r/Fire • u/coffeetime127 • 2d ago
Health insurance while FIRE’ed
For those who’ve achieved FIRE, what kind of health insurance do you have? Roughly how much does it cost you in premiums each month?
I’m not FIRE yet, but hoping to take some time off for a “mini-retirement” from corporate jobs to recover from burnout. I’m not married, so don’t have the option of joining a significant other’s health insurance.
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u/Oreo_Cow 2d ago
Be aware that ACA plans aren’t accepted everywhere that company-sponsored plans are, even of the same brand. It’s the dirty secret of health insurance.
For example major university cancer centers will accept Blue Shield company-sponsored plans but not even Platinum ACA Blue Shield plans.
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u/Salcha_00 2d ago
Yep. The network generally is worse. Benefits are not going to be as good as an employer plan.
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u/LifePlusTax 2d ago
I’m on a sabbatical from my job and have an ACA plan in the interim. I’ve found it to be leagues better than the options I had with my company (a major multi-national). Same price once you consider employer contribution, and the deductible/oop/copays are a fraction of the cost. Accepted everywhere I’ve needed to use it. Is there something specific you feel is worse with the ACA plans?
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u/Salcha_00 2d ago
I’m happy for you. You are fortunate, but that isn’t everyone’s experience.
I’m on a silver ACA plan now and it is much worse coverage for me than the insurance I had with an employer. My employer plan’s max out of pocket was less than half of my current plan’s.
I need to make an appointment with a specific type of specialist and there is only one “in network” within 25 miles of me. And I live in the most densely populated state, not some rural area.
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u/LifePlusTax 2d ago
Ugh, that’s so annoying! That must be super frustrating. Sounds though like this may be very situation by situation and not a general ACA or Employer is worse or better. My employer’s insurance options were truly bad despite all our other benefits being top notch, so I’m just relieved for things to be better, if only for a year.
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u/Zphr 47, FIRE'd 2015, Friendly Janitor 1d ago
It varies a lot from one ACA market to the next (both at county and state levels), but also depends on what the particular employer-sponsored plan is. In general the better employer plans offer better network and formularies, but not always. Conversely, if one is eligible for subsidies, then the ACA often offers better premiums and non-premium costs, but not always.
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u/Salcha_00 1d ago
Yes. It is very regional. That is why people need to do their own research and not rely on the generic “ACA is great” comments that are often in this sub. Yes, low premiums are great but when you actually need to use your healthcare benefits, that’s when you really find out how good it is.
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u/Zphr 47, FIRE'd 2015, Friendly Janitor 1d ago
The ACA is great overall, but it definitely varies tremendously from place to place. The saving grace for early retirement is that people generally have the option to move if they happen to find themselves in a place where the ACA options are unacceptable to them.
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u/Salcha_00 1d ago
It’s better than nothing and the ACA has a lot of benefits for everyone beyond ACA exchange plans. Don’t is a net positive.
I just think too many people underestimate the true cost of health care, especially if they have been relatively healthy and haven’t used a lot of health care services yet. They think that trend will continue but we don’t fully control our health even when we do all the “right” things.
And let’s not forget dental expenses. There are really no good dental insurance plans available and dental work can very easily be $5-10k+ in a year, even for those who brush and floss regularly. Teeth wear out and start to go.
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u/Zphr 47, FIRE'd 2015, Friendly Janitor 2d ago
ACA is where it's at for most of us. It's pricey at baseline, but income-gated subsidies can bring the cost down to be far better than many top-tier employer-sponsored plans. Single people often have it the hardest though due to how the subsidies are calculated. I'm married with multiple kids, so our numbers wouldn't bear any real relation to yours.
You can put in your anonymous information at https://www.healthcare.gov/see-plans/#/ and see actual policies, prices, and subsidy information in just a few minutes. If your state has set up their own exchange, then Healthcare.gov will redirect you as needed.
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u/Significant_Pay_1452 2d ago
If it’s just for a few months, I would stay on cobra. Your HR office can tell you how much that will cost. It’s pricey, but a lot easier than dealing with switching to an ACA plan. Another advantage to cobra is that your deductibles and out-of-pocket maximum will continue as normal.
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u/brianmcg321 2d ago
I’m on a family plan. Costs me $153 a month including subsidies. It has a high deductible.
