There really aren't that many local insurers anymore, most plans are backed by one of the big four networks.

This is part of the problem, smaller health systems have little negotiating power with someone like BCBS except to go out of network, and the only people that really hurts are the patients.

This is a fascinating thread and very critical to me. I just turned 58. I was made redundant in Jan this year and I had an accident that makes it unlikely I will work again. I had/have United Healthcare insurance, which the company continued to subsidize for 6 months and has recently gone from $100/month to $600/month. So I need to change. Not sure if I qualify for Medicare/Medicaid. Obviously its a complicated situation and technically I am not retired! I'm reading everything here avidly. If anyone has specific advice for my situation I am all ears. Thanks. Rx

I think applying for SS disability would be the way to go.

You should be able to login or create an SS account online and it will show you, based on your contributions, what you might qualify for under SSI.

You'll likely need an attorney.

You'll most likely be put on Medicaid until Medicare age should your application be approved.

Thanks CS that's about what I figured. Good to hear it from someone in the know! Hope you are well

Eek! I did not mean that to disrespect the others who have commented. Sorry if it sounds like that!

Rich - sorry to hear about your situation. Sounds like a really lousy year. A few thoughts and questions about your forced retirement.....

Did your accident occur after your were laid off? If you were injured prior to the layoff, should you have been on long-term disability (assuming the company covers you for that)? You said the company subsidized your insurance for 6 months - was that part of the layoff package? Understand that you can also sign up for COBRA which gives you 18 months of coverage under your employer plan but without subsidy.

To qualify early for Medicare as others have noted you need to qualify for Social Security disability. I'm not sure if that gives you a break on Medicare premiums though. Medicare + supplement + prescription drug coverage can run $300-400 a month (assuming you qualify for free Medicare Part A). You can also purchase an individual policy on the ACA marketplace and the price you pay depends on your income. Are you living on retirement savings now? If so, you might be able to manage your adjusted gross income down to a level which gives you a significant subsidy on a ACA policy.

Medicaid is basically for the destitute. Medicaid has very broad powers to investigate your total net worth - retirement savings (including tax-sheltered and creditor-shielded accounts like IRAs and 401k), real estate, everything. You have to spend down almost all of your savings before you qualify.

And now something important which you haven't indicated yet..... what were the circumstances of your accident? Was it just a freak thing involving only you, or was there another party involved? Speaking from experience of being in an auto accident and finding out what my regular medical insurance did not cover in that situation (yes, there can be limitations you don't know about until it happens.....), I now understand why personal injury lawyers are necessary. If another party might have been liable for your injury, I hope you have consulted an attorney.

And finally, you say your are paying $600 a month for insurance. Frankly, at your age that's not bad, so I understand you want to get that down, but it's not an unreasonable amount. I'm retiring at 62 and plan on spending somewhere in the region of $600-800 per month (depends if I go COBRA or ACA), for a very high deductible plan. I am planning on $400 when I'm on Medicare at 65.

Thanks Pierre! Its interesting, I cant remember if I was still working at the time of accident. I was working from home on and off around the time of my accident, which was my fault,, I was drunk at home and fell and hit my head. but a welfare check found me unconscious in bed. and i remained unconscious for 2 weeks. The work record shows the office closed a week or 2 before the accident and my memory tells me I continued working till the accident but I cant verify that. Except I still have the work laptop, wiped of company business.
I believe the 6 months extended subsidized coverage was due to COBRA. I just got a mailshot from United Healthcare that suggests medicare/medicaid options. I havent followed up yet.
I think applying for social security should be my priority Disability allowance. I am not completely disabled but I have days its hard to get to the mailbox!

It can actually be much worse than that. Some COBRA coverage explicitly states that it is secondary to Medicare _whether or not_ a person actually signs up for Medicare. There was a horrible case I read about recently where someone with a younger spouse was using her employment coverage and then she stopped working and they both went on COBRA. He then discovered he had a rare form of cancer and in six months had ~$300k of medical bills. The COBRA coverage paid it out until they noticed that he was past Medicare age. They are now taking legal action to get the $300k back that they "overpaid". I think the guy is dead now so it's a claim against his estate.

The rules for healthcare access in general are so ridiculously complex that it's inevitable that some will fall foul of gotchas like this. "American Exceptionalism" or something.

And then, when you've got yourself a great medical plan and you think you're covered for everything.... think again. Ever had a car crash? You think your comprehensive medical insurance will pay to put your broken body back together? Not necessarily. And you won't know this until *after* your accident of course. Like you said, there is always a gotcha.

Between the gotchas, debt collectors coming after me for unpaid bills because of insurance company screw ups, coming home to find my wife in tears (again) having spent all day on the phone trying to sort out messed up billing and mail-order prescriptions which haven't arrived and she's run out, the 'fake' top-line billing (you know - top line price $20,000, insurance negotiated price $1900. How can there ever be a 90+% discount on anything? It's all BS), there have been many times I've just screamed in frustration at the madness of it all.

And just last week something else..... COBRA is a federal requirement to allow up to 18 months of continuation medical coverage from your company insurance, but I found out that California has 'Cal-COBRA' which might give you another 18 months on top of that. I had no idea about that. There seems to be no end to the research needed to understand all you need to know, and there's always a feeling you missed something important.

With the "might" being the operative factor! It doesn't apply if your employer is employer is _self-insured_, as many large companies are.

Indeed. But the definitions you find are confusing. Self insured plans aren't covered, but PPO HMO etc are. I have a PPO but that's just an admin layer because the company actually pays claims directly via the insurance company which manages the interface with medical providers. So...it seems to be self insured, but is that how Cal-Cobra interprets it?

That's a good question. I know the only policy that my erstwhile self-insured employer had that was covered by the California COBRA rules was Kaiser - an HMO.