Ultra High Deductible Health Insurance?

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atomicsquirrel
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Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Tue Feb 11, 2020 2:52 pm

Is there such a product available?

In the next year or so my wife and I may need to purchase health insurance on the open market. A cursory look seems to say I can expect to pay around 2k /mo or 24k per year for private medical insurance for the two of us. I want to be protected should one or both of us need major medical care so going without insurance is not an option.

Are there any medical insurance plans that have a significantly higher deductibles with a much lower premium? Say a 25k or 50k deductible? Wife and I are pretty healthy, we exercise and watch what we eat, don't smoke. I am willing to accept my exposure to a larger medical bill if I can find a plan with a much lower premium.

We have significant savings in our HSA accounts plus liquid assets should we need to pay out of pocket.

Any thoughts on how to tackle health care insurance is appreciated. We won't qualify for Medicare for many years to come.

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simplesimon
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Re: Ultra High Deductible Health Insurance?

Post by simplesimon » Tue Feb 11, 2020 2:58 pm

No.

https://www.healthcare.gov/glossary/hig ... alth-plan/

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)

sailaway
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Re: Ultra High Deductible Health Insurance?

Post by sailaway » Tue Feb 11, 2020 3:03 pm

simplesimon wrote:
Tue Feb 11, 2020 2:58 pm
No.

https://www.healthcare.gov/glossary/hig ... alth-plan/

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)
That is the definition for an HSA eligible plan. There are plans with deductibles and/or OOP expenses that exceed these limits, but they are not HSA eligible. I have not seen one as high as what OP is looking for though.

There might be something in the short term market?

adamthesmythe
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Re: Ultra High Deductible Health Insurance?

Post by adamthesmythe » Tue Feb 11, 2020 3:08 pm

atomicsquirrel wrote:
Tue Feb 11, 2020 2:52 pm
Are there any medical insurance plans that have a significantly higher deductibles with a much lower premium?
There does not appear to be such a thing. Which may mean that a substantial part of the cost of present plans pays for the few outliers with very high medical expenses.

OR the market for such a plan is too small and/ or too hard to calculate.

Now if you were a company that self-insured...apparently many of those do buy insurance against extremely large claims.

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simplesimon
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Re: Ultra High Deductible Health Insurance?

Post by simplesimon » Tue Feb 11, 2020 3:08 pm

sailaway wrote:
Tue Feb 11, 2020 3:03 pm
simplesimon wrote:
Tue Feb 11, 2020 2:58 pm
No.

https://www.healthcare.gov/glossary/hig ... alth-plan/

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)
That is the definition for an HSA eligible plan. There are plans with deductibles and/or OOP expenses that exceed these limits, but they are not HSA eligible. I have not seen one as high as what OP is looking for though.

There might be something in the short term market?
Interesting, can you provide a link to one? I'm searching "non-qualified high deductible health plan" and not coming up with anything. Thanks for pointing that out.

sailaway
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Re: Ultra High Deductible Health Insurance?

Post by sailaway » Tue Feb 11, 2020 3:32 pm

simplesimon wrote:
Tue Feb 11, 2020 3:08 pm
sailaway wrote:
Tue Feb 11, 2020 3:03 pm
simplesimon wrote:
Tue Feb 11, 2020 2:58 pm
No.

https://www.healthcare.gov/glossary/hig ... alth-plan/

For 2020, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn't apply to out-of-network services.)
That is the definition for an HSA eligible plan. There are plans with deductibles and/or OOP expenses that exceed these limits, but they are not HSA eligible. I have not seen one as high as what OP is looking for though.

There might be something in the short term market?
Interesting, can you provide a link to one? I'm searching "non-qualified high deductible health plan" and not coming up with anything. Thanks for pointing that out.
It is going to depend on your state and other details. It can be very hard to get details without handing over details. Search for high deductible short term insurance within you state.

JonnyB
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Re: Ultra High Deductible Health Insurance?

Post by JonnyB » Tue Feb 11, 2020 3:37 pm

sailaway wrote:
Tue Feb 11, 2020 3:03 pm
That is the definition for an HSA eligible plan. There are plans with deductibles and/or OOP expenses that exceed these limits, but they are not HSA eligible.
As it link states, that is the limit for an ACA compliant high deductible health plan. You will not find ACA compliant plans with higher deductibles than the total out of pocket limits of $6,900 $8,200 for an individual or $13,800 $16,400 for a family.

