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Many Reasons to Act Now: Open Enrollment for Medicare and Obamacare Is Here

Category: Health and Wellness Issues

November 12 Update: Final Medicare Part B Premiums and Deductibles Announced
October 27, 2015 — This is the open enrollment period for both Medicare and Obamacare. If you are retired and need health care before age 65, or you are 65 or over and eligible for Medicare, you need to pay attention, as these are, with some exceptions, the only times you can enroll or change your coverage. And there are many good reasons why you might want to change it.

Two different enrollment periods
Which open enrollment period you need to worry about depends on whether you are talking about Medicare or the Affordable Care Act (Obamacare).
Medicare enrollment started on October 15 and runs through December 7. If you are 65 or over you need to enroll/make your changes by then or wait until next year (with some exceptions). The changes you make go into effect on Jan. 1, 2016.
Affordable Care Act enrollment for those not eligible for Medicare goes from November 1 to December 15 (much less time than last year). Changes go into effect Jan. 1, 2016.

What is an Open Enrollment Period
An open enrollment period is the time during which you can sign up for coverage for the upcoming year if you don’t have it now. You can also change your policy and plan for the next year without penalty. In some circumstances you can change your plan outside of this period if you have a qualifying event like you have moved, lost coverage, or had a baby. You can sign up when you turn 65, whenever that is.
Because Medicare and Obamacare are so different we will discuss enrollment periods for each type of health insurance separately.

The Medicare enrollment period
Medicare has several parts to it. Part A (hospitalization and skilled nursing) is the main form of Medicare you must enroll in. You also have a choice to enroll in Part B (doctor visits and outpatient) or Part C – Medicare Advantage (more of an HMO type plan). You can also choose Part D (prescription drug plan) as an add-on. Medicare premiums for Parts A and B will increase significantly for most people in 2016.

Not changing your plan could hurt you
There are some important reasons why you should look to the open enrollment period as an opportunity to review your plan and make sure it still meets your needs, before the new billing year begins:
– There might be a better option you didn’t know about
– If your health has changed or you see a big event (like a hip replacement) coming up – you might want different coverage than you have now
– You might not have one of the Parts (B, C, or D) and want to add it now.

Here are some of the considerations you should be looking at when you review your plan:

– During the open period you can decide to move from Part B to Part C (Medicare Advantage), or vice versa. This is a major decision because although Medicare Advantage plans tend to have very low premiums and copays, they also have a limited range of “in-plan” doctors and providers.
– Do you have Part D (prescription drug coverage)? If not, should you add it? Know that if you do not add it when you first sign up for Medicare, but then later enroll in Part D, you will be assessed a penalty for every year you did not have it.
– Do you have supplemental (Medigap) insurance)? These standardized plans from the private sector help cover what Parts A and B do not. There are 10 standard plan levels from A to N.

– Drugs are added and dropped by the plans. Have the drugs you take changed? If so you need to be sure the drugs you need are covered, and to what extent.
– Doctors and doctors groups go in and out of the various plans, especially Medicare Advantage.
– Do you travel a lot or are you a snowbird? You need to know what will happen if you are away from your home base and require medical services – will you be in or out of network?

What to do if you are confused or overwhelmed by all these choices
Medicare has published a wonderfully helpful booklet – “Medicare and You“, which you have probably received in the mail. Or call 1 800 MEDICARE, or go to

Obamacare and the Open Enrollment Period
Assuming that you don’t have health care insurance from your employer or some other source, people ineligible or too young to qualify for Medicare can sign up for or change their medical insurance plans for the next year during the enrollment period. You can change carriers, coverages, types of plans, deductibles, etc. during this time. You can, however, change your plan at other times via a special enrollment period if you have a major life changing event like a move, loss of health care coverage, or the birth of a child. You probably have received a letter from your insurer which details changes in premiums, coverages, etc. If you do nothing, in most cases the plan you have now will automatically renew. Fines for not having insurance are higher again this year – if you don’t have insurance you will be fined 2.5% of your income or $695 per adult, whichever is higher.

Although it might be a pain, it is very important that you go onto the exchanges (there are 13 state exchanges and the federal site, and compare your current plan with other options available for next year. The biggest reason is that this market is so new that everything is changing, with companies adding or dropping plans. By shopping around, you can help guarantee that you get the best plan for the least amount of money. The Obama administration estimates that the price of midrange “silver plans” will increase by 7.5% on average across the 36 or so states that do not have their own state health insurance exchanges. Consumers in some state run exchanges will see double digit increases.

These are some of the important considerations you need to look at during the open enrollment period:
– If your income changes next year the amount of your subsidy will change, but you won’t know by how much unless you enter your new information into the exchange
– If you are in need of or are considering a major procedure like a knee replacement, you need to know what your payment responsibilities will be under the plans you are considering
– Know how rates have changed for your insurer, or others you might want to consider
– Be aware of how your plans and coverages are changing
– Understand if deductibles and co-pays will change
– Drugs are added and dropped along with co-pays – how does that affect the ones you need?
– Doctors and doctors groups go in and out of the various plans (this might involve you calling the providers to find out, the exchanges don’t always have complete information on this)
– What constitutes “out of network” and what will you pay – are your doctors and hospitals in the plan your have?

To find out more visit the exchanges (that site will tell you if you need to visit a state exchange).

For further reading:
No COLA for SS Recipients in 2016: Medicare Premiums Will Jump 50% for Many
Current House Bill Would Eliminate popular File and Suspend Strategy
Now That You’re 65 – 10 Things You Need to Know (Part 1 in a series – includes how to sign up for Medicare)
Part 2: Topretirements Survey Results: Our Members Love Medicare!
Part 3: How to Solve the Health Care Puzzle If You’re Not 65 Yet
Why Obamacare Open Enrollment Matters to Boomers (MarketWatch)
Beware of Shifting Medicare Options (NY Times) – Start here for answers to almost all your questions about Obamacare.
Affording Health Care Costs in Retirement
Consumer Reports info on Medigap Policies

What are your questions and concerns about Medicare and coverage under Obamacare? Is it working for you? Please share your experiences in the Comments section below.

Posted by Admin on October 26th, 2015


  1. I am on Obama care and got my renewal notice. It is for my Hub and me. It went up $20+ for each of us per month. So another $490 per year! That is outrageous! $6,434 a year for two people WITH the $1011.00 subsidy per month! With no subsidy it would cost $18,566 a year!

