Why buy medical insurance ?

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lthenderson
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Re: Why buy medical insurance ?

Post by lthenderson »

beyou wrote: Mon Sep 21, 2020 8:00 pm What worst case scenarios make the insurance necessary ?
My mom had health insurance but it wouldn't cover her chemotherapy drug when she was battling brain cancer. We had to make the decision to proceed at $75,000 per dose out of our pocket or just let cancer kill her. We were two doses in before a cancer research place agreed to pick up the tab if they could have access to her records. I remember being terrified for her financial future those two weeks and I wouldn't wish those sleepless nights on anyone. For the record, the $600,000 worth of chemo ultimately didn't save her life but it gave us a spring and summer without cancer worries before the cancer came back for the final time. I'm glad we made the decision to go ahead despite not knowing how we were going to pay for it. She died at 63.
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cheese_breath
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Re: Why buy medical insurance ?

Post by cheese_breath »

beyou wrote: Tue Sep 22, 2020 6:16 am
cheese_breath wrote: Mon Sep 21, 2020 11:36 pm Read my signature line. We all have opinions, but nobody will know the real answer until you guys reach Medicare age.

My DW had a lot of medical issues. I expected that someday she might have a heart attack or other sudden event, spend maybe a week or so in a hospital, and then she'd be gone. I never anticipated a massive stroke that would keep her confined to nursing homes for 3 1/2 years and still counting.
So sorry to hear that. Do you have LTCI ? How well is it covering your costs ? This is another type of insurance I am living without so far. Many of the plans offered have a relatively low cap on payout, which to me defeats the purpose of insurance. Some pay for 3 years, and you are
now beyond that point.
No I don't have LTCI. I took a chance that she wouldn't need it. With all her health problems she probably wouldn't have qualified anyway. But I'm still taking the same chance on myself. I spoke with an elder law attorney shortly after the stroke, and I could have sheltered almost everything from Medicaid if I chose. But then I wouldn't have been allowed to give her the quality of life things I want to, like a private room with door to the courtyard. So I chose to go private pay instead. I know I might have to consider Medicaid someday if the money runs out, but until then I'll do everything I can to make it a little better.
The surest way to know the future is when it becomes the past.
JackoC
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Re: Why buy medical insurance ?

Post by JackoC »

quantAndHold wrote: Mon Sep 21, 2020 9:27 pm
beyou wrote: Mon Sep 21, 2020 9:07 pm When insurance companies deny claims and/or docs refuse to take patients at negotiated rates, seems to me you aren’t paying for much.
I’m not saying our medical system isn’t broken, because it clearly is. But the number of horror stories people post on the internet, about any topic, not just health insurance, are completely out of proportion with how often they happen in real life. People post when they’re riled up. I had a major illness a couple of years ago. I paid my deductible and copays, hit my out of pocket max, and the insurance company took care of the rest. I had some minor problems with the billing department of one of the medical practices, but I had no trouble getting care, and the insurance company paid exactly what it was supposed to pay. I could post that, but that wouldn’t be a very interesting post.
Our experience was similar. Serious illness, first yr's headline bills totaled $123k, $24k out of pocket (mainly due to expensive drug with 50% copay excluded from the OOP limit, this was pre-ACA which generally doesn't allow that), over following 3 yrs till cured another $70k headline $35k OOP (again drugs, plus being under the deductible/OOP for more of it spread over 3 yrs). But the insurance did what it said it would, and no funny business from the medical providers (at top institution). We've had smaller scale horror stories of surprise out of network bills as it seems most people have, but never a serious issue with an insurance co. It can happen, lots of stuff can happen but the relative frequency is often distorted in media and many people IME also subconsciously reference portrayals of common societal villains in fictional TV/movies as part of their impression of real life.

As other posts have mentioned, medical insurance has a wild card (besides it being potentially a literal matter or life and death) compared to say home insurance. The home repair contractor isn't going to send you a bill for several times as much because you don't have homeowners insurance. So it's not a straight game of chance v a fixed set of bills, the bills will be higher without insurance.

Looking at worst financial case though, as others mentioned, it also depends what you have to lose financially. Besides Social Security, IRA/401k's would generally be protected in bankruptcy up to a ~$1.3mil total, as would a residence in many places (you'd need to know those details exactly from authoritative sources before actually doing anything, obviously). A lot of people in the general population have little beyond such assets, though many or most here also have significant taxable account financial assets, which increases the financial loss in the worst case. And obviously if being uninsured compromised the care you got for a life threatening illness that's a huge additional downside, I'm not ignoring that. Personally, and especially as main financial planner for both wife and self, I would not consider dropping medical insurance.
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Watty
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Re: Why buy medical insurance ?

Post by Watty »

beyou wrote: Mon Sep 21, 2020 8:00 pm Was reading another thread about in-network doctors refusing to honor the contract prices. Also facing layoff in my 50s (refusing to relo with employer and thinking FIRE instead). Given cost of Cobra and ACA without subsidy, thinking whether it makes sense to self-insure.

Assume 2,000/mo unsubsidized with high
deductible, why not put aside $2k/mo or $240k over next decade. Am I really likely to spend more than $240 k for a couple in their mid 50s until we hit Medicare ?

What worst case scenarios make the insurance necessary ?
Something to keep in mind is that even when you get on Medicare it is not free. For my wife each we pay about.
1) Medicare part B premium $144
2) Medicare "G" supplement $220
3) Part D - Drugs $35

Total $399 a month for one person, and we still have some prescription costs. When I get on Medicare we will have similar costs for me.

There may be some less options like if you have a low cost Medicare Advantage program in your area that you would trust but that was not right for us.

If you would be paying $1,000 a month per person for COBRA that is not all that much higher.

I also saw that other thread and that was for a very specific situation where it sounded like the procedure was not a standard procedure and the doctor was not following the "in network" rules.
michaeljc70
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Re: Why buy medical insurance ?

Post by michaeljc70 »

Do you self insure your home and cars? I know they aren't exactly the same....it is worse with healthcare. If I smash my car and it is $5k to fix, it is $5k whether I am using insurance or not. If I go and get $5k (list price) in tests (say blood work and an MRI), the insurance rate might be $1k. I know people think they are paying cash and going to go in and negotiate and get everything at a big discount. That rarely works. An insurance company that has 5 million insureds has more buying power than Joe Schmoe off the street. Not to mention it is hard to negotiate when passed out in the back of an ambulance. Not to mention many contracts between providers and networks prohibit any discounting to uninsured people unless the patient is indigent.