The 2017 tax law also included some changes to health plans. They now allow so-called "skinny" plans that used to be limited to three months, which can now be extended to a year. These non-compliant plans also have a lot of restrictions. For example, coverage may be excluded for pre-existing conditions. They also have maximum payout ceilings for expensive treatments like cancer or major surgery. Availability of these skinny plans vary from state to state, depending on state regulations.
Last edited by JonnyB on Tue Feb 11, 2020 6:30 pm, edited 1 time in total.

SeekingAPlan
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Re: Ultra High Deductible Health Insurance?

Post by SeekingAPlan » Tue Feb 11, 2020 6:20 pm

I have an ACA plan for an individual.

Deductible - $7,400

In Network Out of Pocket Max - $8,150

Premium - $10,080 / yr

Please note that the network is very narrow. It is quite possible to go to an in network hospital and get out of network bills for doctors, labs, etc. These bills mount up very quickly. Basically the sky is the limit, even with ACA insurance.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Tue Feb 11, 2020 6:23 pm

I don't know if I care if the insurance is ACA compliant. I'm not looking for a medical plan I'm looking for actual insurance. Insurance that covers me if [things really go downhill — moderator oldcomputerguy], like cancer and I rack up a million dollar bill. I am fully willing and able to pay for my own yearly physicals, medications, bills up to 50k, etc. Its the much larger, more serious and unlikely event I wish to insure against. The state of residence would most likely be Florida, if it matters.

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.

I guess that's why medical insurance called the golden handcuffs. Not sure how Medicare for all would play out, but the current system is unsustainable. Ever since Obamacare kicked in my insurance premiums have tripled and the deductibles have gone from $750 annually to $6900. Sorry for the vent. I know many people are in the same boat.

JonnyB
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Re: Ultra High Deductible Health Insurance?

Post by JonnyB » Tue Feb 11, 2020 6:32 pm

SeekingAPlan wrote:
Tue Feb 11, 2020 6:20 pm
I have an ACA plan for an individual.
Deductible - $7,400
Thanks. You prompted me to correct my comment above to include the right 2020 limits.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Tue Feb 11, 2020 6:35 pm

SeekingAPlan wrote:
Tue Feb 11, 2020 6:20 pm
I have an ACA plan for an individual.

Deductible - $7,400

In Network Out of Pocket Max - $8,150

Premium - $10,080 / yr

Please note that the network is very narrow. It is quite possible to go to an in network hospital and get out of network bills for doctors, labs, etc. These bills mount up very quickly. Basically the sky is the limit, even with ACA insurance.
That number would double for 2 people, wife and I. It really feels way too expensive for what you get. As a kicker my scripts are cheaper thru GoodRX than thru my insurance.

SeekingAPlan
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Re: Ultra High Deductible Health Insurance?

Post by SeekingAPlan » Tue Feb 11, 2020 6:48 pm

atomicsquirrel wrote:
Tue Feb 11, 2020 6:35 pm
SeekingAPlan wrote:
Tue Feb 11, 2020 6:20 pm
I have an ACA plan for an individual.

Deductible - $7,400

In Network Out of Pocket Max - $8,150

Premium - $10,080 / yr

Please note that the network is very narrow. It is quite possible to go to an in network hospital and get out of network bills for doctors, labs, etc. These bills mount up very quickly. Basically the sky is the limit, even with ACA insurance.
That number would double for 2 people, wife and I. It really feels way too expensive for what you get. As a kicker my scripts are cheaper thru GoodRX than thru my insurance.
I agree as long as one is healthy. But one minute a person is well and the next they may be diagnosed with cancer. Many cancers are now an expensive chronic disease. I think in that case the insurance price for drugs would be better than GoodRX. And the guaranteed reissue and negotiated contract rates for the ACA plan would start looking very attractive. I think you have to be careful about going too high on the deductible & out of pocket maximum because you are well. One is only well until suddenly they are not and that dedecutible has to be paid *every* year not just once.

adamthesmythe
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Re: Ultra High Deductible Health Insurance?

Post by adamthesmythe » Tue Feb 11, 2020 6:49 pm

atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm
I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
I have read about several strategies

- retiree coverage
- spouse continues to work
- engineer an income low enough to get subsidies
- health ministries
- maybe some go bare

The health care issue is, in my opinion, why FIRE can be an option for a small minority at most.

I have sympathy for those who really cannot continue to work. But why should government policy NOT encourage those able to work to continue working until Medicare age??