    Can anyone imagine how much health care will cost in the future? No one will be able to afford it. I am in the Silver plan and could drop down to a Bronze plan. I have not gone onto the Access Health website yet to see if there are any cheaper Silver plans…

    Hub has 17 months before he can get on Medicare and I have 34 months. I am thankful we have it but at this rate it puts a dent in the budget! Plus, SS recipients get no COLA this coming year which could have helped offset this increase.

    by Louise — October 27, 2015

  2. Louise,
    Even when your on Medicare the cost is high. $600.00 + per month for my wife and I. This includes Part B, C & D.

    Also regarding Obamacare. Be careful not to exceed the annual income level you provided them when you signed up. I went over a bit in 2014 and had to pay some of the subsidy back when I filed my income tax return.

    by Jim C — October 28, 2015

  3. Health insurance is just so expensive. I have been self employed for 15 years and have been buying private insurance which keeps going up. This year I’m switching to Obamacare. With the subsidy I will save around $1,500 a year which helps with silver plan and lower deductible than what I had. I am 60 so Medicare is still a long ways off. I should have done it last year but I didn’t understand the subsidy part. Also switching my husband from regular Medicare with a supplement to Medicare Advantage plan, which will save another $3350 a year, there are some higher costs if care is needed but the maximum out of pocket does not exceed the savings so to me that is an easy risk to take. It really takes a lot of time to analyze all of the options.

    by ljtucson — October 28, 2015

  4. Jim C. you are absolutely right. I got out my paperwork yesterday to see what my income was reported for this year so I can calculate for 2016. Things are changing in our income for 2016. Hub retired this year so we won’t have that work income, however, I will begin SS next year. Hub will collect SS for 12 full months next year compared to 8 months this year. I have to adjust the amount we took from an annuity this year and reduce it down for next year. I will meet with the financial adviser to have her transfer funds as of January. Starting next year our income should become steady and not a hodgepodge of different streams of income. The transition retiring mid year made for difficult planning to keep under the radar screen for Obamacare. Plus, I am dreading reporting the changes in income to Access Health. They just don’t get certain things and you just can’t get them to understand either.

    by Louise — October 28, 2015

  5. For those that will exceed the annual income level that you provide the ACA folks, remember you can always contribute to a 401k or an IRA, as those two items bring down your Modified Adjusted Gross Income that the ACA limits are based on. And you have till April 15th to open/add to either the 401 or IRA (just be sure to do your income taxes AFTER you add to them… ;).
    Bringing down the MAGI is *especially* important if you pass the 400% mark, because at that point you lose your subsidy. Even if you have to borrow the money to put in the IRA it would have been worth it. For example, for 2 people earning $63,500, the subsidy would be $627 per month. If you earned just $500 more you would be ineligible for the subsidy and have to pay all of it back (over $7.5k). Much better to just borrow the money and pay simple interest, it is much less than paying the subsidy back. And after all, the IRA you borrowed for is still your money.
    Standard Disclaimer: I believe I am reading the law right, but I am not a lawyer or CPA, nor do I play one on TV, nor did I sleep at a Holiday Inn Express last night. This is not legal or tax advice, just my understanding. Please consult with a qualified tax profe$$ional for real advi$e.

    by Art Bonds — October 28, 2015

  6. Love your sense of humor Art! LOL! I believe you are 100% right because the CPA that does our taxes told me the same thing about opening an IRA in the event your surpass the income limit to get a subsidy!

    Art, can you tell us how you did the calculation for two people earning $63,500, the subsidy would be $627?

    The calculation I am familiar with is if you make $63,500 divided by the 2015 poverty level of $15,930 gives you 3.99% or 399% mark for the subsidy. (Hawaii and Alaska use a different poverty level figure). From there how do you get the $627? Math is not one of my strong points! I think it has something to do with basing the second highest cost Silver plan.

    by Louise — October 28, 2015

  7. I applied for Medicare this year (turned 65) and am on Part A, but not Part B because I don’t collect Social Security and I have health insurance through my employer – and pay approximately $50 a month for it. I’ll be in the 30% next year when I start taking Social Security and go on Medicare completely, if I don’t find my “retirement employment” with health insurance benefits. I just read in USA Today that Congress has a bi-partisan bill that will move the increase to 14% ($120) per month, plus a $3 monthly surcharge on high earning Medicare recipients:

    by Elaine C. — October 28, 2015

  8. Thanks Art for that comment about 401K/IRA contribution to stay within subsidy range – EXCELLENT advise. I’ve been sharping my pencil to ensure that I have this all correct and that is my ace in the hole!

    by ljtucson — October 28, 2015

  9. Just found out my Bronze PPO with HSA account available is being discontinued for 2016. Now I need to shop all over again. My premium estimate for 2016 will be $160 per month higher than the 2015 plan premium. Single, self-employed individual and it will be $486 a month. Can’t find out anything else, like what my deductible will be, until 01 November. I suspect it will be higher too. It was $6,000 a year in 2015. Feel pretty much like I pay all this $$ and get ZILCH for it.

    by Bonnie — October 28, 2015

  10. “Art, can you tell us how you did the calculation for two people earning $63,500, the subsidy would be $627?

    The calculation I am familiar with is if you make $63,500 divided by the 2015 poverty level of $15,930 gives you 3.99% or 399% mark for the subsidy. (Hawaii and Alaska use a different poverty level figure). From there how do you get the $627? ”

    Louise, your math is fine. Time to trade brain power for elbow grease. What I did was to go on, selected preview the plans and filled out the form. Hubby and wiff, ages, zip code, non-smokers, income of 62k, and let the website tell me what the subsidy was. Back up, increment the income by $500, find out what the subsidy is. Lather, rinse, repeat… until it told me I lost the subsidy.

    Just did that again, it sez my subsidy at 63,500 is $649, and I lose it when I check for 64,000. Why $649 today and $627 yesterday? Today I put in my wife’s age as one year more. Then I went back and put in my wife’e age at 5 years more (don’t tell her I’m making her older… she’ll kill me!). With her 5 years older my subsidy is $735. A bigger subsidy for being older? Now… that kind of age discrimination I can handle!