Though medical insurance is expensive, I would never risk not having it unless I was ridiculously wealthy (like 9 figures or more).
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

lthenderson wrote: Tue Sep 22, 2020 8:33 am
beyou wrote: Mon Sep 21, 2020 8:00 pm What worst case scenarios make the insurance necessary ?
My mom had health insurance but it wouldn't cover her chemotherapy drug when she was battling brain cancer. We had to make the decision to proceed at $75,000 per dose out of our pocket or just let cancer kill her. We were two doses in before a cancer research place agreed to pick up the tab if they could have access to her records. I remember being terrified for her financial future those two weeks and I wouldn't wish those sleepless nights on anyone. For the record, the $600,000 worth of chemo ultimately didn't save her life but it gave us a spring and summer without cancer worries before the cancer came back for the final time. I'm glad we made the decision to go ahead despite not knowing how we were going to pay for it. She died at 63.
So sorry to hear of her experience and your loss.

This story seems the opposite though, a case of how insurance is not what you think it is, never know what you have until it’s needed.
quantAndHold
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Re: Why buy medical insurance ?

Post by quantAndHold »

beyou wrote: Mon Sep 21, 2020 11:20 pm
William Million wrote: Mon Sep 21, 2020 11:17 pm You can gamble on collision insurance for your car. If you lose, you're out $20k or $40k. If you lose without health insurance, you end up broke.

Only people who don't insurance are ultra-rich or poor.
I have no issue paying for umbrella insurance, costs me little for protection of millions. And every time you drive you risk such liability. Point is, everything has a value. Umbrella insurance seems a good price for what you get, medical insurance less so. Dental no value at all.
In my working life, one of the things I did was risk management. Risk is a combination of two factors, a) the odds that the risky event will happen, and b) the impact of that event.

Umbrella insurance insures against very low probability, high impact events. The reason umbrella insurance is cheap is because the probability of needing to use it is very low.

Health insurance insures against a combination of things, so it’s hard to tease out how much you’re paying for what coverage. But one of the things it insures is moderate probability, high impact events. The probability of having to use your health insurance on a high impact health event is *significantly* higher than the probability of needing to use your umbrella insurance. And as we get older, that probability ratchets up significantly. Which is why health insurance costs so much more than umbrella.
Yes, I’m really that pedantic.
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TexasPE
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Re: Why buy medical insurance ?

Post by TexasPE »

Topic author has been a member since 2010 with 3000+ posts - looks like 'click bait' to me :mrgreen:
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)
SimonJester
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Re: Why buy medical insurance ?

Post by SimonJester »

My late FIL had just been laid off from work, was on cobra felt a pain in his lower right abdomen thought it was appendicitis. He went into the ER, they diagnosed him with leukemia, he went from the ER directly to an inpatient hospital room where he stayed for the next 90 days! Three months in the hospital with so many treatments you couldn't keep track. They sent the bill via fedex in a banker box.
"They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety." - Benjamin Franklin
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lthenderson
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Re: Why buy medical insurance ?

Post by lthenderson »

beyou wrote: Tue Sep 22, 2020 10:15 am
lthenderson wrote: Tue Sep 22, 2020 8:33 am
beyou wrote: Mon Sep 21, 2020 8:00 pm What worst case scenarios make the insurance necessary ?
My mom had health insurance but it wouldn't cover her chemotherapy drug when she was battling brain cancer. We had to make the decision to proceed at $75,000 per dose out of our pocket or just let cancer kill her. We were two doses in before a cancer research place agreed to pick up the tab if they could have access to her records. I remember being terrified for her financial future those two weeks and I wouldn't wish those sleepless nights on anyone. For the record, the $600,000 worth of chemo ultimately didn't save her life but it gave us a spring and summer without cancer worries before the cancer came back for the final time. I'm glad we made the decision to go ahead despite not knowing how we were going to pay for it. She died at 63.
So sorry to hear of her experience and your loss.

This story seems the opposite though, a case of how insurance is not what you think it is, never know what you have until it’s needed.
Not being covered by insurance and not having insurance are the same thing aren't they? The drug in question was deemed experimental and thus the reluctance of the insurance industry to cover it. Regardless, I would never consider self insuring due to this experience and others I have seen that have destroyed families financially. I paid $18,000 annually to insure a family member for five years until they were on Medicare and though we would have been better off in hindsight self insuring, it still seemed like a small price to pay to insure my financial well being over that time.
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

TexasPE wrote: Tue Sep 22, 2020 10:29 am Topic author has been a member since 2010 with 3000+ posts - looks like 'click bait' to me :mrgreen:
Your signature is apropos for what I think about your post.
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

quantAndHold wrote: Tue Sep 22, 2020 10:16 am
beyou wrote: Mon Sep 21, 2020 11:20 pm
William Million wrote: Mon Sep 21, 2020 11:17 pm You can gamble on collision insurance for your car. If you lose, you're out $20k or $40k. If you lose without health insurance, you end up broke.

Only people who don't insurance are ultra-rich or poor.
I have no issue paying for umbrella insurance, costs me little for protection of millions. And every time you drive you risk such liability. Point is, everything has a value. Umbrella insurance seems a good price for what you get, medical insurance less so. Dental no value at all.
In my working life, one of the things I did was risk management. Risk is a combination of two factors, a) the odds that the risky event will happen, and b) the impact of that event.

Umbrella insurance insures against very low probability, high impact events. The reason umbrella insurance is cheap is because the probability of needing to use it is very low.

Health insurance insures against a combination of things, so it’s hard to tease out how much you’re paying for what coverage. But one of the things it insures is moderate probability, high impact events. The probability of having to use your health insurance on a high impact health event is *significantly* higher than the probability of needing to use your umbrella insurance. And as we get older, that probability ratchets up significantly. Which is why health insurance costs so much more than umbrella.
Agreed this is the risk/reward relationship to consider.
But I have a more clear understanding that if I lose a lawsuit due to relevant liability (meaning I am not DWI for instance) for $1M my umbrella policy will pay that $1M. No experimental exceptions, no out of network issues.

