https://www.gpo.gov/fdsys/pkg/PLAW-104publ191/pdf/PLAW-104publ191.pdf is the text of the HIPAA of 1996. Title IV restricts the imposition of pre-existing condition limitations on new insureds of group health plans for those previously covered for a specified amount of time recently.
So does that imply the following: just donāt change jobs or health insurance until age 65?
If so, it is not that helpful for our kidsā generation.
1986: COBRA: those losing employer group coverage may buy into the group coverage for 18 months afterward.
1996: HIPAA: employer group coverage may not restrict pre-existing conditions for new employees who previously had sufficient continuous coverage.
2014: ACA: new individual and family plans may not restrict pre-existing conditions; individual mandate or tax penalty.
In theory, ACA is supposed to ensure the availability of individual and family plans, although some areas have very limited offerings, and ACAās future is in doubt. If ACA is repealed or offerings cease to exist on the ACA exchanges, then people with pre-existing conditions basically have to remain employed at employers with group coverage (with gaps shorter than the COBRA limit) until reaching Medicare age minus the COBRA limit, or becoming poor enough to get Medicaid. However, the HIPAA rules allow changing jobs after sufficient continuous coverage without pre-existing condition limitations.
Or, for those few who become wealthy enough, reserve a few million dollars to be able to self-pay any needed medical care if insurance becomes unavailable or inadequate.
The ability to ājust stay at your jobā until youāre 65 implies that the choice always made by the employee. This is not the case. Folks who have been employed with the same company 25 or 30 and are mid-50s are prime targets for corporate layoffs.
If we have to pay $30,000 a year for our health insurance, so be it. My fear is that we wonāt be able to get any decent coverage at that price. Thatās ridiculous to me.
The disparity (luck) between different companies/plans for those who retire early is maddening to me. My cousinās husband retired early and his company allows for continued coverage at a subsidized rate for them - I think they pay $400 a month or so. Just happened to work for a company that does this. Another friendās husband retired early from UPS - I think they pay $25 a month? Granted - both of these people were long-term employees - at least 30 years. BUT, what really gets my goat is that I look at the actual health of these couples compared to the health of dh and me, and there is no correlation between the health of people and what people pay.
Sorry - I realize that probably has no relevance at all, but it bugs me.
^wow - sorry for so many typos!! I clearly needed more coffee!
I keep coming back to how insane it is that we tie health care to employment in this country. Could you imagine if K-12 education worked the same way?
Many times one spouse has a mediocre job but excellent insurance benefits. When both H and W have some work options - many decisions in life.
It may seem ill considered, however, could you imagine if it was changed? As if the companies would then take that additional money not used towards health insurance and pay it to the employees. Ha! Stock buybacks and management bonuses going through the roof alreadyā¦
My company self insures. Really great insurance for very cheap. Iām not sure how they work that out, but they do.
Self insuring is where the insurance company essentially gets paid to process the claims and the company takes the risk for a lot of high end medical costs. When I worked for TAMU, they were self insured - had BCBS of TX; we had claims pre-processing (early 1980ās); I worked for Insurance and Risk Management. employees reported medical fraud (we had a chiropractor that was successful prosecuted - he would charge for services not performed.)
Your insurance with COBRA will be a whole 'nother story. For family, for example we paid only a portion, and maybe $400/month. Each DD would have had to pay over $600/mo for COBRA/single. When they got insurance through their jobs after college graduation, we changed our family plan to employee plus one, and they/our company with our insurance coverage was obligated to have DDs show that they did have insurance, and DDs also received packets of what COBRA would cost.
If one had a ālife change eventā and were under 26 years of age, we could add them back in based on the legal say so.
Tying health insurance to employment was the result of a deal that Harry Truman (I think) made with labor unions to get something done. It gave them more chips in the bargaining. Completely senseless.
