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Periodic Contributor

Budgeting for Medical Insurance

Hello everyone,

 

I just turned 51 last month and plan to retire in six or seven years, by the time I am 57. I have been saving for this since I was 20 and feel prepared to manage costs off my savings until I am 59 1/2 and can access my traditional retirement funds. In budgeting for the several years until I can qualify for Medicare I am looking for ways to estimate covering myself: medical/dental/vision and hopefully long-term care. Are there recommended providers to consider? It is my wife and I, non-smokers without children or any pre-existing conditions. Can anyone share there opinion on expected costs or where they could get such an estimate? I have been using my own budget model of $1,400/month growing with historical inflation. I am starting to believe my estimate is too high and my growth rate of the costs too low. So, I am also interested in historical trends going back at least a decade for such insurance costs.

I am doing my own research and asking friends and family. I am putting this out here to case a wider net and get as much advice and suggestions as I can.

 

(This is also my first attempt at putting a topic out into the community.)

 

Thank you.

 

Tom

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Honored Social Butterfly

@TomReader 

I may have missed it somewhere in your post but are you considering what your income will be and how that will affect what Tax Credit Subsidy will be, if any, under an ACA plan for those < 65 years old years?  Depending on your forecasted income, these subsidies could mean a whole lot - a little - or none at all cause they are based on family income and makeup.

 

Maybe it would be beneficial to your forecast to actually (symbotically) pick an ACA plan and go thru the calculations based on your predicted income and family makeup.  By picking a symbolic coverage option, you will be able to determine better your co-insurance %, perhaps copays, other OOP cost like medications and deductibles and will see the price of the policies today based on those guidelines.  I'd add in at least 10% per year and then adjust it as the years come and go - up or down.

 

Since these plans don't cover those others - like vision/dental - you will have to research those separately.  But personally, I pay for those things OOP - some providers will give you a better discount if you pay cash and that is better than what the coverage plans give.  Plus I like to pick my own providers, not somebody on a list.  

 

LTC is another problems that is more immediate, I believe - who knows what type of hybrid-type plans will be out there in the future - actually you might consider some sort of desirable hybrid LTC policy in the next few years (maybe mid-50's)  - rather than waiting until you are older - rates only get higher.  Then that will be one thing you can take off of the estimation list.

 

Trying to forecast Medical cost, including insurance, medications is difficult since so much of it is in constant price flux.  It also depends a lot on you and your family - health status, philosophy about the extent you go to extend life - I mean if there is a cancer diagnosis and you get to the treatment that cost OOP $10,000 a month but it only extends your life about 4-months, not including quality of life, each person has to decide that on their own.

 

Hope this helps a little  - I wish you every success in your early retirement plans- when you turn 65 we can help you through the Medicare maze if it is like what it is today.  And hey, if it gets tight financially - it is not like you couldn't earn a little income - Right ?!  Maybe it would be something you really love!    Good Luck !

 

 

 

 

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna

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Super Contributor

@TomReader It is not clear if you trying to track actual healthcare costs and/or the cost of health insurance plans. Both are difficult to do especially with the myriad of financial arrangements with hospital and physician providers as well as various insurance plan provisions. Should you elect to tackle tracking healthcare costs, payments to providers are not easy to find. The Center For Disease Control and Prevention provide statistics regarding morbidity sorted by demographics. However, cost data is not available. Here is a link https://www.cdc.gov/nchs/hus/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fhus.htm. Although somewhat cumbersome, I think reviewing various health insurance plans and their cost may be a better approach. If you are employed by a large company that provides self insured employee benefits, you may request copies of the Annual Reports (aka Form 5500). You may already receive a summary of Form 5500 called the Summary Annual Report  (SAR). Many participants may not think the SAR is important. However, the SAR will indicate aggregate cost data and put you on notice that the full complete Form 5500 is available. This will be helpful when estimating the cost for Continuation Coverage aka COBRA. The other approach is to simply follow the health insurance plans that are available through the ACA at healthcare.gov. The number of Plans will vary depending on your zip code. Their costs will vary depending on level of coverage (bronze, silver, gold). Your cost will vary depending on eligibility for a subsidy. You indicated that you will manage your costs off your savings. So, you can, in effect, control your annual amount of income to qualify for a subsidy by withdrawing a combination of income and principal to equal the amount that you need. For example, if you receive $25 K of interest/dividends, but need $50 K to manage your costs, withdraw the other $25 K from principal. Your savings or principal is not income and does not disqualify you from receiving a subsidy. Under current ACA provisions, an age 57 with $25 K of income will qualify for approximately $718 per month subsidy. I used an arbitrary zip code near an urban area and found a bronze plan with a $4,500 deductible/$6,900 out of pocket max for $61.95/month; a silver plan with a $200 deductible/$2,850 out of pocket max for $240.84 per month; and a gold plan with a $750 deductible/ $8,550 out of pocket max for $403.11 per month. If you will not qualify for a subsidy, add $718 per month to the above costs. The three above plans are all PPOs. Remember, you are six years away from the target retirement date and there may be changes. Hope this helps.    

