Yep. As the saying goes…“the best sort of patient is the one who leaves town the next day”. Better yet, leaves the country.
As mentioned above, I missed that you want to stay local. I am a heavy user of specialists in my area. This is a parallel problem that I’m trying to solve as well.
My definition of “home base” may consider ex-US locations. As such, my input to this topic reflects this eventuality. I wouldn’t be a medical tourist, but a native user of systems in other countries.
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My sister warned me about those. BIL retired 3 years back at 55. She found that off marketplace plans will sometimes only cover you for 364 days, and because of that auto-renewal is not automatic. You have to reapply for the policy every single year and because of that you might not get accepted. It was a hassle they found unacceptable.
I’m learning that nearly everything about our insurance industry in the USA is just totally fracked up.
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Certainly people buying insurance will check to see which doctors and hospitals they use are in plan. I stand by the idea that some insurance company are widely accepted by medical personnel. It’s a good idea to identify the ones in your area and check them out. In my area United Healthcare is excellent. As always your mileage may vary.
Very true.
But some early retirees, and I admit they are few, who live outside the USA have managed by paying out of pocket for more lower cost medical that they felt was equal to US care.
Paul ter Horst
You retired at 35 years of age, how many years ago was that?
We retired in 1984, 23 years ago. We both turned 58 this year.
They’re much older now of course.
Billy Akaisha Kaderli. Sadly Billy lost his wife this year.
They retired in 1991 at the age of 38 and traveled the world. Not for everyone.
I would find perpetual traveling exhausting. Some folks thrive on it.
And these individuals net worth increased during their retirement. Compounding never sleeps.
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Indeed. The remarkable thing to me is that most of the developed countries we tend to think of when nattering about universal healthcare that’s working better than the US … at least, when looked at from the outside … all have some sort of collaboration between taxpayer funded and private insurance payer system.
Mind you, as far as those I’ve attempted to study and understand over the years, each country is almost as different from each other as they are from the US … so I don’t know how any particular one might work as a model for change here. Especially given the inate selfishness of the US consumer … when, if given the option, a good many would pick and choose coverage for their own needs alone. Childless folk tend to baulk at paying for pre natal/obstetrics care (regardless of the huge cost savings these confer on a system). Single women maybe would prefer a plan that excludes prostate care/male urinary issues and so on. Maybe folk in countries with universal coverage might act the same … and taxation models reflect an understanding of this and, irksome as it might be to some, appear to fare better when delivering care across the board (at least, when viewed from the outside)
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Probably the case. I was wondering if you knew the answer/where to locate the data or were just hand waving that “more and more” were dropping MA plans in significant numbers.
DB2
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I posted this as a starting point:
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Right, and the article doesn’t say what the average number of MA members changing is. The plan we had was discontinued a couple of years ago and we signed up with another one from the same company.
FWIW, we have had no problems with either plan.
DB2
JAQing off, in other words maybe?
As I mentioned, this topic has cropped up on so many occasions that, if someone still needs to ask this question, or is in any doubt that voluntarily opting for a MA plan is an increasingly unsafe choice (regardless of past personal experience) they’re probably better off choosing their own prompts for a satisfactory Google response. I don’t feel the need to provide convincing arguments…even if it required minimal effort and reading on my part.
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Because nearly everything in the US is for sale.
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People that haven’t had any problems with their MA plan tend to be those that haven’t had to use it for an expensive and complicated medical event.
It’s just arithmetic. With Medicare Advantage you’re sending about 15% or so of your $19,000/yr Medicare benefit to a for-profit insurance company’s overhead and profit. You’re buying a lot less care than you would receive, without the attempt to cheat you, in traditional Medicare. As an engineer and “numbers person”, I’m astonished that this needs explanation.
intercst
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It is true that I’m on the lighter use end of the medical spectrum, particularly for my age (78). That said, over the last couple of years – covering both the old plan and the new – I’ve had retina surgery and two operations for cancers. Claims submitted were north of $500K. My cost has been $4K.
That pertains to the cost side, not the “problem” side.
DB2
But isn’t cost one of the big attractions advertised by these plans?..can’t be Joe Namath’s teeth. The promotions make them look appealing for all manner of other reasons too…implying, for instance, an efficient network of primary care, specialty and hospital care plus meds in one cohesive, smooth running package. And it probably would be if the insurance industry wasn’t 100% in control of the $$$bucks. As it is, the problems seem to occur with increasing regularity such that to ignore them when made well aware is pure denialism.
