Early Retiree Shares His Mastering Health Insurance Story

A 55-year old Human Resources executive retired after more than 30 years in the business world. “A heart attack forced me to change my lifestyle. I couldn’t do the global travel every week anymore, so I retired.” He’s now covered by COBRA with a national for-profit health insurance carrier, but his coverage comes to an end soon.

What is important to him? The early retiree answered a few questions:

• Medical needs: Yes, a history of heart disease, but otherwise healthy.
• Physician relationship: Yes, a cardiologist who is associated with a major medical center.
• Financial concerns: No, he’s fortunate to be able to afford individual coverage.

What has he done so far? He’s a sophisticated consumer who has shopped for coverage on the federal marketplace (www.HealthCare.gov). Unfortunately, none of the plans have his cardiologist and his associated medical center in their networks.

What should he do next? Work with a licensed health insurance broker to identify all of his options:

• Any plans available directly through health insurance carriers (but not on the marketplace)
• A conversion policy through his current carrier
• A plan on the federal marketplace

What else? The early retiree can always see his cardiologist, but he will be responsible for out-of-pocket costs if his cardiologist is out of network. If he enrolls in a plan with an out-of-network benefit, he will get some coverage. He can further control out-of-pocket costs if any other services are done in network.

If he needs to be hospitalized in an out-of-network hospital, he should make arrangements with the hospital’s finance department if at all possible. The hospital may be willing to work with him, especially if he has financial resources. Otherwise, best to find an in-network hospital that can meet his current and future needs.

Finally, the early retiree is now free to travel the globe on his own terms. “My passport is still always ready, but now I invest in a travel health insurance policy before I go anywhere. And while it is expensive, it’s the only way to travel.” In other words, he’s Mastering Health Insurance.