Do We need health insurance??

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ResearchMed
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Re: Do We need health insurance??

Post by ResearchMed » Sun Aug 05, 2018 10:37 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
For just this reason, ACA coverage is available for initial purchase either at annual renewal dates OR if there is a significant change in circumstance (e.g., marriage, loss of a job, etc.).

Otherwise, why would *anyone* purchase insurance until they got sick?
That's like only getting homeowner's insurance once the house is on fire :shock:

Do you live in Canada now?
(Also, how does $$$$ allow one to gain Canadian citizenship? I didn't think that "lack of needing employment", etc., was sufficient.)

RM
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TravelGeek
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Re: Do We need health insurance??

Post by TravelGeek » Sun Aug 05, 2018 10:41 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).
You state that as a fact, but Canadians overall and perhaps overwhelmingly seem to be very proud of and happy with their healthcare system, based on 5 second google searches.
Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
Can you schedule your large sickness to happen right before open enrollment and not be super urgent? ;)

Read up on enrollment procedures. I think it’s been discussed in this thread and others.

UnitaryExecutive
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Re: Do We need health insurance??

Post by UnitaryExecutive » Sun Aug 05, 2018 10:48 am

ResearchMed wrote:
Sun Aug 05, 2018 10:37 am
UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
For just this reason, ACA coverage is available for initial purchase either at annual renewal dates OR if there is a significant change in circumstance (e.g., marriage, loss of a job, etc.).

Otherwise, why would *anyone* purchase insurance until they got sick?
That's like only getting homeowner's insurance once the house is on fire :shock:

Do you live in Canada now?
(Also, how does $$$$ allow one to gain Canadian citizenship? I didn't think that "lack of needing employment", etc., was sufficient.)

RM
Ah, interesting. Didn't know there were "open enrollment" periods built into the ACA.

My mom's family and wife's family lives in Canada. There were rumors that it was ending, but for years there was a provision that if someone had > 1.5M net worth and lent the government X amount of money that they were allowed into the country. Resulted in a large flood of immigrants from Hong Kong in the late 90's and, more recently, a bunch of mainland Chinese money flooding the Vancouver real estate market.

ResearchMed
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Re: Do We need health insurance??

Post by ResearchMed » Sun Aug 05, 2018 10:51 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:48 am
ResearchMed wrote:
Sun Aug 05, 2018 10:37 am
UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
For just this reason, ACA coverage is available for initial purchase either at annual renewal dates OR if there is a significant change in circumstance (e.g., marriage, loss of a job, etc.).

Otherwise, why would *anyone* purchase insurance until they got sick?
That's like only getting homeowner's insurance once the house is on fire :shock:

Do you live in Canada now?
(Also, how does $$$$ allow one to gain Canadian citizenship? I didn't think that "lack of needing employment", etc., was sufficient.)

RM
Ah, interesting. Didn't know there were "open enrollment" periods built into the ACA.

My mom's family and wife's family lives in Canada. There were rumors that it was ending, but for years there was a provision that if someone had > 1.5M net worth and lent the government X amount of money that they were allowed into the country. Resulted in a large flood of immigrants from Hong Kong in the late 90's and, more recently, a bunch of mainland Chinese money flooding the Vancouver real estate market.
IF that program is still in existence, would buying property in Vancouver "count" as "lending money to the government"?
Interesting.

RM
This signature is a placebo. You are in the control group.

TravelGeek
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Re: Do We need health insurance??

Post by TravelGeek » Sun Aug 05, 2018 10:54 am

libralibra wrote:
Sun Aug 05, 2018 12:09 am
I'm wondering what language people are referring to. I went back and re-read the OP and didn't notice anything. This sounds like mind-reading, which is dangerous in any discussion (i.e. if you imagine the other party to be irrational, then you are less likely to take his questions or answers seriously).
OP could mean original post or original poster. I think you need to read more than the original post.

That said, I would encourage us to not discuss other posters, but rather the topic raised. The goal of BH (for me) is to find solutions to problems.

Rupert
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Re: Do We need health insurance??

