A Couple and their Coverage in Southern California

A couple in Southern California talked about their health insurance coverage over an online dinner during the pandemic. He retired when he turned 65. She’s 60 years old and still working “for the health care benefits.” Here’s their story.

• Why employer coverage? The wife’s employer offered a PPO plan, which had a broad network, generous benefits, and reasonable costs. She’s always covered her husband, who was an individual proprietor. They’ve been pleased with the health plan through several serious illnesses.
• When Medicare coverage? The husband enrolled in Part A (hospital) when he turned 65. He didn’t enroll in Part B (medical) because his wife’s plan was less expensive. It also met certain qualifications so he won’t be penalized when enrolling in it in the future.
• What about pre-existing conditions? They worry that, if the Supreme Court overturns the Affordable Care Act, her employer coverage may be affected because of his medical history. While unlikely to affect employers (and Medicare), “you never know what could happen.”
• When retirement? The wife doesn’t plan to retire until she turns 65 because she needs coverage. The cost of a health plan—through COBRA or Covered California—would be prohibitive. “I’m hoping Biden is elected president and expands Medicare to 60-year olds.”
• Where next? They’ve lived their lives in Southern California with its excellent health care delivery system. “We have friends who moved to the country only to drive 40 minutes to the nearest hospital when one had a heart attack.”
• What else? Two cats and a dog live very nice lives. But as they’ve aged, they’ve had a series of health issues—atrial fibrillation (who knew?) and pancreatic cancer—that have proven very expensive. “If we’d only insured them when they were young and healthy. Now, they’re like people who can’t afford insurance!”

The couple loves to travel. They’ve spent a few weeks every September enjoying Europe, where they’ve learned that Europeans don’t depend on their jobs for health care coverage. But they’ve had to postpone this year’s trip because of the pandemic. In the meantime, they’re Mastering Health Insurance.

Photo: Southern California Skyline