SchruteB&B
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Re: Ultra High Deductible Health Insurance?

Post by SchruteB&B » Tue Feb 11, 2020 6:57 pm

atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/

Jags4186
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Re: Ultra High Deductible Health Insurance?

Post by Jags4186 » Tue Feb 11, 2020 7:09 pm

SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm
atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Tue Feb 11, 2020 8:05 pm

Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm
atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

tjtv
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Re: Ultra High Deductible Health Insurance?

Post by tjtv » Tue Feb 11, 2020 8:14 pm

I think the problem is that when ACA was passed into law and the rule about not being able to discriminate against those with pre-existing conditions. Under that model those insurers then need as many healthy folks as possible to subscribe to their plans to help pay for the unhealthy ones. If the healthy ones buy "catastrophic-only" insurance and then get sick - the following year they switch to a "normal" plan with a lower deductible since the insurance company can't exclude them. If the "normal" plans have only ever unhealthy subscribers it doesn't work.

All of the true "catastropic-only", very high deductible, low premium plans basically disappeared when ACA was passed.

Flyer24
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Re: Ultra High Deductible Health Insurance?

Post by Flyer24 » Tue Feb 11, 2020 11:26 pm

Topic moved to Personal Finance (insurance).

mgensler
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Re: Ultra High Deductible Health Insurance?

Post by mgensler » Wed Feb 12, 2020 7:11 am

I posted this question a year ago. viewtopic.php?f=11&t=271006

In the end, we decided to stick with the ACA bronze HSA plan. We found paying cash for everything is less costly than having them submit bills to the insurance. The discounted cash rate has been cheaper than what we owe the insurance after it is billed and covered. We also use GoodRX for the prescriptions. The ACA is basically our catastrophe plan.

We know some early retirees who are able to keep their income low enough that they qualify for a fully subsidized ACA plan. This may have involved putting some of their money into an annuity before retirement.

BruDude
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Re: Ultra High Deductible Health Insurance?

Post by BruDude » Wed Feb 12, 2020 8:00 am

You are looking for something that doesn’t exist anymore. ACA limits the deductible and out of pocket max for all compliant plans. Non-compliant plans aren’t true major medical health insurance. They will have some type of limitations, whether it be benefit limits, pre-ex exclusions, or a combination of both.

1130Super
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Re: Ultra High Deductible Health Insurance?

Post by 1130Super » Wed Feb 12, 2020 8:03 am

atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm
atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies

NotWhoYouThink
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Re: Ultra High Deductible Health Insurance?

Post by NotWhoYouThink » Wed Feb 12, 2020 8:04 am

ACA outlawed those policies for people over 30. Many of us would love to have them, but insurers are not allowed to offer them. For now, anyway.

FrankLUSMC
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Re: Ultra High Deductible Health Insurance?

Post by FrankLUSMC » Wed Feb 12, 2020 8:54 am

I am 63 and retired, wife is 62 this June and retired this past December. Her company retirement insurance was close to $30k/yr and Cobra (only 18 months) would be over 24K/year.

So we have opted to buffer ourselves until Medicare with Christian Healthsharing Ministries. It isn't insurance, but a cost sharing program. We are both healthy and expect to pay OOP up to $500 per incident.

Something to consider for you.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 9:29 am

FrankLUSMC wrote:
Wed Feb 12, 2020 8:54 am
I am 63 and retired, wife is 62 this June and retired this past December. Her company retirement insurance was close to $30k/yr and Cobra (only 18 months) would be over 24K/year.

So we have opted to buffer ourselves until Medicare with Christian Healthsharing Ministries. It isn't insurance, but a cost sharing program. We are both healthy and expect to pay OOP up to $500 per incident.

Something to consider for you.
I've heard of heath care sharing but because its not actual insurance, I'm not willing to risk my retirement on it. No offense, just my opinion. Glad its working for you.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 9:32 am

1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm
atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.

knightrider
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Re: Ultra High Deductible Health Insurance?

Post by knightrider » Wed Feb 12, 2020 9:35 am

The reason why there are no ultra high deductible insurance plans is because very few people understand their benefits. Everybody I talk to just wants low out of pocket expenses, even if they have money lying around. They don't understand that insurance companies have huge overheads that they pass on to you via high premiums. I debated this with family and friends to no avail. They just don't get it. I have given up..