Post by Rupert » Sun Aug 05, 2018 11:02 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:48 am
ResearchMed wrote:
Sun Aug 05, 2018 10:37 am
UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
For just this reason, ACA coverage is available for initial purchase either at annual renewal dates OR if there is a significant change in circumstance (e.g., marriage, loss of a job, etc.).

Otherwise, why would *anyone* purchase insurance until they got sick?
That's like only getting homeowner's insurance once the house is on fire :shock:

Do you live in Canada now?
(Also, how does $$$$ allow one to gain Canadian citizenship? I didn't think that "lack of needing employment", etc., was sufficient.)

RM
Ah, interesting. Didn't know there were "open enrollment" periods built into the ACA.

My mom's family and wife's family lives in Canada. There were rumors that it was ending, but for years there was a provision that if someone had > 1.5M net worth and lent the government X amount of money that they were allowed into the country. Resulted in a large flood of immigrants from Hong Kong in the late 90's and, more recently, a bunch of mainland Chinese money flooding the Vancouver real estate market.
Yes, what you propose doing is in economic terms called "freeriding," and the ACA was designed to prevent just that sort of malfeasance. If everyone did what you propose, the system would collapse because only sick people would buy health insurance. Health insurance only works as a product if healthy people subsidize sick people (that's how insurance in general works, actually -- people who don't file claims subsidize people who do). Do some reading on freeriding and "the tragedy of the commons."

UnitaryExecutive
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Re: Do We need health insurance??

Post by UnitaryExecutive » Sun Aug 05, 2018 11:02 am

TravelGeek wrote:
Sun Aug 05, 2018 10:41 am

You state that as a fact, but Canadians overall and perhaps overwhelmingly seem to be very proud of and happy with their healthcare system, based on 5 second google searches.
In my experience, it's like Plato's cave. They all think it's great because it's free and they view the wait times and lower quality care as normal. In the majority of cases it's fine like when you have a cold or a broken arm. When you need high quality specialists and equipment, it's very not fine and many have either never experienced it or view it as normal.

Most of my evidence is anecdotal, but I've had a family die of cancer and there was an 8 month wait for chemo. My parents couldn't afford to get him to the US for chemo at that point so he waited while it got worse. My mother-in-law was misdiagnosed with asthma for 3 years, wasn't allowed to see a specialist and we sent her to a specialist in the US and learned that it was allergies. When she needed a breast MRI, the wait was 4 months and she thought this was totally standard and normal. We have a friend who had bleeding during her pregnancy and couldn't see an OB until 21 or 23 weeks - they just wouldn't see her - turns out she had an ovarian cyst, it took too long to diagnose/treat and now they just have to wait and she may never be able to have kids. That never happens in the US if you have insurance.

TravelGeek
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Re: Do We need health insurance??

Post by TravelGeek » Sun Aug 05, 2018 11:05 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:48 am

My mom's family and wife's family lives in Canada. There were rumors that it was ending, but for years there was a provision that if someone had > 1.5M net worth and lent the government X amount of money that they were allowed into the country. Resulted in a large flood of immigrants from Hong Kong in the late 90's and, more recently, a bunch of mainland Chinese money flooding the Vancouver real estate market.
I was curious and spent a minute googling around and came across this site that offers a questionnaire to determine your eligibility for immigration to Canada.

https://www.canada.ca/en/immigration-re ... -tool.html

I essentially said I wanted to come to Canada to start a business (“early retirement with free healthcare” didn’t appear to be an option), had between $300k and $10m, was willing to invest $2m in Canada, and had not run a business in the past two years. They didn’t want me. :(

Our worst case fallback option is to move to Europe if health Insurance in the US becomes unavailable prior to Medicare (next 10-13 years for us). Dual citizenship to the rescue.
Last edited by TravelGeek on Sun Aug 05, 2018 11:10 am, edited 1 time in total.

UnitaryExecutive
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Re: Do We need health insurance??

