How the hell are we supposed to retire?

JimN said:
My wife and I had a gold level Aetna plan last year that was $1684/month. Aetna pulled out of the NJ marketplace, so this year we now have the Horizon Omnia Silver plan, and it's $1753. The Horizon Omnia Gold plan would be $2323. Not apples to apples obviously.
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The devil is always in the details:
Looks like a 70/30 plan
Do you mind sharing the deductible,
Primary copay
Specialist copay
Max Out of Pocket (doesn't include copays)
Actual Max Out of Pocket (includes copays and was new since the last time I hit the MoO, freaking snakes)
 
stb222 said:
Looks like a 70/30 plan
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Yeah, (as I'm sure you know) you either pay more per month to have a lower deductible/out of pocket max, or you pay less per month and have a higher deductible/out of pocket max. It's annoying to have to decide this when you cannot predict the future.

stb222 said:
Do you mind sharing the deductible,
Primary copay
Specialist copay
Max Out of Pocket (doesn't include copays)
Actual Max Out of Pocket (includes copays and was new since the last time I hit the MoO, freaking snakes)
Click to expand...

My main concern is if something catastrophic happens, and/or one of us needs surgery. Everything else is kind of a guessing game at this point. We would have preferred to keep the Aetna plan we've had for the past year, so that kinda sucks that they went away. We've been on a shared plan together of some type or another for probably 20ish years, though I don't know if that makes the most sense for us.
 
JimN said:
Yeah, (as I'm sure you know) you either pay more per month to have a lower deductible/out of pocket max, or you pay less per month and have a higher deductible/out of pocket max. It's annoying to have to decide this when you cannot predict the future.



My main concern is if something catastrophic happens, and/or one of us needs surgery. Everything else is kind of a guessing game at this point. We would have preferred to keep the Aetna plan we've had for the past year, so that kinda sucks that they went away. We've been on a shared plan together of some type or another for probably 20ish years, though I don't know if that makes the most sense for us.
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Yeah, they make every part of the insurance and using the insurance process difficult to figure out by design.
I still have an 8020 plan and like everything the deductible keeps getting higher along with the maximum amount of pocket, my company has kept the premium the same for a few years so that’s a plus, but with the higher deductible, it’s sort of balances out. In theory the high deductible plans with an HSA account is the way to go, but you are exposed for a few years before you get the HSA built up. With all of the stuff that my wife’s been through, there’s no way I can make the jump to a high deductible/HSA plan because I could literally be crippled financially in a year.
 
roc said:
But, whatever, we will pay. There is no other option.
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Well, you have the option to go without insurance. What did people do for all those centuries before insurance was invented? I went without for most of my 50s. Got subsidized ACA after that and now on Medicare. If I saw those premiums, I'd opt for a cheap catastrophic plan and take my chances.
 
SmooveP said:
Well, you have the option to go without insurance. What did people do for all those centuries before insurance was invented? I went without for most of my 50s. Got subsidized ACA after that and now on Medicare. If I saw those premiums, I'd opt for a cheap catastrophic plan and take my chances.
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My wife has an employee who refuses to get health insurance through her company. Every time anyone in her family isn't feeling good or has a toothache or any minor issue she takes off and they go wait at the ER. Sometimes she'll miss work for several days just trying to see a Dr.
 
Bike N Gear said:
My wife has an employee who refuses to get health insurance through her company. Every time anyone in her family isn't feeling good or has a toothache or any minor issue she takes off and they go wait at the ER. Sometimes she'll miss work for several days just trying to see a Dr.
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Cool story, but not sure what point you're trying to make.
 
JimN said:
. We would have preferred to keep the Aetna plan we've had for the past year, so that kinda sucks that they went away.
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They did? Because they just sent us new cards. Being the wife works for a hospital maybe they carry for just big corporate hospitals only...
 
SmooveP said:
Cool story, but not sure what point you're trying to make.
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You had just mentioned the option about going without insurance.. When there's a will. there's a way. When I was in the Bone Marrow Unit at RWJH my wife was concerned about all the bills. There were 9 rooms in the unit and the nurses mentioned that we all get treated exactly the same even though not all of us had insurance.
 
