Find and Manage Health Insurance Between Ages 62 and 65
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When planning ahead for retirement, one of the concerns many people have is how to manage the health insurance gap between the ages of 62 and the age of 65 when retirees are eligible for Medicare.
This article will cover:
The key 18-month COBRA window
Spouse’s employer coverage
ACA Marketplace
Soft retirement employer coverage
Healthcare subscriptions
Making the right choice for you
The 18-month COBRA Window - Did you know that 63 ½ is a very popular age for retirement? Some pre-retirees home in on the 18-month window prior their 65th birthday as the ideal time to resign. Why? If you purchase your health insurance through your employer, you may be eligible for COBRA Continuation Coverage up to 18 months after you resign. This allows you to cover the gap until you are eligible for Medicare.
Because your employer will stop contributing their portion of the monthly premium, you will have to pay yours, theirs, and a 2% administrative fee for the duration of your coverage. Your total monthly outlay may be a bit of a financial shock, but if you have underlying health conditions and/or need to keep the same healthcare network and doctors, this is often a good path to consider. Note that you cannot be enrolled in COBRA and Medicare concurrently. Once you turn 65 or enroll in Medicare, your COBRA coverage will end.
Consider Coverage with Your Spouse’s Employer - If your employer’s COBRA premium is too pricey (or your current employer doesn’t offer health insurance), another option is to look at your spouse’s employer for coverage. Your retirement will trigger a Special Enrollment Period (SEP) because losing your employer’s health insurance will be deemed a ‘qualifying life event’.
This option will be less expensive although you may be transferred to a new health network. If have no spouse, or they do not have health insurance through an employer, you will need to continue to look at options.
Look Into the ACA Marketplace - The next consideration is to check out the Health Insurance Marketplace (aka Obamacare) for insurance at https://www.healthcare.gov/. You will be able to find various coverage options/tiers though the premiums may be pricey. Insurers are allowed to charge older adults up to three times more than younger adults. This is because older adults utilize healthcare services on a more frequent basis than younger adults.
Premiums can reach $1000 per month or more, so qualifying for financial subsidies will be very important when choosing ACA Marketplace coverage. You can get an estimate of what your cost could be by using the KFF Health Insurance Marketplace Calculator. You have 60 days to enroll after a qualifying life event (like losing health insurance through your employer), or you can enroll during Open Enrollment which runs from November 1 to January 15. Note that enrolling by December 15 activates coverage on January 1, while signing up between December 16 and January 15 starts coverage on February 1.
If you opt for the ACA Marketplace, it is important to know that coverage does not cancel automatically at age 65. When you begin the process of enrolling for Medicare, you will need to update or close your ACA Marketplace application at the same time to help prevent tax penalties or paying full-price dual coverage.
Part-time Employer Coverage - You may be wondering what this is all about. Such trickery! You are looking to retire, not to sign up for a part-time job! Right?! Many retirees are considering ‘soft retirement’. Soft retirement is scaling back responsibilities and hours, or making a switch altogether to a lower stress role.
Not everyone knows that there are part-time employers that offer health insurance. This allows you to keep coverage for a reasonable monthly cost and also limits the amount of money you withdraw from savings during the first few years of soft retirement. You can find out which part-time employers offer health insurance at https://findaworkaround.com/find-jobs-beyond-50/part-time-jobs.
Healthcare Subscriptions - These are options that are meant to fit alongside your insurance plan, not as a replacement for them.
Direct Primary Care Memberships - Health insurance premiums are rapidly increasing and healthcare is becoming unaffordable for many Americans. These membership-based or direct care models charge a flat monthly or annual fee to cover routine primary care, telehealth visits and prescription discounts.
My Primary Care Physician offers this model:
Telehealth and in-office appointments limited to 20/year for a 12-month membership
24–48 hr appointment availability for sick and urgent visits
Cash-friendly labs and imaging guidance
Annual Wellness Exam
Discounted supplements and labs
Clear, predictable fees: Ages 41–60: $85 every 4 weeks, Ages 61+: $110 every 4 weeks
No co-pays
Once you buy a membership from the medical office, they do not bill insurance. Outside insurance is recommended, but not required. They can give you a list of labs and facilities that are ‘cash-friendly’, but in some instances your care may require hospital services. In these cases, you would need traditional health insurance to cover more detailed labs, imaging, medications, and doctors’ services.