Post by UnitaryExecutive » Sun Aug 05, 2018 11:06 am

Rupert wrote:
Sun Aug 05, 2018 11:02 am
Yes, what you propose doing is in economic terms called "freeriding," and the ACA was designed to prevent just that sort of malfeasance. If everyone did what you propose, the system would collapse because only sick people would buy health insurance. Health insurance only works as a product if healthy people subsidize sick people (that's how insurance in general works, actually -- people who don't file claims subsidize people who do). Do some reading on freeriding and "the tragedy of the commons."
I'm familiar with the tragedy of the commons. It's why I don't think the current system for insuring the poor works in the US and the government should just implement a medicare option for all but not go single payer so that the private system is still there for folks to buy their own insurance or get it through their employers.

Rupert
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Re: Do We need health insurance??

Post by Rupert » Sun Aug 05, 2018 11:13 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 11:06 am
Rupert wrote:
Sun Aug 05, 2018 11:02 am
Yes, what you propose doing is in economic terms called "freeriding," and the ACA was designed to prevent just that sort of malfeasance. If everyone did what you propose, the system would collapse because only sick people would buy health insurance. Health insurance only works as a product if healthy people subsidize sick people (that's how insurance in general works, actually -- people who don't file claims subsidize people who do). Do some reading on freeriding and "the tragedy of the commons."
I'm familiar with the tragedy of the commons. It's why I don't think the current system for insuring the poor works in the US and the government should just implement a medicare option for all but not go single payer so that the private system is still there for folks to buy their own insurance or get it through their employers.
Really poor people actually have pretty good insurance here. It's the people who are borderline poor or working class or work for themselves or are retired early who have really crappy options.

I like the German system as a model for the US. It's not terribly dissimilar from what you propose.

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celia
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Re: Do We need health insurance??

Post by celia » Sun Aug 05, 2018 11:15 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:24 am
celia wrote:
Sun Aug 05, 2018 1:12 am
Let me ask you a question: If you have a house, do you carry homeowner's insurance?

If the house has never burned down, why do you still carry the insurance?

It's the same reason. You want to pay a small amount to insure against a financially catastrophic event that may not happen. But, if it does happen, the insurance lessens the financial hit to your family.
If I were in his shoes, obviously depending on the cost of my house, but up to 1M, I probably wouldn't even bother to carry homeowners. But I'm pretty anal about making mathematically correct decisions over the long run.
Double whammy: Your house catches fire at night while you are sleeping. You and your family are finally rescued but have sustained major burns and injuries. The physical and emotional toll would be enormous. But what about the financial toll?

My relatives lived near a neighbor's house that was struck by lightning during the night. We saw the missing roof and fire damage on the way to visit them and wondered if everyone was ok. (Actually, we didn't see any roof. Can't see something that isn't there any more.)

financeperchance
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Re: Do We need health insurance??

Post by financeperchance » Sun Aug 05, 2018 11:21 am

OMG this thread is ridiculous. There is no other answer than yes, you need health insurance. Just look at the cancer risk for example:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544764/

Regular chemo treatment can wipe out a lot of net worth over a matter of months.

With a net worth of 8 digits, even a couple thousand bucks a month for health insurance is just a rounding error.

Katietsu
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Re: Do We need health insurance??

Post by Katietsu » Sun Aug 05, 2018 11:25 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
Have you or a close family member had a serious or chronic illness in the US? The wait to see a rheumatologist in my area area is 6-8 months even if your daily life is a significant struggle due to a debilitating auto immune disease. The PCP’s see no patients outside of clinic hours and usually will not see you for same day emergencies (eg flu symptoms). Instead, you are referred to the emergency room. My cousin is on the kidney transplant list and has only ever seen a nurse practitioner from the transplant team. She will probably never meet an MD until she is about to be put under for the transplant. MRI’s for aneurysms and brain tumors are waiting weeks to be read due to a shortage of specially trained radiologists and that is after the time spent waiting to have the MRI in the first place.

I understand that this is not true in all institutions and all areas of the country. But the strain on the system is growing and spreading. And a majority of healthcare plans available through the ACA have limited networks, sometimes with a single option for highly specialized care, so you do not have a choice of facilities. I hope you never experience this side of the US healthcare system but you should be aware of the state of affairs for those who are truly ill.

