One of the biggest factors in figuring out when early retirement is possible for me is the uncertainty of health care. I’ve looked into ACA plans, tried to estimate how much things will cost when life is healthy and when it isn’t, and considered alternative scenarios, but haven’t made myself comfortable, yet, with my options. What are you considering before you qualify for Medicare?
- ACA and other commercial plans?
- Spouse/partner not retiring early?
- Participate in a country with universal/national healthcare?
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We’re looking at this problem too and my wife suggested something I hadn’t seen before: student healthcare.
As in, enroll in a school with the smallest class load (1 class?) to be eligible for student health insurance which is usually fairly affordable. I wouldn’t mind taking classes anyway in retirement so this appeals to me.
I think it would be great if we had our own little FIRE wiki/article with various options like this. Had heard this from someone else before, but had forgotten about it.
Another aspect of FIRE health insurance is how to pay for it. If you have it available and plan ahead, you can use previous HSA contributions to pay for premiums after you retire. This takes years of annual contributions without using it in that tax year, but those funds can also be invested and grow tax free (for healthcare spending including insurance premiums). More than 50% of my HSA account balance has been from investment returns (boring total stock market index fund) instead of my annual deposits.
Do you plan to use ACA or some other plan?
We’re at least 5 years out from our earliest of early retirement, so we don’t have a clear answer yet. Options we’re exploring:
- Student health insurance
- Boutique subscription one-stop-shop heath care practice that doesn’t take insurance
- Work out a deal with current employer to work very low part-time hours to maintain employer subsidized health insurance
- ACA plan unsubsidized
Given the rightward direction that both political parties are going, I don’t have confidence in the ACA’s longevity.
What’s your plan?
We’re both old, but still years away from Medicare. At least one of us has a W-2 job with a health plan at all times. It doesn’t even need to be full time, so long as health insurance is available for us both.
A intentional opiate overdose.
I don’t think it’s that kind of retiring we’re talking about :)
I’ve been looking into this quite a bit lately. The realistic option is to use an ACA plan, but man the plans are rough compared to my employer provided insurance based on any metric: premium, oop max, out of network coverage, you name it. That all sucks but mostly comes down to budgeting. What I’m actually worried more about is how narrow the networks are for the average plans in my county, the average plan has something like a 14% provider participation rate which is abysmal.
What I’m most likely going to do is lean into concierge medicine for primary care and then couple it with whatever ACA plan makes the most sense.
Are there good resources for looking into concierge medicine? That’s something I’ve only been more recently reading about in these kinds of forums.
There’s not a whole lot to it, it starts with finding a good doctor and practice which isn’t unique to concierge. Beyond that you pay an annual fee per person, around me that’s in the $2-3k range. That fee is out of pocket and outside insurance: this fee doesn’t cover specialists, surgery, etc. In exchange for the fee you typically get more attention and appointments on demand. The downside is that the cost is on top of insurance and you could argue its buying into or supporting a two tiered healthcare system, where the benefits you’re getting are because you’re pricing out people who can’t afford to do the same.