I have friends locally who have managed Medicare (which is what an MA plans is) Not universally thrilled but still don’t understand why dh and I don’t opt for the same…suggesting (incorrectly) that the issues aren’t likely to occur for us because we have some sort of in. Quite the reverse. It’s because we have the insight that we avoid them.
Not wishing to imply they’re making really dumb decisions, I’ll oftentimes point out that, since I’ve spent a good few decades complaining about and doing my bit to fight insurance company intrusion into Healthcare, it would be an act of spectacular hypocrisy to voluntarily place control of my health and wellbeing in the hands of an insurance company
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I think the main attraction is convenience – one stop shopping – rather than cost. But once again, you’re referring to the cost side rather than the benefit side.
DB2
Whilst that one stop shopping theoretical might be attractive to you, from my experience nattering to patients over the years (decades) that I was in practice, one of the things they disliked the most were the somewhat restrictive (in their view) PPO plans and limited HMO networks…which is the reality of an MA plan. Granted, these weren’t specifically managed Medicare, but the cost containment model was the same.
I’d been willing to bet that, as compared to the era I’m talking about, today’s MA plans would make the insurance companies involved look like high spenders!
When you have certain doctors that happen to be out of network, it doesn’t meant that you can’t use the services of those doctors anymore, it just means that you have to pay for their services (partially or entirely). For example, my primary physician back about 8 or 9 years ago stopped being in-network, but I continued to see him regularly and pay the bill as necessary. There was no way I would ever leave his care as he literally* saved my life in 2010. He remained my PCP doctor from 1997 when I first met him (randomly recommended by the person I bought my house from I think) until 2022 when he sadly retired. During those two and a half decades, there were at least 2 periods when he was “out of network”.
* When I say “literally” I am using the classical meaning of the word, not the current vague use of it. He ACTUALLY saved my life by quick action or at a minimum prevented me from requiring an “all heart valve” replacement a few hours later.
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Well, I think this is something of a given…i.e that it’s possible to avoid jumping through the cost containment hoops put in place by a third party payer (insurance industry or taxpayer funded universal coverage system or combo thereof) by the simple act of dipping into one’s own pocket. However, look at the list of doctors that the OP mentions in addition to a primary care physician. This is the real barrier to the theoretically reasonable idea of just simply paying yourself/so called “self insurance”. A primary care physician’s customary fee schedule for what would be considered customary care is not a realistic comparison.
It’s actually become increasingly difficult to get smooth coordination of care between a diverse group of specialists when restrictive networks are in force and paying full whack is impossible/unacceptable (a brief glance at a few of @bjurasz insurance company EOBs would likely confirm the financial barrier alone)
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My understanding is that those are specifically known as “short-term” plans. There are also “off-marketplace ACA compliant” plans that sound much closer to what you’re looking for. If this article is to be believed: Non-Marketplace vs. Marketplace Health Insurance , some of the specific benefits of the off-marketplace ACA compliant plans are often “broader networks” and “PPO flexibility.”
In other words, a better chance that your doctors are covered and a higher likelihood that even if not, your insurance will provide some level of backstop.
You do sacrifice the ACA premium subsidy by going off-marketplace, but it looks like you keep the ACA rules on pre-existing condition coverage and “qualifying event” issuance protection.
Regardless of whether or not that is the specific path you take, the reality is that there are multiple options in front of you if you are looking to make a change before age 65.
With a target of age 60, and including 18 months of COBRA coverage, you’re looking at a roughly 3.5 year period where you might need insurance outside of that currently provided by your employer (and roughly 5-years of you covering the total insurance costs).
That can be expensive, but it is time-bound. Also, if your employer is a tolerable place to work and isn’t shoving you out the door, it sounds like you have some control over how much of that window of time you’re really exposed to.
So it really starts to look like a time vs. money optimization challenge. If you have the financial means, then it becomes a choice. If you don’t have the means, then your options are more limited.
If you do have the means, though, be sure to consider your “active healthspan”, not just your “total remaining lifespan,” in your decision.
Regards,
-Chuck
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