I have close friends and family in 3 countries with government run health coverage, including Canada. I would say that most of them are happier with their options than the family members dealing with the US system. One relative returned to the U.K. for cancer treatment and another went from the ER to neurosurgery for a back problem in under a week in Australia. So, it all depends on your personal experiences. Not all health care plans in the US are created equal and not all regions have the same access. Similarly, there seems to be a wide range of experiences within Canada, across the EU, or Australia.

UnitaryExecutive
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Re: Do We need health insurance??

Post by UnitaryExecutive » Sun Aug 05, 2018 11:30 am

Rupert wrote:
Sun Aug 05, 2018 11:13 am
UnitaryExecutive wrote:
Sun Aug 05, 2018 11:06 am
Rupert wrote:
Sun Aug 05, 2018 11:02 am
Yes, what you propose doing is in economic terms called "freeriding," and the ACA was designed to prevent just that sort of malfeasance. If everyone did what you propose, the system would collapse because only sick people would buy health insurance. Health insurance only works as a product if healthy people subsidize sick people (that's how insurance in general works, actually -- people who don't file claims subsidize people who do). Do some reading on freeriding and "the tragedy of the commons."
I'm familiar with the tragedy of the commons. It's why I don't think the current system for insuring the poor works in the US and the government should just implement a medicare option for all but not go single payer so that the private system is still there for folks to buy their own insurance or get it through their employers.
Really poor people actually have pretty good insurance here. It's the people who are borderline poor or working class or work for themselves or are retired early who have really crappy options.

I like the German system as a model for the US. It's not terribly dissimilar from what you propose.
I think the Singapore system would be a great mode and love how there's an option for catastrophic events but also holds folks to pay for and understand how much care they're using, effectively limiting one of the downsides of a free system, which demand increases substantially.

TravelGeek
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Re: Do We need health insurance??

Post by TravelGeek » Sun Aug 05, 2018 11:33 am

UnitaryExecutive wrote:
Sun Aug 05, 2018 11:02 am

In my experience, it's like Plato's cave. They all think it's great because it's free and they view the wait times and lower quality care as normal. In the majority of cases it's fine like when you have a cold or a broken arm. When you need high quality specialists and equipment, it's very not fine and many have either never experienced it or view it as normal.

Most of my evidence is anecdotal ...
Non anecdotal data is available, e.g. on this site:

https://www.cihi.ca/en/infographic-wait ... anada-2017

One other point: I try to avoid the term “free” when describing other countries’ heathcare systems. They are “free” in the same sense as police, fire services and my local library are free to me. They are paid for by my taxes (and my property tax bill tells me exactly how much of my taxes goes to the library). If I wanted more access to books or more cops on the streets or another fire station, I could lobby for more funding. I assume Canadians could lobby to allocate more taxes to healthcare if they perceived their system to be in need of improvement (say, wanted faster access to MRIs).

But this thread isn’t really about the quality of the Canadian healthcare system, so I suggest we don’t continue down that road. To avoid lockdown of the thread, I think we need to focus on solutions for BHs under the current system (incl. moving elsewhere for care).

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LadyGeek
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Re: Do We need health insurance??

Post by LadyGeek » Sun Aug 05, 2018 11:52 am

TravelGeek wrote:
Sun Aug 05, 2018 11:33 am
But this thread isn’t really about the quality of the Canadian healthcare system, so I suggest we don’t continue down that road. To avoid lockdown of the thread, I think we need to focus on solutions for BHs under the current system (incl. moving elsewhere for care).
I agree.
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arsenalfan
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Re: Do We need health insurance??

Post by arsenalfan » Sun Aug 05, 2018 11:54 am

Yes.

Pennywise and pound foolish.

I have taken care of
1. 50-something healthy man turning tan = new onset metastatic pancreatic cancer, who has no health insurance. 60+ day inpatient stay, 32+ days ICU intubated, 8 surgeries, going to rehab facility. Who knows how long they will be there/what that costs.

2. As a resident, a FIRE 53yo who just shot par for the first time on his home course, but had a funny tongue feeling = nasopharyngeal cancer, requiring excision, tracheostomy x 1 year, multiple facial reconstructive surgeries/free flap from fibula and rehab.

