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Hi all:

So inspired by early retirement stories! But what do all you Early Retirees do for health insurance? I’ve been on employer insurance all my life and feel overwhelmed by sorting out options. I’m interested in ACA options, especially the subsidy if I keep my taxable retirement income low, and also HDHPs so I can continue my HSA contributions/savings. What is your advice? Where do I start? What are your stories?

I posted this to PB Personal Finance board so apologies if you are seeing this again:
Husband and I hope to retire in the next couple years but will be too young still for Medicare. What are your best resources for learning about and managing subsidies for ACA? What are the strategies for keeping withdrawals from accounts low enough to keep the subsidy? One of our plans is to withdraw some of our contributions to our ROTHs to live on because I believe these withdrawals will not be taxed or show up as income. But I am new to all this and am looking for any and all help or resources out there on learning about ACA subsidies and/or other health care strategies? How have you done it? What are your stories? Where do you go for info?

Thank you all!
BF
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There are basically five options:

1. ACA - hopefully with a subsidy but if not, then congrats as you have a nice early retirement income regardless.

2. If you are married and your spouse is still working, you can be added to your spouse's plan.

3. Seek part-time work for a company that provides insurance coverage.

4. Seek a freelance job that provides insurance coverage.

5. Move to a country where insurance is cheaper and/or the healthcare is cheaper.


I am pretty sure you neither have access to a HDHP nor can you contribute to a HSA without earned income.



If anyone else has any other ideas, please share them. I am personally aiming for #5.



Hawkwin
Who is hopeful that we will eventually see Medicare pushed down to 60 to alleviate this issue for the vast majority of early retirees.
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From Ed Slott

"There is no requirement that you have earned income in order to contribute to an HSA, as there is with most retirement plans. There are also no income limits. No one makes too much money to be eligible to contribute. Contributions are always fully deductible."

https://www.irahelp.com/slottreport/how-you-can-utilize-hsa-...
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The problem with #5 is that if you're an American, nobody wants you. The EU, Canada...? High bars for entry, not the least of which is because they know Americans want their universal healthcare (plus, we're just so damned annoying that they flat don't like us).

intercst spends some time on this topic:

https://retireearlyhomepage.com/health_sum.html

He took the ACA route, and minimized his income to qualify for maximum subsidies. A big part of that was not owning much that paid dividends, as I understand it. Keep ordinary income below something like $90K and there is no tax of cap gains, too. Though I believe cap gains ARE used in the calculation to determine ACA subsidies, so you would still have to control that.
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There is no requirement that you have earned income in order to contribute to an HSA

Thanks!

This lead me to also do a bit more research and I found that there are HDHPs within the ACA network. Learned two things new today.
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The problem with #5 is that if you're an American, nobody wants you.

Psha!

Ever country wants immigrants with money.

https://internationalliving.com/countries-best-healthcare-wo...


https://www.expatden.com/costa-rica/moving-to-costa-rica/
* Expats who enroll and pay into Caja Costarricense del Seguro Social, the public healthcare system, for about $30 per month, have access to 100% healthcare as long as they are active contributors.

* A private medical insurance policy for a 60-year-old woman would cost about $2,500 per year. This type of insurance provides comprehensive coverage at private hospitals and clinics with extremely low deductibles. Many expats opt for this type of private coverage because of the greater quality of care.

https://residencies.io/residency/costa-rica/temporary-reside...

Costa Rica grants a temporary residency visa under the category of “rentista”, to foreign-nationals willing to immigrate to the country, who have a regular monthly income of at least US$2,500 from a guaranteed source for two years.

Usually, this requirement is met by making a bank deposit of US$60,000 at a local bank and by obtaining a commitment letter that at least US$2,500 per month will be made available. This amount includes dependents (spouse and minor children under 25 y.o., or older with disabilities); for additional dependents a higher amount may be required.
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A friend of mine is married to a man from Bolivia. She said health insurance is about $60 per month US but she can only live there 6 months per year.
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Maybe by the time you retire the Medicare age will be lowered enough (60? 55?). Not that I'd count on that.
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I'm on ACA marketplace plan after coming off of COBRA.

My monthly insurance premiums are down drastically, but with a trade off in coverage and deductible.
If I have to use my insurance, I'll probably be in the ballpark cost of my very expensive COBRA coverage. But better to be covered than not.

The American Rescue Plan did away with the subsidy cliff, where if you made just 1.00 over the limit you didn't get any subsidies. But I believe that's only the rule for 2 years and that action would need to be taken to extend it. So if you are talking about retiring in a couple years, things may change.

https://www.hhs.gov/about/news/2021/03/12/fact-sheet-america...

I suggest you go onto marketplace coverage to get an idea of current costs and coverage.
https://www.healthcare.gov/

Using tax programs you can try to estimate your income if the subsidy cliff returns.

As a side note, the Mr. Money Mustache website has a lot of young retirees and threads on this as well.

I hope this helps
nag
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