange.  Our first carrier (WPS - Wisconsin Physicians) in 2014 decided they didn't like dealing with one hospital/medical group (Froedtert) so they left the Milwaukee County and surrounding areas.  We picked up UHC in 2016 at an increase of something like 20%.  AND then THEY TOO LEFT Wisconsin in 2017 and now we were left with a choice of two . . . something called Molina (which would not cover Froedtert in-network) and the newly created Childrens Community Network which is a subsidiary of . . . guess who?  YEP - Froedtert.  My insurance premium increased over 30%!

So to keep our doctors (and I'm still in post follow-up for ovarian cancer, not interested in changing docs or facilities) . . . we really only had the one choice.  Molina has already announced they are leaving Wisconsin in 2018.  So who knows how much the privilege will cost us next year.


----------



## rapmarks (Aug 17, 2017)

Timeshare von, what is badger care?   Hear the term a lot


Sent from my iPad using Tapatalk


----------



## PamMo (Aug 17, 2017)

DH and I won't know what our rate will be until the new plan rolls out on November 1st. With only one insurer, I highly doubt we'll pay less than the $1,350.32/mo (with $6K/pp deductible) we pay now for the least expensive plan (no dental).


----------



## wilma (Aug 17, 2017)

Don't really understand the purpose of this discussion....people are just complaining about their individual issues but can't propose a solution because that would cross the line into politics?


----------



## vacationhopeful (Aug 17, 2017)

It is a rotten pile to be under.

You feel without voice. Alone. This is called sharing. I know I don't feel like I am as alone.

And that leads toward maybe the future will be better ... as I and other posters are not alone. Or Singled out. Or stupid. Or made a bad choice.


----------



## bogey21 (Aug 17, 2017)

VacationForever said:


> Does your son qualify for Medicaid?



He lives in Illinois.  I checked Medicaid a couple of years ago.  I don't think he qualified then but may have to take another look at it.

George


----------



## Panina (Aug 17, 2017)

wilma said:


> Don't really understand the purpose of this discussion....people are just complaining about their individual issues but can't propose a solution because that would cross the line into politics?


Sharing, that's what some of us are doing.  It's kind of a support network, sometimes speaking to others that are experiencing the same hardship is comforting, knowing others understand.


----------



## bogey21 (Aug 17, 2017)

wilma said:


> Don't really understand the purpose of this discussion....



My purpose in starting this discussion was to point out that my Son was insured with an alternative to the ACA which as of now will not be available when my Son's current policy expires in December.  IMO it was a viable alternative.  Others are free to not agree.

George


----------



## Tia (Aug 17, 2017)

It's a gamble as you never know when your going to have something come up like a gall bladder or accidental fracture missing a step. I didn't know about those policies Bogey21 talks about until now. 



SmithOp said:


> You could roll the dice and go with no insurance, then just pay the ACA penalty if it survives the reform efforts.
> 
> 
> Sent from my iPad using Tapatalk


----------



## PamMo (Aug 17, 2017)

wilma said:


> Don't really understand the purpose of this discussion....people are just complaining about their individual issues but can't propose a solution because that would cross the line into politics?


Hmmmmmm.......to inform others that a healthcare option is no longer available, or maybe it's a case of misery loves company?

In the TUG community, a timeshare scam is nothing compared to not having access to healthcare when someone in your family needs it.


----------



## VacationForever (Aug 17, 2017)

bogey21 said:


> He lives in Illinois.  I checked Medicaid a couple of years ago.  I don't think he qualified then but may have to take another look at it.
> 
> George


If not, look into a silver plan, he may qualify for both premium subsidy and cost sharing subsidy.  If he does, you may be surprised with how little out of pocket cost to him/you.


----------



## Timeshare Von (Aug 18, 2017)

rapmarks said:


> Timeshare von, what is badger care?   Hear the term a lot
> 
> 
> Sent from my iPad using Tapatalk



I believe it is basically the state medicare program.  Even when I was unemployed and collecting unemployment, I/we were not eligible for it.  That was a few years ago.


----------



## Patri (Aug 18, 2017)

I am in the same boat as some of you. I was laid off from my job over a year ago and am paying Cobra. It runs out Dec. 1. DH goes on Medicare Oct. 1. I can't find a job with health benefits. I think they think I am over-qualified or too old. The best I can find under ACA for me alone is $993 a month. We only have two providers to choose from.
The insurance broker suggested looking into Christian Healthcare Ministries. I tooled around on the website last night. It is a strong possibility for me. My medications are not expensive. They also offer a prescription card that seemed to drop the price significantly. There are three plans, and you pay for routine services out of pocket. But you get good coverage for major incidents. Another search now shows there are a number of religion based organizations that work off the same concept, the group helping the individual with large medical expenses. And I'd rather be the person paying in, but never needing the funds.
Never thought I would find myself in this situation.


----------



## Panina (Aug 18, 2017)

Patri said:


> I am in the same boat as some of you. I was laid off from my job over a year ago and am paying Cobra. It runs out Dec. 1. DH goes on Medicare Oct. 1. I can't find a job with health benefits. I think they think I am over-qualified or too old. The best I can find under ACA for me alone is $993 a month. We only have two providers to choose from.
> The insurance broker suggested looking into Christian Healthcare Ministries. I tooled around on the website last night. It is a strong possibility for me. My medications are not expensive. They also offer a prescription card that seemed to drop the price significantly. There are three plans, and you pay for routine services out of pocket. But you get good coverage for major incidents. Another search now shows there are a number of religion based organizations that work off the same concept, the group helping the individual with large medical expenses. And I'd rather be the person paying in, but never needing the funds.
> Never thought I would find myself in this situation.


I didn't quote numbers but about the same here for our individual coverage.  Mind boggling that almost $12,000 a year and that doesn't include the very high deductible and copayments that have to be paid too.  

This is not political as I am saying everyone regardless of their political opinions......What if ALL federal employees, elected and not elected had to use ACA? .... they would understand our situation


----------



## rapmarks (Aug 18, 2017)

Panina said:


> I didn't quote numbers but about the same here for our individual coverage.  Mind boggling that almost $12,000 a year and that doesn't include the very high deductible and copayments that have to be paid too.
> 
> This is not political as I am saying everyone regardless of their political opinions......What if ALL federal employees, elected and not elected had to use ACA? .... they would understand our situation



I think congress has to use aca, they get the cost subsidized 75 per cent and get a silver plan.


Sent from my iPad using Tapatalk


----------



## VacationForever (Aug 18, 2017)

rapmarks said:


> I think congress has to use aca, they get the cost subsidized 75 per cent and get a silver plan.
> 
> 
> Sent from my iPad using Tapatalk


Where did you read that they use ACA?  I thought it was long debated years back but their Federal health care plan was sacred.


----------



## ace2000 (Aug 18, 2017)

VacationForever said:


> Where did you read that they use ACA?  I thought it was long debated years back but their Federal health care plan was sacred.



I think this answers it pretty well:

http://www.snopes.com/members-congress-health-care/


----------



## Panina (Aug 18, 2017)

ace2000 said:


> I think this answers it pretty well:
> 
> http://www.snopes.com/members-congress-health-care/


Says it all, more choices, subsidies regardless of income, not what the rest of us are offered. If they had one choice and no subsidies then they would understand.


----------



## VacationForever (Aug 18, 2017)

The issue remains regardless of ACA or AHCA is that individual plan health care costs are extremely high for older people.


----------



## Tia (Aug 18, 2017)

Someone at work the other day told me she used www.goodrx.com/  when she didn't have insurance and it saved her $ for prescriptions


----------



## Timeshare Von (Aug 18, 2017)

Tia said:


> Someone at work the other day told me she used www.goodrx.com/  when she didn't have insurance and it saved her $ for prescriptions



I have insurance through the exchange and with pretty fair copays on Rxs.  We buy ALL OF OUR MEDS through bidrx.com . . . and they are all less than our insurance copays.

Last year UHC had both my husband & me go in for a "health screening follow-up" at no charge to us.  Once there we learned it was because we had been flagged due to the number of appointments and medical expenses we had incurred for chronic issues . . . and yet had ZERO prescription expense for them.  They were fishing around to see if there had been insurance fraud.

They could have just called and asked a few questions, rather than incurring over $500 of useless additional doctors' appoints.


----------



## Tia (Nov 12, 2017)

Just got notice my employer subsidized insurance is going up $1000+/yr starting Jan 1st OUCH, benefits getting trimmed at the same time.