I recognize the out-sized risk, but not sure there is a policy that covers that risk once I leave my job/Cobra. I have good insurance now AFAIK, and ACA policies in my area are VERY restrictive as to what doctors you can see and very expensive. So I am trying to decide if I should continue working at my job, forced to relo to a state I do not want to move to, or settle for bad insurance post cobra or go naked. None are good choices.

And to the point about Medicare is not that much less, it covers any doctor, much better coverage than ACA in my area at less than half the cost. No MBA deciding which procedures are ok for me. I have no problem paying for my medicare when I get to 65, but I have a gap until then.

Going to see if my wife’s small employer can get us into a group plan instead of ACA, if it has better coverage. My wife still enjoys her work, and not subject to relocation like me. Would not be subsidized, but if comparable coverage and cost to my employer, would pay the price. This may or may not carry us to 65.
smitcat
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Re: Why buy medical insurance ?

Post by smitcat »

beyou wrote: Tue Sep 22, 2020 1:24 pm
quantAndHold wrote: Tue Sep 22, 2020 10:16 am
beyou wrote: Mon Sep 21, 2020 11:20 pm
William Million wrote: Mon Sep 21, 2020 11:17 pm You can gamble on collision insurance for your car. If you lose, you're out $20k or $40k. If you lose without health insurance, you end up broke.

Only people who don't insurance are ultra-rich or poor.
I have no issue paying for umbrella insurance, costs me little for protection of millions. And every time you drive you risk such liability. Point is, everything has a value. Umbrella insurance seems a good price for what you get, medical insurance less so. Dental no value at all.
In my working life, one of the things I did was risk management. Risk is a combination of two factors, a) the odds that the risky event will happen, and b) the impact of that event.

Umbrella insurance insures against very low probability, high impact events. The reason umbrella insurance is cheap is because the probability of needing to use it is very low.

Health insurance insures against a combination of things, so it’s hard to tease out how much you’re paying for what coverage. But one of the things it insures is moderate probability, high impact events. The probability of having to use your health insurance on a high impact health event is *significantly* higher than the probability of needing to use your umbrella insurance. And as we get older, that probability ratchets up significantly. Which is why health insurance costs so much more than umbrella.
Agreed this is the risk/reward relationship to consider.
But I have a more clear understanding that if I lose a lawsuit due to relevant liability (meaning I am not DWI for instance) for $1M my umbrella policy will pay that $1M. No experimental exceptions, no out of network issues.

I recognize the out-sized risk, but not sure there is a policy that covers that risk once I leave my job/Cobra. I have good insurance now AFAIK, and ACA policies in my area are VERY restrictive as to what doctors you can see and very expensive. So I am trying to decide if I should continue working at my job, forced to relo to a state I do not want to move to, or settle for bad insurance post cobra or go naked. None are good choices.

And to the point about Medicare is not that much less, it covers any doctor, much better coverage than ACA in my area at less than half the cost. No MBA deciding which procedures are ok for me. I have no problem paying for my medicare when I get to 65, but I have a gap until then.

Going to see if my wife’s small employer can get us into a group plan instead of ACA, if it has better coverage. My wife still enjoys her work, and not subject to relocation like me. Would not be subsidized, but if comparable coverage and cost to my employer, would pay the price. This may or may not carry us to 65.
"I recognize the out-sized risk, but not sure there is a policy that covers that risk once I leave my job/Cobra. I have good insurance now AFAIK, and ACA policies in my area are VERY restrictive as to what doctors you can see and very expensive. So I am trying to decide if I should continue working at my job, forced to relo to a state I do not want to move to, or settle for bad insurance post cobra or go naked. None are good choices."

I do not know how you are going to get reasonably good advice since this is not neccesarily the case with many others reading the thread. We have had independent insurance now for many years and it is relatively expensive but it works OK. We would never be without health insurance as a best approach plan for us. One could easily argue that for 12+ years I had little or no 'payouts' from that higher cost insurance - untill last November where I 'hit the jackpot' and unfortunetaly it paid out in substantial 6 figures.
Good luck with whatever you decide.
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alpenglow
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Re: Why buy medical insurance ?

Post by alpenglow »

My MIL played the no insurance game when my FIL was between jobs. She didn't want to pay the COBRA. Of course, she had a heart attack during that time period and will be on a payment plan forever. FWIW, both in-laws have health issues so this was an especially poor choice.
michaelingp
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Re: Why buy medical insurance ?

Post by michaelingp »

My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
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beyou
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Re: Why buy medical insurance ?

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michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Glad to hear it worked out, and thanks for the contribution. I am not planning to play that game though. Trying to decide if I am willing to relocate to avoid Cobra or else will definitely sign up for the 18 months. What I fear most is what happens AFTER Cobra. Guess I have 18
months to figure that out, but by then ageisim will make it hard to get good employment I believe (and will have walked away from my job by them). If we had better ACA plans in my area would make my decisions easier. Would still stick with COBRA while on severance/retirement package, and then could decide to switch to ACA mid-stream or at the end. But unless there is major improvement for me, what’s coming is much worse than what I am leaving. The plans do not include many doctors and no out of network coverage at all, zero. I once had an hmo with very limited docs, and they almost killed me with bad medicine, had to threaten to sue to get care I needed. Don’t want to go back to those days.
smitcat
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Re: Why buy medical insurance ?

Post by smitcat »

beyou wrote: Tue Sep 22, 2020 4:16 pm
michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Glad to hear it worked out, and thanks for the contribution. I am not planning to play that game though. Trying to decide if I am willing to relocate to avoid Cobra or else will definitely sign up for the 18 months. What I fear most is what happens AFTER Cobra. Guess I have 18
months to figure that out, but by then ageisim will make it hard to get good employment I believe (and will have walked away from my job by them). If we had better ACA plans in my area would make my decisions easier. Would still stick with COBRA while on severance/retirement package, and then could decide to switch to ACA mid-stream or at the end. But unless there is major improvement for me, what’s coming is much worse than what I am leaving. The plans do not include many doctors and no out of network coverage at all, zero. I once had an hmo with very limited docs, and they almost killed me with bad medicine, had to threaten to sue to get care I needed. Don’t want to go back to those days.
"If we had better ACA plans in my area would make my decisions easier."
This is what makes these posts so personal and different - in our area of the NE the ACA plans are very good and even in some cases exceed the plans that are otherwise available as paid plans.
JDave
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Re: Why buy medical insurance ?

