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Decrease Well being Insurance coverage CostsMaximize ACA Subsidies and Decrease Well being Insurance coverage Prices


There are three predominant challenges to purchasing medical insurance as a person:

  • The excessive value of our medical system
  • The complexity of understanding and navigating the system
  • Political instability that makes long run planning nearly unattainable.

Every of these dynamics modified considerably, if solely briefly, in 2021 with passage of the American Rescue Plan Act of 2021. These modifications impacted medical insurance prices and choices for these buying their very own medical insurance by 2022.

These modifications have been prolonged, not less than by 2025, as one provision of the lately handed Inflation Discount Act. Whereas nonetheless not very best for these of us planning for a decade or extra till Medicare eligibility, this new laws not less than extends the planning window a number of years.

It’s vital to grasp buy the optimum medical insurance coverage protection to your family whereas controlling your prices. So, I’ve up to date this put up initially printed in 2021 to replicate this most up-to-date change in regulation.

Desk of Contents

What’s Modified For the reason that Unique Reasonably priced Care Act (ACA)?

I initially wrote about the big affect that the American Rescue Plan Act of 2021 had on medical insurance prices for early retirees and others shopping for medical insurance on the Well being Insurance coverage Market and using ACA subsidies to make it reasonably priced. The passage of the Inflation Discount Act in August 2022 extends these modifications by 2025.

These modifications to the ACA lower value and complexity for these shopping for medical insurance on their very own. 

On the unfavorable aspect, these payments spotlight how unstable the system is and the way difficult it’s to plan for well being care prices for the long run. On a extra optimistic observe, each of those latest payments decrease medical insurance premiums for a lot of voters. The longer they’re in place, the much less politically widespread it will likely be to vary them again.

Let’s begin by reviewing what has modified and for a way lengthy.

Decreased Well being Insurance coverage Premiums for Many

Beneath the Reasonably priced Care Act, the value you pay for medical insurance premiums has at all times been a perform of your family revenue, amongst different components.

These with the bottom incomes are eligible for Medicaid. The minimal revenue threshold is 100%-138% of the Federal Poverty Degree (FPL) relying in your state of residence.

As soon as your revenue exceeds this threshold, you qualify for subsidies to make insurance coverage premiums extra reasonably priced below the Reasonably priced Care Act (ACA). The official time period for the subsidies are Premium Tax Credit (PTC). All through this text, I’ll use these phrases interchangeably.

Ultimately, these with larger incomes, exceeding 400% of FPL, didn’t qualify for subsidies. They needed to pay the complete value of medical insurance below the unique ACA.

The American Rescue Plan made two important modifications, which had been prolonged by 2025 by the Inflation Discount Act. First, those that already acquired subsidies will now obtain bigger subsidies, decreasing their out of pocket bills.

Second, the brand new regulation eradicated the cap of 400% of FPL which is a characteristic of the unique ACA.

The modifications within the most share of family revenue paid in the direction of insurance coverage premiums by 2025 are summarized within the desk beneath.

Earnings as % FPLUnique ACAAdjustments to ACA By way of 2025
As much as 150%2.07 – 4.14%0%
150-200%4.14% – 6.52%0% – 2%
200-250%6.52% – 8.33%2.0% – 4.0%
250-300%8.33% – 9.83%4.0% – 6.0%
300-400%9.83%6.0% – 8.5%
>400%No Cap, Subsidies Eradicated8.5%

Eliminating the Subsidy Cliff Decreases Planning Complexity

Beneath the unique ACA, subsidies had been fully eradicated when family revenue exceeded 400% of FPL. This was continuously known as the subsidy cliff.

When you had an revenue of $X that put you proper on the cliff, you certified for beneficiant subsidies of 1000’s of {dollars} per 12 months. In case your revenue elevated to $X + 1 and that pushed you over the cliff, you fully misplaced the subsidy. 

This was in impact a a number of thousand greenback tax on that one greenback of additional revenue. It made planning difficult for entrepreneurs, freelancers, individuals who have a considerable portion of revenue within the type of ideas and commissions, and others with irregular and unpredictable revenue. 

The subsidy cliff additionally introduced challenges for early retirees who should generate revenue from a mixture of sources and may be incorporating tax-gain harvesting or Roth IRA conversions to decrease their future tax burden.