----------



## VacationForever (Nov 12, 2017)

I forgot about this thread.  So here is my update for what is happening now with my state and county.  Anthem BCBS is leaving end of the year and the exchange now has 2 choices for next year, both HMO.  I walked through the process online - none of my doctors is in their network and my "lifeline" drug is not covered at all.  Fortunately there is one player that sells in the individual market where all my doctors, except for the OBGYN (which is easy to replace), accept the plan.  It also covers that one drug that I am on (autoimmune issue).  I am 55 and my premium will be $896 per month, with $3K deductible and $7.35K max out of pocket.  The same plan costs $1,205 at age 64. My husband said I need to get old quickly so that I can start on Medicare.


----------



## vacationhopeful (Nov 12, 2017)

Reminds me to pay my next 3 months (quarterly bill) for my Medicare of $402 soon. What a difference from the $1000/monthly of 6+ months ago. My blood pressure came down ... as the older we become our insurance coverage expenses SOARED while benefits SANK like a lead balloon. Our doctors closed up their offices (retiring or joining hospital's WALK IN clinics at ER rates) ... medical records seem to NEVER get transferred ... your doctor (actually, your NP) gets a better job ...etc. I have for the last several years, just ask the guy who works with me "so, who is our current MD or MP AND where are they located?" ... as his wife is retired and keeps track of these almost monthly changes).

As for pharmacies ... I got reamed out on yesterday from the NEW pharmacy yesterday ... about my attitude ... which I had to change due to my new script plan. The pharmacist seems to think I had an attitude that I had to WAIT several days for them to get in the meds to fill my scripts ... but common blood pressure & collestaral meds not in stock? Expect all those hundreds of drug stores to start cutting back locations and hours.... seems the insurance companies have titled the balance to "Mail Order" prescription filling.

I wonder HOW 'mail order' is going to annoy me .... I have no street delivery address on any records, just a PO Box .... including my driver's license, car registration, voting records or medical cards. Domestic Violence victims and residents of crime areas do NOT receive any mail or deliveries at their home. 

And the USPS actually does have a procedure for mail delivery .... PM me if you need to know how MY post office handles it in some cases where the "POWERS to BE" demand sending something to a STREET ADDRESS (works ONLY for USPS delivered packages ... not UPS or other commercial delivery services).


----------



## WinniWoman (Nov 12, 2017)

VacationForever said:


> I forgot about this thread.  So here is my update for what is happening now with my state and county.  Anthem BCBS is leaving end of the year and the exchange now has 2 choices for next year, both HMO.  I walked through the process online - none of my doctors is in their network and my "lifeline" drug is not covered at all.  Fortunately there is one player that sells in the individual market where all my doctors, except for the OBGYN (which is easy to replace), accept the plan.  It also covers that one drug that I am on (autoimmune issue).  I am 55 and my premium will be $896 per month, with $3K deductible and $7.35K max out of pocket.  The same plan costs $1,205 at age 64. My husband said I need to get old quickly so that I can start on Medicare.




Wow. One of the big issues as to why I can't retire until at least 65. Even then, who knows how much the supplements will cost.


----------



## VacationForever (Nov 12, 2017)

mpumilia said:


> Wow. One of the big issues as to why I can't retire until at least 65. Even then, who knows how much the supplements will cost.


I keep threatening my husband that I will need to go back to work for a company that has a medical insurance which my doctors accept.  The issue is that I have to find out what kind of insurance that they offer.  Many companies cut medical insurance costs by going with bare bones minimal or cheapest plan.  My PCP who knew that I was stressing over Anthem BCBS withdrawal and needing to find an insurance that would cover my doctors for next years told me MGM had good insurance and one of his patients worked at their florist just to get on their medical insurance.  But every company reviews their medical plans each year and they can go from a good plan to an inferior plan the following year.


----------



## WinniWoman (Nov 12, 2017)

VacationForever said:


> I keep threatening my husband that I will need to go back to work for a company that has a medical insurance which my doctors accept.  The issue is that I have to find out what kind of insurance that they offer.  Many companies cut medical insurance costs by going with bare bones minimal or cheapest plan.  My PCP who knew that I was stressing over Anthem BCBS withdrawal and needing to find an insurance that would cover my doctors for next years told me MGM had good insurance and one of his patients worked at their florist just to get on their medical insurance.  But every company reviews their medical plans each year and they can go from a good plan to an inferior plan the following year.




But then again a lot of companies have gone to high deductible plans with decent networks or PPO's, with good prescription drug coverage through mail order. So you could luck out. My husband has no premium in such a plan and my premium is $200 per month with the plan. But- big deductible= $6000/$12,000. Have an HSA and we put over $700 per month into it to cover our out of pocket expenses. You can't win to lose as they say.


----------



## VacationForever (Nov 12, 2017)

mpumilia said:


> But then again a lot of companies have gone to high deductible plans with decent networks or PPO's, with good prescription drug coverage through mail order. So you could luck out. My husband has no premium in such a plan and my premium is $200 per month with the plan. But- big deductible= $6000/$12,000. Have an HSA and we put over $700 per month into it to cover our out of pocket expenses. You can't win to lose as they say.


The key is have an insurance that is PPO or EPO (new term that I learned - an extended/enhanced network).  In the healthcare market, the employers and consumers are the losers.  Health insurance companies and Pharmaceuticals, Medical Equipment Manufacturers are the huge winners.


----------



## icydog (Nov 12, 2017)

Patri said:


> I am in the same boat as some of you. I was laid off from my job over a year ago and am paying Cobra. It runs out Dec. 1. DH goes on Medicare Oct. 1. I can't find a job with health benefits. I think they think I am over-qualified or too old. The best I can find under ACA for me alone is $993 a month. We only have two providers to choose from.
> The insurance broker suggested looking into Christian Healthcare Ministries. I tooled around on the website last night. It is a strong possibility for me. My medications are not expensive. They also offer a prescription card that seemed to drop the price significantly. There are three plans, and you pay for routine services out of pocket. But you get good coverage for major incidents. *Another search now shows there are a number of religion based organizations that work off the same concept, the group helping the individual with large medical expenses.* And I'd rather be the person paying in, but never needing the funds.
> Never thought I would find myself in this situation.



Can you please share some of these religious based organizations. My searches proved fruitless. Thanks


----------



## icydog (Nov 12, 2017)

Timeshare Von said:


> I have insurance through the exchange and with pretty fair copays on Rxs.  We buy ALL OF OUR MEDS through bidrx.com . . . and they are all less than our insurance copays.
> 
> Last year UHC had both my husband & me go in for a "health screening follow-up" at no charge to us.  Once there we learned it was because we had been flagged due to the number of appointments and medical expenses we had incurred for chronic issues . . . and yet had ZERO prescription expense for them.  They were fishing around to see if there had been insurance fraud.
> 
> They could have just called and asked a few questions, rather than incurring over $500 of useless additional doctors' appoints.



I get calls from UHC routinely asking me to allow a nurse to do a home visit. I always decline. Now, Last week I get a call from my PC doc asking me to come in for a physical After reading your post I will be canceling that appointment. If it seems to good to be true it probably isn't!  I was suspicious before-- but now I am certain. Thanks posting this!


----------



## vacationhopeful (Nov 12, 2017)

Timeshare Von said:


> .....asked a few questions, rather than incurring over $500 of useless additional doctors' appoints.



Is that over $500 pf appointments YOU PAID out of your pocket for? For them to do a hunt for fraud on your part BUT you paid for the costs for them to try and 'get you' into being charged for fraud?

If you paid the $500 .. I would write them a letter (if you found another medical insurance company by now) to request REIMBURSEMENT as no fraud was charged legal against you ... (don't stay found ... that is an opinion on your part and they might then file a minor fraud claim against you).

I am NOT A LAWYER .. I am NOT GIVING YOU LEGAL ADVICE. YOU MIGHT WANT TO CONSULT A LAWYER IN YOUR STATE. 

Or just eat the loss of the $500+ .... and be sure ONLY your enemies ever buy medical insurance from them in the future.


----------



## WinniWoman (Nov 12, 2017)

icydog said:


> Can you please share some of these religious based organizations. My searches proved fruitless. Thanks



One I have heard that is good is called Liberty Healthshare. Another is Medishare. Another is Samaritan Ministries. Another is Christian Healthcare Ministries.

http://www.medicalcostshare.com/comparison-of-major-healthcare-sharing-ministries.html


----------



## ottawasquaw (Nov 12, 2017)

These are great suggestions if you are in need of an individual policy.