Post by JDave »

I worked in emergency departments for 27 years. Here's a tip: most emergencies aren't planned. They happen when people have made other plans.
JackoC
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Re: Why buy medical insurance ?

Post by JackoC »

beyou wrote: Tue Sep 22, 2020 4:16 pm
michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
....
If we had better ACA plans in my area would make my decisions easier. Would still stick with COBRA while on severance/retirement package, and then could decide to switch to ACA mid-stream or at the end. But unless there is major improvement for me, what’s coming is much worse than what I am leaving. The plans do not include many doctors and no out of network coverage at all, zero. I once had an hmo with very limited docs, and they almost killed me with bad medicine, had to threaten to sue to get care I needed. Don’t want to go back to those days.
Curious what state you're in with perceived bad ACA plans and what state(s) with good ones. We've had private insurance since pre-ACA. Back then private insurance here in NJ was 3-4 times as much as PA or DE where insurers could price for pre-existing conditions whereas state law prohibited that in NJ long before ACA. As I've updated potential moves over the years I've noticed that gap is basically gone, prices generally rose much faster in neighboring states after ACA and NJ no longer stands out as much more expensive. One northeast state I know is still different is NY, where private plans can't charge by age, so it's notably more expensive than NJ for younger people (assuming no ACA subsidy) and less for older. We, couple avg 3 yrs from Medicare, pay $16.3k/yr for high deductible HSA eligible plan (HSA deduction is effective $2.5k discount, NJ allows medical deduction over 2.5% of income so that's another smaller discount). Not close to qualifying for ACA subsidy. Of course I'd rather it be cheaper but it's workable for us and I wouldn't consider dropping it.
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alpenglow
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Re: Why buy medical insurance ?

Post by alpenglow »

michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Never knew that about COBRA. I wonder if that would have helped my in-laws. Too late now.
JBTX
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Re: Why buy medical insurance ?

Post by JBTX »

I'm currently paying $1100 a month for COBRA for me and kids. Not being insured is just not a consideration. Eventually may jump on spouses plan but family add ons are paid near 100% by employees so it wouldn't be much cheaper.
random_walker_77
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Re: Why buy medical insurance ?

Post by random_walker_77 »

You can't usually get a good estimate of the cost of an operation ahead of time, and the provider won't go through with it unless they know they'll get paid. There's an asymmetry of information and you can't always find out what it should cost, and you have little leverage to negotiate a fair price after the fact when you've already been charged, and there's limited ability to negotiate a final price beforehand since no one knows if there will be complications.

For an elective procedure, a hospital gave us an estimate of $90K, ended up billing insurance for $59K, and accepted a payment from insurance for $5.4K. Will you be able to, and know when it's appropriate to negotiate a 90% discount? (documented here: viewtopic.php?p=5298458#p5298458)

And this was the best case scenario where it was a scheduled elective operation that was not time-sensitive. When you consider that potentially life-saving cancer operations are time-sensitive and are also elective operations which only happen when all the financial arrangements are in order (and no covid shutdowns...), I don't know that self-insurance can work. Even if you can afford to write a check for $200K, is that going to be ok when they want to bill 800K? Can you negotiate that? Is the system even setup to handle such negotiations, or is it less hassle for them to just say no and choose another client? I'd also have concerns -- if this is a top hospital that's over-busy, could it make it harder to schedule an operating slot?

For the cash-rich early retiree, it doesn't seem that you can buy your way into broad PPO networks such as offered by large employers, but taking no insurance seems like folly. You might be able to self-insure $200K, but how can you ensure you won't be paying $2M just because you lack the insurance network's negotiating leverage?

This doctor's own employer *collected* from his insurance nearly $11K for a $75 covid-19 test, causing him to quit in disgust. To dial up the irony, his job was as a part-time medical director overseeing covid-19 testing: https://www.texastribune.org/2020/09/05 ... ency-room/
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Re: Why buy medical insurance ?

Post by squirm »

Because you could get hit by a bus tomorrow and be in intensive care for weeks. I don't even like being without insurance for a day. But it's your gamble.
quantAndHold
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Re: Why buy medical insurance ?

Post by quantAndHold »

SimonJester wrote: Tue Sep 22, 2020 10:32 am My late FIL had just been laid off from work, was on cobra felt a pain in his lower right abdomen thought it was appendicitis. He went into the ER, they diagnosed him with leukemia, he went from the ER directly to an inpatient hospital room where he stayed for the next 90 days! Three months in the hospital with so many treatments you couldn't keep track. They sent the bill via fedex in a banker box.
That happened to a good friend of mine, except that he came home short of breath from his daily 5 mile run, his wife took him to the ER, and he didn’t see his house again for over a year, chemo, radiation, and a bone marrow transplant later. It was the first year of he ACA. I have no idea how much the insurance company has paid, but I don’t doubt it’s well into seven figures. At one point the insurance company was paying rent for an apartment on the grounds of the world class cancer treatment center in another city, so his wife could be with him while he was being treated. I had no idea that kind of thing was covered.
Yes, I’m really that pedantic.
ncbill
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Re: Why buy medical insurance ?

Post by ncbill »

kramer wrote: Mon Sep 21, 2020 11:31 pm I don't really see any rational way a person with means can go bare in the US ... it's not just the uniquely high cost of US health care, but the unnegotiated rates paid by the uninsured.

But you can go bare in other countries, where cash for services is much more common (and often even the norm). But you have to live there and you have to be willing and ready to spend when the time comes (for even some people with sufficient means their portfolio is not structured in a way for this to be possible). Buy short term or travel insurance for visits to the US.
No need to go bare...e.g. in Mexico an expat the OP's age could buy into the national health plan (most treat it as catastrophic insurance) for under $500 per year...looks like more traditional "outside the USA & Canada" health insurance coverage there would run $250-$300/month for someone the OP's age.
Starfish
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Re: Why buy medical insurance ?

Post by Starfish »

240k$ go a very long way in many (all?) countries where you can get good healthcare.
The thing to consider is emergencies. You have no choice when you are unconscious. I would look for some kind of very high deductible insurance for this type of case (or any case really).
flaccidsteele
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Re: Why buy medical insurance ?

Post by flaccidsteele »

I find it interesting that posters know how much their medical bills are? How do you know it was $130k for the collapsed lung or $400k for the cancer treatments?