Chances are low/I wouldn't wish these on you.

Point is, lightning strikes happen.

In both cases, with no insurance you'd tear through your $14MM in the first 1 year. Then you'd fall below income maximums to get Medicaid.

ZX 11
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Re: Do We need health insurance??

Post by ZX 11 » Sun Aug 05, 2018 5:41 pm

I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.

badProgrammer
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Re: Do We need health insurance??

Post by badProgrammer » Sun Aug 05, 2018 7:39 pm

ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
"The average annual premiums in 2016 are $6,435 for single coverage and $18,142 for family coverage." (https://www.kff.org/report-section/ehbs ... insurance/)

How low would you want the premiums to go in exchange for a super-high deductible like $50K or $100K?

runner540
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Re: Do We need health insurance??

Post by runner540 » Sun Aug 05, 2018 8:26 pm

ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
I am NOT an actuary or insurance expert, but my guess is that there is not a big enough group that wants this coverage, to spread the risk enough for the insurance company. How many of the households in your state even have $100k in financial assets? Then remove all those covered by Medicare or employer plans.

UpperNwGuy
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Re: Do We need health insurance??

Post by UpperNwGuy » Sun Aug 05, 2018 8:30 pm

I don't know about others, but I certainly need health insurance. And I say that being in very good health.
Buy-and-hold retired investor with a 60/40 taxable portfolio: Total Stock + Total Int'l + Total Bond + Interm Term Tax Exempt.

delamer
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Re: Do We need health insurance??

Post by delamer » Sun Aug 05, 2018 9:03 pm

badProgrammer wrote:
Sun Aug 05, 2018 7:39 pm
ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
"The average annual premiums in 2016 are $6,435 for single coverage and $18,142 for family coverage." (https://www.kff.org/report-section/ehbs ... insurance/)

How low would you want the premiums to go in exchange for a super-high deductible like $50K or $100K?

Those are total premiums for insurance provided for workers by their employers.

They are very different than the costs an individual purchasing insurance would experience. Plus, generally, workers don’t pay the entire premium.

TravelGeek
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Re: Do We need health insurance??

Post by TravelGeek » Sun Aug 05, 2018 9:27 pm

ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
High deductible plans are available to select groups (under 30 is one criteria). But your desired “high” seems to be an order or two of magnitudes higher.

Perhaps talk to an insurance broker familiar with your market to explore your options.

BigJohn
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Re: Do We need health insurance??

Post by BigJohn » Mon Aug 06, 2018 3:16 pm

123 wrote:
Mon Jul 02, 2018 10:26 pm
Health insurance gives you rates for services that are negotiated by the insurance company. A hospitalization that can cost $250,000 at the hospital "rack (cash) rate" for something like a heart pacemaker or a cardiac stent with a couple of days in the hospital can get a negotiated rate of $75,000 for the insurance company to pay with your out-of-pocket expense of likely under $5,000. A stay or a week or longer in the hospital for something like pneumonia can put a serious dent in your assets without health insurance. Health insurance is a better deal than Costco!
If you want real world example... from a 1 day hospital stay post surgery. Surgeon bill $28K negotiated down to $5K by insurance, hospital $82K down to $23K. Without insurance you are going to pay all of the higher number.

P.S. I thought I was healthy but things have a way of sneaking up on you. In addition, a lot of those things are such that are you not going to want or be able to wait until after you sign-up for insurance. The nature of all insurance is to cover unexpected and catastrophic events. I agree with all other posters in saying you need to get health insurance ASAP!

badProgrammer
Posts: 36
Joined: Wed Nov 30, 2016 7:14 am

Re: Do We need health insurance??

Post by badProgrammer » Mon Aug 06, 2018 8:11 pm

I think part of the problem is that people who have not experienced a misfortune in which insurance pays off sometimes conclude that insurance premiums were "wasted." It's like some form of survivorship bias.

This is true for my parent who told me that no health insurance was necessary during the gap until Medicare kicked in because insurance had never paid off in the lifetime thus far.