----------



## Sugarcubesea (Nov 12, 2017)

Patri said:


> I am in the same boat as some of you. I was laid off from my job over a year ago and am paying Cobra. It runs out Dec. 1. DH goes on Medicare Oct. 1. I can't find a job with health benefits. I think they think I am over-qualified or too old. The best I can find under ACA for me alone is $993 a month. We only have two providers to choose from.
> The insurance broker suggested looking into Christian Healthcare Ministries. I tooled around on the website last night. It is a strong possibility for me. My medications are not expensive. They also offer a prescription card that seemed to drop the price significantly. There are three plans, and you pay for routine services out of pocket. But you get good coverage for major incidents. Another search now shows there are a number of religion based organizations that work off the same concept, the group helping the individual with large medical expenses. And I'd rather be the person paying in, but never needing the funds.
> Never thought I would find myself in this situation.



This is my biggest worry. I’m 56 and I work in the automotive industry and this is an industry that thinks your over the hill the day you turn 50. I’m so hoping that I make it at my company till I’m 65 so I can get Medicare.  My financial planner tells me that to have to pay for insurance will take a huge chunk out of my retirement savings.


----------



## VacationForever (Nov 12, 2017)

I am quite certain that I can secure meaningful full-time employment if I want to.  If Amazon were to pick our local city as their second HQ, I may reconsider going back to work.  We average more than 100 days a year on vacation, i.e. travelling to somewhere else,  timesharing, cruising, land touring, visiting friends and family amd not counting golfing locally when we are in town. To work full time means I will have to give up almost all travelling for pleasure.  Healthcare insurance cost is certainly the white elephant in our room.  My husband does not want me to work anymore and wants me to spend time doing activities and traveling together.  I feel that I still have plenty of drive, good grey matter and many productive years in the work force.  If I go back to work then maybe I will stop spending 10 hours a day on TUG.


----------



## Patri (Nov 12, 2017)

mpumilia said:


> One I have heard that is good is called Liberty Healthshare. Another is Medishare. Another is Samaritan Ministries. Another is Christian Healthcare Ministries.
> 
> http://www.medicalcostshare.com/comparison-of-major-healthcare-sharing-ministries.html



Thanks for finding that, MaryAnn. I will most likely sign up with CHM, but have not looked into all of these.


----------



## WinniWoman (Nov 12, 2017)

VacationForever said:


> I am quite certain that I can secure meaningful full-time employment if I want to.  If Amazon were to pick our local city as their second HQ, I may reconsider going back to work.  We average more than 100 days a year on vacation, i.e. travelling to somewhere else,  timesharing, cruising, land touring, visiting friends and family amd not counting golfing locally when we are in town. To work full time means I will have to give up almost all travelling for pleasure.  Healthcare insurance cost is certainly the white elephant in our room.  My husband does not want me to work anymore and wants me to spend time doing activities and traveling together.  I feel that I still have plenty of drive, good grey matter and many productice years in the work force.  If I go back to work then maybe I will stop spending 10 hours a day on TUG.




Honestly, going back to work sounds depressing. Think long and hard about giving up your autonomy. The appeal vanishes quickly as the drudgery sets in. But I get it about the darn health insurance costs. It really stinks.

For me, just knowing I have at least 4 more years of working full time makes me ill. My anxiety level each day is off the charts. Especially now with winter coming up. I fear something will happen to me because of the stress I feel about it and I won't make it. It's not the actual job, though I am tired of it, but the schedule day to day and the morning rushing around and having no time or energy for much else afterwards. Being accountable. Ugh! 

Never mind if I do make it will my husband and I be able to handle trying to sell the house and all it entails to relocate as we will be pushing 70 almost at that point. I feel I should be doing those things NOW- probably should have been doing them 10 years ago! But- alas- the harsh reality is I need to work and I need access to health insurance because my husband will retire before me. If I stop working now, or go part-time, how the heck will I be able to get a full time job with health insurance at age 64? It won't happen. So, though I get health insurance now through my husband, I need to keep working to have access to it for me for when he retires.  I don't have the heart to ask him to keep working one more year past age 66 to age 67 for when I turn 65 and can get Medicare. He wants to retire badly also.

Of course, who knows if I will still have this job then. You never know what could happen.

So- I plan our vacations and enjoy our timeshares. Something to look forward to besides more work.


----------



## vacationhopeful (Nov 12, 2017)

Health Care is the WHITE ELEPHANT in many homes ... with people under 65 yo. I spent the last several years counting the MONTHS til I was Medicare qualified. 

As for Amazon, they are building a warehouse *right now in Southern NJ* ... near Paulsboro (on Mantua Grove Road) .. .a million plus square foot warehouse. This was a former Shell Plastic Plant closed for more than a decade. Off I-295 (by 1/4 mile) between the Commodore Barry and Walt Whitman bridges, and about 18 miles from the Delaware Memorial Bridge directly to I-95 going South along the Eastern USA. There is 2 big plots of land leftover ... would be a great location for the 2nd Headquarters to be built somewheres in the USA. PHL airport is less than 2 mile directly across the Delaware River ... 15-20 miles via either the Walt Whitman Bridge or the Commodore Barry Bridge to this airport ...say helicopter flight? 

"Quality of Life" is very good .... major city and airport (PHL), good schools, affordable (upscale) housing, developed road network and great dining. Philadelphia is the 5th largest metro area in USA ... 100 miles from either NYC or DC. Many universities and colleges within 20 miles ... U of Penn, Drexel U, Rutgers U, Rowan U, U of DE, West Chester U, Temple U, Jefferson Medical U plus several I don't recall right this minute. Less than 90 miles to the Atlantic Ocean beaches or 120 miles to the Poconos Mountains (with winter ski areas). Plus NY's day has the Philadelphia Mummers' Parade which Amazon could become a MAJOR sponsor. Plus all major professional sports franchises are located in the immediate area ... Chester has professional soccer and PHL for all other teams.


----------



## ottawasquaw (Nov 12, 2017)

vacationhopeful said:


> Health Care is the WHITE ELEPHANT in many homes ... with people under 65 yo.



So true! It drove me back into corporate America, but I am happy! I landed a job that is better than I ever dreamed.  When individual policies were available at a reasonable price, I could afford to cobble together multiple income streams. I had more time to volunteer, ride my bike, lunch with my girlfriends and travel.
Still, I am very grateful for the job I have now. When circumstances change, you've got to change with them.


----------



## Sugarcubesea (Nov 12, 2017)

mpumilia said:


> Honestly, going back to work sounds depressing. Think long and hard about giving up your autonomy. The appeal vanishes quickly as the drudgery sets in. But I get it about the darn health insurance costs. It really stinks.
> 
> For me, just knowing I have at least 4 more years of working full time makes me ill. My anxiety level each day is off the charts. Especially now with winter coming up. I fear something will happen to me because of the stress I feel about it and I won't make it. It's not the actual job, though I am tired of it, but the schedule day to day and the morning rushing around and having no time or energy for much else afterwards. Being accountable. Ugh!
> 
> ...


I do understand, I’m so tired every day when I get home.  I have decided that to try and put my place up for sale in 2018. I want to downsize now, so that I can move into a new place while I’m still working so that if anything needs to be done to the place I will have the cash fow to do it. I also want to invest in the bars in the bathroom and basically get the house all prepped for my old age before I need it. I hope my plan works, I just went to the funeral home today to pay my respects to a friend that was diagnosed 7 weeks ago with inoperable cancer.  So I want to make every day count from now on.


----------



## vacationhopeful (Nov 12, 2017)

While I agree with you ... I have a business which I run fulltime with physical assets not easily cashed out. I had my house up for sale for 6 months with a realtor who put a USED and SMALL sign out front of the 3.5 acre property. No offers, no active sales action and a OUTRIGHT to my face refusal to release me from the 6 month contract after 3 months of NO ACTION on her part.... I can NOT say ONE nice thing about HER ... and I had a track record with this agent and the office ... which her brother owns. AND she works fulltime in the office ... I don't have a clue as to what she does for 8-10 hours per day in that office.


