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My husband will be turning 65 in about 15 months and will be signing up for Medicare. I am only 57, do not work and have lots of serious health conditions (including advanced cancer). Obviously, I can’t get Medicare coverage until I am 65 (if I should happen to live that long). But at the moment, I am a dependent on my husband’s employer-based medical plan.
What do I do for health insurance once he makes the transition? I have never used the health insurance market place and am wondering if it is really possible to get good, reliable health insurance (the kind where you don’t have to fight every bill) with many pre-existing conditions. And, if so, how much would this great health insurance cost? Right now we have an Aetna PPO and pay about $17,000/year for the two of us.
What if Obamacare winds up being undermined political in coming years and those with pre-existing conditions can be denied coverage again?
My husband will be turning 65 in about 15 months and will be signing up for Medicare. I am only 57, do not work and have lots of serious health conditions (including advanced cancer). Obviously, I can’t get Medicare coverage until I am 65 (if I should happen to live that long). But at the moment, I am a dependent on my husband’s employer-based medical plan.
What do I do for health insurance once he makes the transition? I have never used the health insurance market place and am wondering if it is really possible to get good, reliable health insurance (the kind where you don’t have to fight every bill) with many pre-existing conditions. And, if so, how much would this great health insurance cost? Right now we have an Aetna PPO and pay about $17,000/year for the two of us.
What if Obamacare winds up being undermined political in coming years and those with pre-existing conditions can be denied coverage again?
I am kind of stressed out about this.
Ideas?
ACA doesn't allow basing eligibility for coverage on pre-existing conditions.
ACA has proven itself to be vital in this pandemic as a way to get and keep people insured. As a NYS Marketplace agent, I will debate anyone who says other wise.
I would suggest applying to the Marketplace. I always advise my callers to "throw everything at the wall" and ask for consideration for subsidized insurance.
My husband will be turning 65 in about 15 months and will be signing up for Medicare. I am only 57, do not work and have lots of serious health conditions (including advanced cancer). Obviously, I can’t get Medicare coverage until I am 65 (if I should happen to live that long). But at the moment, I am a dependent on my husband’s employer-based medical plan.
What do I do for health insurance once he makes the transition? I have never used the health insurance market place and am wondering if it is really possible to get good, reliable health insurance (the kind where you don’t have to fight every bill) with many pre-existing conditions. And, if so, how much would this great health insurance cost? Right now we have an Aetna PPO and pay about $17,000/year for the two of us.
What if Obamacare winds up being undermined political in coming years and those with pre-existing conditions can be denied coverage again?
I am kind of stressed out about this.
Ideas?
You say he will be signing up for Medicare, but do not say if he is retiring. He could keep working and keep the coverage, if that is possible for him to do.
You say he will be signing up for Medicare, but do not say if he is retiring. He could keep working and keep the coverage, if that is possible for him to do.
Yes, too many questions in the original post. If his employer has 20 or more employees he does not need to enroll, as long as he continues to work. He should speak to HR to make sure his health insurance plan qualifies.
If he is retiring, then look at COBRA versus the ACA. Under COBRA, your husband’s insurance can continue for at least 12 months, but you have to pay the full premium. The ACA is definitely area dependent so I would browse the website just to get some ideas.
My husband and I had a similar situation, although we are both in good health. I am older, and went on Medicare as I am self-employed. He is on the ACA and although my insurance is better, he still got a good plan with low co-pays.
My husband will be turning 65 in about 15 months and will be signing up for Medicare. I am only 57, do not work and have lots of serious health conditions (including advanced cancer). Obviously, I can’t get Medicare coverage until I am 65 (if I should happen to live that long). But at the moment, I am a dependent on my husband’s employer-based medical plan.
What do I do for health insurance once he makes the transition? I have never used the health insurance market place and am wondering if it is really possible to get good, reliable health insurance (the kind where you don’t have to fight every bill) with many pre-existing conditions. And, if so, how much would this great health insurance cost? Right now we have an Aetna PPO and pay about $17,000/year for the two of us.
What if Obamacare winds up being undermined political in coming years and those with pre-existing conditions can be denied coverage again?
I am kind of stressed out about this.
Ideas?
Do you qualify for Social Security disability benefits? "Medicare is available for certain people with disabilities who are under age 65. These individuals must have received Social Security Disability benefits for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). There is a five month waiting period after a beneficiary is determined to be disabled before a beneficiary begins to collect Social Security Disability benefits. " https://medicareadvocacy.org/medicar...sed%20services.
You say he will be signing up for Medicare, but do not say if he is retiring. He could keep working and keep the coverage, if that is possible for him to do.