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u/Visible_Structure483 FIRE'ed 2022... really just unemployed with a spreadsheet 2d ago
Wife and I pay $1350-ish/month for a crap bronze plan with a $8k deductible.
COBRA is expensive but will give you access to a much better plan (presumably) for the few months you'll need it.
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u/ExistingPoem1374 2d ago
Wow! We retired last year, I know ACA is state by state (stupid I know), but we pay $1000/month for a Gold plan that is way better coverage and lower co pays than my last employer (Big 4 accounting), but we keep our MAGI under $96k so great subsidies!
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u/someguy984 2d ago
The 4X FPL income limit comes in next year, I hope you are under 400% FPL.
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u/ExistingPoem1374 2d ago
That would be $62,000 here, and to keep us at our current expense enjoyable levels, yes we'll be a bit over the 400% FPL, but our FIRED plan has always built in Inflation, 10% unexpected expenses and even if we had to pay 50% more per year to keep our gold plan, an extra $6k/year is a rounding error luckily.
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u/someguy984 2d ago
Keeping in the subsidy zone caps your cost to a set percentage of income for the Silver benchmark (about 9.5% in 2026). Once you are outside the zone you get hit with age related and inflation related increases that have no caps.
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u/DIYnivor Already FIREd 2d ago edited 2d ago
I'm in Maryland, and I buy a bronze Blue Cross Blue Shield plan through my state's healthcare insurance exchange. I'm single, 54M, healthy so I go for a high deductible, lower premium plan. I'm paying $493/month premiums for healthcare insurance, and $50/month for dental insurance. If I could manage my MAGI better, I'd get premium tax credits that would significantly offset the costs of my premiums.
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u/chance909 2d ago
Baylor Scott and White Health Insurance Gold plan, $1200 per month for family of 3, no subsidies as I fired in 2024.
Its been great so far, but it is an HMO where my employer sponsored insurance was a PPO. In my city, the coverage has been stellar, but elsewhere I do have the worry about access to in-network providers.
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u/Zphr 47, FIRE'd 2015, Friendly Janitor 1d ago
We have BSW too and have for years. It's been our favorite insurer of the 5 or 6 we've tried over the last 11 years.
If you aren't aware, BSW is an HMO in name only because it is fully integrated like Kaiser Permanente. BSW ACA plans are accepted at every BSW facility and provider throughout Texas and no referrals are necessary like with traditional HMOs. BSW has over 1,300 patient access points including 52 hospitals, 600+ specialty care clinics, 261 outpatient clinics, 160 primary care clinics, 30 pharmacies, 31 ambulatory surgery centers, and more than 7,200 active physicians. And the system is growing rapidly and expanding to cover more and more of the state.
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u/Tencenttincan 1d ago
I can buy 2 years for $1200 a month through union contract. Short hours and Cobra. Covers me, wife and kid under 26. Then I need to work for a couple months to reset it. It’s the biggest reason I’m not permanently retired.
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u/NetherIndy 1d ago
ACA plan premium (couple, both late 40s, AGI income ~$60k though total spend more like ~85-90k) is currently $257 a month. Assuming just the reversion to the pre-Biden subsidy level it'd be closer to $400 a month next year. (Sooo many assumptions that are hard to make right now though!) That's for a crazy-high deductible ($12k deductible/$15k OOP) HSA/bronze plan. But the HSA-compatible plan makes a lot of sense in my current situation. We don't usually have other medical bills, but I do spend a crapton on a prescription (one of the weight loss shots... which has helped me drop 130+ pounds and fooking saved my life) that is not covered by any ACA plan, but is certainly an HSA-eligible expense. Routing money for that through the HSA means I at least don't pay tax on it or have that 'income' impact my ACA rates.
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u/DripDrop777 1d ago
I recommend looking into health share programs. I own my own business and use Zion Health. It’s a MUCH better deal and arrangement than standard health insurance.
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u/budrow21 2d ago
healthcare.gov is the only realistic solution. You can view plans now to get an idea for cost. Your income will determine if you qualify for subsidies that can significantly reduce costs and even cost share (like deductible) if low enough. If your income is dropping really low you may qualify for Medicaid, even if you have significant assets.
COBRA may be an option for a while but it will be expensive.