----------



## sue1947 (Nov 12, 2017)

Sugarcubesea said:


> This is my biggest worry. I’m 56 and I work in the automotive industry and this is an industry that thinks your over the hill the day you turn 50. I’m so hoping that I make it at my company till I’m 65 so I can get Medicare. * My financial planner tells me that to have to pay for insurance will take a huge chunk out of my retirement savings.*



Take a look at individual plans in your area to see if this is actually true.  I made the same assumption based on 'conventional wisdom' and was hanging in with my job.  A colleague was preparing for retirement and told me they found individual insurance that was cheaper than the group plan.  That set me off to investigate and I found I could get individual insurance for $120/month.  I took early retirement.  Ten years later, my premiums went up each year to a high of $300/month last year but now down to $166 via ACA.   It varies by area and circumstances, so look around to see what is available for you.  

Sue


----------



## VacationForever (Nov 12, 2017)

sue1947 said:


> Take a look at individual plans in your area to see if this is actually true.  I made the same assumption based on 'conventional wisdom' and was hanging in with my job.  A colleague was preparing for retirement and told me they found individual insurance that was cheaper than the group plan.  That set me off to investigate and I found I could get individual insurance for $120/month.  I took early retirement.  Ten years later, my premiums went up each year to a high of $300/month last year but now down to $166 via ACA.   It varies by area and circumstances, so look around to see what is available for you.
> 
> Sue


What sort of plan is this?  Is it full medical or catastrophic insurance?


----------



## sue1947 (Nov 13, 2017)

VacationForever said:


> What sort of plan is this?  Is it full medical or catastrophic insurance?


Full medical bronze plan through the HMO I've been with for 30+ years.   I benefited from the attempt to kill the ACA via eliminating the company subsidies which increased my personal subsidy by about $150.  
Plans vary greatly across the country and by personal circumstances but my point is to not accept the conventional wisdom and look at things for your specific situation.  

Sue


----------



## VacationForever (Nov 13, 2017)

sue1947 said:


> Full medical bronze plan through the HMO I've been with for 30+ years.   I benefited from the attempt to kill the ACA via eliminating the company subsidies which increased my personal subsidy by about $150.
> Plans vary greatly across the country and by personal circumstances but my point is to not accept the conventional wisdom and look at things for your specific situation.
> 
> Sue


Thanks.  Unfortunately I have specialists who are on only PPO plans in the private individual market and a medicine that is not covered by HMOs on and off exchange.


----------



## WinniWoman (Nov 13, 2017)

Sugarcubesea said:


> I do understand, I’m so tired every day when I get home.  I have decided that to try and put my place up for sale in 2018. I want to downsize now, so that I can move into a new place while I’m still working so that if anything needs to be done to the place I will have the cash fow to do it. I also want to invest in the bars in the bathroom and basically get the house all prepped for my old age before I need it. I hope my plan works, I just went to the funeral home today to pay my respects to a friend that was diagnosed 7 weeks ago with inoperable cancer.  So I want to make every day count from now on.




Yes, that sounds like a good plan.  If you can keep your job while making the move that is what I would do.

Being we have to stay here in NY right now we did fix up our home in the past 5 years so it is more or less updated and we could basically live on the first floor if we have to-in case our home doesn't sell. We have a pull out couch downstairs. There is a bathroom downstairs also, though a wheel chair couldn't get through the doorway to it or the laundry area, and it is a bathtub/shower- not a shower stall like we have upstairs. And our 700 foot driveway is not a good thing as we age either, not to mention the seclusion. And we have no friends or family here.

Meanwhile, yesterday I saw what seems like the perfect condo for us in New Hampshire in exactly the area I want to live in and it kills me that we can't go yet. I wish we could afford two homes right now, but I learned a lesson many years ago not to buy a home before you sell your present one, never mind years in advance.

Good luck with your plan!


----------



## WinniWoman (Nov 13, 2017)

vacationhopeful said:


> While I agree with you ... I have a business which I run fulltime with physical assets not easily cashed out. I had my house up for sale for 6 months with a realtor who put a USED and SMALL sign out front of the 3.5 acre property. No offers, no active sales action and a OUTRIGHT to my face refusal to release me from the 6 month contract after 3 months of NO ACTION on her part.... I can NOT say ONE nice thing about HER ... and I had a track record with this agent and the office ... which her brother owns. AND she works fulltime in the office ... I don't have a clue as to what she does for 8-10 hours per day in that office.




The first thing I am going to do when I retire is put the house up for sale on my own- on Craigs' list. And, if that doesn't work, I will use realestateagentsIcantrust.com.  Essentially because I do not trust most real estate agents. Though I did have a great experience with a real estate duo I used for my parents home after they passed. But they are in another county.


----------



## Talent312 (Nov 13, 2017)

Retirement: I would never contemplate the idea of returning to work.
Every day is Saturday. As seen on a t-shirt: "It's an endless weekend."

Health Insurance: My policy is state employee group, unsubsidized for retirees.
The premiums took the place of the home-mortgage that we paid off.
The $$ goes to the insurance company instead of the bank (for a few more years).


.


----------



## geekette (Nov 13, 2017)

VacationForever said:


> Thanks.  Unfortunately I have specialists who are on only PPO plans in the private individual market and a medicine that is not covered by HMOs on and off exchange.


Have you asked these specialists what True Self Pay would cost per visit or treatment?  Sometimes, cash is the best deal/  The med, check with mfg.  My mother has some crazy expensive meds and has been able to negotiate with drug company to pay what she can afford.

Everything is negotiable, right up until the other party says it is their bottom line.

Just this fall I got a dx that now puts me into pre-existing condition stats so I kind of hope concierge medicine catches on as I feel that might be best way for me to navigate from 60 to Medicare.  Or maybe I linger in a lesser pt role with same employer at the point I don't want the career job; I'd work PT in the cafeteria happily if it preserved my med ins.


----------



## VacationForever (Nov 13, 2017)

geekette said:


> Have you asked these specialists what True Self Pay would cost per visit or treatment?  Sometimes, cash is the best deal/  The med, check with mfg.  My mother has some crazy expensive meds and has been able to negotiate with drug company to pay what she can afford.
> 
> Everything is negotiable, right up until the other party says it is their bottom line.
> 
> Just this fall I got a dx that now puts me into pre-existing condition stats so I kind of hope concierge medicine catches on as I feel that might be best way for me to navigate from 60 to Medicare.  Or maybe I linger in a lesser pt role with same employer at the point I don't want the career job; I'd work PT in the cafeteria happily if it preserved my med ins.



My issue is a bit more complicated, other than an existing specialist and a medicine that I must have, there is another specialist whom my PCP wanted me to see who does not take any of the exchange plans.  It is a long story, but that procedure with a different specialist in the same field whom I saw this year, cost a negotiated rate of $3K with Anthem BCBS.  Since I must have this procedure done (again) for next year, buying a PPO plan for next year is the right choice for me.


----------



## bogey21 (Nov 14, 2017)

VacationForever said:


> Since I must have this procedure done (again) for next year, buying a PPO plan for next year is the right choice for me.



Good Decision.  HMO's are great cost wise but if you want (or need) maximum flexibility regarding hospitals and doctors a PPO is your friend.

George


----------



## JohnPaul (Nov 14, 2017)

Yes, I am anxiously awaiting when I turn 65 in a little over two years.  The good news/bad news is that my retirement income is enough that I don't qualify for any subsidies.   I'm also fortunate to live in California where there is a strong individual marketplace.

Even so, last year I had a gold plan for $1305 a month.  For 2018 it would be around $1500.  Luckily my health is pretty good so for 2018 and probably 2019 I went with Kaiser (HMO) with a bronze plan.  I pay $899 a month and it doesn't really pay for anything until I've incurred about $6000 in costs.  However, by changing plans from my existing I'm saving $600 a month ($7200 for the year) so even if I have to pay the full deductible/max out of pocket I'll be ahead.


----------



## WinniWoman (Nov 14, 2017)

JohnPaul said:


> Yes, I am anxiously awaiting when I turn 65 in a little over two years.  The good news/bad news is that my retirement income is enough that I don't qualify for any subsidies.   I'm also fortunate to live in California where there is a strong individual marketplace.
> 
> Even so, last year I had a gold plan for $1305 a month.  For 2018 it would be around $1500.  Luckily my health is pretty good so for 2018 and probably 2019 I went with Kaiser (HMO) with a bronze plan.  I pay $899 a month and it doesn't really pay for anything until I've incurred about $6000 in costs.  However, by changing plans from my existing I'm saving $600 a month ($7200 for the year) so even if I have to pay the full deductible/max out of pocket I'll be ahead.




Wow. Those numbers would make me vomit.