In an ideal world, @busdriver11, we would transfer it to a single entity that would have vastly more bargaining leverage over drug companies, hospitals, etc. and increase either corporate or personal tax rates to cover it. When the German or Australian government agencies contracting for drugs give a company the choice of either being in the country or not, they have a lot of leverage on price ā and they use it. Take a look at the graph within this paper: https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier or this, which is specifically about drug prices: https://www.bloomberg.com/graphics/2015-drug-prices/. According to experts, the German system could be a good model for the US: https://www.healthaffairs.org/do/10.1377/hblog20161229.058150/full/ and https://www.hsph.harvard.edu/news/hsph-in-the-news/german-model-for-drug-price-regulation-may-be-good-for-u-s/.
https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html describes some of the history behind why US medical insurance is so closely tied to employment.
Basically, during World War II, there were labor shortages (since many people went into military service), cash pay was frozen, and medical insurance benefits were declared tax-free. So employers competed for employees with medical insurance benefits in lieu of competing on cash pay. Post-war, proposals for national medical insurance in 1945 were opposed by businesses, unions, and the medical industry.
Wellā¦young self employed folks are really screwed. Itās a LONG time for them to be Medicare eligible.
It sounds like the German model for drugs is s good one, @shawbridge. However, I donāt know about their healthcare system. Donāt know if this is still true, but Iād heard that anyone who can afford private insurance, buys it.
āWellā¦young self employed folks are really screwed. Itās a LONG time for them to be Medicare eligible.ā
Iām not sure that is necessarily the whole story. If you are already self-employed then you presumably have a plan. Thereās no reason to think those plans will be cancelled even if they are no longer offered. And if underwritten plans (i.e. those that can turn down sick people) are allowed again, many self employed people would qualify for those plans and be able to pay less (after all if they really wanted great healthcare and low deductibles most would have looked for the better coverage available from employers).
The people who would lose out would be a) those stuck with legacy ACA health plans because they have poor health, since those plans would have spiraling costs due to adverse selection and b) those who donāt want to leave a job because they wouldnāt qualify for underwritten health insurance.
I have lots of sympathy for the people in category a) if they donāt get subsidies to pay for their insurance, but I very much doubt the number of people in category b) would come close to the number of people who could get cheaper plans because they are healthy and therefore might be more willing to become self employed. And itās already becoming a problem to leave a job and become self-employed because ACA plans (or COBRA) are incredibly expensive if you have to pay the whole cost yourself.
So as the cost of plans continues to rise, the question of how to manage the care for category a) people is critical. In particular should cross subsidies be implicit (young and/or healthy people pay more than their actuarial risk as under the ACA) or explicit (high risk insurance is subsidized for people who canāt get underwritten coverage as in the pre-ACA arrangement). It all traces back to the US spending more on health insurance than other countries, but that problem is not likely to be fixed before the current system breaks down.
Folks, hold on to the handrails. Mr B aka the market bull has just turned negative. He never, ever touched his 401(k)ā¦ and he has just rebalanced it in a quite conservative way.
āNegativeā or just āconservativeā?
If your total Asset Allocation was heavy into equities (as a %), and you are nearing retirement, it may make perfect sense to balance that out with bonds/short term instruments. (I did just that two years ago, and therefore missed a bigger run up, but still sleep well at night.)
Iām out of the market [ as a month ago] and totally into cash/ short term CDās.
It aint over yet [ and may be quite a while before I go bottom fishing}, with US interest rates scheduled to continue to rise + trade tensions + the tax cut stimulus petering out in 2019 + who knows what else may be coming down the pike.
DH thanked me for getting us out in early Sept.
Close to 100% cash is ānegative.ā Not conservative. His previous allocation was just fine thankyouverymuchforasking. 
This is just one of the accounts, but very uncharacteristic of him, aka the market bull who would always stay the course. And he is not close to retirement yet.
True dat, BB.
Time to go to the mattresses? 
Well, PenFed has raised rates for savings accounts, 1.64%, I believe for $100K minimum deposit. Might be a tad safer than a mattress. CDs are out there, but there tend to be early withdrawal penalties.
We will likely put some of our cash into a safe newer/new car.