Health Insurance Nightmares

[pineywoods]

I hear ya. This a big part of decision process in retiring early. My wife was only on ACA for 2 year. I am 10 years younger so I am still not that close to Medicare. Till 2026 my monthly premiums were palatable. Next year will have a higher monthly, but it will likely pay off with the cost of meds and specialists. 2 years during retirement I maxed OOP from accidents/surgeries. While unexpected, I am still active and thus there are things that can happen. 7 years to go.

My wife and I are both over 65 but when we looked at Plan G and the costs we are better off with her work insurance

 

[sandyut]

My wife and I are both over 65 but when we looked at Plan G and the costs we are better off with her work insurance

I believe it! Workplace ins is a great deal. I dont think I ever really new how good it was till I had to buy it on the marketplace. We did Cobra for a minute, that is WAY expensive. That was one decision I regret, but it was only 3-4 months till we sorted everything out.

 

[texomakid]

I decided to go ahead and get medical insurance for 2026 despite the extremely high cost. The cheapest policy for myself and my wife is $2622 per month. I've run several scenarios with & without and as much as this is out of my budget I'm still gonna do it. If we have one catastrophe it could essentially whip out what I worked my entire life to save.

MERICA!

 

[sandyut]

I decided to go ahead and get medical insurance for 2026 despite the extremely high cost. The cheapest policy for myself and my wife is $2622 per month. I've run several scenarios with & without and as much as this is out of my budget I'm still gonna do it. If we have one catastrophe it could essentially whip out what I worked my entire life to save.

MERICA!

OUCH! Ok my monthly sounds better now. I have had a couple accidents in 3 years and both were north of $200K/each. S**t happens.

 

[sandyut]

The ER I went to in Feb finally sent the bill. They were arguing about a $330 "discount" my insurance applied to the $4800 bill. They conceded on the the discount. Pretty ridiculous. I am confident they waisted far more than $330 fussing around with the insurance company. I asked if there was a discount to pay in full...big no. At least I can start next year without that hanging over me.

 

[thirdeye]

The ER I went to in Feb finally sent the bill.

I hate when that happens. I had two physicians that I saw for an annual visit and they were notorious for late billing of my small co-pay amount. So one year I told each one that I would pay the entire bill and submit to insurance. They apologized and I got a statement in about 3 weeks. As it turns out, each one used the same third party company to code and submit the paperwork to insurance companies.

 

[sandyut]

I hate when that happens. I had two physicians that I saw for an annual visit and they were notorious for late billing of my small co-pay amount. So one year I told each one that I would pay the entire bill and submit to insurance. They apologized and I got a statement in about 3 weeks. As it turns out, each one used the same third party company to code and submit the paperwork to insurance companies.

Its pretty lame. When I lived in UT the medical bills were always more than three months after. But 10 months is a joke. Common Spirt pulled the 10 months BS. I dont get that from any other provider in CO...so far

 

[jcam222]

The ER I went to in Feb finally sent the bill. They were arguing about a $330 "discount" my insurance applied to the $4800 bill. They conceded on the the discount. Pretty ridiculous. I am confident they waisted far more than $330 fussing around with the insurance company. I asked if there was a discount to pay in full...big no. At least I can start next year without that hanging over me.

Our local hospital estimates the bill including insurance and offers 20% discount for pay in advance

 

[DougE]

Only good thing I have seen so far with Common Spirit is that the providers in the network use carepayment that lets you make reasonable monthly payments on your balance interest free.

 

[clifish]

Such BS, I was called at 4pm the day before I was supposed to get a stress test saying they did not participate in my plan. I have been with this cardiologist practice for over 5 years. My wife works for our insurance provider for 34 years, she knows that they screwed up. We told them we would private pay for the test, knowing we were covered. They told us they could not accept private pay (aka cash) as we had insurance...wtf???

 

[sandyut]

Such BS, I was called at 4pm the day before I was supposed to get a stress test saying they did not participate in my plan. I have been with this cardiologist practice for over 5 years. My wife works for our insurance provider for 34 years, she knows that they screwed up. We told them we would private pay for the test, knowing we were covered. They told us they could not accept private pay (aka cash) as we had insurance...wtf???