Periodic Contributor

Thank you,

 

For budgeting, I am more interested in the cost of health insurance plans. I know things change and legislation, economic environment, etc. makes things difficult to judge. I am fine with that. Most of my adult life I have paid for homes, vacations, moving to another state, vehicles, etc. planning five or more years in advance. I am used to dealing with uncertainty and choose to go carefully if still bravely forward. You suggest some sources I have not considered and I appreciate that. For instance, I did not consider any ACA subsidy. Here is what I have done:


I asked my financial advisor who helps manage the finances of many retired clients. He recommends budgeting for about one thousands dollars per month is "about right". I was able to get two different insurance agents to give me their opinion. Once said "between one and two thousands dollars per month." The other did some research and said "At that point, options will be ranging from around $787--1,096/month." That's oddly specific, but OK.

 

Then, I got quotes as if I was now 57 from several places. They ran from several hundred dollars to fifteen hundred dollars per month. (I assume any prices today will be significantly higher in several years.)

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Bronze Conversationalist

you are six years away from the target retirement date and there may be changes

 

@Tonster521  no doubt . . . .


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Periodic Contributor

I may be a bit more pessimistic than you. I am six years away from the target retirement date and there will be changes

 

I plan and adjust at least once per year.

Bronze Conversationalist

@TomReader

I may be a bit more pessimistic than you. I am six years away from the target retirement date and there will be changes

 

I plan and adjust at least once per year.

 

On more than one occasion I have been accused of over-analyzing things. You make me seem like an amateur.

 

But I do believe you are over-thinking this. Too many variables to project more than a year or two out.

 

When Obamacare legislation passed I knew the promises of a nominal impact on rates was garbage. One college professor granted interviews and said IN PRINT the impact on rates would be in the 3% range.

 

Rates jumped 50% and more in the first year. Factor in higher deductibles, OOP and smaller provider footprint projected costs essentially DOUBLED the first year.

 

Granted, there is no way to project what your OOP cost will be for health care but just the hard cost increase was enough to drive some folks (still working) away from the health insurance market.

 

Between the government pledging to "fix" things and market forces the landscape for health care (cost and financing) can be quite volatile from one year to the next.

 

Health care inflation tends to be roughly 2x the widely referenced CPI. Add in utilization and it is not unusual to see double digit increases on a year to year basis.

 

The U65 health insurance market has been insane since 2014. I knew what would happen but was shocked at how quickly it deteriorated. I thought it might implode in 3 - 4 years.

 

I was wrong.

 

The market had all but collapsed by 2016.

 

I left that market in 2010 and transitioned to the Medicare side of consumer advising. The 65+ market is considerably more stable as long as you avoid managed care.

 

YMMV

 

Good luck!


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Honored Social Butterfly

When the ACA first came in there was not a 50% overall jump in rates. When you add in the deductions the average person could get there was very little change in rates, and now we know costs have started to go down again since the damage done by the Trump Admin. has been ended. If the ACA was bad it would have been repealed by the Rep controlled Congress. It was not. The ACA has performed just about as expected when you take out the damage done to it by the Rep., and Trump. The U65 was insane prior to 2014 and the ACA was the start to end that, but that was held up a few years due to the actions of our President of that time. The ACA was in fact a Rep. plan written as an answer to Hillery care, and tried in Mass. by a Rep Governer, and Dem legislature where it worked.

