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One of the greatest benefits I received from my last employer was the gift of health care insurance in my retirement years. At the time I was hired (almost 28 years ago), they offered an early retiree benefit: work for twenty years and, if you chose to retire after you turn 55, you could continue to receive coverage as if you were an active employee. Needless to say, it’s a benefit they no longer offer.
I retired on my 55th birthday, after nearly 24 years of employment. I have to pay a portion of my health insurance premium and it’s been steadily increasing. Next year my share of the premium will be $409/month versus the $240/month I’m paying this year. The full cost of the insurance (according to my former employers website) is $ 1223 per month.
I assumed my premiums would go up over the years although even I’m surprised by the magnitude of this year’s increase. But it was the chance I took retiring at such a young age.
This morning I found this article on CNBC: https://www.cnbc.com/2025/10/17/aca-enhanced-subsidy-lapse-government-shutdown.html
It documents a couple who both retired early, ie. before they became eligible for Medicare. They estimate they’ll earn $127,000 in pension income in 2026 and are upset because they may not get their ‘enhanced’ ACA healthcare plan subsidies. They currently pay $442/month (total) for their ACA care insurance plan that covers both of them. The ‘enhanced’ subsidies were introduced during the pandemic to allow more people to afford to enroll in the ACA plans. Based on their income, they wouldn’t have been eligible to receive subsidies prior to the pandemic. Without the ‘enhanced’ benefits, their ACA premium will jump to $1700/month for the two of them.
It makes me wonder how many people jumped on the ‘early retirement’ boat between 2021 and now assuming that the ‘enhanced’ ACA premiums would be in place forever. $1700/month in premiums for two people isn’t unusual–and a bit of a bargain depending on the coverage they have. If I were covering my husband on my ‘early retiree benefit’ plan, we’d be paying nearly $1100/month for coverage (with my former employer picking up an additional $1350/month). And our income is nowhere close to the $127,000 a year the couple in this story have.
I guess I’m both fortunate and lucky! Given the option to either retire or continue employment in an extremely stressful and competitive environment, I took advantage of an early retirement offer over 25 years ago due to a corporate merger/downsizing. In addition to my pension, both me and my wife get reimbursed for our monthly Medicare premiums and our supplemental Medigap insurance health premiums; it also includes Part D drug premium coverage. We are very thankful, but like Richard Quinn and corporate benefit bulletins indicate each year, the company states they reserve the right to discontinue these ‘benefits’ at any time and for any reason.
My spouse retired early because of serious health issues. She hated the entire ACA system; the annual research for insurance and high monthly insurance fees. Add the deductibles and we were paying more than $14,000 a year for her, and that was 10 years ago.
In America we tend to conflate insurance with care. They are not the same and must be approached separately. The ACA is a subsidized insurance with progressive fees. When we reach Medicare age we can move to Medicare Advantage plans that insurance companies loved because of the profits generated.
I do have a Medicare Advantage plan. My out-of-pocket costs have always been what I consider to be “reasonable”, particularly when I review the various statements. In one year, the total billed was more than $750,000; the next was about $500,000. My out of pocket never exceed two percent, including the cost of transportation and insurance.
In general, I’ve received excellent care. In 2023 I was given a few months to live. I’ve greatly exceeded that, in large part because of the efforts of my doctors and my involvement in my care. I have an opinion about insurance and then I have a separate opinion about medical care. I further differentiate between hospitals and other care. Hospital emergency rooms are a crap shoot. Quality of such care is determined by the doctors on call and the hospital. No matter what the circumstances, there are always going to be risks. One has to be an advocate for oneself, become educated about treatments, conditions and risks.
Staying alive and living a useful life may require real work.
What matters most is the quality of available care. How to pay for it is another matter. For too long, Americans have made assumptions about this, and with the specialization of doctors, which is where the money is, it is becoming increasingly difficult to find a GP. For that reason, both my spouse and I have a Nurse Practitioner supported by specialists.
A challenge with the current approach is determining how to get care. Hospital Emergency Rooms and Urgent Care facilities are always an option. But I prefer to avoid them. For example, I recently experienced what seemed to be a kidney infection. I contacted my nephrologist, who is responsible for my kidney care. However, I found out that I really needed to speak with my urologist about this. I also routinely and periodically require a bilateral nephrostomy replacement. Neither the nephrologist or the urologist handle this. It is required that I contact Interventional Radiology. Periodic CT and MRI’s are arranged with my oncologist. I make copies of lab and imaging results and so on, and provide them to my NP. Why? First, I want an objective individual to monitor my health. Second, because transfer from one department or to another, or to a different medical group is difficult. I’m not the only one who experiences this, with others telling me of their experiences in MI, CT, NY, IL and AZ.
The costs of dealing with extreme old age and deadly disease, and the attendant quality of life issues are another problem, altogether.
I recall when the ACA was being debated and the proponents stated that if not approved there would be “death camps” in America. Fear was a primary motivator and remains so, today.
I know this is a discussion about the expiring ACA subsidies but I have to say this. Our health care system is a mess. The way someone qualifies for insurance, the way they pay or not pay for it, all the entities taking a percentage of the healthcare dollar, it’s all illogical and it cost us in lives since we spend the most but don’t get the results.