I recently had a couple come see me regarding health insurance for 2022. They are currently covered by their employer, but are starting their own business at year’s end. They won’t have employer coverage going forward and don’t qualify for a subsidy under the Affordable Care Act. So healthcare will be eating up a significant portion of their monthly budget.

The husband is turning 65 years old in January 2022 and will be eligible for Medicare. His wife will be turning 64, also in January. They actually share the same birthday, just one year apart.

But what a difference a year makes.

Since they both travel for work and play, it was important to have coverage outside of Michigan. While looking at the coverages available to them it became apparent that the one year difference in their ages made the strongest argument possible for universal healthcare or at the very least lowering of Medicare eligibility age to 60 or even 55.

We did a side by side comparison of an ACA Silver travel plan and a Medicare Advantage plan. For her the monthly premium is $1,020.89 with a $5,500 deductible. For him the monthly plan premium is $0, and his deductible is $0 (he will have to pay $157.70 for his Part B Medicare). So right out of the gate there is a difference $15,858.28 cash outlay.

Although there are many services covered for her before the deductible, her exposure and overall cash annual outlay far exceeded his. He has an annual out-of-pocket maximum of $5,650. Her maximum out-of-pocket limit is $8,700. Add in her premium and she’s responsible for over $20,000 before she has 100% coverage.

In addition he will have dental, vision, hearing and myriad of additional benefits that are available to her at additional cost. He will have out of state at any doctor or hospital under the Medicare, she will be covered by a specific limited network. The list goes on and on. Sadly there is very little anyone can do under our current healthcare system.

One of President Joe Biden’s campaign promises was to lower the eligibility age for Medicare. So far he has not added this to any of the proposed legislative items currently before congress. But the rumblings have started.

A group of 80 House Democrats wrote to the White House on Monday calling for Biden to lower the eligibility age to 55. “Lowering the eligibility age and improving its benefits package would provide immediate and substantial relief for millions of individuals throughout the United States, as well as much-needed long-term security,” the letter said.

And they are right.

The Kaiser Family Foundation (KFF) released a report last week that showed that by lowering the eligibility age for Medicare there would be a corresponding lowering of costs for employer-sponsored health plans. They found that if people age 60 to 64 were no loner enrolled in their employer plan, the costs for those plans could drop by 15% and if we lowered the eligibility age to 55 the costs could drop by as much as 30%.

According to KFF the average annual worker and employer contributions for single and family coverage in 2020, for a PPO plan, is $7,880 for single and $22,248 for family. Of that the employee pays $1,335 and $6,017 respectively.

A 30% reduction in cost would be $2,364 for single employees and $6,675 per family. That could translate into higher wages and greater capital investment for so many business. Yet when we look at the billions upon billions of dollars earned by the health insurance industry coupled with the hundreds of millions contributed to congressional campaigns to maintain the current system, it is a very high mountain to climb.

It just seems so unfair when 12 months is the only difference between paying $0 and paying $1,021 per month for health insurance. Obviously our current Congressional representative has no incentive to change the status quo, but we do.

Add your voice to those already fighting for healthcare reform. Email the White House at whitehouse.gov to tell them to keep their promise and make healthcare more equitable.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a financial services, and certified health insurance organization, now affiliated with Michigan Planners, in Traverse City. Questions or comments about this column or interest in our monthly Medicare classes can be directed to (231) 922-1010 or fred@srbenefitsolutions.com.

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