The elimination of the cliff makes planning easier. When you earn an additional greenback, or perhaps a few thousand further {dollars}, over the 400% FPL threshold, your subsidy decreases and out of pocket prices improve step by step till they ultimately section out. Small planning errors are usually not practically as punishing.

Subsidy Cliff Complexity Nonetheless Exists

The subsidy cliff on the decrease finish of the revenue spectrum continues to be in place with this new laws. You should have a MAGI of not less than 100 to 138% of the FPL (relying in your state of residence) to obtain subsidies and keep away from being pushed into Medicaid. 

The extent is determined by whether or not you reside in a state that expanded Medicaid. Avoiding Medicaid is fascinating for many individuals, as a result of Medicaid is just not accepted by many well being care suppliers and establishments. 

It is usually vital to not make the error of signing up for a Market plan quite than Medicaid for those who don’t have sufficient revenue to achieve this decrease threshold, as a result of you’ll not qualify for ACA subsidies. 

Most early retirees might generate revenue by doing Roth IRA conversions. Simply concentrate on this and do it earlier than the tip of the calendar 12 months.

Highlighting Political Instability

These latest items of laws spotlight the instability and unpredictability of the medical insurance market. Marrying medical insurance premiums to tax subsidies is problematic.

Our well being and thus well being care wants are unpredictable. Anybody who has had any must make the most of the system is aware of that well being care prices are extraordinarily excessive and infrequently clear in america. Including to the problem, well being care prices persistently improve sooner than the final inflation fee. 

These points make planning for well being care bills difficult, even with out incorporating tax planning into the equation. Including within the tax planning part could make for a nightmare!

Tax legal guidelines can and do change continuously. The American Rescue Plan is an ideal instance of why planning for well being care prices for the long run is unattainable.

This regulation was in impact for 2021 and 2022. The regulation didn’t go into impact till March 11 of 2021. That’s about 3-4 months after most People made their medical insurance choices for 2021. The inflation discount act not less than extends our planning home windows three extra years by 2025.

What’s going to occur after 2025? Your guess is nearly as good as mine. If nothing modifications, we’ll revert again to the unique ACA guidelines. Nonetheless, as famous above, the longer the present guidelines are in place, the much less politically widespread it will likely be to revert again.

Sure features, notably eliminating the subsidy cliff, make sense and simplify the method of shopping for insurance coverage. However as we’ll see beneath, frequent sense and ease are in low provide with the ACA. So we will’t assume these modifications are everlasting.

Shopping for a Well being Insurance coverage Plan on Healthcare.gov

Shopping for insurance coverage by healthcare.gov (or your state’s market) ensures entry to medical insurance much like what we historically have had by our employers. There’s a lot I don’t like about our present healthcare system. That mentioned, I discover consolation in familiarity. 

Some of the learn articles on this website explores the various imperfect medical insurance choices that American early retirees have obtainable. I’ve additionally completed a deep dive into the perfect different for our household, Well being Care Sharing Ministries.

I’ve concluded that purchasing conventional medical insurance by the Market using obtainable premium tax credit is the perfect resolution for our household if we will’t get insurance coverage by an employer. An ACA compliant plan permits us to have contractually binding medical insurance that ought to defend us in a worst case situation. 

Our problem is figuring out get hold of the perfect protection in probably the most reasonably priced manner.

Utilizing a Well being Insurance coverage Calculator to Help Planning

I’m an enormous fan of the Kaiser Household Basis’s Well being Insurance coverage Market Calculator. It’s useful in  numerous methods when planning for brief and long-term medical insurance prices.

It reveals what your estimated medical insurance premiums will value for a Silver Degree plan with and with out subsidies. Each are helpful items of knowledge.

The dimensions of your Premium Tax Credit score determines your precise prices for medical insurance. Calculating that is useful in planning for the upcoming 12 months.

Figuring out the complete unsubsidized value of medical insurance is helpful when contemplating what your insurance coverage would value if the regulation modifications and/or your revenue exceeds the boundaries which let you qualify for subsidies. This prepares you for worst case situations.

Utilizing the calculator can be useful for planning functions. It reveals what components affect your medical insurance prices, a few of which you could possibly management.

What Elements Affect Your Market Well being Insurance coverage Subsidies and Prices?