As a Canadian I don’t see any bills like that. Even when my parents were undergoing cancer treatment I didn’t see anything similar. They did the treatments, and went back to their normal routine when done. :confused
squirm wrote: Tue Sep 22, 2020 6:20 pm Because you could get hit by a bus tomorrow and be in intensive care for weeks. I don't even like being without insurance for a day. But it's your gamble.
😬
The US market always recovers. It’s never different this time. Retired in my 40s. Investing is a simple game of rinse and repeat
Erwin007
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Re: Why buy medical insurance ?

Post by Erwin007 »

flaccidsteele wrote: Tue Sep 22, 2020 10:05 pm I find it interesting that posters know how much their medical bills are? How do you know it was $130k for the collapsed lung or $400k for the cancer treatments?

As a Canadian I don’t see any bills like that. Even when my parents were undergoing cancer treatment I didn’t see anything similar. They did the treatments, and went back to their normal routine when done. :confused
squirm wrote: Tue Sep 22, 2020 6:20 pm Because you could get hit by a bus tomorrow and be in intensive care for weeks. I don't even like being without insurance for a day. But it's your gamble.
😬
Because you get sent the EOB (explanation of benefits, explaining what was charged, what was covered, and what was disallowed), and then a short time later you start getting the bills for all of the entities to whom you owe money.

Edit: also, people with insurance usually pay a fraction of what those charges are. The huge numbers you see are what is billed before insurance is taken into account, where previously agreed to charges discount the total owed, and insurance pays for some (or all) of the overall charge. Most insurance plans have an out of pocket maximum, which is the most you pay in any given year. Mine is $6,000 per person or $10,000 per family per year. This means if two or more people in my family have a terrible health year and spend a bunch of time in the hospital, the most I would be out is $10,000. This is considered a high deductible health plan and allows me to set aside ore-tax money each year ($6650 per year) to cover health expenses. I can also invest this money and it rolls over from year to year if I don’t use it.
Erwin007
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Re: Why buy medical insurance ?

Post by Erwin007 »

alpenglow wrote: Tue Sep 22, 2020 4:44 pm
michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Never knew that about COBRA. I wonder if that would have helped my in-laws. Too late now.
There’s a time limit to sign up. I think it has to be within 60 days of the qualifying event.
n8healer
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Re: Why buy medical insurance ?

Post by n8healer »

IMHO one needs medical insurance because it caps the fee for contracted doctors and hospitals. $ can easily exceed your allotted/saved money if you need ongoing expensive medications or hospital procedures. Hospital fees can be outrageous when there is no contracted cap. Most, but not all, hospitals and physicians are contracted with the major insurers.

I see people posting here about doctors who are contracted with the insurance and then ask for more money. This is unacceptable. I am a physician myself, and always honored my contractual agreement. Most physicians I know who have made agreements with the insurance companies feel about the same. After all, we knowingly agreed to these fees. There are advantages to the contracts; the companies market their doctors and send them referrals. I would not worry about the insurance failing to provide enough coverage. As I indicated above, the big issue is how huge the medical bills can get when there is no contract agreement to limit fees.
flaccidsteele
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Re: Why buy medical insurance ?

Post by flaccidsteele »

Erwin007 wrote: Tue Sep 22, 2020 10:21 pm
flaccidsteele wrote: Tue Sep 22, 2020 10:05 pm I find it interesting that posters know how much their medical bills are? How do you know it was $130k for the collapsed lung or $400k for the cancer treatments?

As a Canadian I don’t see any bills like that. Even when my parents were undergoing cancer treatment I didn’t see anything similar. They did the treatments, and went back to their normal routine when done. :confused
squirm wrote: Tue Sep 22, 2020 6:20 pm Because you could get hit by a bus tomorrow and be in intensive care for weeks. I don't even like being without insurance for a day. But it's your gamble.
😬
Because you get sent the EOB (explanation of benefits, explaining what was charged, what was covered, and what was disallowed), and then a short time later you start getting the bills for all of the entities to whom you owe money.

Edit: also, people with insurance usually pay a fraction of what those charges are. The huge numbers you see are what is billed before insurance is taken into account, where previously agreed to charges discount the total owed, and insurance pays for some (or all) of the overall charge. Most insurance plans have an out of pocket maximum, which is the most you pay in any given year. Mine is $6,000 per person or $10,000 per family per year. This means if two or more people in my family have a terrible health year and spend a bunch of time in the hospital, the most I would be out is $10,000. This is considered a high deductible health plan and allows me to set aside ore-tax money each year ($6650 per year) to cover health expenses. I can also invest this money and it rolls over from year to year if I don’t use it.
Very interesting. Thanks for the explanation. Can a married couple have 2 separate insurance plans and get everything covered? For example my plan covers what it covers and if it doesn’t cover everything, my wife can use her plan to cover the rest so there’s no out of pocket cost?
The US market always recovers. It’s never different this time. Retired in my 40s. Investing is a simple game of rinse and repeat
runninginvestor
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Re: Why buy medical insurance ?

Post by runninginvestor »

flaccidsteele wrote: Wed Sep 23, 2020 6:51 am
Very interesting. Thanks for the explanation. Can a married couple have 2 separate insurance plans and get everything covered? For example my plan covers what it covers and if it doesn’t cover everything, my wife can use her plan to cover the rest so there’s no out of pocket cost?
No. Benefits for each plan do not affect the other person if they aren't covered under the plan.
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Tamarind
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Re: Why buy medical insurance ?

Post by Tamarind »

As others have said, because it puts an upper cap on my out of pocket medical spending where the theoretical bill can be larger than my life savings. Any cheap HDHP will do, it could have a 5-figure deductible and that'd be fine. I also carry a personal long term disability policy and will keep it until FIRE, in spite of being much less likely to use it than medical insurance and getting no subsidies from anyone, because I have seen friends deal with progressive illness starting at surprisingly young ages and don't want my own FIRE plan to be derailed.

OP, hopefully you did this math already, but if you are FIREing, will your taxable income really be high enough to make you ineligible for ACA subsidy? If your wife is continuing to work and puts you over the "cliff" can you not get subsidized family coverage through her job? Prices in your area may differ, but from my research on my mother's behalf when she retired and went on ACA, a married couple can fit a surprising amount of income under the cliff and even unsubsidized rates were pretty good compared to what I used to pay pre-ACA.

