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Health Insurance for Young Retirees: What to Do Before You’re Eligible for Medicare Thumbnail

Health Insurance for Young Retirees: What to Do Before You’re Eligible for Medicare

You’ve done it!  You worked hard, saved your money, and now it’s time to reap the fruits of your labor. What’s more, you were able to retire before 65, earning yourself some much-deserved time to travel, volunteer, dive deep into your hobbies, or whatever else you please.

While this sounds like “The Life,” there is one potential snag you have to watch out for: the cost of health insurance/medical care.   A 2014 report found that couples who retire before being eligible for Medicare spend an average of $17,000 per year ($18,800 in 2021 dollars) on out-of-pocket health care costs until they are able to enroll in Medicare.  This can represent a real financial burden not just in the price tag itself but needing to cover such large expenses so early in retirement could lead to “sequence of returns” risk.  

So what’s the best way for you to handle healthcare costs before you are eligible to enroll in Medicare?   Let’s walk through the options.  

Health Insurance Options for Early Retirees

Spouse’s Plan

If your spouse or domestic partner has health insurance, either through their current employer or a former employer’s retiree medical coverage, you might be able to be added to that plan as well.  

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law that allows employees (or an employee’s dependents) to keep their group coverage through their former employer’s health insurance plan.  This can be a great short-term stopgap, but it’s not usually well-suited for longer-term solutions. COBRA allows you to keep your current insurance, which means you won’t have any changes to your coverage or network, so you can typically expect to keep your same doctors and pharmacies. By maintaining your insurance through a larger organization, you put yourself in a better position to win a dispute with your insurance provider, should such a dispute occur (to that point, COBRA compliance is only mandated for companies with at least 20 employees; if you worked for a smaller employer, this may not be an option). Typically, it only lasts for 18 months after the employee leaves the company, but it can be extended in some cases.  However, it can be quite expensive.  Usually, when working, your employer will subsidize a portion of your insurance premiums. These are usually passed on to you after you join COBRA. Additionally, COBRA allows your former employer to charge you 102% of their costs to compensate for any additional administrative tasks they undertake to keep you on their insurance plan.  As such, this is best suited for people within a year and a half of receiving Medicare.   

Marketplace

If there isn’t an organization you can receive health insurance through, you can purchase insurance on your own through the healthcare marketplace. Due to COVID-19, enrollment in marketplace health coverage has been extended through August 15th.  Also, if you have a significant life change (such as losing job-based insurance coverage), you can enter into a special enrollment period where you can enroll in a marketplace insurance plan even if it’s outside of the traditional enrollment period.   

All marketplace plans are required to cover 10 essential health benefits, including hospitalization, emergency services, prescription drugs, etc. Plans are broken out into 4 tiers: Bronze, Silver, Gold, and Platinum.  Plans range from low premiums and high deductibles to high premiums and low deductibles and vary by the percent of total healthcare costs that are covered.  Fortunately, there are also caps on age-related pricing, where a 64-year-old can be charged no more than three times the premium rate of a 21-year-old.   The ACA also outlawed denying or increasing premiums for applicants with preexisting conditions and limited out of pocket costs to $6700 per year.

Choosing which tier of insurance to purchase depends on a variety of personal factors unique to your situation.  In general, the more you expect to use your health insurance, the more a high premium-low deductible plan makes sense for you.  But, if you do choose a Bronze or Silver plan, you’ll likely be able to find one that qualifies as a High Deductible Health Plan, which means it’s compatible with a Health Savings Account (HSA).  These can be very useful vehicles for saving for health expenses, as contributions to an HSA are triple-tax advantaged.

Whichever route you go, be sure to investigate your options carefully before retiring early.

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Mike Hengehold Headshot Mike Hengehold, CPA/PFS MST RICP®
Mike is the Founder and President of HCM Wealth Advisors. Over the last 30 years, he’s provided financial planning guidance to a myriad of families to help them realize their financial dreams. Mike is an avid homebrewer and animal lover, and when he’s not at work you can often find him on the golf course working on his short game.
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