Elements that affect prices for market medical insurance plans embody:

  • Earnings, 
  • Geographic location,
  • Whether or not medical insurance protection is offered at your or your partner’s job,
  • Variety of folks in your family (adults and kids),
  • Ages of people that might be coated,
  • Whether or not these coated use tobacco.

We’ll discover every in additional element beneath.

The Impression of Earnings on Well being Insurance coverage Prices

Your Modified Adjusted Gross Earnings (MAGI) determines your Premium Tax Credit score and thus out of pocket prices for medical insurance. This variable is especially vital for planning functions for early retirees.

That’s as a result of we early retirees usually have appreciable management over how we generate the revenue wanted to satisfy our spending wants. 

That is in distinction to entrepreneurs, freelancers, and others with out employer sponsored medical insurance. Controlling revenue could also be tougher and fewer predictable in these circumstances. 

Earnings additionally stands in distinction to different components that decide premium prices, as a result of we now have little to no management over lots of these variables. As a result of it’s so vital to grasp how revenue impacts medical insurance premium prices, we’ll go into extra element beneath. 

First, it is very important perceive what different components affect your insurance coverage premiums.

Geographic Location

There’s variability in the price of medical insurance plans primarily based in your geographic location.

One issue to contemplate is whether or not you reside in a state that expanded Medicaid. When you’re unsure, discover the standing of your state right here. Alternatively, enter your present location and another areas chances are you’ll be contemplating into the calculator to see if it impacts your medical insurance prices.

In states that didn’t develop Medicaid, your revenue must be not less than 100% of FPL to qualify for insurance coverage subsidies. You need to have revenue better than 138% of FPL in states that expanded Medicaid.

One other consideration is variations for residents of one of many non-contiguous states. Observe that Alaska and Hawaii FPL numbers have been adjusted upward because of larger value of dwelling.

Additionally observe, the quantity and high quality of insurance coverage choices obtainable differs enormously by geographic space. This is not going to be evident till you start purchasing for medical insurance plans in your explicit space.

Well being Insurance coverage Obtainable By way of an Employer

An vital variable in the price of your medical insurance is whether or not you or your partner have medical insurance provided by an employer. In that case, you usually received’t qualify for any subsidy and can pay the complete value of a medical insurance plan bought by the Market.

There are uncommon exceptions if protection offered by an employer doesn’t meet minimal requirements for protection or affordability. You may learn full particulars of those exceptions right here.

Variety of Individuals in Your Family

The variety of folks in your family is outlined as a tax filer, their partner, and dependents. The extra folks in a family, given a set family revenue, the upper your Premium Tax Credit score and decrease your out of pocket value might be.

This may be counterintuitive. Chances are you’ll assume that the extra folks you insure, the upper your medical insurance bills might be. That’s true when wanting on the full, unsubsidized prices.

Nonetheless, subsidies are primarily based in your revenue as a a number of of FPL. As a result of it’s usually dearer to deal with, dress, and feed extra folks, a bigger family would have larger bills. A given family revenue wouldn’t go as far in a family with extra folks.

Think about two households with the identical revenue. The bigger family will get a better Premium Tax Credit score and thus pay a decrease share of the medical insurance prices. A smaller family would qualify for much less subsidies, and thus pay a better share of medical insurance prices.

That is vital to contemplate if you can be including (delivery, adoption, marriage, and so on.) or subtracting (dying, divorce, youngsters ageing out, and so on.) folks out of your family. The variety of folks in your family will considerably affect well being care prices, assuming family revenue stays fixed. 

Ages of people that might be coated

Age is an element that makes it particularly vital to optimize your ACA subsidies as we become older. We have a tendency to make use of extra healthcare providers as we age. Thus, medical insurance premiums improve significantly as we become older. 

For instance, premiums for our household of three would have a full unsubsidized premium value of $15,877 primarily based on Kim’s and my ages, in our mid-40’s. 

I experimented with growing the grownup ages to 60 within the medical insurance calculator and leaving all else equal. The total value of an unsubsidized plan jumped to $25,546.

Nonetheless, our out of pocket prices for medical insurance premiums for Market plans are primarily based on a share of our revenue. So our out of pocket prices for premiums are precisely the identical in both situation, no matter our age.