Some people that are without health insurance, or have high-deductible commercial insurance plans, are seeing these direct care models as viable options.
Hybrid & Virtual Care Networks - Services like Amazon One Medical ($99–$199/year) combine 24/7 app-based virtual care with access to physical clinics where traditional insurance is billed for in-person appointments.
Many people have said the convenience of virtual appointments is great and all they really need for the basic ills and ails throughout the year. Over 30 common conditions can be treated directly through the One Medical app: colds and flus, allergies, stomach bugs, vomiting, headaches, injuries, urinary tract infections, yeast infections, skin issues, minor cuts, eye issues, etc.
You can try the service out without a membership. You may sign up for a message visit for $29, or a video visit for $49. No insurance is necessary for these self-pay visits.
Pharmacy & Savings Bundles - Programs like GoodRx Companion ($14.99/month) include more than 200 free generic medications, discounted online care visits, and significant savings on dental, vision, laboratory, and imaging services.
Online visits start at $19 with a paid membership. It is NOT insurance but gives you discount options alongside your insurance. Many folks with cheaper high-deductible insurance plans opt to add a side membership, especially if they know they will have frequent prescription refills. More info can be found at https://www.goodrx.com/care.
Subscription based healthcare supplements are not perfect, but they may assist the uninsured, underinsured, part-time workers without employer coverage, independent gig workers, etc. It is always important to balance out your specific healthcare needs taking into account your age and preexisting conditions along with your quoted premium costs.
Top Medical Care and Services for Adults Ages 55-65 - You may or may not have health concerns right now. No one has a crystal ball as to what care you may need moving forward, so I will briefly lay out the most common types of medical care and services sought by adults aged 55 to 65.
The most commonly sought after primary care visits focus on chronic disease management and routine preventative health screenings:
Blood Pressure and Hypertension Checks - High blood pressure is one of the most frequently managed conditions in this age group, requiring regular monitoring.
Cholesterol and Lipid Panels - Routine blood tests check for dyslipidemia to lower the risk of heart attacks and strokes.
Diabetes Screening - Fasting blood sugar or A1C tests are standard to catch pre-diabetes or Type 2 diabetes early.
Colorectal Cancer Screening - Adults in this age bracket frequently schedule colonoscopies or take home stool tests (FIT/FOBT).
Mammograms - Women aged 55–65 regularly seek routine breast cancer screenings.
Vaccinations - Patients frequently visit clinics for adult immunizations, particularly the shingles vaccine (recommended starting at age 50) and annual flu shots.
In addition to preventative care, our age group commonly seeks out:
Eye Exams - Vision checks become more frequent to monitor for age-related changes, cataracts, or glaucoma.
Dental Cleanings - Preventative and restorative dental care is common to manage gum disease.
Joint and Musculoskeletal Care - Patients often seek initial care for early arthritis, stiffness, or localized chronic pain.
One additional word of caution, watch out for short-term health insurance plans. Short-term plans are designed to bridge gaps when you are between jobs, waiting for Medicare, or outside standard enrollment periods.
They are typically capped at 3 to 4 months and require that you answer a medical questionnaire. Insurers can deny coverage and exclude pre-existing conditions. Buyer beware, if you have existing conditions, these plans will deny coverage for them and lack federal consumer protections.
Older workers shopping for cheaper health insurance must carefully balance lower monthly premiums against high deductibles and restricted doctor networks that can trigger unexpected out-of-pocket medical debt. As many as 66.5% of people who file for bankruptcy blame medical bills as the primary cause. It is said that 550,000 people file for bankruptcy each year for this reason.
Adults aged 50 to 64 face higher rates of chronic conditions and require medical services more frequently than younger demographics, making low-premium, high-deductible plans potentially costlier if care is needed regularly. Choosing a plan with a cheaper monthly payment often means higher deductibles, copays, and coinsurance, a trap that leaves many older workers underinsured. Choose wisely.