    Get on the site and play with it, you’ll have some fun.

    by Art Bonds — October 29, 2015

  11. ” Feel pretty much like I pay all this $$ and get ZILCH for it.”

    Bonnie, I felt the same way. Until I had coronary artery bypass surgery and found out the average bill for heart surgery in the US ranges from $60,000 to $160,000. That kind of sticker shock will give you a heart attack. My out of pocket expenses was $5,000. Kind of made all those earlier payments worth it.

    Heath insurance is kind of like a ponzi scheme. A health young persons pays for the care of us older folks, then as an older folk you hope to start reaping for what you have been paying for. If you make it that far.

    Having health insurance also gets you access to the rates the insurance company has negotiated with the doctor and hospital cartels. Without those negotiated lower rates they will use their ‘master list of charges’ to bill you, which is a lot more than the negotiated rates they give insurance companies.

    Like a medicinal mix of viagra and ExLax, they get you coming and going.

    by Art Bonds — October 29, 2015

  12. Sorry Art I agee with Bonnie. My insurance is $567/mo with a 6500.00 deduct. starting in 2016. Lucky that I have been healthly most of my life. But the insurance covers nothing…I find the monthly payments going higher and higher and getting less coverage. Thanks Obama!

    by lindaf — October 29, 2015

  13. Thanks Art, I understand completely now how you got the Subsidy numbers!

    by Louise — October 30, 2015

  14. As mentioned before my wife and I pay over $600.00 a month for Part B, C and D. Just one month after getting on Medicare I had a heart attack. That was almost 8 months ago and so far I have not payed a dime in out of pocket expenses. In addition we just found out my wife needs hip replacement surgery soon. Based on my experience I would say error on the side of caution when buying insurance. Remember the most common reason for bankruptcy in retirement is medical expenses.

    by jcx1sa — October 30, 2015

  15. Hi lindaf, don’t get me wrong. I had to have insurance to reign in the cost of my surgery. If I was not paying their outrageous rates I would have been forced to liquidate and declare bankruptcy, or not have the surgery and probably die (my mom died from heart disease at 52, dad from diabetes at 47. I have both diseases). American are drowning in medical debt. 3 of 5 bankruptcies are due to medical bills. That was the only reason I said I was “OK” with paying the high cost of health insurance. Compared to the alternative of death or destitution the shakedown by the health industry was the lesser of evils.
    The health industry cartel in this country has us over a barrel. The current system is broken as it does nothing to contain the costs. Here is the summary from a report I read on the surgery I had (Coronary Artery Bypass Graft) between Canada and the US:
    “After controlling for demographic and clinical differences, length of stay in Canada was 16.8% longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5% higher than in Canada.
    The in-hospital cost of CABG in the United States is substantially higher than in Canada. This difference is due to higher direct and overhead costs in US hospitals, is not explained by demographic or clinical differences, and does not lead to superior clinical outcomes.”
    In Germany my $60,000 to $160,000 CABG is $32,500 to $54,500 (
    Here in the US we pay double the average per person than the average in other industrialized nations. And it’s debatable if we have any better healthcare than them. Certainly if you have the money we have “the best” healthcare because you can buy your way to the front of the line. That is why rich folks from Canada, Great Britain and the rest of the civilized countries come here for health care… it’s not necessarily the best, but you can bypass the queue people have to put up with in those other countries.
    EVERYTHING in this country is designed to extract the money from your wallet and put it in the coffers of business, and it is business that contribute to politicians to pass laws benefitting business, not us (Google “ALEC lobbying group” if you have any doubts). It’s called capitalism, and buyer beware.
    The health industry will cry poverty with doctors and hospitals charging us double. It will be this way until we demand and get universal health care like other civilized countries have. Yes they have their problems but at least nobody in those countries goes bankrupt and the results are acceptable, even if delayed.

    by Art Bonds — October 30, 2015

  16. Yesterday I sat in on the mother in law getting signed up for new medical insurance. The medical insurance people spent 2 hours going over different policies/ premiums with her. Previously on Anthem’s she had had two heart surgeries with in 8 weeks time and only seen a bill for $500. On her AARP last year she had two hospital stays each over $5K.. MIL said “I don’t want no surprises this year”. The insurance people told me ” most retirees want the cheapest premiums which “bankrupts” them later. The more people signed up for the same Company policy, the more things are covered in the policy. The premiums or coverage CAN change after the enrollment period, if less people sign up than the previous year. We get a lot of calls from retirees not understanding WHY they have medical bills that high. ” Please friends, take the time to sit down and talk it through with the medical insurance people. It is very important this year because of the changes coming next year.

    by DeyErmand — October 30, 2015

  17. Oh, and one last thing while I am on a soap box. The insurance company’s job is to negotiate rates with medical providers, then pass those costs on to the consumer with a markup (their profit). Then they act as gatekeepers and try to find ways to deny your claim so they can make an even higher profit between the difference they take in vs what they pay for.
    The Affordable Care Act (Obamacare) set some limits on how much money they take in vs how much they have to pay out. It’s called medical loss ratios, and it has resulted in refunds of medical premiums for some businesses I know (translation: they were being charged to much in the first place and the law made them give it back).
    Another way the insurance companies make money is to write the policy to exclude coverage. You paid for a (usually cheaper) coverage in the plan but the plan didn’t cover squat. Your safety net had gaping holes that a Mack truck could drive through. Pre-existing condition are excluded (and everything was pre-existing…). Costs were capped (they would pay $5,000 towards your cancer treatment. Want higher limits? Pay higher premiums). To combat this scam the ACA set minimum essential coverages to insure the insurance actually covered something. No more coverage in name only. This of course costs more money.
    Insurance is shared responsibility. Everybody shares in risk and pays something to cover the bills. If only one person paid… well, think of how much that would have costs you per month. That is why there was an individual and employer mandate in the ACA.
    Net effect is that everybody now has to pay for medical care that has real coverage limits (not a sham policy), the insurance companies have to take everybody, and they have to pay out a certain ratio of what they take in.
    Yes, you can thank Obama and the Dems for bringing some sort of honesty to that crooked game.
    All of this costs money. Why? Because nobody addressed the root of the problem, medical costs. The hospitals, the doctors, the drug companies. That beast is still out of the cage, and was left out of the cage in order to get the ACA passed in the first place. Opposition from the AMA would have doomed the bill. As it is the AMA saw it as a means to extract even more from our wallets… after all, everybody now has to pay and they are the prime recipients. Trickle down theory… all that money will eventually trickle down to them.
    So I would not blame the insurance companies or Obamacare for premium hikes. Obamacare was an attempt to weed out the unscrupulous, set minimums and share responsibility (the basis for all insurance), while the insurance companies are just passing along the costs. And there is no incentive to keep the price down in a pass through arrangement. Put the blame where it belongs.
    I’ll put away my soap box now, sorry for disturbing so many bytes on the internet.

