The ACA guarantees that you can get insurance outside your employer's group policy. Before health reform, people over age 50 often found themselves blocked from obtaining coverage of any sort because of preexisting conditions. That is prohibited under the ACA.

We all know people who have hung on to jobs by their fingernails just to keep health insurance while they wait to become eligible for Medicare at age 65. Research by the Center for Retirement Research at Boston College confirms this, showing a marked spike in retirement (as measured by Social Security claiming decisions) at age 65. In effect, the ACA means these fingernail hangers can let go.

"We're already seeing it in some of our client conversations," says Michael Kitces, partner and director of research for Maryland-based Pinnacle Advisory Group. "We'll ask, 'If access to health insurance wasn't an issue, would you still be doing what you're doing now, and working where you work?' The answer in a lot of cases is, 'Actually, no.'"

New Math

Although insurance companies can set premiums up to three times higher if you're over age 50, the overall cost will be held down for many by cost-sharing subsidies and advanceable, refundable tax credits on premiums.

The cost offsets depend on your income, and that's why CBO is forecasting that some people will reduce their working hours. The tax credits are available to families with income between 100 percent and 400 percent of the federally defined poverty guideline. At 400 percent, families aren't required to spend more than 9.5 percent of their income on premiums.

This year the subsidies are available for individuals with annual income between $11,490 and $45,960, and from $23,550 to $94,320 for a family of four. The definition of income is modified adjusted gross income (MAGI), which includes wages, salary, foreign income, interest, dividends and Social Security benefits.

The subsidies are creating new math that anyone getting close to retirement age should heed.

They create incentives for households to carefully manage income to stay within premium assistance brackets. Limiting the number of working hours is one way to do that; another is to reduce taxable income by maximizing contributions to a 401(k) or health savings account at work.

Deferred Annuities