----------



## geekette (Nov 14, 2017)

VacationForever said:


> My issue is a bit more complicated, other than an existing specialist and a medicine that I must have, there is another specialist whom my PCP wanted me to see who does not take any of the exchange plans.  It is a long story, but that procedure with a different specialist in the same field whom I saw this year, cost a negotiated rate of $3K with Anthem BCBS.  Since I must have this procedure done (again) for next year, buying a PPO plan for next year is the right choice for me.


Always more complicated, isn't it?  Knowing your own situation well is your own best insurance in getting the best insurance for your own situation.  Good going, homework is almost always worth doing!


----------



## Panina (Nov 15, 2017)

mpumilia said:


> Wow. Those numbers would make me vomit.


Unfortunately that is the reality for many people.  It's like a rent or mortgage, the highest bill for many and sadly not the best coverage.


----------



## Sugarcubesea (Nov 15, 2017)

duplicate post, deleated


----------



## Sugarcubesea (Nov 15, 2017)

sue1947 said:


> Take a look at individual plans in your area to see if this is actually true.  I made the same assumption based on 'conventional wisdom' and was hanging in with my job.  A colleague was preparing for retirement and told me they found individual insurance that was cheaper than the group plan.  That set me off to investigate and I found I could get individual insurance for $120/month.  I took early retirement.  Ten years later, my premiums went up each year to a high of $300/month last year but now down to $166 via ACA.   It varies by area and circumstances, so look around to see what is available for you.
> 
> Sue



Sue,

I will look again at the cost of insurance when I reach 62, as I currently have 2 in college and I'm trying to help them both out a small bit.   Thanks, hopefully I can retire sooner than 66


----------



## bogey21 (Nov 15, 2017)

JohnPaul said:


> Yes, I am anxiously awaiting when I turn 65 in a little over two years.....
> 
> Last year I had a gold plan for $1305 a month.  For 2018 it would be around $1500.....for 2018 and probably 2019 I went with Kaiser (HMO) with a bronze plan.  I pay $899 a month and it doesn't really pay for anything until I've incurred about $6000 in costs....



Medicare will be a winner for you even with the cost of a Supplement and Part D for prescriptions.  If you are willing to gamble with an Advantage HMO Plan it will be ever cheaper yet.  

George


----------



## VacationForever (Nov 15, 2017)

bogey21 said:


> Medicare will be a winner for you even with the cost of a Supplement and Part D for prescriptions.  If you are willing to gamble with an Advantage HMO Plan it will be ever cheaper yet.
> 
> George


Most people who are on Kaiser before Medicare kicks in usually prefer to stay on Kaiser when Medicare starts.  We had Kaiser in N. CA for almost 20 years and loved Kaiser until our experience in recent years - appointments with specialists were difficult to make, and there was no follow up after procedures and visits.  In general, with a HMO system, you need to be an advocate for yourself.  It is fine if you have no medical issues but when you have it is an inferior system.  I now have a health plan that closely resembles a PPO system and it is refreshing to have doctors who actually track medical issues and ensure that follow up appointments are made.  After leaving Kaiser, my husband chose a Medicare Advantage HMO plan and we were not thrilled with how long it took to get an appointment with his PCP.  We learned this year during open enrollment that he also has a choice of picking a Medicare Advantage PPO plan for just a little more.  It is sort of a best of both worlds - lower costs than a Supplement and Part D for prescriptions and getting a choice of doctors while not being stuck in an all encompassing HMO system.


----------



## Timeshare Von (Nov 16, 2017)

vacationhopeful said:


> Is that over $500 pf appointments YOU PAID out of your pocket for? For them to do a hunt for fraud on your part BUT you paid for the costs for them to try and 'get you' into being charged for fraud?
> 
> If you paid the $500 .. I would write them a letter (if you found another medical insurance company by now) to request REIMBURSEMENT as no fraud was charged legal against you ... (don't stay found ... that is an opinion on your part and they might then file a minor fraud claim against you).
> 
> ...



No we didn't pay nor were were charged for them.  But they did show up on EOB's so I know what they cost the insurance company.   Just more wasteful spending and expense that keeps the cost of healthcare inflated.

The system is so rigged against the consumer, it is not funny!


----------



## Timeshare Von (Nov 16, 2017)

icydog said:


> I get calls from UHC routinely asking me to allow a nurse to do a home visit. I always decline. Now, Last week I get a call from my PC doc asking me to come in for a physical After reading your post I will be canceling that appointment. If it seems to good to be true it probably isn't!  I was suspicious before-- but now I am certain. Thanks posting this!



I should have also said (or been clearer) . . . the health screening appointments were not with our regular PCP . . . but rather, through a clinic setting within a pharmacy here in the Milwaukee area.  They even "bribed" us by giving us $25 Visa gift cards if we would do it.  Silly us!


----------



## vacationhopeful (Nov 16, 2017)

Ever since the Affordable Care Act hit ... I counted the MONTHS til I qualified for Medicare. My individual health insurance policy more than doubled the first ACA year and each 'yearly new' policy was cancelled by its 1st birthday. 

If we are going to have a mandated health insurance, government employees should buy on the market place ... not have a 'classification' of a government insurance program for 'them' and another program for 'us'.... esp the elected politicians who passed the ACA (that version of health insurance) while keeping their health insurance program which us common folk pay for with our tax dollars (but can't afford for ourselves anything like the plan THEY get).

Remember, the premise of the ACA was a bigger pool of healthy and sick, young and old, single or families to ALL SHARE the costs and benefits.... let's add in all Federal, state and local employees and all elected politicians.... they don't look sickly to me.


----------



## WinniWoman (Nov 17, 2017)

vacationhopeful said:


> Ever since the Affordable Care Act hit ... I counted the MONTHS til I qualified for Medicare. My individual health insurance policy more than doubled the first ACA year and each 'yearly new' policy was cancelled by its 1st birthday.
> 
> If we are going to have a mandated health insurance, government employees should buy on the market place ... not have a 'classification' of a government insurance program for 'them' and another program for 'us'.... esp the elected politicians who passed the ACA (that version of health insurance) while keeping their health insurance program which us common folk pay for with our tax dollars (but can't afford for ourselves anything like the plan THEY get).
> 
> Remember, the premise of the ACA was a bigger pool of healthy and sick, young and old, single or families to ALL SHARE the costs and benefits.... let's add in all Federal, state and local employees and all elected politicians.... they don't look sickly to me.




I say this all the time- and that goes for pensions also- with the exception of police, fireman and the military. Government workers should contribute to SS instead. Why should taxpayers fund pensions for government workers (federal, state and local)- and I include teachers in that- (sorry - our property and school taxes are through the roof!)- with our taxpayer money when we ourselves do not have pensions? And due to high taxes, we can barely save for our own retirements and pay our high health insurance premiums and deductibles and so forth? 

Taxation is theft- pure and simple. But that in itself is another issue.


----------



## Brett (Nov 17, 2017)

mpumilia said:


> I say this all the time- and that goes for pensions also- with the exception of police, fireman and the military. Government workers should contribute to SS instead. Why should taxpayers fund pensions for government workers (federal, state and local)- and I include teachers in that- (sorry - our property and school taxes are through the roof!)- with our taxpayer money when we ourselves do not have pensions? And due to high taxes, we can barely save for our own retirements and pay our high health insurance premiums and deductibles and so forth?
> 
> Taxation is theft- pure and simple. But that in itself is another issue.



don't worry, you will be getting *HUGE* tax cuts soon and you will be able to retire rich and comfortable.

Buh-lieve Me !


----------



## WinniWoman (Nov 17, 2017)

Brett said:


> don't worry, you will be getting *HUGE* tax cuts soon and you will be able to retire rich and comfortable.
> 
> Buh-lieve Me !




LOL! Yeah right! Ha! Ha! Not in New York!


----------



## Tia (Nov 17, 2017)

Realtor ~59 yo last evening told me so long as they have a low income you can qualify for Colorado Care- aka Medicaid. This person saw this as a +.  Another person this week recently divorced  (stayed home with now grown kids) going back to work last 2+ years as a business owner, drives pretty new Range Rover, qualifies for the same.


----------



## VacationForever (Nov 17, 2017)

Tia said:


> Realtor ~59 yo last evening told me so long as they have a low income you can qualify for Colorado Care- aka Medicaid. This person saw this as a +.  Another person this week recently divorced  (stayed home with now grown kids) going back to work last 2+ years as a business owner, drives pretty new Range Rover, qualifies for the same.