It always strikes me as odd that folks who never would have refused health insurance when offered it with an employer subsidy suddenly start theorizing about whether insurance is worth it when they are no longer being offered the subsidy.
random_walker_77
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Re: Why buy medical insurance ?

Post by random_walker_77 »

Honestly, I wish my employer offered unsubsidized retiree coverage. In my part of the country, there aren't any individual plans with extensive nationwide networks (similar to a cigna PPO). The ACA and non-ACA plans have very limited local networks, which means that travel medical insurance may become necessary for domestic vacations.

Paying full-freight + 3% COBRA, as "expensive" as that may be, still sounds fine and I'd love to have that option for more than just 18 months after retiring. I'm hoping that some of the newer health insurance startups succeed in disrupting the status quo. Maybe Oscar health will become a viable insurer for my needs when the time comes.
delamer
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Re: Why buy medical insurance ?

Post by delamer »

beyou wrote: Tue Sep 22, 2020 4:16 pm
michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Glad to hear it worked out, and thanks for the contribution. I am not planning to play that game though. Trying to decide if I am willing to relocate to avoid Cobra or else will definitely sign up for the 18 months. What I fear most is what happens AFTER Cobra. Guess I have 18
months to figure that out, but by then ageisim will make it hard to get good employment I believe (and will have walked away from my job by them). If we had better ACA plans in my area would make my decisions easier. Would still stick with COBRA while on severance/retirement package, and then could decide to switch to ACA mid-stream or at the end. But unless there is major improvement for me, what’s coming is much worse than what I am leaving. The plans do not include many doctors and no out of network coverage at all, zero. I once had an hmo with very limited docs, and they almost killed me with bad medicine, had to threaten to sue to get care I needed. Don’t want to go back to those days.
Have you contacted an insurance agent to find out if there is an affordable non-ACA policy that has better coverage?
InMyDreams
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Re: Why buy medical insurance ?

Post by InMyDreams »

In the "good ol' days", i.e., pre-ACA, most (all?) medical insurance plans had a $1M max lifetime benefit. I knew people who had met that limit. And that was yesterday's dollars.

So, if it were me, I would carry the COBRA as long as I could. I gather from other threads that some states have extensions to COBRA. You might check for your state.

You could check out the type of insurance that Trump expanded a year or two ago. There are other threads about it. Buyer beware.

You could check out Health Ministries sharing plans. Buyer beware.

If you choose to go without, well, how about figuring out how best to protect your assets in the event of medical bankruptcy, and do some pre-planning. Hopefully you would never need to implement the full plan.

It's not just a matter of covering your assets. I am aware of physicians that will not take self-pay patients, including an in-law who could not find anyone to do his back surgery without insurance, even with upfront cash payment.

US healthcare financing is a mess.
random_walker_77
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Re: Why buy medical insurance ?

Post by random_walker_77 »

InMyDreams wrote: Wed Sep 23, 2020 12:14 pm
If you choose to go without, well, how about figuring out how best to protect your assets in the event of medical bankruptcy, and do some pre-planning. Hopefully you would never need to implement the full plan.

US healthcare financing is a mess.
Medical bankruptcy isn't even the worst case. I'd argue that the worst case is being unable to secure timely but critically necessary medical treatments for something like early stage cancer while it's still treatable. If you don't have the money, the ER is required to treat your heart attack, stroke, or terminal pneumonia, but hospitals and doctors don't have to treat anything that isn't going to immediately kill you.

If you have the money, given how much of a mess things are, it's an open question whether you can get the surgical slot you want at a reasonable rate, even though you have the cash. The way things are set up, it's not a matter of being overcharged by 20%, but of being overcharged by 20x
Nyarlathotep
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Re: Why buy medical insurance ?

Post by Nyarlathotep »

One idea I haven't seen mentioned so far is short-term medical insurance. It isn't ACA compliant, but the premiums are MUCH lower due to various caps and limitations. I purchased this for myself a few years ago when I unexpectedly lost a very good, employer-provided PPO plan. I needed something to bridge the gap for a few months until I could get back on an ACA bronze-level plan. But, honestly, it was a reasonably full-featured plan that covered pretty much everything that wasn't a pre-existing condition. It had something like a $1,000,000 lifetime cap on certain things. I would think that a short-term plan like this coupled with substantial self-insurance would be good enough in 99% of cases. I've seriously thought about going this route for myself, but it's that 1% chance of something going really wrong that keeps me from pulling the trigger.
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SmileyFace
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Re: Why buy medical insurance ?

Post by SmileyFace »

So if you catch cancer you are faced not only with what might the worse personal battle of your life for your life - but you may also have to spend 100's of thousands of dollars doing so. Unfortunately the risk of cancer is simply too high (https://www.cancer.org/cancer/cancer-ba ... ancer.html) to overlook. And then you have other risks like a car accident, etc. that can rack up very large bills.

The last thing I would want to worry about in a hospital on my deathbed is if there will be enough left after the bills are paid for my spouse to live on comfortably. I didn't work hard all my life for that.
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LilyFleur
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Re: Why buy medical insurance ?

Post by LilyFleur »

Nyarlathotep wrote: Wed Sep 23, 2020 1:18 pm One idea I haven't seen mentioned so far is short-term medical insurance. It isn't ACA compliant, but the premiums are MUCH lower due to various caps and limitations. I purchased this for myself a few years ago when I unexpectedly lost a very good, employer-provided PPO plan. I needed something to bridge the gap for a few months until I could get back on an ACA bronze-level plan. But, honestly, it was a reasonably full-featured plan that covered pretty much everything that wasn't a pre-existing condition. It had something like a $1,000,000 lifetime cap on certain things. I would think that a short-term plan like this coupled with substantial self-insurance would be good enough in 99% of cases. I've seriously thought about going this route for myself, but it's that 1% chance of something going really wrong that keeps me from pulling the trigger.
It's not enough if you have to buy insulin.
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Picasso
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Re: Why buy medical insurance ?

Post by Picasso »

The plan I work at sees more $1M+ claims than you would imagine. Self-insuring is not something I would consider with the expansion of gene therapy and specialty pharma costs.
Nyarlathotep
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Re: Why buy medical insurance ?