Sadly it was opposed by a lot of Insurance agents who lost income due to it, and some Carriers who felt the same way. The Carriers have found a way to stay in the line of business with the ACA and there are more offering plans than before. Yes they are different.

The end of all of this will be Medicare for under 65 which in conjunction with other plans in operation provide better costs. You have to look at the total subject of health care not just insurance end to solve the problem. We have people in the USA who are doing that and we have all benefited.  There will be many more changes in the next few years so any one trying to plan in this area better get a good local advisor to assist them in planing. AARP I am sure will play a big part in what takes place just as it has in bringing us the ACA.

Super Contributor

@john258 As you know, there are pros and cons regarding the ACA. On the positive side, the ACA provided a way to obtain health insurance coverage if you did not have any. Most of the coverage was provided via the enhanced Medicaid provisions. I read that as many as 13 million folks out of about 20 million obtained coverage through the ACA via the enhanced Medicaid provisions. That is approximately 65% which is a huge amount of folks that, in effect, contributed minimal, if any, premiums. As you know, someone has to pay for that shortfall. I understand the taxpayers and other ACA insureds paid (via higher insurance premiums) for that shortfall. I am providing a link to  Forbes article that addresses the ACA ,10 year after implementation https://www.forbes.com/sites/sallypipes/2020/03/20/a-decade-of-obamacare-has-been-ten-years-too-many.... The author, Sally Pipes, who cover health care policy as President of the Pacific Research Institute provides empirical data that documents the ineffective results of the ACA. If I linked the article correctly, I suggest clicking on all the items/links highlighted in blue especially the link, 17 million. That will connect you to empirical data complied in 2019 that indicates about 12 million of the 17 million covered by the ACA were enhanced Medicaid folks. If you maintain the ACA was a success, it is only successful as an enhanced Medicaid insurance program. The ACA has failed in all other measures for the non-Medicaid folks. I became an independent consultant in 2011 and had to purchase health insurance (U65). I enrolled in a high deductible Plan ($5,000) with the Blues for $227.41 per month. When the individual mandate became effective in 2014, I lost that Plan because it did not comply with the ACA. I had to select an ACA Plan and found a similar plan for $357.43 per month which was $130.02 more per month for essentially the same coverage. I will agree that I did have more items covered with the ACA Plan, but that coverage was for health services that I would never use. In effect, I was subsidizing others.The employer mandate which would include about 125 million or more folks to the ACA  was tabled by the Obama Administration. The Cadillac tax was never implemented as well. These two provisions would have provided the lower premiums that the ACA promised. Without them, premiums could only increase especially with adverse risk and community rating.

Honored Social Butterfly

You use a bad support article as the author just gives the anti ACA line as she cherry picks. Her article is so badly slanted it is worthless to do anything to help people understand the subject. That has been a big problem in health care for years. The ACA has not failed it has worked inspite of the efforts of the far right to kill it. The high delectable policy you purchased was really an excess major medical insurance policy designed to be a back up to a basic coverage policy. It was junk medical insurance  when used as a basic policy and the ACA stopped it from being used which was an improvement. There was a lot done to try and stop the ACA but so far nothing has done that.

Sadly there are many people who have no true understanding of health coverage and that is a big problem to overcome.

The end result of all of this will be Medicare for under 65 as that will solve the remaining problems. Sadly we still have to many people who do not understand the full subject which means the experts have to put forth what is really needed to solve the problem, and the ACA was the start.