Our subsidy on this instance will increase by practically $10,000/12 months by getting into the next age! This demonstrates why it’s extra vital to have the ability to optimize your Premium Tax Credit score as you age.

Use of Tobacco

Utilizing tobacco is one other issue that impacts your medical insurance prices. The calculator doesn’t point out how way more tobacco customers can pay. It merely states: “Chances are you’ll pay extra in case your insurer prices the next fee for tobacco use. In most states, insurers can cost a tobacco surcharge of as much as 50% of your complete premium earlier than the tax credit score. The tax credit score can’t be utilized to the tobacco surcharge.”

I can consider many causes which are higher than saving cash on medical insurance to cease utilizing tobacco. Elevated threat of cancers, lung illness, coronary heart illness, and stroke bounce entrance of thoughts. The direct monetary advantages of not shopping for tobacco merchandise and paying the excessive taxes on them are others. But when paying a decrease medical insurance premium pushes you over the sting to stop, all the higher!

Eliminating discrimination primarily based on pre-existing situations is among the most politically widespread provisions of the ACA. I discover it odd that tobacco use is the one behavioral issue that’s, for no matter purpose, so stigmatized that it may trigger you to pay the next medical insurance premium. For present planning functions, that is all it is advisable to know. 

When planning for the long run, it will likely be vital to see whether or not this stays the case. Or will different behaviors and life-style associated situations that will affect your prices be incentivized or punished through medical insurance subsidies and premiums? Keep tuned!

How Earnings Impacts Your ACA Subsidies

The issue which you’ve gotten probably the most management over to maximise your ACA subsidies and restrict your out of pocket bills is revenue. It’s vital to first perceive what counts as revenue because it pertains to acquiring Premium Tax Credit. 

What Constitutes Earnings For ACA Subsidies?

Your subsidies, and thus your private well being care bills for a given 12 months, might be primarily based in your family revenue in that 12 months. So subsequent 12 months’s subsidies and your share of bills might be primarily based in your revenue in that 12 months. 

You’ll have to estimate this. In case your estimate is off, you’ll should pay the distinction or obtain a refund after the actual fact. 

Your present 12 months’s revenue will most likely be a adequate approximation to start out planning in case your expectation is that your scenario isn’t going to vary a lot.

If you’re retiring, reducing again work, transitioning to self-employment, or making different modifications that can considerably improve or lower your revenue, you’ll make your greatest guess at what revenue within the following 12 months might be. 

It is usually vital to grasp that subsidies are primarily based on complete family revenue, even when not everybody within the family wants to purchase insurance coverage by the Market. 

Think about a family of three the place just one partner works. The working partner has insurance coverage by their employer, however protection is just not prolonged to their household. The employee’s revenue counts towards the subsidy the remaining partner and little one can qualify for.

Lastly, it is advisable to perceive what counts as revenue which impacts premium subsidies and out of pocket premium prices. For the needs of this dialogue, revenue is your Modified Adjusted Gross Earnings (MAGI).

Calculating MAGI for ACA subsidies

I’ve written about calculate your Adjusted Gross Earnings (AGI) and Modified Adjusted Gross Earnings (MAGI). If you’re not accustomed to these phrases and calculate these numbers, begin there.

When you usually perceive these calculations, you’ll should think about how a number of particular components associated to medical insurance choices will alter these calculations.

Lastly, after getting your AGI, learn to regulate it to reach at your MAGI. This quantity determines your Premium Tax Credit score and out of pocket insurance coverage premium prices.

Figuring out Eligibility for a Well being Financial savings Account (HSA)

Contributing to a HSA supplies an “above the road” deduction that lowers your AGI, and thus MAGI. Decreasing your MAGI will improve the subsidy you qualify for. This in flip lowers your out of pocket expense for medical insurance premiums.

Since 2017, we’ve obtained our medical insurance by my spouse’s employer. Annually, we now have chosen a high-deductible well being plan. A part of our reasoning for doing so was being able to contribute to an HSA.

Associated: Utilizing a HSA to Save for Retirement

We assumed we might select related protection and proceed contributing to an HSA yearly when buying a Market plan. We assumed the figuring out issue of whether or not a plan was a high-deductible well being plan was… the scale of the deductible. Don’t assume!

I created an account to discover particular insurance coverage plan choices provided by the Market at Healthcare.gov. I started by exploring plans with related options to these we at present have. The closest equal to our present protection is a Silver Degree plan.