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 9:56 am

knightrider wrote:
Wed Feb 12, 2020 9:35 am
The reason why there are no ultra high deductible insurance plans is because very few people understand their benefits. Everybody I talk to just wants low out of pocket expenses, even if they have money lying around. They don't understand that insurance companies have huge overheads that they pass on to you via high premiums. I debated this with family and friends to no avail. They just don't get it. I have given up..
I get it. Its like banging your head against the wall. I understand my situation may be unique but its far from rare.

If I could land a catastrophic only plan for say 7k in premiums w/ 30k deductible, that would leave me with about 17k a year to cover actual out of pocket medical expenses. I could purchase a lot of routine, cash discounted health care with 17k.

whomever
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Re: Ultra High Deductible Health Insurance?

Post by whomever » Wed Feb 12, 2020 10:03 am

FWIW:
I know a couple who had a policy like you want some years ago. It might work if you are in your 20's and have zero medical visits in a year, but they were in their late 40's and while generally healthy would occasional actually need medical care. And the problem was evinced by those bills you get of the form 'Amount billed $10K; negotiated rate with your insurance $500; your insurance pays $450; you owe $50'. And the super high deductible insurance hadn't negotiated any rates, so the provider wants $10K from you. It only takes one or two of those a year to make 'normal' insurance a better deal.

It would be completely different if you were only asked to pay the actual going rate, i.e. $500.

(The lack of such policies is a real loss for us all - people with those policies are the only people with any actual motivation to price shop and thus put any price pressure on providers)

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simplesimon
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Re: Ultra High Deductible Health Insurance?

Post by simplesimon » Wed Feb 12, 2020 10:07 am

atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm


They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
You'd need significant Roth assets.

Topic Author
atomicsquirrel
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Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 10:35 am

whomever wrote:
Wed Feb 12, 2020 10:03 am
FWIW:
I know a couple who had a policy like you want some years ago. It might work if you are in your 20's and have zero medical visits in a year, but they were in their late 40's and while generally healthy would occasional actually need medical care. And the problem was evinced by those bills you get of the form 'Amount billed $10K; negotiated rate with your insurance $500; your insurance pays $450; you owe $50'. And the super high deductible insurance hadn't negotiated any rates, so the provider wants $10K from you. It only takes one or two of those a year to make 'normal' insurance a better deal.

It would be completely different if you were only asked to pay the actual going rate, i.e. $500.

(The lack of such policies is a real loss for us all - people with those policies are the only people with any actual motivation to price shop and thus put any price pressure on providers)
That's good to know. Are you sure that's correct? It seems odd that insurance carriers wouldn't have negotiated discounted rates. Its in their interest even with high deductible plans to pay as little as possible. I can't imagine they wouldn't have negotiated rates. That would be a deal breaker for me.

whomever
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Re: Ultra High Deductible Health Insurance?

Post by whomever » Wed Feb 12, 2020 10:49 am

"Are you sure that's correct? It seems odd that insurance carriers wouldn't have negotiated discounted rates"

It's what I was told, and the source is usually reliable.

My sense is this: even BCBS doesn't have an agreement with every provider, and negotiating all the agreements they have must be a nontrivial effort. And the super-high-deductible company was a small company, so the cost of negotiating provider agreements could only be spread over a small customer base.

It's possible that geography might matter - a small company in CO, for example, might spend most of its limited negotiation budget looking for providers in the Denver area, leaving customers in Grand Junction in a bind. Just guessing, though. There is also the issue of your personally preferred providers not being in a small network.

Surely it's safe to say this: if you are depending on using the the insurance company's negotiated rates, be sure that whatever providers you plan to use are on board with your insurance company. That's true for us all, of course, but with a big company like BCBS the odds are more in your favor. It's a pity that, AFAIK, the big companies like BCBS don't offer genuine catastrophic plans (if anyone is still allowed to).

NotWhoYouThink
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Re: Ultra High Deductible Health Insurance?

Post by NotWhoYouThink » Wed Feb 12, 2020 10:52 am

knightrider wrote:
Wed Feb 12, 2020 9:35 am
The reason why there are no ultra high deductible insurance plans is because very few people understand their benefits. Everybody I talk to just wants low out of pocket expenses, even if they have money lying around. They don't understand that insurance companies have huge overheads that they pass on to you via high premiums. I debated this with family and friends to no avail. They just don't get it. I have given up..
No, the reason is that Congress in their wisdom outlawed these plans for people over 30 in the ACA.