Super Contributor

@john258 I am not sure if my "copy and paste" of the Forbes Obamacare article dated March 20, 2020 (10 years after) appeared with all the support items/links highlighted in blue. If it did, it is clear you did not read all of those supporting/reference documents that I suggested to review. Those links provide the empirical data which you need to know to make an educated analysis of the ACA  as opposed to just an opinion. Instead, you elected to "shoot the messenger" and author, Sally Pipes, who I thought did a very professional presentation of the ACA 10 years after implementation. If her presentation was incorrect, I believe the Forbes' editors would have not printed the article. The empirical data that is linked in the article came from the Dept. of Health and Human Services (HHS), Centers for Medicare & Medicaid Services, Office of the Assistant Secretary For Planning and Evaluation -HHS, Public Medical Central (PMC) - U.S. National Library of Medicine - National Institute on Health, PEW Research a non-partisan organization that conducts data driven research, and KFF (Kaiser Family Foundation) as well as the Office of the Actuary of the HHS -  Center for Medicare & Medicaid Services. If you read the data, the common fact that will be noted from all organizations is the percentage of folks covered by the enhanced Medicaid provisions of the ACA at no premium. That shortfall which is huge has to be paid by taxpayers and folks who actually pay premiums for their insurance coverage (non-subsidy folks). The data indicates that the enhanced Medicaid folks varied from 50% to 65% of the folks covered by the ACA. In 2014, the first year of the individual mandate, the enhanced Medicaid folks cost on average $5,488/year and contributed $0.00. Using simple math, lets say that 50% of 20 million enrolled are enhanced Medicaid, the other 10 million would have to contribute at least $54,880,000,000 ($54.9 Billion) more than their own premium for the ACA to break even. As you know, this would be the end of the ACA. So, the  Government continues to fund this failure with taxpayer money that may be better allocated for disabled folks including children, veterans, widows living at poverty levels, homeless, and so on.

 

High Deductible Health Plans (HDHP) with or without a Health Savings Account (HSA) are used by a more educated person who is more willing to take responsibility for their own health. Generally, this HDHP/HSA approach takes healthy folks away from insurance pools leaving those less willing to take responsibility for their health with increased premiums. This approach was popular with the concept called Consumer Driven Health Care in the early 2000's and still today. The folks in the HDHP pay a lower premium that, in effect, frees up cash flow to save (HSA) or spend. Funding the HSA also provides a tax deduction which if you are in a higher tax bracket is a win/win.

 

At the present, Medicare for the over age 65 and disabled is in financial trouble. Part A is projected to be depleted by 2025. Part B is currently subsidized 75% by the Federal Government. In my opinion, Medicare for U65 would need some creative financing which means increased taxes. I do not believe most folks are OK with that solution.

Honored Social Butterfly

Lets go by the numbers.

1. I read all of your supporting data, and I also know the entire subject, and what the author wrote does not fit the entire picture and should not be used to try and come up with any solution for the entire health care program. As I have said before you have to have people who know the full subject and want to reach the same goal of providing a good end program. We do not have that right now. We have a group of people who are doing their best to kill the ACA, and if that happens you kill the healthcare system as we know it. Lets hope the SC ruling yesterday might be the end to seeing efforts to kill the ACA through the courts. Time will tell. There is no reason the Forbes editors should not have used her story as it is her oponion and allows all to see what is happening within the group trying to kill the ACA. Most data can be used to support ones oponion and unless the consumer of the article understands the entire subject many times they will not put what is said in true perspective to the entire subject. We have experts in this field who can and do this all the time and they are the ones who in the end will come up with the needed changes. The SC showed us that yesterday when they ruled States AG had no standing in their law suite. The ACA is  a stepping stone to the final solution and has done its job so far in-spite of the never ending unjustified attacks on it by one segment of our population.

2. Excess Major Med Policies were designed to use as a vehicle to provide coverage that filled gaps in ones existing Medical coverage. I had one for years since there were some caps on coverage amounts in my basic coverage. They were cheap, but never designed to be base coverage. Sadly that is what they became for many as they were cheap, and a lot of people did not understand what they did till claim time and then found out they really were self insured to the high deductible stage. When the ACA was designed the experts ended these policies being used as base coverage and that was the  correct thing to do.

Insurance is based on a group of people pooling their money to cover cost of medical treatment. That means you have a mixture of healthy and sick joining the pool with out a medical exam. If everyone is in the pool you can rate the pool. If you allow people to join the pool when they want to many will wait till they have an illness so rates become to high, and Carriers use a health exam to stop this or a pre ex. With medicare everyone is in the pool so you need neither, and to have a real effective cheap system that is the road.