    by Art Bonds — October 30, 2015

  18. Obama had a good idea to help those without medical insurance be able to obtain medical insurance. But with him setting minimum medical coverage, the company I worked for cut my medical insurance coverage to the minimum and raised the cost of my premiums. Still it cost me less than the ACA premiums.

    by DeyErmand — October 30, 2015

  19. That’s a great explanation Art Bonds.

    by Debra — October 31, 2015

  20. Just got my employer’s (Fortune 500) medical plan sign-up for 2016, and the preferred provider plan is going to cost me (widow-no dependents) $220/mo, with a $5,000 deductible plus $25/$40/$50/$150 co-pays for different kinds of services. The drug plan is extra (Fortune 500). I understand this is still less than buying insurance myself, but I thought it might help to put some of the insurance plans into perspective. When I had the family coverage with a $7,000 deductible, one of my kids needed surgery in December. The surgery was corrected in January, so my cost for one medical event was $14,000 plus various copays. If I had bought one of the cheaper plans with higher co-pays and deductibles, I shudder to think about how much more it could have cost.

    One of my kid’s employers (small firm) has dropped its medical coverage, and is referring employees to the Healthcare websites to purchase their own coverage. They’re getting a $250/mo credit to help them pay for it whether they have families or if they’re single. I suspect a lot of that is going on now too.

    by Sharon — October 31, 2015

  21. Sharon brings up a very good point. Your deductible is from Jan 1 to Dec 31. If treatment stretches over two months, say March and April, you get to pay a years worth of deductible. If the treatment started in December and ended in January, you have to pay both last years deductible and this years deductible. Both her and a friend of mine that had cancer have been caught by this. I realize not everything treatment can be delayed, some things are life threatening, but if possible try to schedule major medical treatment to avoid having to pay double.
    To me this is yet another scam, a fair deductible would be based on a rolling 12 month period. For example, if you paid your full deductible for treatment in March and April, your rolling 12 month period for a new deductible would kick in May of next year, so anything done in May would be under a new deductible.
    This and other flaws could be fixed tomorrow by Congress, but they don’t want to fix the current system. They claim they want to Repeal and Replace, but I fear the Replace would be to put it back the way it was… double digit premium increases every year, policies and scams that gave you nothing but a potential bankruptcy, cherry picking the healthy and blacklisting anybody that actually needs care, you name it. Their idea sound a lot like a popular song last year… “It’s all about Repeal, bout Repeal, no Replace. It’s all about Repeal, bout Repeal, no Replace.”
    The ACA is not perfect, but it is a darn sight better than what it replaced. JMO of course.

    by Art Bonds — November 1, 2015

  22. We ALL need to demand a thorough and complete healthcare plan from any candidates from every party running for ANY office in 2016. There has to be a better way out there – other countries seem to have found an answer. Why aren’t our educated leaders examining best practices and finding a solution? Surely there are courageous candidates willing to fight for us, not big business!

    by SandyZ — November 2, 2015

  23. Of course there is a better way. I believe some candidates do have a health plan. A good place to start is contacting your Congressional representatives. Without approval of Congress it doesn’t make any difference how good the plan is if it won’t pass.

    by Debra — November 3, 2015

  24. Be careful what you wish for! If the White House and Congress fall under Republican control they will try to repeal ACA and alter Medicare as we know it.

    by jcx1sa — November 3, 2015

  25. I personally think we should consider WHOM is elected to Congress and vote people who will make it first consideration to “tweek” the program not do away with it. I don’t know what the answer is, but then that is why I vote for politicians who are qualified to make decisions. Right now, with so many out of work, which effects our Social Security wellness, I understand many are not working so they can get “free” medical coverage as the jobs they had didn’t pay them enough to afford the Obama care program.

    by DeyErmand — November 3, 2015

  26. DeyErmand, I have heard variations of that claim that folks are not working to get “free” medical coverage, but have not found any evidence to support the claim. Have you seen any studies or is this a “sounds like it could be true” type of thing (like the false claims about President Bush a few years back)?

    by Art Bonds — November 3, 2015

  27. No studies.; personal contact with those who have done it. I live in an area that the factories are closing up, and unemployment has run out. I know 5 people who chose this route. I don’t need a “study” to prove to me what I see daily. I have talked with the Mayor of my town about this and other issues to get jobs with medical insurance attracted to our town. I travel with my job and see it isn’t just my town. I also help with the local homeless shelters on trying to find these families jobs.

    by DeyErmand — November 3, 2015

  28. I am going to throw this question out there and probably look like a fool but here goes…

    Rather than invent a whole NEW insurance program (Affordable Care Act ACA) why didn’t they expand Medicare? It seems to work, it has been around a long time and it is somewhat affordable? Why did they have to reinvent the wheel when they had a program in place? All they needed to do was to piggy back onto Medicare and come up with some new rules for those not 65 years old.

    There is also the Veterans health care that is specifically for Veterans. Wouldn’t it be cost effective if all these programs were merged together? For Veterans it could be Medicare VA plan, for people 65 and older it could be Medicare Senior Plan and for those younger than 65 it could be Medicare Well Being plan. Just names off the top of my head!

    by Louise — November 3, 2015

  29. Dey, to get covered under the ACA you have to be making 100 percent of the poverty rate for the size of family you have. If you are unemployed you certainly do not qualify for coverage under the ACA. They may be getting “free” coverage under Medicaid or another low income program, but this is not part of the ACA.
    Louise, covering everybody under Medicare would raise howls of protest from the right as it sounds too much like “universal health care”, and since Medicare attempts to restrain costs and pays at a lower rate the AMA will fight it. Ultimately I think universal health care/government single payer is the only way to go. Like a large insurance company they can negotiate with the health cartels for better prices. And since most (all?) other industrialized nations have universal health care, our corporations are at a disadvantage when trying to sell their products overseas because the cost of employer health care is built into what they have to charge for the product, making the costs higher. Universal health care/government single payer would level the playing field. I am surprised the right is not more on the bandwagon because it lowers a corporations expenses and improves US competitiveness around the globe.
    Just my opinion.