To my shock, Utah has no silver degree plans which are HSA suitable. We have to select a Bronze Degree plan that has significantly larger deductibles and coinsurance quantities than we’re accustomed to. In any other case, we lose the power to contribute to an HSA.

You will discover the {qualifications} for a high-deductible well being plan in IRS publication 969. Alternatively, when purchasing plans on the Market you’ll be able to type them by whether or not they’re HSA suitable.

Take residence: Don’t assume it is possible for you to to contribute to an HSA and declare that deduction when projecting revenue till you discover the plans obtainable in your space. Chances are you’ll not discover an HSA suitable plan to your liking.

Round Logic for Self-Employed Deductions

Shopping for your personal medical insurance supplies one other precious above the road deduction that reduces AGI for the self-employed. Nonetheless, it shortly turns into obvious that this additionally provides complexity to your calculation.

Self-employed medical insurance prices are deductible. The deduction lowers AGI. A decrease AGI results in receiving a bigger tax credit score. A bigger tax credit score means decrease medical insurance prices for you. 

These decrease prices cut back your deduction. The decrease deductible quantity will increase AGI. A better AGI ends in lowered tax credit score. The smaller subsidy ends in larger insurance coverage premium prices.

After entering into circles with this, I used to be sure I didn’t perceive one thing. I reached out to CPA Mike Piper to make clear. 

He assured me my understanding of the regulation was right and pointed me to a superb useful resource from the Harry Sit’s Finance Buff weblog. It  supplies IRS Steering On Round Reference in ACA Premium Subsidy and Deduction and explains resolve it.

If you’re self-employed, take time to grasp calculate this deduction accurately to legally reduce premium prices.

Modifying AGI to Decide Premium Tax Credit

After you have an appropriate estimate of your AGI, it is advisable to modify it to get to your ultimate revenue quantity that can decide your Premium Tax Credit score. Discover the calculations to find out MAGI for the needs of medical insurance subsidies on the IRS Directions for Kind 8962.

That is an estimate. We’re making an attempt to find out our prices for medical insurance subsequent 12 months, primarily based on projections of revenue we’ll make this 12 months. We received’t in the end know our ultimate prices till spring of the next 12 months once we file our tax returns and have our precise MAGI.

That is the perfect we will do for now. So we use the estimated MAGI that we calculated to estimate our Premium Tax Credit score.

Estimating Your Premium Tax Credit score 

You may decide your estimated Premium Tax Credit score by filling out an software at HealthCare.gov. Nonetheless, watch out earlier than leaping to this step.

Earlier than you begin purchasing on the Market, play with an AGI calculator to experiment with manipulating your revenue. Then plug completely different revenue numbers into the KFF Well being Insurance coverage Market Calculator to positive tune your planning, till you’re assured in your estimate.

I began on the Market web site and accomplished an software. I wished to vary one revenue quantity to see the affect of contributing to a 401(okay). Doing so required going by the whole software once more, which took practically ten minutes.

After going again and dealing with the opposite calculators, I discovered the estimated subsidy from the KFF calculator was inside $4 of my outcomes on HealthCare.gov. Along with being exact and correct, the KFF calculator offered a extra user-friendly expertise when experimenting with completely different revenue situations.

The screenshot beneath reveals our outcomes from the KFF calculator.

How Do Premium Tax Credit Work?

Based mostly on our greatest assumptions for subsequent 12 months’s revenue, mixed with our family dimension, geographic location, and our ages, we qualify for a month-to-month subsidy of about $830/month. The KFF calculator reveals that with this premium tax credit score, we might pay a couple of $440 premium for the second lowest value Silver Degree medical insurance premium.

You would not have to decide on that individual plan. Your premium tax credit score is identical whatever the plan you select.

If we had been to decide on the next value Silver degree or Gold degree plan, our subsidy would stay the identical, however our out of pocket prices for premiums can be larger than proven on the calculator.

Conversely, if we select a decrease value Bronze degree plan, our premium value can be decrease. Our out of pocket value might doubtlessly be $0 if we select a plan with a price ticket equal to or lower than our $830 month-to-month subsidy.

The PTC is a non-refundable tax credit score. In different phrases, for those who select a plan with premium prices lower than your PTC, you don’t get any extra tax refund.