Bike N Gear said:
You had just mentioned the option about going without insurance.. When there's a will. there's a way. When I was in the Bone Marrow Unit at RWJH my wife was concerned about all the bills. There were 9 rooms in the unit and the nurses mentioned that we all get treated exactly the same even though not all of us had insurance.
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Ah, OK. I personally don't try to exploit the system like that. When I went without insurance, I paid out of pocket and tried to limit my risk. I remember times on the MTB thinking I better not hit that jump or whatever. I know that the fear of getting cancer or having some other expensive episode is why most people consider insurance to be mandatory. but there's a point where the insurance becomes so expensive that it's reasonable to choose to self insure or just just accept the risks.

I know your story and I'm sure you're glad you opted to be insured, but the financial end of healthcare is a broken mess in the US and continues to get worse. Every other developed (and some not-so-developed) country has gone with socialized healthcare. Seems like that's the "least bad" of all the shitty options. There's all kinds of interesting philosophical discussions to have about the pros and cons, but seems to me that's where we'll eventually end up.
 
A lot of the problem here is the current US system is Insurance=Healthcare.

What we pay to Insurance companies covers the normal medical expenses, the extra-normal medical expenses and then all the loss due to an entire industry passing paperwork.

If pricing was transparent and there was competition you could pay out of pocket for normal expenses like checkups, bloodwork, etc and have insurance for the rare extreme events like a rare cancer. Now we're paying through convoluted systems all of it.

It's the only insurance that's treated this way. Your house insurance doesn't include the plumber fixing leaks and a lawn care crew every week.
 
Santapez said:
A lot of the problem here is the current US system is Insurance=Healthcare.

What we pay to Insurance companies covers the normal medical expenses, the extra-normal medical expenses and then all the loss due to an entire industry passing paperwork.

If pricing was transparent and there was competition you could pay out of pocket for normal expenses like checkups, bloodwork, etc and have insurance for the rare extreme events like a rare cancer. Now we're paying through convoluted systems all of it.

It's the only insurance that's treated this way. Your house insurance doesn't include the plumber fixing leaks and a lawn care crew every week.
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It's a big obstacle to fixing it. If we made the switch to socialized, it would put a lot of companies out of business and employees out of work. We haven't had the guts to do it yet.
 
Red Mosquito said:
I think it's mostly because that machine has a pretty big lobby behind it.
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Definitely that too. "Healthcare" spending is almost 20% of our economy. Not sure how much of that is the insurance piece, but probably big enough to be a shock to the economy if we pulled the plug suddenly. I'm sure the lobbyists will hit that angle.
 
mattybfat said:
They did? Because they just sent us new cards. Being the wife works for a hospital maybe they carry for just big corporate hospitals only...
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We have a Medicare Aetna Advantage PPO here in NJ, while we have coverage for 2026, its my understanding that they will no longer renew plans after March.
Our coverage is thru my Union, so far they have been able to keep us in cadillac plans at fairly reasonable cost.

Wife has an autoimmune disorder, needs an injection every 6 weeks, works well, but inurance company is billed $29k for that 90ml shot. Its one of the drugs they advertise on tv.
0 cost to us after we reach $2k yearly deductible.
Close friend on the same plan has MS, gets a $60k infusion every 3 months, no cost to him, maybe becuse it needs to be done at a hospital infusion center, its on major medical plan in stead of drug coverage?

How do people without insurance pay? I believe the drug maker has a program to assist you if your assets and income are below a certain level,
but what if you have some assets and no insurance?
 
SmooveP said:
Well, you have the option to go without insurance. What did people do for all those centuries before insurance was invented? I went without for most of my 50s. Got subsidized ACA after that and now on Medicare. If I saw those premiums, I'd opt for a cheap catastrophic plan and take my chances.
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But you can't own anything. People have lost their home over health care bills. You are not protected if you don't have insurance but life is like a crap shot anyway.
 
roc said:
You know you have to have it, but other than 1 yearly visit to her doc, that is all she uses. We are paying 20K, just in case of a trip to the hospital, or god forbid something terrible. Thankfully, her premium is a little less than your wife's. Maybe she has Silver? Still a lot of money!

But, whatever, we will pay. There is no other option.
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Agree, it’s critical to have insurance. I have had three different ‘surprise’ medical issues that each cost almost $500K. I don’t think that is too unusual actually. Insurance is kinda broken but I think each time folks do a bottoms up analysis on the total cost the biggest issue remains the staff costs for each and every step of the medical process ( higher in US vs peer countries )
 
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