    by Art Bonds — November 3, 2015

  30. Art, yes I meant welfare/Medicaid when I stated “free”, ex: family of four qualifies if they make less than $23,225, in my area. They also qualify for assistance on food, housing, child care and monetary benefits. Yet a family of 4 making $25,000 a year (apprx 2083 monthly before tax deductions) doesn’t qualify for any assistance and under ACA they pay a monthly health premium between $657-749. That leaves them with less than $1400 a month to budget rent, food, child care and any medical co pays. Due to the plants closing or moving, there are not many better paying jobs in my area. Their tax credit comes after they have paid monthly for a year, around $6K or $7K. Averages in the end to like $92 a month not counting the co pays. Of course I am not an expert on ACA.

    by DeyErmand — November 3, 2015

  31. Louise,
    The only way expanded health care could be passed was with the agreement of the insurance companies and hospital corporations. They would profit by having more people paying premiums and using medical services. Expanding Medicare and thereby cutting out the insurance industry and all of its thousands of employees would not have been an option as those companies are large contributors to politicians as are the hospitals and doctor’s associations. The doctors and hospitals are not happy about the amount of Medicare reimbursements to begin with and many refuse to accept Medicare patients. The ACA was the only way at that time to expand medical coverage and keep the major players on board. Things may change in the future but not without a major fight by those who would be giving up millions in profits.

    by LS — November 4, 2015

  32. DeyErmand. Interesting figures you have there, must be different plans where you are.
    At I put in a typical family of 4 (h 35, w 34, boy 12, girl 8 yo) with an income of 25k, Eastern Tennessee zip code, and get the following as the lowest cost Silver plan: $278 per month, $200 deductable per year, with a 10% coinsurance after deductable. Maximum out of pocket is $2,400, which would represent a coinsurance on over $20,000 in medical expenses. There is a $517 per month subsidy to get to that per month figure, and it can be applied towards the monthly bill as they happen. No waiting to the end of the year to get it back, all they family pays is the $278 per month. And they could get help on out of pocket health care costs for deductibles, copays and coinsurance, it’s part of the Silver plan.
    This is supposed to be a national plan, not sure why it would be different in your area.

    by Art Bonds — November 4, 2015

  33. I opted to pay the penalty until now because or the high costs.of insurance since this Obamacare went into effect. I will not be eligible for Medicare until mid 2017 and am really afraid of waiting that long for insurance. Has anyone had any experience with the christian health share programs like Liberty Healthshare? It satisfies the insurance requirement even though it is not actually insurance.

    by Gloria — November 4, 2015

  34. Art, All health insurance plans are based on your zip code. This is why I am trying to transfer to any state with a lower ACA rate It was the same thing when I tried the Medicare health insurance, different premium costs in different states. I want to relocate before retirement and prepare for the medical aspects before and after. I put in lots of different States zip codes to get the best option.Big difference. My daughter moved to get cheaper ACA premiums in South Carolina. My son is transferring to Knoxville, a no income tax state with lower ACA premiums as being single he pays a lot more than a married couple.

    by DeyErmand — November 4, 2015

  35. Gloria, have you checked ACA Bronze plans? They are lower cost and if you get a subsidy they cost almost nothing in some cases. It will satisfy the insurance requirement.

    by Louise — November 5, 2015

  36. Gloria, I looked at Liberty a while back. The question at the time was which providers take them as payment. Or do you have to pay the providers complete bill upfront and file for reimbursement through Liberty? They also say they cover up to a certain amount ($125k to $1 million), depending on your ‘voluntary share’. This was a red flag. Old insurance polices pre-ACA were written this way to limit the liability of the insurance company. Under the ACA there are no limits, so if you suffer a catastrophic illness under the ACA you are legally covered completely by the insurance company, under Liberty you are not.
    What was even worse was their own legal statement, which I post here:

    “General Legal Notice
    The following legal notices are the result of discussions by Liberty HealthShareSM or other healthcare sharing ministries with several state regulators and are part of an effort to ensure that Sharing Members understand that Liberty HealthShareSM is not an insurance company and that it does not guarantee payment of medical costs. Our role is to enable self-pay patients to help fellow Americans through voluntary financial gifts.

    This program is not an insurance company nor is it offered through an insurance company. This program does not guarantee or promise that your medical bills will be paid or assigned to others for payment. Whether anyone chooses to pay your medical bills will be totally voluntary. As such, this program should never be considered as a substitute for an insurance policy. Whether you receive any payments for medical expenses and whether or not this program continues to operate, you are always liable for any unpaid bills.”


    This to me was a tremendous red flag. So despite their flowery language that they cover up to X amount of dollars, they are under no legal obligation to pay if the donations are not there. If they don’t pay you are legally on the hook to the healthcare providers, probably driving you into bankruptcy. In a way even THEY advise getting health insurance.

    Given the fact that the cost per month and the annual membership was about the same as I had to pay under the ACA and the risks involved with it not being an insurance company, I gave it a pass. While a hope and a prayer may be enough to base my eternal salvation on, it is not enough to base my medical care and the possibility of financial destitution on.

    Just my opinion of course.

    by Art Bonds — November 5, 2015

  37. DeyErmand, we agree with your son. Wife and I are satisfied we moved to Tennessee. BCBS is reasonable, property tax is low, and as you point out income tax is non-existent. The only downside is the high sales tax… but living on the border with Virginia (the twin cities of Bristol) we buy most everything in VA with it’s lower sales tax rate. Good luck finding you final landing spot.

    by Art Bonds — November 5, 2015

  38. Art, TN seems like a great place to retire. My cousin lives in Kingsport which is not too far from where you are I am thinking. My question is, do you have a Costco nearby. Either in TN or VA? I love Costco and would like to live near one.