There is a loophole in ACA as it looks at pure income (MAGI), without considering assets.  Individuals can qualify for Medicaid or premium and cost sharing subsidies if they have minimal income.


----------



## rapmarks (Nov 17, 2017)

mpumilia said:


> I say this all the time- and that goes for pensions also- with the exception of police, fireman and the military. Government workers should contribute to SS instead. Why should taxpayers fund pensions for government workers (federal, state and local)- and I include teachers in that- (sorry - our property and school taxes are through the roof!)- with our taxpayer money when we ourselves do not have pensions? And due to high taxes, we can barely save for our own retirements and pay our high health insurance premiums and deductibles and so forth?
> 
> Taxation is theft- pure and simple. But that in itself is another issue.


We paid in for our pensions, 12 per cent.  State was supposed to match, they never did, borrowed from our fund instead.  You know what, if we had been paying into social security the state would have been forced to match.  They saved a lot of money by denying us social security.  So in our state, you really didn't pay for our pensions. But in New York our friends got both social security and a pension they didn't have to contribute towards.


----------



## ace2000 (Nov 17, 2017)

rapmarks said:


> We paid in for our pensions, 12 per cent.  *State was supposed to match*, they never did, borrowed from our fund instead.  You know what, if we had been paying into social security the state would have been forced to match.  They saved a lot of money by denying us social security.  So in our state, you really didn't pay for our pensions. But in New York our friends got both social security and a pension they didn't have to contribute towards.



State was supposed to match?  In our school retirement system, the employer pays the match.  I thought that's how it worked in all of them.


----------



## VacationForever (Nov 17, 2017)

ace2000 said:


> State was supposed to match?  In our school retirement system, the employer pays the match.  I thought that's how it worked in all of them.


Employer = State = Taxpayers.


----------



## ace2000 (Nov 17, 2017)

VacationForever said:


> Employer = State = Taxpayers.



Actually, wouldn't it be Employer = Local Taxes = Taxpayers then?  

My point is, for us, the state would not provide the match, which is what we were talking about.


----------



## rapmarks (Nov 17, 2017)

ace2000 said:


> State was supposed to match?  In our school retirement system, the employer pays the match.  I thought that's how it worked in all of them.


No not in illinois


----------



## rapmarks (Nov 17, 2017)

ace2000 said:


> Actually, wouldn't it be Employer = Local Taxes = Taxpayers then?


Employer didn't contribute to the pension nor did the state, the state didn't but instead borrowed. So the state has an obligation which they haven't met.the current teachers are paying for the retired teacher pensions, like a giant pyramid scheme.  Yes local taxpayers paid our salaries, but we paid the pension.
What is really bad is that certain school districts in the wealthier Chicago suburbs not only pay really big salaries but were offering enormous packages prior to retirement.  But the entire state is on the hook for those pensions, when it should be the local district.
I met some retired Florida teachers last week who had just retired.  He got an additional check for $120000 for unused sick days when he retired. Unbelievable


----------



## VacationForever (Nov 17, 2017)

rapmarks said:


> No not in illinois


Illinois lawmakers operate under a different set of laws which we would normally describe as illegal.


----------



## WinniWoman (Nov 17, 2017)

rapmarks said:


> Employer didn't contribute to the pension nor did the state, the state didn't but instead borrowed. So the state has an obligation which they haven't met.the current teachers are paying for the retired teacher pensions, like a giant pyramid scheme.  Yes local taxpayers paid our salaries, but we paid the pension.
> What is really bad is that certain school districts in the wealthier Chicago suburbs not only pay really big salaries but were offering enormous packages prior to retirement.  But the entire state is on the hook for those pensions, when it should be the local district.
> I met some retired Florida teachers last week who had just retired.  He got an additional check for $120000 for unused sick days when he retired. Unbelievable




Unused sick days? What the heck is that? In the private sector those don't exist anymore. It's PTO time- use it or lose it and it's capped.

When I am on vacation, all the retired people-some retired a long time- who are also much younger than me- are either government workers or teachers living the good life. Glad I could help them out.


----------



## VacationForever (Nov 17, 2017)

rapmarks said:


> We paid in for our pensions, 12 per cent.  State was supposed to match, they never did, borrowed from our fund instead.  You know what, if we had been paying into social security the state would have been forced to match.  They saved a lot of money by denying us social security.  So in our state, you really didn't pay for our pensions. But in New York our friends got both social security and a pension they didn't have to contribute towards.



So what sort of pension did you end up with, as the State not making good on their part? I think you have posted this before but I have forgotten.


----------



## rapmarks (Nov 17, 2017)

We have good pensions, the legislature keeps introducing legislation to cut back.  They have established three tiers and the retired teachers currently can't be changed, but younger teachers won't get what we have.  But I fully expect the pensions to end or be curtailed at some point hopefully not real soon.  I think the state borrowed thirty billion from the fund to pay other bills.  We get newsletters occasionally about the finances, but we no longer live there so don't know details.  Remember all current teachers are still paying in.


----------



## icydog (Nov 18, 2017)

Timeshare Von said:


> I should have also said (or been clearer) . . . the health screening appointments were not with our regular PCP . . . but rather, through a clinic setting within a pharmacy here in the Milwaukee area.  They even "bribed" us by giving us $25 Visa gift cards if we would do it.  Silly us!



Oh!   My doctor must be getting compensated by UHC because I got a call from his receptionist to come in for a physical. Since this never has happened before— in the 25 years I’ve known him—I thought it sounded suspicious. I’m always concerned when something comes out of the blue—when someone offers me something that seems like it’s a tremendous boon to me—for no apparent reason!


----------



## VacationForever (Nov 18, 2017)

Even though I have seen my PCP regularly, I received information about the need for an annual physical check up, with a card in mail from Anthem BCBS, an email from Anthem BCBS and a call from a third party company who could facilitate with scheduling a physical with my doctor.  I got a feeling that it might have been something that got sneaked into the law that the insurers have to make sure that the subscribers get an annual physical.  Needless to say I ignored all of that.


----------



## Timeshare Von (Nov 18, 2017)

Under ACA, annual physicals by your primary care physician are at no charge.  Watch for the add-ons though . . . like labs and EKGs.

The ACA has them as an "added benefit" feature because someone (the medical community or government?) believe in an ounce of prevention . . . like paying for your screening colonoscopies and mammograms for the ladies.


----------



## Tia (Dec 2, 2017)

Watch for the add-on is right. My doctors office add on another charged visit to the when you ask any kind of question or some other  rigamarole reason.




Timeshare Von said:


> Under ACA, annual physicals by your primary care physician are at no charge.  Watch for the add-ons though . . . like labs and EKGs.
> 
> The ACA has them as an "added benefit" feature because someone (the medical community or government?) believe in an ounce of prevention . . . like paying for your screening colonoscopies and mammograms for the ladies.


----------



## Timeshare Von (Dec 2, 2017)

Tia said:


> Watch for the add-on is right. My doctors office add on another charged visit to the when you ask any kind of question or some other  rigamarole reason.



Ironically we just got the EOB for his annual physical today.   The total billed to the insurance company was $871 with the "exam" being free under the ACA benefit.  The breakdown of the entire statement is as follows:

Periodic Preventative Exam (previous patient) $412 billed & $244.69 allowed amount.  Insurance paid $244.69, due from patient = $0
ECG Routine $122 billed & $38.87 allowed amount.  Insurance paid $23.33, due from patient = $15.54
Flu vaccine $18 billed & allowed.  Insurance paid $18, due from patient = $0
Pneumonia vaccine $14 billed & allowed. Insurance paid $14, due from patient = $0
Destruction of premalignant lesion (aka . . . a mole!) $305 billed & $207.78 allowed amount. Insurance paid $124.67, due from patient = $83.11

Total: $871.00 billed less network discount of $347.66.  Plan paid $424.69 & patient owes $98.65


----------



## vacationhopeful (Dec 2, 2017)

I went to my doctor's office to get a script renewed which had run out. I told them THAT was they ONLY reason I was there ... not my FREE physical as allowed by new Medicare patients. They wrote my scripted and charged Medicare as my intake physical when they sent in the charges... to get MORE money.

Yes, I am looking for a NEW doctors' office .... once a thief, always a crook.


----------



## Sugarcubesea (Dec 2, 2017)

mpumilia said:


> The first thing I am going to do when I retire is put the house up for sale on my own- on Craigs' list. And, if that doesn't work, I will use realestateagentsIcantrust.com.  Essentially because I do not trust most real estate agents. Though I did have a great experience with a real estate duo I used for my parents home after they passed. But they are in another county.