Post by Nyarlathotep »

LilyFleur wrote: Wed Sep 23, 2020 1:32 pm
Nyarlathotep wrote: Wed Sep 23, 2020 1:18 pm One idea I haven't seen mentioned so far is short-term medical insurance. It isn't ACA compliant, but the premiums are MUCH lower due to various caps and limitations. I purchased this for myself a few years ago when I unexpectedly lost a very good, employer-provided PPO plan. I needed something to bridge the gap for a few months until I could get back on an ACA bronze-level plan. But, honestly, it was a reasonably full-featured plan that covered pretty much everything that wasn't a pre-existing condition. It had something like a $1,000,000 lifetime cap on certain things. I would think that a short-term plan like this coupled with substantial self-insurance would be good enough in 99% of cases. I've seriously thought about going this route for myself, but it's that 1% chance of something going really wrong that keeps me from pulling the trigger.
It's not enough if you have to buy insulin.
True, but if you were diagnosed with diabetes (or some other serious, chronic condition that required expensive medications) while on short-term insurance, you could easily sign up for an ACA-compliant silver or gold plan during the next open enrollment. Your maximum exposure to higher payments for something like insulin would be less than 12 months. I'm sure there are situations where you could take a big financial hit before jumping back to an ACA plan, like, for example, a sudden, severe disease onset requiring a very expensive drug regimen. But I'd imagine those kinds of situations to be extremely rare.
InMyDreams
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Re: Why buy medical insurance ?

Post by InMyDreams »

random_walker_77 wrote: Wed Sep 23, 2020 1:01 pm
InMyDreams wrote: Wed Sep 23, 2020 12:14 pm
If you choose to go without, well, how about figuring out how best to protect your assets in the event of medical bankruptcy, and do some pre-planning. Hopefully you would never need to implement the full plan.

US healthcare financing is a mess.
Medical bankruptcy isn't even the worst case. I'd argue that the worst case is being unable to secure timely but critically necessary medical treatments for something like early stage cancer while it's still treatable. If you don't have the money, the ER is required to treat your heart attack, stroke, or terminal pneumonia, but hospitals and doctors don't have to treat anything that isn't going to immediately kill you.
Agreed. In many places, you may be able to obtain treatment, but it may be delayed. Diagnostics to see if you need treatment may be difficult to obtain.
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kramer
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Re: Why buy medical insurance ?

Post by kramer »

ncbill wrote: Tue Sep 22, 2020 8:25 pm
kramer wrote: Mon Sep 21, 2020 11:31 pm I don't really see any rational way a person with means can go bare in the US ... it's not just the uniquely high cost of US health care, but the unnegotiated rates paid by the uninsured.

But you can go bare in other countries, where cash for services is much more common (and often even the norm). But you have to live there and you have to be willing and ready to spend when the time comes (for even some people with sufficient means their portfolio is not structured in a way for this to be possible). Buy short term or travel insurance for visits to the US.
No need to go bare...e.g. in Mexico an expat the OP's age could buy into the national health plan (most treat it as catastrophic insurance) for under $500 per year...looks like more traditional "outside the USA & Canada" health insurance coverage there would run $250-$300/month for someone the OP's age.
I am actually living in Mexico at the moment ... my opinion is that the government health system in Mexico is of pretty low quality in most geographical areas ... I personally don't see the worth of signing up (even as a back up) if you have the means to pay private hospitals which have a high standard of care or get private insurance as you suggested... but I am not a resident yet and so I have not had to make that choice yet.

I am registered and paid up in the government health system in the Philippines, also, and that is worth almost nothing. But I have bought in so far since it's cheap and it's more like a card you can use to guarantee treatment, even in most private hospitals, since they know they will get something from you, at least (the government will pay the private hospital a portion of what a public hospital would have cost, might be 10% to 15% of a private hospital bill). But I would never go to a public hospital there, either. But paying cash at a private hospital is OK there, not expensive at all by American standards and although it's generally lower quality it's not that bad for most things.

But I do agree with the thrust of your post that a place like Mexico can be a great alternative for someone who can't afford health insurance in the USA, especially if they do have the means to pay big bills (but maybe no so big like in the USA) that arise along the way or to get private insurance. Quality of health care in private hospitals in Mexico is great.
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

delamer wrote: Wed Sep 23, 2020 9:50 am
beyou wrote: Tue Sep 22, 2020 4:16 pm
michaelingp wrote: Tue Sep 22, 2020 4:08 pm My DIL once asked me the same question. It was early in the year, and she had a job starting in September that guaranteed her insurance. My big concern at the time was that she could develop a chronic condition and never be able to get insurance again due to "existing condition", but that wasn't a concern due to the upcoming job. She was young and healthy and it was only a few months, so I reluctantly said it would probably be OK. Wouldn't you know she developed an ectopic pregnancy? The first bill was for $28K. But here's the cool part of the story. There is one situation where you can buy health insurance *after* you find that you need it. COBRA! She signed up for COBRA and they covered the entire procedures.
Glad to hear it worked out, and thanks for the contribution. I am not planning to play that game though. Trying to decide if I am willing to relocate to avoid Cobra or else will definitely sign up for the 18 months. What I fear most is what happens AFTER Cobra. Guess I have 18
months to figure that out, but by then ageisim will make it hard to get good employment I believe (and will have walked away from my job by them). If we had better ACA plans in my area would make my decisions easier. Would still stick with COBRA while on severance/retirement package, and then could decide to switch to ACA mid-stream or at the end. But unless there is major improvement for me, what’s coming is much worse than what I am leaving. The plans do not include many doctors and no out of network coverage at all, zero. I once had an hmo with very limited docs, and they almost killed me with bad medicine, had to threaten to sue to get care I needed. Don’t want to go back to those days.
Have you contacted an insurance agent to find out if there is an affordable non-ACA policy that has better coverage?
Not yet. I shopped online and found literally no direct to consumer offerings and was directed back to ACA. Have not called a broker yet, don't want to do that until I really am ready to buy. For now just trying to see if retiring early is going to mean not getting healthcare my family needs. Paying cash one can get whatever one can afford, but if I hand my cash to an insurance company and they don't deliver what we need, have to have even more cash. ACA is very likely to under-deliver. For a very healthy person who just needs checkups and has basic medical needs any docs will do. But then again in such case you don't need insurance, you can pay out of pocket. And for those needs that you can't afford out of pocket, you generally want the best care you can get for expensive life impacting issue, and my ACA options simply do not IMO handle that.

So assuming I retire next year as planned I will :

1) Go on Cobra to delay this problem for up to 18 months.