    by Louise — November 5, 2015

  39. For those of you who are Costco members you can get health insurance through them. I don’t know too much about it but I did look at it quickly and looks like with my subsidy, I could save money. I am currently enrolled in a Silver Plan through Anthem BCBS and think I will stick with it but for those who might be interested, here is a link:

    by Louise — November 5, 2015

  40. Louise, I agree, Costco is a great store. While we have a Sam’s Club nearby (Bristol, VA) , Costco is over 100 miles away. In fact we have 5 that are located between 100 and 120 miles away. The quickest one to get to would be down Interstate 81/40 to Farragut (southwest Knoxville) at about 120 miles. The closest at 104 miles would be Winston-Salem NC (by back roads… slower than the freeways).

    by Art Bonds — November 5, 2015

  41. LOL, Art! I live less than 20 miles from Costco where I live and WHINE about the distance! No way I’d drive the distance you mentioned! I guess I’d have to order stuff on line if they have it available and go to Sam’s Club! Come on Costco, open a store in the East side of TN!

    by Louise — November 5, 2015

  42. Art, All financial situations put aside, How is the retirement situation in Tennessee? Health care and activities?

    by DeyErmand — November 6, 2015

  43. ‘I tried the Medicare health insurance, different premium costs in different states. I want to relocate before retirement and prepare for the medical aspects before and after. I put in lots of different States zip codes to get the best option.Big difference.’

    DeyErmand can you tell us what States were low cost for Medicare costs?


    by Louise — May 7, 2016

  44. I am attaching an article on how to protect your assets if a spouse needs to go to a nursing home and go onto Medicaid.

    The irrevocable annuity is a new idea that I have not seen before. The article warns not to attempt to do this on your own and to see an Elder Attorney. The annuity has to be a specific type and getting the wrong one could disqualify your spouse from receiving Medicaid. There are good examples in the article. The article also warns not to start spending money before the spouse enters the nursing home. Bottom line is see an Elder Attorney.

    Has anyone used this strategy?

    by Louise — May 7, 2016

  45. Louise,
    That was a very interesting article on protecting assests. It gives one hope that you can protect your assets and having Medicaid pay for long term care expenses.
    The only down-side to this proposition is that, from whatnI have heard, those people in nursing homes under medicaid, do not recieve the same type of care as those who are not on medicaid. I am sure the actual nursing care is equivalent, but things like room size, furnishings, etc are different.
    Does anyone have any info on this?

    by LocoBill — May 8, 2016

  46. Louise of Nov. 2015, east TN Costco, Farragut, TN 15 mi west of Knoxville. Can’t get ant more east TN without being in NC. Sam’s heare is filthy, disorganized, and poor quality mdse. Besides, IT’S WALMART.

    by John D — May 8, 2016

  47. DeyErmand, how do Medicare’s premium cost compare in GA, say to MO and TN? I thought they were all the same.

    by John D — May 8, 2016

  48. John D. Premiums for Medicare is based on how many people in the service area are on the same program you choose then they raise or lower them by your individual age, location, tobacco use, spouse, and your history of medical care. Tennessee and Georgia limits the premium levels on this factors. I have no idea about Missouri. You can compare the different premiums online by zip code. It is a good question to ask at most doctors office. The billing department knows which one pays the best, and which is used the most. Most seniors want low premiums until they see the out of pocket. When you move to a different service area, you have the option of changing your medical insurance plan at that time.

    by DeyErmand — May 9, 2016

  49. Louise,
    The link you provided on protecting assets through specific annuities, guided by elder attorneys was very helpful. I am sure many people have this concern in the backs of their minds. How to protect as much of your assets when you have to put your spouse in a nursing home and qualify for medicaid can be very tricky. It’s good to know that there are options available.

    On the other hand, I have heard that those residents on medicaid in nursing homes do not enjoy the same accommodations as those paying through insurance or self financed. I would hope that the care is equivalent, but the environment, such as rooms, furnishings, etc are not on the same level. Does anyone have any experience in this? Also, has anyone taken advantage of an elder attorney and their advice?

    by Locobill — May 9, 2016

  50. I have been a LPN in nursing homes and assisted living, the care is the same for everyone. No one but billing is suppose to k ow who is on Medicaide, Medicare, Personal Insurance, or Cash. It is on the face sheet but no one know and it shouldn’t matter anyway for nurses we swore to be patient advocates. In the places I worked the furnishings where the same for everyone but if you were on Medicaide you could not get a private room unless your family wanted to pay the difference. The thing that I will say that the person who has a lot of visitors and stays on top of how the patient is being cared for will get better care because the sticky wheel gets the grease.

    by Marge — May 9, 2016

  51. Marge, Thanks for your insight; good to hear from someone with experience. However, i’ve been told that facilities are able to number the amount of Medicare beds that are available. Meaning i would have a better chance of getting into a facility of my choosing if i have either LTC insurance or the necessary income, rather than Medicare.

    by ella — May 10, 2016

  52. Marge you are absolute right. I want to remind others that Nursing Home are not “Retirement Villa’s” and the nursing staff is there to care for the residents, not provide “room service”. Family makes the difference not insurances! Louise suggested a good annuity that I intend to check out. Too many times I have seen the MIL not receive better health care because she didn’t qualify for medicaid due to income and her physician knew she could not afford the co pays. I nipped that in the bud! Also I want to mention that hospitals write off medical bills by your income not by your assets.

    by DeyErmand — May 10, 2016

  53. DeyErmand, When you check out the annuity can you please let us all know what you find out. I have never heard of this and would like to know more about it.


    by Louise — May 10, 2016

  54. DeyErmand,

    I am attaching another article on the Community Spouse Annuity called a Single Premium Immediate Annuity (SPIA).