I’m so nervous to put my house for sale on Craig’s List.  I worry about all of the weirdos out there.  I do like the idea of selling it myself because like you I don’t trust realtors. We sold our first two houses thru realtors so many promises that they never kept.


----------



## VacationForever (Dec 2, 2017)

There are some good realtors but paying their commission is painful.  I sold 2 homes in the past 3 years, using realtors that specialize in that geographical area.  It helped that the realtors were recommended by friends who had dealt with them.  They each cost me 5% in commission.  One was sold within 24 hours of listing, the other had 4 offers, with 3 competing offers at the end and it went into contract on 49th day of listing - with an all cash buyer and closed in 10 days.


----------



## WinniWoman (Dec 3, 2017)

Sugarcubesea said:


> I’m so nervous to put my house for sale on Craig’s List.  I worry about all of the weirdos out there.  I do like the idea of selling it myself because like you I don’t trust realtors. We sold our first two houses thru realtors so many promises that they never kept.




I know what you mean. You need to be careful for sure. We have sold nearly all our old cars on Craigslist, with people coming to our house to see the cars, but letting people *INTO* your home is another thing altogether.

I do know someone who did it after having their home listed forever with realtors. Last ditch effort she threw it on Craigslist and it sold in one day! A guy in another state- Florida- who retired there but missed his kids on Long Island, NY so he happened to be visiting them and was in NY when he saw the ad and he bought her house which is about 1.5 hours away from his family. Close enough but not too close.


----------



## rapmarks (Dec 3, 2017)

I gave away my mothers living room set and advertised it on Craigslist.  My mother lived in a neighborhood that was on the verge of not safe.  Before They arrived, I told the woman in the next condo what we were doing.  She came out and stood glaring at them when they came to get the furniture.  They were a couple of young guys, and her comment was they're harmless,


----------



## Passepartout (Dec 3, 2017)

Sugarcubesea said:


> I’m so nervous to put my house for sale on Craig’s List.  I worry about all of the weirdos out there.  I do like the idea of selling it myself because like you I don’t trust realtors. We sold our first two houses thru realtors so many promises that they never kept.


What does this have to do with health insurance?


----------



## WinniWoman (Dec 3, 2017)

Passepartout said:


> What does this have to do with health insurance?




LOL! Back in mid November I responded to vacationhopefuls' 11/12 post on page 3 this thread and it morphed a bit from there I guess.


----------



## Talent312 (Dec 3, 2017)

How a home sale relates to health insurance:
Some peep might need to sell their house to afford health insurance.

When I retired, the subsidy of my health insurance by my employer stopped.
So I paid off my mortgage. My payments shifted from the bank to the insurance.

.


----------



## WinniWoman (Dec 4, 2017)

Talent312 said:


> How a home sale relates to health insurance:
> Some peep might need to sell their house to afford health insurance.
> 
> When I retired, the subsidy of my health insurance by my employer stopped.
> ...




In New York paying off your house is great (and we did a long time ago), but the $10,000 in school and property taxes on a house worth $250,000 if we're lucky (Bought for $208,000 30 years ago!) plus health insurance premiums will bankrupt us in a heartbeat.


----------



## vacationhopeful (Dec 4, 2017)

Start counting the months til YOU turn 65 ...for Medicare. I was paying OVER $1000 a month for health insurance premiums as a single person til my 65 b-day 8 months ago. 

And been trying to sell my home of 15+ years for the LAST 15 months ... the brokers want to list it for less than I paid for it. These negative numbers has me 'trapped' in the house ... nice place, but am thinking HOW to get some income/money out of the place. 5 more months til 66yo. Waiting to MAXIMIZE my social security at 72 ... yes, I am still working_ full time ... _leaving out of the house in 15 -20 minutes for another FULL, FILLED adventure DAY. What else can you call WORK these days? I spend 35% of the day in my car or truck, running a 10 mile section of the interstate between 4 towns with their municipal employees.

6:10AM ... at least, today I was rested enough to NOT have a client wake me up looking for me at 8:30AM like on Friday with the phone ringing. Leaving out of here in 15 minutes.


----------



## Timeshare Von (Dec 4, 2017)

vacationhopeful said:


> Start counting the months til YOU turn 65 ...for Medicare. I was paying OVER $1000 a month for health insurance premiums as a single person til my 65 b-day 8 months ago.
> 
> <<SNIPPED>>



I am in that same boat too . . . paying $1,200 for my coverage today and just turned 60!  I'm curious what you pay now in terms of Medicare + gap supplement?


----------



## bogey21 (Dec 4, 2017)

Timeshare Von said:


> I am in that same boat too . . . paying $1,200 for my coverage today and just turned 60!  I'm curious what you pay now in terms of Medicare + gap supplement?



It is not a free lunch.  Mine is a touch above average as I have income over $133,000 resulting in a  higher cost for Medicare Part B.   Medicare Part B $348.30 deducted from my Social Security; Medicare Part D IRMAA $54.20 deducted from my Social Security; Medicare Part D premium is $56.20; and my Medicare Supplement premium is $77.33 (High deductible Plan F).  *Add is all up and my monthly cost is $536.03.*

George


----------



## VacationForever (Dec 4, 2017)

vacationhopeful said:


> Waiting to MAXIMIZE my social security at 72 ...



Just want to make sure you know that the amount does not increase from age 70 to 72.  You might as well start drawing on SS at 70.


----------



## Talent312 (Dec 4, 2017)

VacationForever said:


> Just want to make sure you know that the amount does not increase from age 70 to 72.  You might as well start drawing on SS at 70.



I thought about delaying SS until 67 and relying solely on my pension and retirement savings.
But I'd be 82 before marginal increase in benefits would exceed the total of missed payments.
By starting now, I keep more $$ invested and get a better return than the early SS penalties.
Also, at age 82, I doubt I will need the higher SS benefit.

.


----------



## Timeshare Von (Dec 6, 2017)

bogey21 said:


> It is not a free lunch.  Mine is a touch above average as I have income over $133,000 resulting in a  higher cost for Medicare Part B.   Medicare Part B $348.30 deducted from my Social Security; Medicare Part D IRMAA $54.20 deducted from my Social Security; Medicare Part D premium is $56.20; and my Medicare Supplement premium is $77.33 (High deductible Plan F).  *Add is all up and my monthly cost is $536.03.*
> 
> George



Thanks for the info George.  I knew it wasn't a free ride, but also knew it would save me a boatload vs. what my current situation is with an ACA exchange policy.

So much can (and will) change in the next five years, until I turn 65.  I have to just sit and wait.


----------



## SusanRN (Dec 10, 2017)

If you need excellent health coverage for reasonable rates, check into getting a job with a big medical system. My experience is the policies are comprehensive and heavily subsidized by the employer. Also, they are often available (at a higher rate) to employees who work at least half-time. 
     Last year when I was still half-time with a big medical system I was paying $300/month for my individual gold policy (higher because I was only 20 hrs/week), but when I had surgery and subsequent physical therapy and occupational therapy my co-pays (with no deductible) were literally $0 because I made sure I went to facilities that were part of their system. I'm sure you can imagine how comforting it was for me to go to the BC/BS website and see  "Member Co-pay $0" for many thousands of dollars of bills.
     You could also look into employment with state or local governments (which might include the local community college). Now that I am eligible for Medicare and am working half-time at a community college, I find it's a better deal to get my dental insurance through the college rather than through my Medicare Advantage company (which is Johns Hopkins, BTW).  I also can have a flexible spending account.
     Good luck.
Susan


----------



## Talent312 (Dec 10, 2017)

Under DW's Part D plan, she pays virtually -0- for regular generics. Nice.
Recently her doc prescribed a specialty medication with no generic equivalent.

He didn't tell her how expensive it was. The pharmacy did, up front.
We researched it on the internet. There's no alternative. GoodRx.com: $1,164.

Under the drug plan, she had to pay $530 (the deductible and a copay). Ouch.
Fortunately, it's just once.

.


----------



## bogey21 (Dec 10, 2017)

You have to choose your Medicare PartD Plan carefully to see how they handle the drugs you use.  There are major differences between Plans.  Then when you have one you like you need to check the Formulary for the upcoming year every November.  Mine just moved Pradaxa from Tier 3 to Tier 4 increasing the cost for a 3 month supply from $115 to over $500 in 2018.  If possible, one needs to find a plan that treats the drugs you take more favorably or talk to your Doctor about changing drugs.