2) Search then current options via brokers and/or ACA (if it still exits)

3) Query wife's employer and see how good a plan they have (unsubsidized but if comparable to my Cobra may make sense)

4) Start own company and a small business plan ? Anybody try that ?
I am not talking about a shell or fake company, no deception. My wife or I can possibly freelance and start a company, make some cash part-time to pay for insurance, buy small business employer insurance which may exceed ACA plans ? I am not too excited to go down this path, but
if it results in superior health care coverage I would consider it. My current employer plan is great but they have thousands of employees. We won't.
blovia10
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Re: Why buy medical insurance ?

Post by blovia10 »

coachd50 wrote: Mon Sep 21, 2020 9:07 pm As someone mentioned above, the negotiated rates are SIGNIFICANTLY lower than what someone uninsured would be paying.
This is very dated information. Nearly all of the appointments my family members have had over the past couple years came with co-pays that were more than 50% greater than the cash price for an individual with no insurance. We would have paid substantially less for care overall had we never purchased insurance (and that's not even accounting for the cost of premiums).

Similarly, GoodRx prices for drugs are often less than the co-pays for people who use insurance. They held their IPO today, and at close they had a market cap of $19 billion. How does company that merely quotes an honest, straightforward price for a product have such a high valuation? Probably the biggest reason is that the so-called "negotiated" rates of insurers and PBMs are not negotiated in the interests of consumers at all.

Yes, bankruptcy is certainly possible without insurance, but if most of my assets were in ERISA-covered plans I'd seriously consider the OP's proposal. Our system is so heavily financialized now that in many cases your body and your health "issues" are little more than an excuse for the provider to send a big bill to your insurer or the government. There are many people who would be healthier now had they never had any interaction with the "health care" system.
Starfish
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Re: Why buy medical insurance ?

Post by Starfish »

flaccidsteele wrote: Tue Sep 22, 2020 10:05 pm I find it interesting that posters know how much their medical bills are? How do you know it was $130k for the collapsed lung or $400k for the cancer treatments?

As a Canadian I don’t see any bills like that. Even when my parents were undergoing cancer treatment I didn’t see anything similar. They did the treatments, and went back to their normal routine when done. :confused
squirm wrote: Tue Sep 22, 2020 6:20 pm Because you could get hit by a bus tomorrow and be in intensive care for weeks. I don't even like being without insurance for a day. But it's your gamble.
😬
That is true, but on the flip side from all the people I know who immigrated in Canada (tens) the vast majority are not happy with the health care.
Of course most Americans are no happy with theirs either, but for different reasons.
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MP123
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Re: Why buy medical insurance ?

Post by MP123 »

beyou wrote: Wed Sep 23, 2020 2:40 pm 4) Start own company and a small business plan ? Anybody try that ?
I am not talking about a shell or fake company, no deception. My wife or I can possibly freelance and start a company, make some cash part-time to pay for insurance, buy small business employer insurance which may exceed ACA plans ? I am not too excited to go down this path, but
if it results in superior health care coverage I would consider it. My current employer plan is great but they have thousands of employees. We won't.
Group health plans require that you have at least one common law employee, so you'd need to hire someone other than your spouse.

But if you do get a group plan for your company or even just an ACA plan you may be able to deduct the cost of your health insurance up to the amount of net profit of the business as the self employed health insurance deduction.
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

MP123 wrote: Wed Sep 23, 2020 3:37 pm
beyou wrote: Wed Sep 23, 2020 2:40 pm 4) Start own company and a small business plan ? Anybody try that ?
I am not talking about a shell or fake company, no deception. My wife or I can possibly freelance and start a company, make some cash part-time to pay for insurance, buy small business employer insurance which may exceed ACA plans ? I am not too excited to go down this path, but
if it results in superior health care coverage I would consider it. My current employer plan is great but they have thousands of employees. We won't.
Group health plans require that you have at least one common law employee, so you'd need to hire someone other than your spouse.

But if you do get a group plan for your company or even just an ACA plan you may be able to deduct the cost of your health insurance up to the amount of net profit of the business as the self employed health insurance deduction.
Thanks was wondering about the need to have another employee.

Regarding deduction, that was my only hesitancy about using COBRA, my COBRA can't be deducted against her (existing) business.
She is sort of a contractor to a firm, also part time employee, so she already pays SE tax now and schedule C. If we move to ACA or anything except COBRA, I think we can deduct. But COBRA is probably the best coverage I can get as I have what was a great employer (until they decided to move). I would not have her work for me, for professional and liability reasons. It's either her firm OR my firm but not together, different professions.
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beyou
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Re: Why buy medical insurance ?

Post by beyou »

blovia10 wrote: Wed Sep 23, 2020 3:25 pm
coachd50 wrote: Mon Sep 21, 2020 9:07 pm As someone mentioned above, the negotiated rates are SIGNIFICANTLY lower than what someone uninsured would be paying.
This is very dated information. Nearly all of the appointments my family members have had over the past couple years came with co-pays that were more than 50% greater than the cash price for an individual with no insurance. We would have paid substantially less for care overall had we never purchased insurance (and that's not even accounting for the cost of premiums).

Similarly, GoodRx prices for drugs are often less than the co-pays for people who use insurance. They held their IPO today, and at close they had a market cap of $19 billion. How does company that merely quotes an honest, straightforward price for a product have such a high valuation? Probably the biggest reason is that the so-called "negotiated" rates of insurers and PBMs are not negotiated in the interests of consumers at all.

Yes, bankruptcy is certainly possible without insurance, but if most of my assets were in ERISA-covered plans I'd seriously consider the OP's proposal. Our system is so heavily financialized now that in many cases your body and your health "issues" are little more than an excuse for the provider to send a big bill to your insurer or the government. There are many people who would be healthier now had they never had any interaction with the "health care" system.
If I was single, I would almost surely go cash pay. But I have a nervous wife with pre-existing conditions and for now a child who is ill.
The child will age out of my company plan right around the time I move to Cobra, so I will have to find something for him, likely ACA
or medicare since he's also got pre-exising conditions. For me I can most easily get coverage but have the least need/desire, but I will go on the
policy I get for my wife. And yeah, the "health care" system seems to leave a lot (medically speaking) to be desired. I would say the vast majority of our interactions with healthcare have not resulted in improved health but of course always exceptions and I guess you need to try.
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