How are you handing healthcare in retirement or what do you plan to do for coverage once you retire? Let us know in the comments below.

This is why I love maximizing the benefits in my HSA

Retired early here, during a round of layoffs with a severance plan. Started medical with Cobra, then a high deductible plan via corporate S&P50 that is currently getting close to $800/mo that is deducted from pension for an individual. Prescriptions are trivial due to good health so far. But a DIY accident at the house incurred some expenses for a few months. Income just over ACA limits so that was not an option. Hate to say it, but I'm looking forward to Medicare 🤣 rates. Side note: I'm glad I have freedom of choice in medical providers. That's not always possible in other countries where there is likely a waiting list as well. See White Coat Investor blog for his time volunteering medical services in other countries. I'm glad the US in general has superior medical services, but I'll acknowledge a single payer service for basic things like well care should help lower costs slightly.

I left my parent's healthcare plan when I was 18 because that's when the insurance company kicked me off. This was pre-ACA days. I had coverage through the university while I was at school, but it didn't cover dental, so I went to the dentist 2 times in 4 years. It was nice to have coverage when I got my first full time job, but I still had to contend with "pre-existing conditions" which meant a 6 month wait to get allergy medication any time I changed jobs. Things are better under the ACA.

Great episode, and timely. After going years of paying premiums without having any serious issues, a couple months ago my wife tore her ACL. I am still working full time and have a good insurance plan, and thank goodness for that. Between the MRI, ortho doc visits, the surgery, and physical therapy we are well over $50,000 in expenses that would be out of pocket if not for an insurance plan. Definitely not something to skip.

Appreciate revisiting this one a bit more! It's definitely huge, as you guys acknowledge. Definitely going to think about my Roth-heavy plan – didn't realize there was an income minimum for the subsidy!
Got any favorites on ex-pat approach? I haven't started that research yet, either 😂
Cheers! 🍻

Medical outside of the US is increasing by leaps and bounds. Do your research. Costs are considerably lower while quality if high and offers more than in the US.

Healthcare is the #1 reason people continue to work because it’s so complicated and expensive to navigate. Otherwise more people would retire early and thus create more opportunities for younger people . Thanks for this video, so very helpful.

Health care in America is so complex. Good job sharing your conversation of how you guys are trying to navigate it

Mark Cuban's Cost Plus pharmacy has saved me a bunch on prescriptions – even though it is not covered by insurance.

For me, COBRA is the most expensive option. ACA offers me lower cost plans, especially when one qualifies for subsidies based on your level of income.

Step 1) Graduate in Europe where is basically free, some countries even pay you to get a college education.
Step 2) Work 15-20 years in the US where taxes are low and wages for highly skilled professionals are high
Step 3) Retire in Low Cost good Healthcare countries in Europe.

Oh, don't forget the most important part, step 0: be born in a first world country, being white helps.

This is a complicated topic, made more complicated in that your spouse's risk tolerance might be different than your own. My wife was not receptive to an high deductible plan as she feels that we will be making decisions that compromise whether we would be going to a doctor or not. I can't fault her logic for that since she knows I can be cheap 🙂 She'd rather pay a bit more up front and keep a low threshold in accessing the medical system to treat issues as early as possible. Her viewpoint is that without health, you have nothing regardless of how much you have in the bank, and we budget accordingly. Just food for thought.

I feel a certain amount of guilt in receiving subsidies or qualifying for benefits when I intentionally lowered my income in early retirement. Fortunately, I have tricare as a military retiree, so I didn't have to go through the exchange. I still feel like I'm not paying my share, but altruism helps.

I’m fortunate to be retiring in Thailand where health care insurance is very affordable and health services are world class. For those who have the flexibility to look at international retirement destinations, the potential savings on health care costs (in addition to no capital gains tax) can lower your FI number significantly…with less complexity and worry about the cost of healthcare breaking your plans. Expat health care premiums in Thailand are (roughly) 2,000 USD per annum for individuals and 7,500 USD for families.