George


----------



## Timeshare Von (Dec 10, 2017)

SusanRN said:


> If you need excellent health coverage for reasonable rates, check into getting a job with a big medical system. My experience is the policies are comprehensive and heavily subsidized by the employer. Also, they are often available (at a higher rate) to employees who work at least half-time.
> Last year when I was still half-time with a big medical system I was paying $300/month for my individual gold policy (higher because I was only 20 hrs/week), but when I had surgery and subsequent physical therapy and occupational therapy my co-pays (with no deductible) were literally $0 because I made sure I went to facilities that were part of their system. I'm sure you can imagine how comforting it was for me to go to the BC/BS website and see  "Member Co-pay $0" for many thousands of dollars of bills.
> You could also look into employment with state or local governments (which might include the local community college). Now that I am eligible for Medicare and am working half-time at a community college, I find it's a better deal to get my dental insurance through the college rather than through my Medicare Advantage company (which is Johns Hopkins, BTW).  I also can have a flexible spending account.
> Good luck.
> Susan



Thanks for the suggestions & thoughts Susan.  My sister works for such a group in NoVA and said the insurance is fabulous AND dirt cheap.

Unfortunately, I work in the non/not-for-profit sector and at the age of 60, there simply aren't jobs I'm qualified for or interested in.  I guess I could take a job paying around half of what I'm making now to have better and more affordable insurance, but the financial numbers and quality of life simply wouldn't make sense.  State jobs are even tougher around here.


----------



## Timeshare Von (Dec 10, 2017)

Since I'm 5 years from Medicare, I will have to sit patiently to wait to see what's around when the time comes for me.  I do get ancy waiting and wondering though.  I appreciate everyone's input on the subject. 

Yesterday I finalized our 2018 ACA Exchange choices.  DH's policy went up from $788 to $1,000 . . . and mine went down from $1,200 to $1,164.  Both policies for 2018 are with a decrease in benefits (higher deductibles & copays/co-insurance) . . . with mine with the most significant changes just to keep my premiums "about the same" in 2018 since my employer reimburses me for the expense as "salary" on a monthly basis.  I'm just happy they offered me this arrangement when they hired me 4 years ago.

At that time, my premium for an ACA Exchange policy was just $663.  It's continued to exponentially go up each year . . . $800, then $900 and last year $1,200.  And in 2016 and 2017 the prior year's insurance company exited the ACA Exchange in my area (Milwaukee County, WI).  It has been stupid how much the policies have cost.


----------



## Timeshare Von (Dec 10, 2017)

I should add, however, I'm glad I had insurance as I had ovarian cancer in 2015 and was out of pocket $7,000 while the the total bill for treatment (no chemo or radiation) was over $120,000!


----------



## SusanRN (Dec 10, 2017)

bogey21 said:


> You have to choose your Medicare PartD Plan carefully to see how they handle the drugs you use.  There are major differences between Plans.  Then when you have one you like you need to check the Formulary for the upcoming year every November.  Mine just moved Pradaxa from Tier 3 to Tier 4 increasing the cost for a 3 month supply from $115 to over $500 in 2018.  If possible, one needs to find a plan that treats the drugs you take more favorably or talk to your Doctor about changing drugs.
> 
> George


If you are on Medicare, there is actually a website that will calculate the expected costs for you under all of the plans you choose to compare:
https://www.medicare.gov/find-a-plan/questions/home.aspx
  When I was selecting for next year, I ended up choosing the higher cost plan rather than the same company's HMO, because two of my meds were Tier 2 and Tier 3 with the HMO and Tier 1 with the plan with more choices of providers.
Susan


----------



## Timeshare Von (Dec 16, 2017)

Well we've done our enrollment for 2018.  I was able to reduce my monthly premium slightly ($1,186 to $1,164 per month), but will have huge increases in deductible, copays and out of pocket max.

David's policy is going up from $788 to $1000/month . . . and has a slight increase in deductible, copays & out of pocket max.


----------



## Passepartout (Dec 16, 2017)

Timeshare Von said:


> Well we've done our enrollment for 2018.  I was able to reduce my monthly premium slightly ($1,186 to $1,164 per month), but will have huge increases in deductible, copays and out of pocket max.
> 
> David's policy is going up from $788 to $1000/month . . . and has a slight increase in deductible, copays & out of pocket max.


Ouch!, but in view of your previous cancer history, it's good that you were able to even get coverage. I hope you don't need the insurance!


----------



## Timeshare Von (Dec 16, 2017)

Passepartout said:


> Ouch!, but in view of your previous cancer history, it's good that you were able to even get coverage. I hope you don't need the insurance!



Thank you . . . and you're correct! I'm fortunate to have had insurance back in 2015 and to be able to continue to carry coverage since I work for a small not-for-profit that can't even obtain or offer a group plan.

I always feel like I'm in a big Catch-22 on this issue.


----------



## ottawasquaw (Dec 17, 2017)

vacationhopeful said:


> I went to my doctor's office to get a script renewed which had run out. I told them THAT was they ONLY reason I was there ... not my FREE physical as allowed by new Medicare patients. They wrote my scripted and charged Medicare as my intake physical when they sent in the charges... to get MORE money.



Linda, I'm pretty sure that is reasonable and customary. I thought the point of the script expiring was because the doc needed to check you again? It makes sense they would charge for the appointment.


----------



## ottawasquaw (Dec 17, 2017)

George[/QUOTE said:
			
		

> Did you ever mention what you did for your son? As I recall, you started this topic because you were looking for options for him.


----------



## ottawasquaw (Dec 17, 2017)

[QUOTE="Timeshare Von, post: 2079441, member: 11097" my employer reimburses me for the expense as "salary" on a monthly basis.  ...  It has been stupid how much the policies have cost.[/QUOTE]
I do hope you continue to have a clean bill of health! Cancer is scary. 80% of cancer diagnoses are made over the age of 55. It just makes that premiums for our age group would be higher.
I am confused by many of your comments. I thought in 2015, we were all required to have medical insurance? Also, since the ACA, I thought pre-existing conditions are no longer an issue? So, you are eligible for a policy no matter what. There's no more pricing based on sex, only on age.
Also, I have let my Health & Life insurance lapse, but before ACA, it was not legal or permitted for an employer to reimburse you for the cost of your policy through your salary. Not sure if that has changed or if they found a loop hole.


----------



## Timeshare Von (Dec 19, 2017)

ottawasquaw said:


> [QUOTE="Timeshare Von, post: 2079441, member: 11097" my employer reimburses me for the expense as "salary" on a monthly basis.  ...  It has been stupid how much the policies have cost.
> 
> I do hope you continue to have a clean bill of health! Cancer is scary. 80% of cancer diagnoses are made over the age of 55. It just makes that premiums for our age group would be higher.
> 
> ...




As the "HR" person (I do have a professional HR certification) for our very small staff (only 2 FT + 3 PT) I'm confident we're handling my insurance correctly within the scope of the tax law and ACA.  If your employer has fewer than two employees offered and ON the plan, they are not able to get a group plan.  Further, as such a small employer, they are not required to offer/provide it.  As the executive director, my position is the only one that the board of directors authorized for medical insurance.  The other FTer has a spouse with their insurance coverage, so they wouldn't be on the plan even if offered to them.

So our "legal workaround" that we agreed to when they hired me was to pay the premiums as a payroll event, to reimburse me for the plan.  The law requires that it go through payroll and be treated as taxable income to me . . . and my employer.  So my $1,200 monthly premium actually costs them more due to taxes plus that "income" must also participate in their 3% Simple IRA contributions into my employer funded plan.  Ditto for me.

What is not legal is for the employer to "pay the invoice" since it is not a bonafide plan . . . and not report that "benefit" as income to me.  Therefore it is simpler and cleaner on the accounting end of things to just pay it through payroll, that participates in all of the mandated taxes, etc.

Yes I'm fortunate to have insurance and under the current ACA, I cann't be turned away due to a preexisting condition, like cancer.  But there has been talk that some of the proposed changes to ACA could take that insurability guarantee away.


----------



## Passepartout (Dec 19, 2017)

Timeshare Von said:


> Yes I'm fortunate to have insurance and under the current ACA, I cann't be turned away due to a preexisting condition, like cancer.  But there has been talk that some of the proposed changes to ACA could take that insurability guarantee away.


Millions of Americans are going to be finding this out.


----------