3. Medicare has been in financial trouble per the raters since the day it was started as it paid claims to people who just joined and had not paid in premium. It is based on the young covering the old and when the number of young decreases to the number of old you have problems. These problems have always been fixed and will be fixed this time also. Sadly the group who opposes health care for all use the numbers to try and kill the system, and have done so since medicare was put into law. The problem will be fixed this time also just as it has been for years. The answer to really fix the problem will come when we have Medicare for under 65 with both systems working from a trust fund which can be used to handle money that should go toward medical costs. An example is what Tobacco Cos. pay the govt for health damage which for the most part goes into the general fund. That is a subject for another day.

 

Our answer will be Medicare for under 65 to start and solve this problem.

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Periodic Contributor

Thank you for sharing the links and the prices you paid and for what coverage. That helps me. I feel even five years out my current $1400/month forecast for out of pocket premium costs is unlikely to be found to be too low.

Periodic Contributor

I believe I would be over-thinking this if I am making a projection and not revisiting it. Like I said, I am reviewing it annually. I actually review my budget models twice per month and then recalibrate each input after one year, based on new knowledge and realities. So, I agree with you that there are  "Too many variables to project more than a year or two out." Indeed, I only project a year out and after that year project for the next year, etc.

 

After rates "jumped 50% and more in the first year," are you finding such steep increases continued year after year, or did they flatten out at all?

 

I guess where we disagree is I do not believer there is "no way to project what your OOP cost will be for health care." I think they may be no accurate way to project, but there can be a reasonably accurate. For instance, I can start and project my monthly cost will be between one dollar and one million dollars per month. Is there evidence to suggest it will be less? I think so. I think from what I learned that it be surprising to see my OOP to be less than $500 / month and surprising to see it more than $5000 monthly. well, that is something I can work with, at least. 

 

I think there is something valuable in what you say, "Health care inflation tends to be roughly 2x the widely referenced CPI. Add in utilization and it is not unusual to see double digit increases on a year to year basis."


What is most interesting to me about this thread is I expected to hear from some current under-65 health insurance market participants on their first hand experience and their costs. That would be for me. a lower bound for my own projections. I am surprised at all this emphasis on volatility, legislative impact, the inability to have a high level of certainty. I actually thought that was all implied in the fact that I am only forecasting and indeed forecasting this particular subject. For instance, I specifically asked "Are there recommended providers to consider?" and have not seen that responded to. I feel I triggered something with the group when really I am asking in a sense a technical question, not a subjective one. I hope allowing for this venting has given some of you a helpful catharsis, if only briefly!


I will be much more careful about using this forum in the future!

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Honored Social Butterfly

@TomReader 

I may have missed it somewhere in your post but are you considering what your income will be and how that will affect what Tax Credit Subsidy will be, if any, under an ACA plan for those < 65 years old years?  Depending on your forecasted income, these subsidies could mean a whole lot - a little - or none at all cause they are based on family income and makeup.

 

Maybe it would be beneficial to your forecast to actually (symbotically) pick an ACA plan and go thru the calculations based on your predicted income and family makeup.  By picking a symbolic coverage option, you will be able to determine better your co-insurance %, perhaps copays, other OOP cost like medications and deductibles and will see the price of the policies today based on those guidelines.  I'd add in at least 10% per year and then adjust it as the years come and go - up or down.

 

Since these plans don't cover those others - like vision/dental - you will have to research those separately.  But personally, I pay for those things OOP - some providers will give you a better discount if you pay cash and that is better than what the coverage plans give.  Plus I like to pick my own providers, not somebody on a list.  

 

LTC is another problems that is more immediate, I believe - who knows what type of hybrid-type plans will be out there in the future - actually you might consider some sort of desirable hybrid LTC policy in the next few years (maybe mid-50's)  - rather than waiting until you are older - rates only get higher.  Then that will be one thing you can take off of the estimation list.

 

Trying to forecast Medical cost, including insurance, medications is difficult since so much of it is in constant price flux.  It also depends a lot on you and your family - health status, philosophy about the extent you go to extend life - I mean if there is a cancer diagnosis and you get to the treatment that cost OOP $10,000 a month but it only extends your life about 4-months, not including quality of life, each person has to decide that on their own.