Problems with all this is who’s in power politically. Trump wanted to abolish the ACA so I really don’t trust this setup we have here in the US. This is the main reason why I’m moving out of the US for early retirement. We’ll be in Portugal next year so I’ll let you know where we end up but probably Lisbon.

i was looking at 55 (48 now ) retirement but decided to work 20 hours a week until 59.5 minimum but probably 62
that gives me social security minimum which should keep me under the minimum wage for 100% subsidy ……… (aca) but OMG this is SO confusing lol…………
im guessing SS is considered income…. and im guessing dividends are income too… and cap gains i pull from Roth and normal brokerage and 401k ……….. maybe ill b paying a pro lol
GREAT video

Federal Employee Health Benefits Program for me in the future 🙂

I ended up with the "Stone plan". That is the one where the insurer comes in and touches up the x-ray, 🙂
I became retired at 57 and started SS at 62. A year and a half later the ACA started. I went for the silver, but wanted the subsidies, so I suspended my SS, stopped all Roth Conversions and moderated capital gains realization.
I had to make sure I was above the Medicaid income levels, otherwise I would have been thrown into that.
It was a very unsure time. I got most of my info from the Bogleheads forum.

Those with kids. 1. Will you subsidize your 18+ adult child? Did you know kids can stay on parents ins until 26 (even if not living with you and yes even if they get married)? Make sure you have this discussion for their own life planning. 2. If you have kids that are or will be in college – are they out of state or country (one of mine might do this)? Ins is on a state level so do not expect the family plan to work. Some schools might offer or not a plan and those costs can vary and are they included in COA numbers from the school (if that is a concern for you)? And skipping insurance is probably not allowed. They can apply for private or aca on their own.

We do a global ex-pat plan, which does not lock us into health care services in a zip code or state like ACA does/can. You do need to stay out of the US for six months per year. The upside is that you can get a Gold plan, HSA contributions, and unlimited Roth conversions. It's about $500 per month for two people, late 40s.

My problem is I have a well managed autoimmune disease, but that means I can’t get private health insurance even if I wanted to. It also has made me wary of going to HD plans in case I have a flare up and need hospital/specialist care 😱

I’m going to use an insurance broker to help determine what my income level should be aimed at to benefit from subsidies while still getting decent coverage. Too complicated – I might be retired, but who has patience the dope through all this crap 🤣😜😜

Great episode, as usual, I enjoy listening and always learn something new. Keep up the good work! 👍 And thanks! 🙏

I've been engineering around the anticipation of the ACA tax credit eligibility for years. Paid off house, roth distributions, bronze with HSA – all the things. Oh, and being Lucky and Healthy is always a good plan to. 🙂 It's a bit harrowing every time there's a court case or a change in congress that jeopardizes it. 30 years ago there was movement toward health care reform, single payer, and it's only getting somewhat better over time. I think Harry Truman and Nixon looked at it also. I just skipped health insurance from 23 to 26 back in the 80's, but as I age, that could be catastrophic. I know someone who went without health insurance from age 62 to 65 – yikes.

If either of you have kids heading to college and hopes to be purchasing healthcare (which sounds like the case), a wrinkle in the healthcare plans is their health support – some schools offer their own plans to students, some do not. If you go out of state, you can't (in the state of NJ BLUE CROSS BLUE Shield) get an HSA plan (the Bronze plan). Do your research, it's a super grey area.

I personally pay my full HSA premium I bought at the exchange and reconcile when filing taxes. You should get the ACA credit applicable based on your filed income and your reference plan as a tax credit…Again Roth conversions will eat it up quickly so make sure you do proper planning. Also the adjusted ACA subsidy tables applicable during Covid expire in 2022 so the new tables may change significantly if congress does not pass an extension for 2023!