Selecting a Plan

When trying to reduce well being care prices, medical insurance premiums are solely a part of the equation. You should contemplate your complete value of insurance coverage premiums plus your share of any prices for care.

I’ve centered rather a lot on the challenges of predicting revenue and thus prices of medical insurance premiums. Predicting well being care wants and prices may be even tougher.

You should decide each your greatest and worst case situation to assist handle threat.

What Is Your Minimal Well being Care Price?

The very best plan for our household primarily based on a mixture of getting our present well being care suppliers in community, value, and HSA compatibility has an unsubsidized premium value of about $905/month. With our premium tax credit score utilized, we might pay solely about $80/month with the Market plan.

Monthly premium after tax credit image

In a greatest case situation the place we don’t want any well being care analysis or remedies, we might pay about $960 in annual premiums. Preventative care is roofed with all Market plans.

This compares favorably to the $300/month or $3,600 we might pay as our share of premiums for a excessive deductible plan by Kim’s employer. We would wish to incur about $2,600 in well being care bills, which is uncommon for our family, simply to get again to even.

What Is Your Maximal Well being Care Price?

Paying a decrease insurance coverage premium is good. However the entire goal of getting insurance coverage is to guard your draw back in a worst case situation. How does this Market plan examine to the insurance coverage we at present have?

The out of pocket most for our household is $13,800 with the Market plan. The plan we at present are coated below has an out of pocket most of $8,000 for our household.

Graphic showing Deductible and Out-of-pocket maximum

Nonetheless, when factoring the worst case situation it’s important to issue within the complete value of insurance coverage premiums and out-of-pocket prices.

The entire premium plus most out-of-pocket bills are $14,760 for our household with the Market plan. The worst case situation below our present protection from Kim’s employer is $11,600 for our household.

The Problem of Shopping for Particular person Well being Insurance coverage 

Our scenario demonstrates the problem of shopping for reasonably priced particular person medical insurance. It requires a mixture of tax planning, threat administration, making wholesome life-style choices, staying updated on ever altering guidelines and laws, and on the finish of the day… luck.

The distinction between the price of backed insurance coverage and the complete value of insurance coverage demonstrates the variability that any early retiree must plan for in case subsidies are discontinued or the system considerably modifications. This solely turns into extra vital as we age and well being care prices and the probability of needing care will increase.

I continuously share articles or write about non-conventional approaches to retirement comparable to semi-retirement, mini-retirements, one partner retiring first, or investing in different asset lessons like actual property or retirement companies that will produce extra retirement revenue than conventional paper belongings.

These approaches enable beginning down the street towards early retirement sooner, with extra revenue and life choices and fewer monetary threat. Nonetheless, having the next revenue produces distinctive challenges to acquiring reasonably priced medical insurance coverage.

Sadly, nobody has a crystal ball. So we now have to make our greatest determination 12 months to 12 months. Hopefully this framework will show you how to reduce your medical insurance prices, not less than by 2025. 

Past that? Keep tuned…

Chime In

How are you coping with the challenges and dangers of acquiring medical insurance? Is medical insurance preserving you trapped in a job while you would in any other case retire, work much less, begin a enterprise, or select one other profession? 

I’m at all times impressed by the extent of data, expertise, and creativity shared by readers of this weblog and look ahead to studying your concepts, insights, and options within the feedback.

I perceive political instability and threat is a part of the problem when planning for medical insurance. Identify calling and ideological rants are usually not useful to anybody making an attempt to develop a plan to transition to retirement sooner.

Please chorus from making this a political dialog. There are literally thousands of different locations on the web for these in search of that. I reserve the precise to delete or edit feedback that don’t adjust to this request. Thanks.

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[Chris Mamula used principles of traditional retirement planning, combined with creative lifestyle design, to retire from a career as a physical therapist at age 41. After poor experiences with the financial industry early in his professional life, he educated himself on investing and tax planning. Now he draws on his experience to write about wealth building, DIY investing, financial planning, early retirement, and lifestyle design at Can I Retire Yet? Chris has been featured on MarketWatch, Morningstar, U.S. News & World Report, and Business Insider. He is also the primary author of the book Choose FI: Your Blueprint to Financial Independence. You can reach him at chris@caniretireyet.com.]

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