America’s healthcare system is already a hotly debated issue and it’s heating up even more during this presidential election year. Most politicians admit publicly or privately that our healthcare system is out of control if not completely broken, but they certainly don’t agree on how to fix it. Rather than even attempt to address systemic issues, I want to focus on the particular challenge of health insurance for men over 50.
For many of us, our health insurance coverage has been provided through our full-time employment. For the most part, someone else has made the coverage buying decision and presented you with limited options. In recent years, the trend has been to a larger percentage of employee-paid health insurance premiums, so the cost burden is lower for the employer. As an employee, paying higher premiums may not be desirable, but you generally do not have to deal with the selection or administration of the coverage.
Employer health insurance plans have been viewed as a right, not a privilege. In my full-time employment years (both as employee and employer), I took employer-paid health insurance for granted. Not only that – the employer-paid plans were excellent: The majority of the monthly premium was paid by the company, deductibles were low, and the coverage was comprehensive.
Nowadays, full-time employment is not a guarantee of similar health insurance coverage. Employers have become stingier and workers are expected to shoulder more of the burden. If an employee leaves a full-time position, retaining health insurance coverage becomes a problem. For example, I left a company with a fine health insurance plan and started my own small business. I was able to stay on my previous employer’s plan for a short period of time via COBRA (a federal law that in most cases lets you stay on your previous employer’s health insurance plan for up to eighteen months, if you pay the full premium yourself). When that ended, I had to purchase health insurance on my own, since I was not yet Medicare-eligible. This was prior to the implementation of the Affordable Care Act. My private health insurance plan became my largest monthly expense.
This is the health insurance conundrum for men over 50 but not yet 65 years old who are no longer employed full-time or who are self-employed. With no employer to handle health insurance coverage details, you are individually responsible for obtaining health insurance coverage for yourself and, potentially, your spouse and children. This is a considerably different challenge – now you have to acquire health insurance coverage from the “Health Insurance Marketplace.” As you’ll see, there are certain enrollment periods and a variety of plans available at different prices. Not surprisingly, the most affordable plans have the highest deductibles.
Unfortunately, the conundrum doesn’t end when you turn 65. This is the age at which you are eligible to sign up for the federal health insurance program known as Medicare. What if you reach age 65 but your spouse has not yet turned 65 and does not have health insurance coverage through an employer? Since Medicare covers only the individual who is 65, your spouse would need to get separate health insurance coverage through the Health Insurance Marketplace. I know people who have done this and let me tell you, it is not an enjoyable experience.
When I reached the age of 65, I signed up for Medicare. While I was relieved of some of the health care insurance costs, I quickly learned that Medicare is not a comprehensive nor free program. Part A (hospital coverage) is provided without cost, but Part B (other medical services such as physicians) requires a monthly premium payment. If desired, you can also choose from a number of Medicare prescription drug insurance coverage plans (Part D). Part C of Medicare offers another entirely different option called “Medicare Advantage,” a completely different type of Medicare plan that may or may not provide coverage that suits your needs. Not included as part of Medicare are supplemental health insurance plans – so called “Medigap” plans – offered by private insurance companies. These plans, which are government-regulated, are designed to literally cover the gaps in Medicare coverage.
The fact is, if you are on Medicare and you want health insurance coverage that is anywhere close to the insurance you enjoyed as a full-time employee, you will likely be paying for it one way or the other. Ironically, you may be doing so at a time when you can least afford it. Since there is no “family plan” in Medicare, if your spouse also wants to be covered by Medicare, he or she will have to sign up individually.
Don’t get me wrong, I am happy Medicare exists. It does relieve those 65 and older of the burden of catastrophic medical costs at a time of life when they are more likely. For those who are willing to pay for it, more comprehensive coverage is available. With all of its flaws, government-supported Medicare is surely better than paying for private insurance or having no health insurance at all.
Still, if you leave full-time employment prior to age 65, getting and paying for your own health insurance coverage is no picnic. Even when you turn 65, Medicare will not be equivalent in coverage to what you probably enjoyed as an employee. That means you will be paying for health insurance at a time when you are likely to have reduced income. That’s a budget line item that many of us will find increasingly difficult to swallow.