This sort of reminds me of what someone else on a different BH thread pointed out to me about attempting market timing - if you buy or sell and then the market soars or tanks, respectively, you may conclude that you are smarter than the market.

There's a reason why insurance of all types pools risk...some people are lucky, some people are not.

ZX 11
Posts: 3
Joined: Sun Aug 05, 2018 5:15 pm

Re: Do We need health insurance??

Post by ZX 11 » Mon Aug 06, 2018 9:09 pm

runner540 wrote:
Sun Aug 05, 2018 8:26 pm
ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
I am NOT an actuary or insurance expert, but my guess is that there is not a big enough group that wants this coverage, to spread the risk enough for the insurance company. How many of the households in your state even have $100k in financial assets? Then remove all those covered by Medicare or employer plans.
Well there are approximately 5M households in th US with $3M or more of net worth. Would think this group would consider the type of policy I am suggesting. I don’t think insurance companies necessarily needed a large pool of similarly insured. Thought that they just needed assets to cover the expected payout for the entire range of policies they write. As an example, Lloyds of London writes policies for satellite launches. Surely there can’t be a large enough pool of insured satellite launches to cover the cost of even one failed attempt. Maybe a just stumbled across a business idea. Any venture capitalists in the audience that want to bank roll my idea? : )

noco-hawkeye
Posts: 331
Joined: Sat Aug 16, 2014 8:20 am

Re: Do We need health insurance??

Post by noco-hawkeye » Mon Aug 06, 2018 9:16 pm

ZX 11 wrote:
Mon Aug 06, 2018 9:09 pm
runner540 wrote:
Sun Aug 05, 2018 8:26 pm
ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
I am NOT an actuary or insurance expert, but my guess is that there is not a big enough group that wants this coverage, to spread the risk enough for the insurance company. How many of the households in your state even have $100k in financial assets? Then remove all those covered by Medicare or employer plans.
Well there are approximately 5M households in th US with $3M or more of net worth. Would think this group would consider the type of policy I am suggesting. I don’t think insurance companies necessarily needed a large pool of similarly insured. Thought that they just needed assets to cover the expected payout for the entire range of policies they write. As an example, Lloyds of London writes policies for satellite launches. Surely there can’t be a large enough pool of insured satellite launches to cover the cost of even one failed attempt. Maybe a just stumbled across a business idea. Any venture capitalists in the audience that want to bank roll my idea? : )
A big part of insurance is negotiation of prices. So say an insurance company goes to your local hospital, and says "we have 10 people that may or may not visit your facility and we would like to negotiate some prices with you for this different group of people. These people will need to be treated unlike any of your other arrangements". I'm not sure that's how it would go down, but I could sure see how this would be a non starter.

NotWhoYouThink
Posts: 2030
Joined: Fri Dec 26, 2014 4:19 pm

Re: Do We need health insurance??

Post by NotWhoYouThink » Mon Aug 06, 2018 9:30 pm

Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.

david99
Posts: 631
Joined: Sat Mar 03, 2007 11:56 am

Re: Do We need health insurance??

Post by david99 » Mon Aug 06, 2018 9:50 pm

UnitaryExecutive wrote:
Sun Aug 05, 2018 10:31 am
Also, here's one other option to consider - with that level of net worth you can easily get Canadian citizenship. That way, you shield yourself against any catastrophic events without having to pay the premiums.

I will caveat Canadian health care system is really bad and a huge downgrade for those of us who have insurance in the US (source: my wife and mom's family are all Canadian).

Also, question for folks on this board. Since the ACA doesn't allow insurers to deny pre-existing conditions, can't you just purchase insurance if you need it? One of our retirement plans was to live near the US border, use Canadian health care for things that are non-urgent and then if some large sickness strikes that we need access to specialists quickly, we'd just buy insurance in the US and get access to the best facilities and equipment.
I have dual citizenship because I was born in Canada. So I could go to Canada if I got cancer but it wouldn't help me if I got hit by a car and was in a coma for a month. I would have to stay in a US hospital until I was well enough to travel.

ZX 11
Posts: 3
Joined: Sun Aug 05, 2018 5:15 pm

Re: Do We need health insurance??