 

Hope this helps a little  - I wish you every success in your early retirement plans- when you turn 65 we can help you through the Medicare maze if it is like what it is today.  And hey, if it gets tight financially - it is not like you couldn't earn a little income - Right ?!  Maybe it would be something you really love!    Good Luck !

 

 

 

 

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna

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Periodic Contributor

Well, I am actually being too pessimistic to consider a Tax Credit Subsidy at this time. Maybe I will change my mind later. Since I will have quite working my income will be very low. I do some adjunct teaching which I plan to continue, so I expect an income of $10K to $20K and that is all I am planning for. (Basically, I will live off a substantial bank account until I am 59 1/2.)


Thank you for your suggestion to "pick an ACA plan and go thru the calculations based on your predicted income and family makeup". I have been doing that approach with private providers (and now I get a lot of spam from them) but I have not done that with https://www.healthcare.gov/

I am going to do that next. Thank you!

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Honored Social Butterfly

@TomReader 

I don't see these premium tax credits going anywhere unless we go to another system all together and any new system would probably be even more lucrative - especially for those of lower income. 

 

Normally, in the ACA, the premium tax credit would represent any premium over 9% of income but since April 2021 and the American Rescue Plan, set in place for 2-years, I think, the premium tax credit has been increased to over 8.5% of income.  I believe that all of this is still based on the average silver plan - 

Base your computations on an ACA silver plan, that's a good [fantasy] plan to plan around and then pick the carrier plan that you think will meet your needs in the near future as far as geographical area providers, co-pays, co-insurance, deductible, medication cost and coverage.  I realize that you are only going to be guessing at your health since this guess is 8+ years away - 

 

The lower your income, the higher the premium tax credit.  But not too low - cause too low would qualify you for only expanded Medicaid, if available in your state, and you don't want that, for sure.

 

You are giving the age of 59.5 years, I assume you gave that age because you want to draw penalty free IRA/401K monies (deferred retirement plans) - but you are still gonna have to have health insurance coverage until 65 - and that additional income will be counted for an ACA premium tax credit.  Depending upon the amount of the retirement distribution at age 59.5 - it will lower or even eliminate the premium tax credit.

 

One other thing that I wanted to mention to you - which is more about income than health insurance -  You can begin receiving retirement income from a deferred account EARLIER than 59.5, penalty free, as long as you go by the IRS rules.  Only you can evaluate whether specific a exception is a good option for you.  Get help from a tax professional if you are interested in applicable exceptions.

IRS - Retirement Topics - Exceptions to Tax on Early Distributions 

 

Here I am specifically speaking about the exceptions of Equal Payments but some of the others may fit your circumstance at that time too.  Again, understand the rules of each exception and consult a tax professional for advice - An IRS Enrolled Agent - is a great source of knowledge about IRS matters - 

 

Again, Good Luck - you have a lot to consider.  It is possible to do and knowing all your options certainly helps.

 

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

I am not sure it is possible todo. Why? Well just look at the SC ruling today because of if it had gone the other way the entire health  care system would be in shambles right now. 

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@TomReader if you can predict the future you should not have to worry about early retirement savings.

 

Coming back to reality, I don't know how most people afford health care, and in particular, in the current market environment. The under 65 health insurance market crashed in 2014 when 95% of health insurance carriers exited the market under the strain of Obamacare. Premiums tripled within a few years and they continue to climb but at a slower pace.

 

Depending on where you live, health insurance premiums for a 57 year old are currently north of $1000 per month for a plan with a $7,000 deductible. As if that isn't bad enough, it is almost impossible to find a PPO plan . . . almost all plans are now HMO.

 

You might have a choice of 3 or 4 carriers if you live in a metro area. In a rural area there may be only 1 carrier writing health insurance.

 

High premiums, high deductibles and smaller networks mean access to adequate health care is a challenge.

 

I consider it criminal that individuals have to commit $10,000 per year or more in health insurance premiums to protect themselves against catastrophic medical bills.

 

Historical trends for health care and premiums are useless. Even actuaries, whose job it is to predict the future, really don't go more than 18 months out.

 

Good luck


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Periodic Contributor

Thanks @somarco 

 

I really appreciate you taking the time to answer my post.

Bronze Conversationalist

@TomReader glad to help.


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