The thing with literally doing barista fire is that those positions suck. Even when you're not 50+, you're treated terribly by both managers and customers, now imagine putting up with that as an older person! Plus, there may not be schedule flexibility for traveling (even if it's not paid) or whatever else.

I've worked both min wage jobs and office jobs and the min wage jobs were more stressful.

Another great show guys, with a very important topic for retirees prior to 65. Thank you and keep discussing these topics. As always things get very complex quickly especially with ACA and impact of reporting your income and balancing with Roth conversions etc…Most of us will rely on the ACA marketplace and subsidies are VERY tricky. Just know that the subsidy can be in your benefit but also a hidden tax, to the tune of 15% per income. This is VERY important when doing Roth Conversions as the subsidies are based on Income level incl any Roth conversions as well as Dividends or capital gains. So its separate from your income tax calculation. So every additional dollar of income over your standard deduction is taxed at 10% Federal PLUS about 15% ACA subsidy loss, which would put effective Fed tax rate at about 25% incremental tax of income exceeding the Standard deduction for Income taxes. However its not so easy again as the act is based on federal poverty level, single is about $13k annually, but don't file income that low either, try to be at least 2 times that, as otherwise you may fall in your states' Medicaid program as a "Poor" person. Not a good place to be when you have assets as they will come for your assets when you use Medicaid. So try to be at least 2 times FPL in income so you qualify to be in MNSure or the your states ACA marketplace…Measure twice cut once and really do your homework where you live…

Next year, I will select a Bronze plan . I am thinking about adding a Direct primary care (DPC) which will add $75 a month based on the doctor that I will use and the tier selected. Each DPC doctor prices varies.

I will use the Bronze plan as my major medical.

Oh boy USA is complicated! In the UK I have a SIPP ( Money Pot Personal Pension) and a Stocks and Shares ISA (Tax free savings account) and that is it! My income is low but by income needs are also low. I have NHS for all my healthcare including dentistry and pay less than $500 out of pocket for dentistry and prescriptions. I qualify for free meds at 60 but that may change.

Great summary of ACA challenges. One of the things we've noticed in our state is that the networks seem to be very localized (geographically). If one wanted to be a snowbird it seems like it would be a challenge to use ACA coverage in your non-resident state unless you were prepared to pay out of network costs for all healthcare obtained while you were away from your permanent home.

The only thing of any value in being considered a 'retiree' when I was laid off @ 55 was the subsidized company medical plan. During my career I never really dug into the differences between the 3 tiers we had – Bronze paid 70%, Silver paid 80%, and Gold paid 90%. I had always thought of the 'get hit by a bus scenario and thought the Silver was a good compromise. After I was out though, I looked at the numbers and the Bronze plan – even in the worst case – made the most sense. The out-of-pocket max was a little higher but the monthly premiums made it much less! So I'm still on Bronze. Like most larger companies, ours actually – behind the scenes – is self-insured, but BC/BS administers it. But the company actually decides on levels of care. It is perfect! The employees can gripe and blame the insurance company for whatever perceived evils, but it's not really up to them! LOL. Single-payer/Medicare for all would be so much better for all. Although, while even still years away, Medicare seems to be a bit skewed/scary by the 'Medigap', 'Advantage' and neither – just Part A, B, and D. Medicare does NOT work if you live in a different country (if you are vacationing up to 30 days I think you are covered). But, generally, medical care is much cheaper in many countries.

Very helpful guys, thank you. I’ll be on COBRA during my severance period (18 months) and will probably move to ACA (Covered California) after that. I’ll need that coverage for about 4 years until I hit 65. My wife is older than me and will enroll in Medicare when I retire.

Not to get political, but one of my biggest obstacles is the way my wife feels about ACA. I’m slowly convincing her that, despite the political origins of the plan and her personal feelings, it will probably make the most sense for us. Especially because I expect my MAGI to be low as I withdraw from my taxable account and do Roth conversions.