Health Care Planning

Thought I would post a few notes about our planning for health care costs.  I also want to say thank you to all the new readers who have signed up to follow this blog lately. It’s good to have you and your ideas so feel free to comment even within the older posts.

Like so many others, I follow Nina’s blog over at Wheelingit. Nina does an amazing job of summarizing current health care options so I’ll leave that to her. We all await future attempts by the US Congress at passing new health care laws. I don’t intend to make political statement so I’ll leave that alone other than to say it does seem reasonable the actual costs associated with health care services must be addressed to get at one root of the problem.  For now, I suppose we must take matters into our own hands based on whatever is available at the time.  So, to that end, I’ll post what I’ve been planning.

Karen and my situation factor in a few “what-ifs” although I don’t like using that phrase when problem solving.

  • We plan to move to fulltime RV living when I’m 56 years old. Karen will be a year from Medicare eligibility. She spent most of her career in medical billing which included helping folks out at hospice to figure out insurance options. I’m lucky to have her around to bounce ideas off.  She also has firsthand experience regarding how health care insurance companies handle claims.
  • Without re-entering the workforce later with health care benefits, I’ll be paying for my own for a good nine years. Our budget will have to include a plan with both of us for the first year. After that there could be supplemental Medicare insurance for Karen. Regarding this, Karen says we have to look at her options in terms of do I keep her on my insurance as a secondary insurance rather than having a supplemental Medicare policy. We will look at that in 2020 when the time arrives.
  • She agrees and I’ve experienced in the past that using COBRA after I leave fulltime employment is about the most expensive option out there. I met with our Human Resources person at work and confirmed its way expensive, even if I’m the only one on the plan. I would have 90 days after leaving a job to decide to file for COBRA which is good for 18 months.
  • In related topics, I’ve done very little research regarding long-term care insurance other than knowing neither of us want the other to ever be in a nursing home. I add this only because it’s health care related and a budget consideration.  Life insurance is in the same category.  At the advice of an experienced friend, I’m to look at the cost difference between taking a reduced pension with survivor benefits verses the cost of life insurance should we decide we even need it.
  • Karen added if she ever had to go in a nursing home she would file for Medicaid and make use of spousal protection clauses to separate our income and assets. She said she would not worry much about only being left with $80 a month from her social security check because she would not live long in a nursing home.
  • All this has to fit in an annual income budgeted at $3,375 a month after taxes and including inflation in 2019 when I plan to leave my job. If you’re interested there is a good thread at the Escapees forum regarding fulltime RV budgets beginning November 2015.
  • I’m always on the hunt for new ways to tax defer income as we have very few deductions to take on our annual taxes.

So here is what I’m thinking and doing today for us. Subject to change…

  • I added a Health Savings Account (HSA) plan at work. We use this to pay for our portion of medical expenses. After reaching a certain balance, the extra can be invested. I contribute the maximum amount allowed by the current tax law which is $6,750 annually. I turn 55 during 2018 when I’ll take advantage of the catch-up clause which allows us to add another $1,000 annually. At work, I enrolled in a high deductible health care insurance plan with Blue Cross and Blue Shield. My employer also contributes an amount to our HSA account as part of the annual $6,750 limit and our account is growing quickly. For those that don’t know, an HSA is not the insurance portion, it’s a savings account with a debit card used to pay for certain health care expense. Among other things, an HSA account cannot be used to pay for our current monthly health insurance premium. The money for the HSA account is deducted from my paycheck before taxes. And I’m not taxed on the money when spent! There were several points to consider before we decided to change our health care plan at work.  You must consider your own health situation before doing this.
  • I’m planning to use the established HSA balance to pay for out of pocket health expenses once we hit the road. If Congress votes in an increase on the maximum contribution limit, I’ll take advantage of it at least until I retire. Then after I’ll most likely come up with a minimum amount I want to keep in the HSA account based on our health care insurance plans maximum out of pocket expenses.
  • More than likely, based on today’s health care insurance availability, I’ll be going with a higher deductible plan at retirement. Some refer to this as a catastrophic plan so you don’t go broke if major medical issues arrive. Again, that’s a what if which includes Karen and I not having any huge medical issues when I retire.
  • Months ago, we joined our local community fitness center which costs $50 a month for the two of us. This included three sessions with a fitness trainer. Living a healthy lifestyle is for sure a way to reduce health care costs. Our family genetics for health issues prior to age 65 are not that bad – but then again that’s a “what if.”
  • I figure we will go to Mexico for eye care and dental. I’m still thinking about how to handle prescription drug cost but will certainly follow the law with whatever option we come up with. OR – research how to cut the cost of this and other health care services. Here enters the notion of finding the best care at the least cost. I found a good article here that was written in 2011 as a starting point. I have zero experience shopping around for affordable health care services. Suppose now that payment is coming out of my HSA account that’s about to change. So far, I’ve found two resources of interest which are mdsave.com and healthcarebluebook.com.
  • Karen had a few comments regarding how insurance is billed. You are at the mercy of the doctor’s billing person. Sometimes they code procedures, treatments and facility fees incorrectly. She says to challenge the costs and file an appeal with the insurance company. You might even be able to talk the doctor’s billing person into refiling the claim if they agree the insurance company (or the billing person) made an error. If you don’t believe the insurance was billed correctly you can also go directly to the insurance company to discuss the issue. Of course this is presuming one is able to recognize the error or what appears to be an out of control price from the doctor’s office (see the above online resources). She added an example where the doctor’s office, who are in-network, can only be paid per the contract with the insurance company. It’s typical that Blue Cross will only pay 49% of the total billed to them by the doctor in our region for example. She says the key is if you are paying the cost out of pocket then negotiate a price which is equal to what the insurance company would have paid.
  • A coworker told me his doctor knows he is paying fees out of pocket through his HSA account. He has a family of four. The doctor’s billing is setup to charge him fees that are lower, presumably closer to the rate an insurance company would have paid. He does not have to negotiate the fees at all. Nor does he get a bill later from the doctor’s office because the insurance claim was denied or not paid in full by the insurance company. I’m hoping more doctors will take this approach and I can find a good one out of the group.
  • I’m also very much interested in speaking with doctors through online video services for the more basic needs. Although I’m concerned something like a chronic cough might become something worse, for example, if we don’t meet in person.  I suppose any qualified doctor or nurse online would know enough to refer us to proper medical care?
  • Briefly, regarding what state and county we intend to take up residency (domicile). We all know health care insurance cost, availability and plan coverage will factor in. And of course that will be one of the considerations as to where we officially call our home.

I know enough about the topic to be dangerous. I’m trying not to put out any bad information and really appreciate your ideas, corrections and additions. PS – I don’t qualify for veterans benefits as I did not have enough combined active service when I was in the National Guard.

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6 thoughts on “Health Care Planning

  1. Question for Karen: What happens if the billing dept enters the wrong patient info so the insurance company refuses payment, and by the time it is corrected the insurance company is refusing payment because the procedure is past their statute of limitations? I’m thinking it is the billing department problem, but is there any precedent? Thanks.

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