In my last post, I listed the 3 things I missed most about having a day job. As promised, here is the separate “reasonably priced benefits” post.
Hubs and I had separate health insurance policies through our respective employers for many years. It was simply the cheapest option. We added him to my health insurance policy during the open enrollment period just before he officially retired. FYI, our health insurance premiums went up by about $150.00/month because we were now “employee + spouse” coverage instead of having separate individual policies subsidized by our employers. I was paying $436.33 in monthly premiums for our coverage when I left my job in May 2022. Once COBRA kicked in, we were charged $1,883.25 monthly for the remainder of 2022. Rates increased to $2,064.38 monthly for 2023. We’ll pay $2,150.18 monthly in 2024 until my pension begins mid-year. At that time, our health insurance rates will drop to $464.72 per month. If claims in 2024 remain low, I’ll consider changing to a lower premium option for 2025.
What about the health insurance marketplace (ACA plans)? They are an option and some of our early retiree friends have this coverage. However, there are two things to keep in mind: (1) not all care providers accept ACA plans and (2) you may not qualify for a premium subsidy because you make over the 400% FPL income limit, or whatever threshold is in place at the time. Unsubsidized rates for ACA plans are expensive and come with really high deductibles and out of pocket maximums. The closest ACA plan to what we currently have quoted premiums of $2822 per month and a maximum annual out of pocket of $17,400. For us, COBRA continuation coverage through my previous employer was the best option in terms of coverage and premiums. (ACA: $33,864 in premiums plus $17,400 OOP or COBRA: $24,772.46 in premiums plus $6000 OOP). This turned out to be a good thing because my husband has a condition that requires specialty care and his main care provider doesn’t accept ACA plans.
The high cost of individual health insurance premiums under our current medical services provision model simply isn’t sustainable over the long-term. To me, the true cost of health care services is actually found in the self-pay rates. Just for grins, I accessed the price estimator tool from my medical provider (Piedmont) to obtain actual self-pay rates. I typically see a physician 2-3x per year. Each established patient visit fee is $121 per visit or $663 for three visits. The usual blood/lipid panel/urine tests ordered at my annual physical and well-woman exams would run $250. A 3D screening mammogram would be $316 and the radiologist’s read fee would run about $203. Add in another $200 for prescription medications and my total is $1,632.00 for the usual array of medical services utilized on an annual basis as a self-pay patient. As an insured patient, those same services will cost me $11,796.48 (single rate) for annual premiums plus about $650 for two office visits and prescription med copays under my prescription drug coverage (one visit would be billed as preventative and covered at 100%, including all tests, mammogram and radiologist fee). In this scenario, the self-pay patient pays 85% less for the same services as a patient with insurance. Are we really paying that much more just in case something really bad happens?
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