The letter comes in a plain envelope, and you almost toss it with the grocery coupons. Then you open it: next year’s health premium, up 28%. That’s the number Centene (CNC) is asking regulators for in Washington and New York. Blue Cross of Illinois wants 15% — stacked on top of last year’s 28%. Elevance Health (ELV) is going double digits in four states, and across the 77 filings tallied so far the median ask is 14%. Meanwhile Cigna (CI) and Aetna, the insurance arm of CVS Health (CVS), are simply walking out of the exchanges, and enrollment has already drained from 22.1 million to 19.2 million. It’s a textbook insurance spiral — the subsidies expired, the healthy bailed first, the pool got sicker, prices climbed, repeat — and no villainy is required to explain it. Just arithmetic, which is exactly why it won’t untangle itself quickly.
Here’s why I care more than the average reader should. This one lands squarely on the early retiree — the Pre-65 Bridge, in planning terms. Retire at 60 and you’re buying roughly five years of your own coverage before Medicare picks you up at 65, and the ACA exchange is usually where that bridge gets built. The households that get hurt aren’t the ones with fancy plans; they’re the ones who penciled in today’s premium as a fixed number. So the move is unglamorous but real: put bridge insurance in the retirement plan as its own escalating line — I stress-test ours at +15% a year — then manage your modified adjusted gross income in those bridge years, because subsidies phase out on income and a Roth withdrawal versus a traditional-IRA draw can swing thousands in a single year. And treat the HSA like what it is: the only triple-tax-advantaged asset in the code, built for exactly this stretch of life. A tax-free bridge asset for a bridge-insurance problem. None of this asks you to guess where the filings settle — regulators will trim some, they usually do. The plan just has to survive the range.
You can already see this weather coming; the filings are public and the trend line’s right there on the page. That’s the whole point of checking the roof while it’s still dry. A review runs about fifteen minutes — bring your latest statement, and if an early exit is anywhere on your mind, a rough guess at what you’d pay to cover yourself to 65.
No portfolio action here — this is a planning alarm, not a trade. Every pre-65 retirement plan we run now gets its healthcare line stress-tested at +15% per year through the bridge, so the decision to retire early is made with the real bill on the table.
And on the investing side: the managed-care names stay off the buy list. Policy risk cuts both directions in this sector, and we don’t need to own the argument to plan around it.