Post by ZX 11 » Mon Aug 06, 2018 9:51 pm

NotWhoYouThink wrote:
Mon Aug 06, 2018 9:30 pm
Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.
The individual mandate ceases after this year. Will catastrophic policies become available to all again beginning next year?

delamer
Posts: 5853
Joined: Tue Feb 08, 2011 6:13 pm

Re: Do We need health insurance??

Post by delamer » Mon Aug 06, 2018 10:11 pm

ZX 11 wrote:
Mon Aug 06, 2018 9:51 pm
NotWhoYouThink wrote:
Mon Aug 06, 2018 9:30 pm
Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.
The individual mandate ceases after this year. Will catastrophic policies become available to all again beginning next year?

From what I’ve read, no.

Technically, the mandate did not go away but the fine for not having coverage did. So the mandate isn’t being enforced.

But the legal rationales for limiting catastrophic coverage have not changed.

bhsince87
Posts: 1755
Joined: Thu Oct 03, 2013 1:08 pm

Re: Do We need health insurance??

Post by bhsince87 » Mon Aug 06, 2018 10:15 pm

ZX 11 wrote:
Mon Aug 06, 2018 9:51 pm
NotWhoYouThink wrote:
Mon Aug 06, 2018 9:30 pm
Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.
The individual mandate ceases after this year. Will catastrophic policies become available to all again beginning next year?
They were still available under previous rules. However, they were limited to 3 months length, and if you only used those, you were required to pay the fine.

Starting in 2019, you will no longer need to pay a fine, and they can legally be extended to three year terms. It remains to be seen if insurance companies will offer them though.
Retirement: When you reach a point where you have enough. Or when you've had enough.

User avatar
dodecahedron
Posts: 3667
Joined: Tue Nov 12, 2013 12:28 pm

Re: Do We need health insurance??

Post by dodecahedron » Mon Aug 06, 2018 11:40 pm

ZX 11 wrote:
Mon Aug 06, 2018 9:09 pm
runner540 wrote:
Sun Aug 05, 2018 8:26 pm
ZX 11 wrote:
Sun Aug 05, 2018 5:41 pm
I am very interested in an answer to OP’s question about the availability of very, very high deductible healthcare insurance, as well. Like in the range of $50K to $100K deductible. I view it more as wealth insurance than health insurance. While I don’t have the OPs level of wealth, I would consider taking the risk of self-insuring for the first $50 to $100K if it considerably lowered the premiums of traditional healthcare coverage. While I would certainly wince at a $100K hit, it would certainly not break me. I really just want to protect against the catastrophic event that could wipe me out. No answer so far after 100+ responses on this thread and I have searched quite a bit elsewhere so I assume this sort of coverage does not exist. A little surprised at that.
I am NOT an actuary or insurance expert, but my guess is that there is not a big enough group that wants this coverage, to spread the risk enough for the insurance company. How many of the households in your state even have $100k in financial assets? Then remove all those covered by Medicare or employer plans.
Well there are approximately 5M households in th US with $3M or more of net worth. Would think this group would consider the type of policy I am suggesting. I don’t think insurance companies necessarily needed a large pool of similarly insured.
Health insurance offerings are heavily regulated by state insurance departments, so it is not a national market. Insurance companies have to submit their proposed policies to state insurance departments for approval annually. There are lots of idiosyncratic pricing issues. Even within a state, a given insurance company may charge different premiums for the same coverage, due to differing health costs in different regions of the state.

Moreover, a significant number of those households with $3M or more in net worth are located in New York State, which even prior to ACA did not permit catastrophic policies of the type you describe. In fact, prior to the ACA, New York State heavily circumscribed nongroup policies so that not even modestly high deductible policies were available, let alone the catastrophic policies you suggest. (Prior to ACA, an individual could not even purchase a policy that would qualify for an HSA, for example.)

Finally, whether it seems rational to you or not, lots of high net worth folks don't want ultra-high deductible policies. Some folks just don't like the idea of lots of confusingly worded (and possibly erroneous) bills sloshing through their mailslots at a time when they are already under stress due to the serious illness of a family member.

craiggsean
Posts: 113
Joined: Wed Nov 27, 2013 5:47 pm

Re: Do We need health insurance??