    They don’t mention what are eligible funds. If a person has their money invested in an annuity already can that annuity be transferred to this type of investment? Would the money need to be withdrawn and taxes paid on the full amount drawn out then reinvested?

    by Louise — May 10, 2016

  55. Louise Sure thing. My agent will be out tomorrow at 2pm so give me time to ask her.

    by DeyErmand — May 10, 2016

  56. DeyErmand,

    Oh, that is great! I don’t have an immediate need for this but I sure want to have this information handy in the event something happens to me or my Hub down the road. Good luck tomorrow with the agent!

    by Louise — May 10, 2016

  57. Single Premium Immediate Annuity (SPIA)

    More reasons to hire an Elder Attorney. Must be very careful not to get the wrong type of annuity.

    by Louise — May 12, 2016

  58. Locobill: I have been through the Medicaid application process relating to elder home care. I definitely would recommend an elder care attorney to provide advice about your state’s rules well-in-advance of the possible need for care. Our elder care attorney saved us in excess of $100K. For ex., in our state the spouse was entitled to retain his or her own 401K, a car (attorney suggested buying a new car for cash just before admission to the nursing home — even a luxury car. The spouse could retain that new car and he had seen cases in which a spouse was unable to pay for car repairs on older family vehicles after a spouse was admitted to a nursing home), the family home and over $100K in assets. Annuities and cash value of life insurance were counted towards assets, but term life had no value. Our kids’/grandkids college 529 accounts were counted as our assets, if either of us was the custodian. I was allowed to spend down assets to pay off marital debts, such as credit cards and the mortgage, after spouse was admitted. The timing of payoff of debts was critical. We needed substantial assets to qualify my spouse for the nursing home of choice, and the nursing home demanded financial statements. It wanted us to self-pay as long as possible. The nursing home did NOT advise me that I could keep any monies or assets during the admssion process, so it was really important I had already gotten legal advice. In fact, the administrator outrigh misrepresented Medicaid rules to me, and told me that after all assets had been spent down to $30,000, they would help with the Medicaid application!

    Once the Medicaid application was filed, the nursing home was NOT permitted to dun me for more. I retained 100% of my own earnings after spouse had qualified for Medicaid. Spouse’s social security went to the nursing home ( with a small allowance for expenses). The nursing home caregivers were not allowed to know which residents were on self-pay, long term care insurance, or Medicaid. There was absolutely no change in spouse’s care during any of the years he was in the nursing home. He stayed in the same private room, etc. Since rules change by state and the rules change all the time, I am not disclosing the state — no one should rely on my experience, except as a lesson that knowing the rules is vital. A couple should get advice for their own state, and for the states where they are considering moving. For ex., I have moved to a state where I’ve been told my 401K would have been counted as an asset. That would have been financially devastating. (I also can’t provide professional advice online – disclaimer). We paid about $350-$400 for an hour with an elder care expert and about $1,500 for assistance with the Medicaid application (which was approved first-time, so these fees were well worth the expense IMO). The advice I got was truly invaluable. For ex., I was told about the look-back period, and the need to retain certain records for years before the application was filed. As a result, I was prepared when the time came, and didn’t have to run around trying to get 5 years of old tax records, bank statements, etc.

    By the way, for those considering annuities, check your state’s insurance dept as to the amount of insurance required by annuity companies for annuity accounts. I’m old enough to remember the bankruptcies of annuity companies back when we had double digit inflation. While states have required some insurance be carried by companies on annuity products since that time, the protections are often much lower than other investments.

    by Kate — May 13, 2016

  59. Louise,
    I was advised according to my State on annuities and medicaid. Moving out of State can affect you in the long run, another reason to be sure where you want to retire. Read Kate’s post above.

    by DeyErmand — May 13, 2016

  60. I picked up this used book called:


    BY: K. GABRIEL HEISER, Attorney with 25 years experience in elder law.

    It is a 2014 edition and includes two chapters on Veterans Benefits.

    I am not affiliated with this book in any way.

    It is an easy read and gives good examples. I have only read a few chapters and it is very informative. This of course doesn’t replace getting an attorney if you need this type of help but can get you educated on what can be done.

    by Louise — May 19, 2016

  61. Subject: Affordable Health Care

    Well, that is the name of the insurance but me oh my it isn’t going to be very affordable for long! I got a letter from Anthem BCBS today and as of June 1, 2016 Anthem filed a request with the Connecticut Insurance Department asking for an increase of 26.8%!!!!!!

    If approved, it will take effect on January 1, 2017.
    Without subsidy my insurance (Silver plan) is $1547.18, with subsidy I pay $443.18 for 2 people.
    If my math is correct, if approved, that will increase the insurance to $1,961.82 without subsidy. Not sure what I will pay with subsidy at that point.

    Oh, and let us NOT forget we on SS got no COLA for 2016. I’d like to get a 26.8% COLA!

    This is OUTRAGEOUS!

    Have any of you on Obama Care gotten such a letter from your insurance provider in other states?

    Hub will be going on Medicare in March next year but I have to wait till August 2018.

    by Louise — June 6, 2016

  62. Louise,
    If you recall a while back we were discussing the cost of Medicare Supplemental insurance in my case Plan F with Mutual of Omaha. Just got a letter from them stating that they are increasing our monthly premium by $14.00 a month effective August 1st. Never heard of an increase happening at mid year. There reason was “escalating Healthcare costs”.

    by Jim C — June 7, 2016

  63. Yes, Jim I do recall that discussion. Hub is approaching the Medicare journey and we are leaning towards Plan F. Not happy to hear more increases have occurred before we have even signed him up!

    Health care insurance is getting to be out of control. I don’t know how we will all keep up with it and the generations behind us are surely going to be suffering greatly. Maybe it is time for Universal Health Care.

    by Louise — June 7, 2016

  64. Louise,
    In the current budget agreement, the cost of limiting the increases in 2016 will be paid for by a loan of general revenue from the Federal Treasury to the Part B Trust Fund. Medicare beneficiaries will pay back the loan over time from set increases to future premiums. Starting in 2016, beneficiaries who are not subject to the hold harmless provision – roughly 30% of Medicare beneficiaries – will pay an additional $3 in their monthly Part B premium for a number of years until the loan is repaid. Starting in 2017 and beyond, all beneficiaries will pay an additional $3 on top of their monthly premium amount, unless they are held harmless under the rules set by the Federal or State. Higher income individuals who are subject to a higher income-related Part B premium will pay a higher additional amount, but apparently not more than roughly $12 per month.
    I can’t help but notice the higher income bracket is $80K and up a year, that laws have been set across the board whether it is taxes, or healthcare. We get penalized for saving for retirement to have a pre-retirement income. I got notice from my employer that our Anthem BCBS is going up in August. and I have checked I will pay more for Anthem BCBS when I retire next year, It is better for me not to retire and hold off 6 years, if I can, to collect more SS benefits, to cover the rising costs of medical insurance.
    Also I want to mention that it is now cheaper to be an “inpatient” at a hospital than as an “outpatient”. Hospitals are collecting more by listing patients as “observatory outpatient” . Check your status when doing your pre-admission! Co pays are increasing along with the premiums!

