A Couple and Their Coverage

A couple in their early 60s talked about their health insurance coverage. They are among the more than 20 million Americans between the ages of 60 and 65, many of whom struggle with coverage until they become eligible for Medicare. But why?

  • How were they insured? Affordable Care Act (ACA). They’ve been covered through the local BCBS carrier for several years and, while they reviewed other plans, they chose to re-enroll in the same plan for 2021.
  • Why not employer health insurance? Unavailable. The employer, a small real estate agency (<50 employees), was not required to provide health insurance to its employees. “We didn’t expect it to be a problem, but it is.”
  • What needs did they have? Specialists. While in overall good health, each had a chronic condition that required them to see specialists several times a year. “Our specialists have to be in-network.”
  • What about open enrollment? Easy. They compared plans on the BCBS website, and re-enrolled there. “We want to stay with BCBS and, since we don’t qualify for subsidies, it’s just easier than the federal marketplace.”
  • Which plan did they choose? PPO. They re-enrolled in a PPO plan with the local BCBS—although their monthly premium increased significantly—because their specialists were in-network and their deductibles were low.
  • How much do they spend? $2,500/month. They paid full price as their income level disqualifies them for a subsidy through the ACA. “It’s too expensive, especially when we have out-of-pocket costs, too.”
  • What about lowering the eligibility age for Medicare? Of course. However, they understood that expanding the Medicare program posed significant challenges. “We’ll have turned 65 by the time it happens,” they laughed.

While many Americans have employer health insurance, those whose employers don’t offer coverage or who have lost both their job and coverage in the pandemic can get covered by the ACA (Obamacare) or Medicaid. This couple looked forward to being covered by Medicare. In other words, they’re Mastering Health Insurance.

Source: Data.Census.Gov (2019)

Photo: Lake Michigan (January 2021)