Ive heard this before. A buddy broke his finger and went to the ER/urgent care where the copay was a lot. He asks "whats the cost without ins?" they say he cant do that because they now know he has ins. Such a messed up system.

 

[sandyut]

Only good thing I have seen so far with Common Spirit is that the providers in the network use carepayment that lets you make reasonable monthly payments on your balance interest free.

The only reason I was at CS was because that was the only ER at the sky resort and that was where the ambulance took me. Care was fine, administration not so fine.

 

[thirdeye]

Just a heads up... It was announced Tuesday that Medicare Part D subsidies, in effect since 2022, will end this year.

So, shop around with different providers, don't just automatically renew for 2027. Providers post their 2027 pricing at the end of September or early October, so you can review and lock-in a price for 2027.

 

[KonaRich]

I am on ACA ins. with Anthem. been with them 3 years, was good enough...till now.

I had cataract surgery scheduled, surgeon is in network and so is his office. He uses a surgery center on the first floor of his building. Surgical center is not in network=DENIED. Surgery canceled. Or I could pay full price, which I will just wait if thats the case.

Broken ankle surgery last March included implants that are now causing issues and need to be removed along with a tendon repair of same ankle. Preapproval at same location as first surgery=DENIED.

Now they are giving me and my surgeons office and bunch of s**t about who and where this next procedure will be done. I was on the phone for an hour and got nothing out of it. The rep was gonna call the surgical centers to see who takes my plan stating "the list on the their website is incorrect". 2 out of the first 3 I called are in-network for orthopedic procedures. My surgeon is not credentialled at the two, but his partner is. My surgeons office got the same run around and ask me to call Anthem and "see what I have to do to get this done". Can you hear me screaming? WTF!

What a joke. I have had implants put in and removed 3 times already. this is not uncommon, but apparently it is with Anthem?

We're on Kaiser Senior Advantage. In Hawaii, it's the only 5-star program in the state. It operates in CO and a few other western states.

Since our only income is Social Security, we qualify for what they call "Medical Financial Aid". Anyone whose gross income is less than 400% if the island's official poverty level qualifies. We're asset-rich but income-poor in their estimation, although our income covers 100% of our total annual cost of living, plus about 40% more, which adds to our savings.

Being on Kaiser's MFA means no deductibles or co pays for anything provided directly by them. Of course, out-island premiums are high. We pay around $8,600/year, automatically deducted from our Medicare income.

Kaiser pays for flights to their Oahu hospital, and overnight accommodations, as required. I've been there 4 times already for various operations. Zero cost to me other than premiums. I like that Kaiser is vertically integrated. All MD's are employees, and everyone uses the same medical record system. Zero confusion or delay.

You should look into what Kaiser offers you.

 

[sandyut]

We're on Kaiser Senior Advantage. In Hawaii, it's the only 5-star program in the state. It operates in CO and a few other western states.

Since our only income is Social Security, we qualify for what they call "Medical Financial Aid". Anyone whose gross income is less than 400% if the island's official poverty level qualifies. We're asset-rich but income-poor in their estimation, although our income covers 100% of our total annual cost of living, plus about 40% more, which adds to our savings.

Being on Kaiser's MFA means no deductibles or co pays for anything provided directly by them. Of course, out-island premiums are high. We pay around $8,600/year, automatically deducted from our Medicare income.

Kaiser pays for flights to their Oahu hospital, and overnight accommodations, as required. I've been there 4 times already for various operations. Zero cost to me other than premiums. I like that Kaiser is vertically integrated. All MD's are employees, and everyone uses the same medical record system. Zero confusion or delay.

You should look into what Kaiser offers you.

Sounds like its working for you.

My mom has Kaiser and they are not so good. She had had misdiagnosis, mean doctors, bad outcomes etc. I wish she would change but she wont.

On my ACA plan I can go nearly anywhere I want, pick my specialists, etc.

 

[KonaRich]

Sounds like its working for you.

My mom has Kaiser and they are not so good. She had had misdiagnosis, mean doctors, bad outcomes etc. I wish she would change but she wont.

On my ACA plan I can go nearly anywhere I want, pick my specialists, etc.

Things are different in the middle of the Pacific on an out-island. There are virtually no specialists. Not nearly enough MD's at all for the population. Kaiser flies specialists in from their mainland hospitals.