    by DeyErmand — June 7, 2016

  65. Here is the article in regard to the proposed hikes the insurance companies in CT are asking for:

    by Louise — June 7, 2016

  66. Louise that looks like a bargain to me. I am paying more than that for just me. This is my last month! Hello Medicare!

    by Debra — June 8, 2016

  67. Debra,
    I am not complaining about what I am paying now but if I had no subsidy I sure wouldn’t be happy. Plus, the possible upcoming increase will be very hard to swallow for most people.

    by Louise — June 8, 2016

  68. Pre-Affordable Care Act the insurance company’s job was was to negotiate rates with medical providers, then sell you insurance to help cover your medical care costs. They acted as gatekeepers to find ways to deny your claim so they can make a profit between the difference they take in vs what they pay for.
    To do this they would write your policy to exclude coverage. Preexisting condition were excluded (and everything was preexisting… just ask them). Costs were capped (they would pay $5,000 towards your cancer treatment). You could get cheaper coverage but the plans didn’t cover squat. Your safety net had gaping holes that a Mack truck could drive through. Want higher limits? Pay higher premiums. Want better coverage? Pay higher premiums. And if you didn’t use the medical care, they really profited.
    The Affordable Care Act (Obamacare) tried to combat these scams by setting minimum essential coverage’s to insure the insurance actually covered something. No more coverage in name only. The ACA also set some limits on how much money the insurance companies take in vs how much they have to pay out. It’s called medical loss ratios, and it has resulted in refunds of medical premiums for some businesses I know (translation: they were being charged to much in the first place and the law made them give it back).
    Insurance is shared responsibility. Everybody shares in risk and pays something to cover the bills. If only one person paid… well, think of how much that would have costs you per month. That is why there was an individual and employer mandate in the ACA.
    Net effect is that everybody now has to pay for medical care that has real coverage limits (not a sham policy), the insurance companies have to take everybody, and they have to pay out a certain ratio of what they take in.
    Obamacare was an attempt to weed out the unscrupulous, set minimums and share responsibility (the basis for all insurance). Yes, you can thank Obama and the Dems for bringing some sort of honesty to that crooked game. The Repubs may complain that they didn’t have any input into the ACA, but they did have 6 years of total control of the White House and Congress and did… squat. Lots of talk, nothing done.
    BUT… and it’s a big BUT… in drafting the ACA nobody addressed the root of the problem. Medical costs. The hospitals, the doctors, the drug companies. That beast was left out of the cage in order to get the ACA passed in the first place. Opposition from the AMA would have doomed the bill. And I don’t suppose it would surprise you much if I told you we have some of the highest paid doctors in the world.
    And since the insurance companies no longer make their money from the gap between what they charge and how much they can deny coverage, where they make their money on the medical loss ratio spread. It is a pass through arrangement. So there is no incentive any more to even try to limit the medical costs. The more they can pass through the more they can take off the top. Prices will keep going up until we, the consumers, are totally tapped out. And we are close. American are drowning in medical debt. 3 of 5 bankruptcies are due to medical bills.
    Here in the US we pay double the average per person than the average in other industrialized nations. And it’s debatable if we have any better healthcare than them. Certainly if you have the money we have “the best” healthcare because you can buy your way to the front of the line. That is why rich folks from Canada, Great Britain and the rest of the civilized countries come here for health care… it’s not necessarily the best, but you can bypass the queue people have to put up with in those other countries.
    The health industry will cry poverty while the doctors and hospitals charge us double. Subsidies under the ACA blunt some of the pain, but in the long run it is not sustainable. It will be this way until we demand and get universal health care like other civilized countries have. Yes they have their problems but at least nobody in those countries goes bankrupt and the results are acceptable, even if delayed.
    I’ll put away my soap box now, sorry for disturbing so many bytes on the internet.

    by Art Bonds — June 8, 2016

  69. Art Bonds,
    Thank you for such an in depth look into insurance then, now and future. The future of health care and dollars spent to have health insurance is bleak to say the least.

    by Louise — June 8, 2016

  70. Louise
    I am not sure after reading your post that insurance premiums and increases are controlled by your local State government

    You failed to mention the immense benefits we all benefit from such as restricting insurance companies from dropping your coverage

    While the ACA may not be perfect it is certainly much better now than before

    The healthcare cost increases come from two sources: 1) pharmaceutical companies exponential profits 2) insurance companies excessive charges and internal salaries

    We could all benefit from the discontinuation of the VA system and absorb this into our existing public hospitals

    by Ron — June 9, 2016

  71. Art you are so on the money. It’s truly sad how this country treats their citizens. We’ve been trying to get national health insurance since the early 1900s. Poor Ted Kennedy fought his whole political life to try to get it passed. Shame.

    by Stacey — June 9, 2016

  72. We have a national defense system but not a national health system.

    “The U.S spent 17.% of its GDP (gross domestic product) on healthcare in 2013, almost 50 percent more than the next-highest spender. Despite this huge investment, the USA is ranked 37th in the world.”

    “We spent four times more money on healthcare than we do on our military. The USA spent 3.9% of its GDP (596 billion dollars) on its armed forces. The USA far outspends the rest of the world on military expenses, accounting for one third of the world’s military expenditures. The US Armed Forces are the best in the world.”

    Here is the link for then entire article. It’s worth a read.

    by Art Bonds — June 10, 2016

  73. Thanks for that, Art. Name added

    by Stacey Walsh — June 11, 2016

  74. This is an odd ball question but I cannot find the answer anywhere on the internet.
    Hub went on Medicare last year and I am on Obamacare till July 31, 2018 then transition to Medicare.

    What are the subsidy rules on a partial year on Obamacare?

    I am still getting a subsidy and am in the 400% poverty level range. The first year Hub and I were on Obamacare together we had a qualifying event when my Hub retired. He had work income for 4 months which didn’t count due to qualifying event status. They looked at our future income and we qualified for the subsidy. My question is since I will be dropping out of Obamacare and there will be still 5 more months of the year of which I will be on Medicare would I be able to dip into my IRA which would add to my income? Thus, exceeding the 400% poverty level. The first year we got on Obamacare they allowed the extra income and it didn’t disqualify the subsidy. Not sure if this makes sense! Basically, I don’t want to increase income and have to pay back subsidy. But if it is allowed to add extra money without penalty I would like to do so.

    by Louise — December 11, 2017

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