He plans to keep working until he is 67 (when I will be 61). I did check and apparently the university where he works has the option of continuing our current plan, although it is not clear to me we will be getting the same discount — yes, we pay $17,000/year with a discount. My husband will also need to enroll in Medicare B starting three months before he is 65. Our current insurance will simply bill him directly for everything Medicare B would have covered if he didn’t sign up.
I did a brief search for health care plans available in the marketplace and so far I see nothing comparable to what we have now. I love our current plan. Yes, it is pricey, but almost everything is covered either 100% or with a small co-pay. In 2019, I went through cancer treatment chemo-radiation and before that lots and lots and lots of tests (multiple CT scans, PET scan 3 laryngoscopies, endoscopy, broncoscopy, 3 different biopsies, blood tests, etc.) since I had an unknown primary (which was never found). The only thing we paid were the Co-pays for the office visits (the tests and treatment were covered 100%) so we wound up paying about $600 out of pocket for all that. It was just so worth the hefty premium.
However, I couldn’t find anything in the marketplace where all tests and treatment would be covered 100%. The best I could find was 90%, which sounds great, until you get a $300,000 medical bill. Then 90% coverage is not great.
If my cancer returns, I might need immunotherapy (Keytruda) which costs about $20,000 a month (just for the immunotherapy, not counting various other charges). Even with 90% coverage that would not be enough since the treatment is often 2+ years long.
This is the kind of thing I am worried about. I also don’t want to have to argue coverage of claims, spend lots of time on the phone with the insurance company while I am being treated for cancer.
Not only did our current insurance cover everything, I also didn’t have to spend my time arguing with the insurance co (Aetna). Everything was smooth.
Do you qualify for Social Security disability benefits? "Medicare is available for certain people with disabilities who are under age 65. These individuals must have received Social Security Disability benefits for 24 months or have End Stage Renal Disease (ESRD) or Amyotropic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease). There is a five month waiting period after a beneficiary is determined to be disabled before a beneficiary begins to collect Social Security Disability benefits. " https://medicareadvocacy.org/medicar...sed%20services.
No, I do not qualify for SS disability. In spite of multiple conditions, I am fully functional (in a low stress environment where I can eat well and get enough sleep every night).
Yes, too many questions in the original post. If his employer has 20 or more employees he does not need to enroll, as long as he continues to work. He should speak to HR to make sure his health insurance plan qualifies.
If he is retiring, then look at COBRA versus the ACA. Under COBRA, your husband’s insurance can continue for at least 12 months, but you have to pay the full premium. The ACA is definitely area dependent so I would browse the website just to get some ideas.
My husband and I had a similar situation, although we are both in good health. I am older, and went on Medicare as I am self-employed. He is on the ACA and although my insurance is better, he still got a good plan with low co-pays.
His employer is very large, but, he does need to enroll in Medicare B. After he turns 65, his employer-sponsored health insurance will bill him directly for what Medicare would have paid if he doesn’t enroll.
As for COBRa, he has that option for 3 years after he retires. So, if he retires at 67, that will bring him to 70 and me to 64, which is still a year short for me.
As I mentioned in another post, I did find out that his university offers “retirement health care plans.” I am not sure how much they cost, if we can keep exactly what we have now or, if not, what the plans will look like. Yes, he needs to sit down with benefits and figure this out. It’s the kind of thing he absolutely hates doing though (don’t blame him actually) so… I will have to work at it.
You would never have to pay 10% of the $300,000 because you would hit your out-of-pocket maximum well before then. I don't know which state you live in, but the out-of-pocket maximum for one of the Silver plans is somewhere around $5000, I think? Once you hit that, then 100% of allowed charges are paid by the insurance company. A family member had a double-hip replacement and hit his out-of-pocket maximum right away -- from there all was covered 100%. This was good because he had to have one hip redone. Try to do big things early in the calendar year so you hit your deductible and out-of-pocket maximum (rather than paying this twice if you straddle between two calendar years).
The on-exchange plans are the same as the off-exchange plans. On-exchange would allow you to reduce premiums with subsidies if your adjusted gross income is under the limit. If you don't qualify for premium subsidies, then remember you're still only on the hook up to your out-of-pocket maximum. Knowing this, some people choose the least expensive Bronze plan for lower premiums, and preventive things like annual GYN, annual physical, and mammogram are covered 100% before deductible.
I thought my old grandfathered Blue Cross plan was so great and stupidly held onto it, paying nosebleed premium prices over the years. Fear of the unknown, in my case. When I finally switched to an ACA Blue Shield plan, it was MUCH better and less expensive. Work the math and plug in different scenarios of your expected expenses. It may turn out that your existing insurance is still better, but compare them. And the light at the end of the tunnel is Medicare.
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