Post by craiggsean » Tue Aug 07, 2018 6:28 am

Dear OP or others,

How is your experience with Health Sharing / Ministries?

Many have been using it and users growing faster after ACA

Rupert
Posts: 3574
Joined: Fri Aug 17, 2012 12:01 pm

Re: Do We need health insurance??

Post by Rupert » Tue Aug 07, 2018 6:47 am

craiggsean wrote:
Tue Aug 07, 2018 6:28 am
Dear OP or others,

How is your experience with Health Sharing / Ministries?

Many have been using it and users growing faster after ACA
There are many prior threads on those ministries. Whenever they're brought up, they always completely derail the OP's thread. I suggest you do a search for the prior threads.

middistancerunner
Posts: 141
Joined: Tue Aug 19, 2014 12:02 am

Re: Do We need health insurance??

Post by middistancerunner » Tue Aug 07, 2018 8:01 am

Also worth of noting/reminding folks about the fact that prior to the ACA, health insurance would usually have annual and lifetime maximum coverage limits, which could easily be exhausted in the case of an expensive illness. So these plans were exactly the opposite of what people are discussing here - you weren't actually insured against the loss of wealth in the case of catastrophe.

Plans like this are going to become more common and more popular with the rewriting of ACA rules that has been happening under the Trump admin - for example, not hard to imagine "short term" plans becoming attractive for folks like the OP because they are cheap, non-marketplace, and will soon be available as a year-round insurance option (without penalty as the mandate is going away). But buyer beware/read the fine print.. they might not accomplish the thing you actually want the insurance to accomplish.

Rupert
Posts: 3574
Joined: Fri Aug 17, 2012 12:01 pm

Re: Do We need health insurance??

Post by Rupert » Wed Aug 08, 2018 10:07 am

bhsince87 wrote:
Mon Aug 06, 2018 10:15 pm
ZX 11 wrote:
Mon Aug 06, 2018 9:51 pm
NotWhoYouThink wrote:
Mon Aug 06, 2018 9:30 pm
Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.
The individual mandate ceases after this year. Will catastrophic policies become available to all again beginning next year?
They were still available under previous rules. However, they were limited to 3 months length, and if you only used those, you were required to pay the fine.

Starting in 2019, you will no longer need to pay a fine, and they can legally be extended to three year terms. It remains to be seen if insurance companies will offer them though.
An article relevant to your last point: https://www.nytimes.com/2018/08/06/us/p ... =RecEngine

States are pushing back because they know these are mostly junk policies or are policies being marketed in a misleading way.

bhsince87
Posts: 1755
Joined: Thu Oct 03, 2013 1:08 pm

Re: Do We need health insurance??

Post by bhsince87 » Wed Aug 08, 2018 12:00 pm

Rupert wrote:
Wed Aug 08, 2018 10:07 am
bhsince87 wrote:
Mon Aug 06, 2018 10:15 pm
ZX 11 wrote:
Mon Aug 06, 2018 9:51 pm
NotWhoYouThink wrote:
Mon Aug 06, 2018 9:30 pm
Catastrophic policies are unavailable for those of us over 30 because Congress decided to make it that way. It isn't an underwriting issue. They used to be available.

Plenty of people decide not to buy health insurance, that has always been the case and always will be. We don't all see risk the same way, and we certainly don't all make rational decisions.
The individual mandate ceases after this year. Will catastrophic policies become available to all again beginning next year?
They were still available under previous rules. However, they were limited to 3 months length, and if you only used those, you were required to pay the fine.

Starting in 2019, you will no longer need to pay a fine, and they can legally be extended to three year terms. It remains to be seen if insurance companies will offer them though.
An article relevant to your last point: https://www.nytimes.com/2018/08/06/us/p ... =RecEngine

States are pushing back because they know these are mostly junk policies or are policies being marketed in a misleading way.
Interesting. Thanks for sharing.
Retirement: When you reach a point where you have enough. Or when you've had enough.

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