Congress knew that many people would want these plans, otherwise they wouldn't have bothered to outlaw them. They are prohibited because Congress wanted to force people to buy pre-paid medical plans that were called insurance. It's not a bug of ACA, it is a feature.

Laws can change, but this one hasn't yet.

EnjoyIt
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Re: Ultra High Deductible Health Insurance?

Post by EnjoyIt » Wed Feb 12, 2020 11:00 am

1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm
atomicsquirrel wrote:
Tue Feb 11, 2020 6:23 pm

I can't be the only one in this position. With the FIRE movement ever so prevalent, how do others leave their employers and maintain health insurance at reasonable costs? And these costs obviously aren't stagnate, they continuously rise significantly year after year.
They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
One can take a large chunk of their pre-tax retirement accounts and convert them to Roth. Pay the taxes now, then live off that money until 65 getting fully subsidized healthcare. If retiring early enough, it may be a mathematically correct decision. Let's figure an early retiree at 50 who would normally pay $25k/yr for health insurance and other healthcare related costs. Over the next 15 years before receiving Medicare that would come out to $375k and likely more if they have healthcare serious medical needs/expenses. It may be worth paying paying $250k in taxes and have some Roth money to live off of while staying in the ACA subsidy threshold and paying nothing or almost nothing for healthcare.

Topic Author
atomicsquirrel
Posts: 43
Joined: Tue Feb 28, 2017 8:53 am

Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 11:30 am

EnjoyIt wrote:
Wed Feb 12, 2020 11:00 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm


They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
One can take a large chunk of their pre-tax retirement accounts and convert them to Roth. Pay the taxes now, then live off that money until 65 getting fully subsidized healthcare. If retiring early enough, it may be a mathematically correct decision. Let's figure an early retiree at 50 who would normally pay $25k/yr for health insurance and other healthcare related costs. Over the next 15 years before receiving Medicare that would come out to $375k and likely more if they have healthcare serious medical needs/expenses. It may be worth paying paying $250k in taxes and have some Roth money to live off of while staying in the ACA subsidy threshold and paying nothing or almost nothing for healthcare.

I get it but if you start at say 50, you can't pull Roth money out until age 59 1/2 without penalty?

Guess it also heavily relies on our current system staying the same, which it seems unlikely to do.

EnjoyIt
Posts: 3391
Joined: Sun Dec 29, 2013 8:06 pm

Re: Ultra High Deductible Health Insurance?

Post by EnjoyIt » Wed Feb 12, 2020 11:40 am

atomicsquirrel wrote:
Wed Feb 12, 2020 11:30 am
EnjoyIt wrote:
Wed Feb 12, 2020 11:00 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm


This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
One can take a large chunk of their pre-tax retirement accounts and convert them to Roth. Pay the taxes now, then live off that money until 65 getting fully subsidized healthcare. If retiring early enough, it may be a mathematically correct decision. Let's figure an early retiree at 50 who would normally pay $25k/yr for health insurance and other healthcare related costs. Over the next 15 years before receiving Medicare that would come out to $375k and likely more if they have healthcare serious medical needs/expenses. It may be worth paying paying $250k in taxes and have some Roth money to live off of while staying in the ACA subsidy threshold and paying nothing or almost nothing for healthcare.

I get it but if you start at say 50, you can't pull Roth money out until age 59 1/2 without penalty?

Guess it also heavily relies on our current system staying the same, which it seems unlikely to do.
That is almost correct. The penalty is on earnings, not on contributions. You can take contributions penalty free if you have your IRA open for over 5 years and did a traditional to Roth conversion.

https://www.investopedia.com/ask/answer ... odroth.asp

1130Super
Posts: 220
Joined: Thu Nov 07, 2019 8:59 am
Location: Minnesota

Re: Ultra High Deductible Health Insurance?

Post by 1130Super » Wed Feb 12, 2020 1:00 pm

atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm
SchruteB&B wrote:
Tue Feb 11, 2020 6:57 pm


They live inexpensively and carefully control their income in order to qualify for the ACA subsidies. See: https://rootofgood.com/affordable-care-act-subsidy/
This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
Hypothetically someone has 3 million portfolio at age 45
1 million taxable
1.5 million TIRA after 401k rollover
.5 million Roth


1. Draw expenses from Roth IRA (you can draw contributions without 10% penalty)
2. Draw Expenses from taxable with highest cost basis
3. Wait till you reach Medicare age to touch TIRA and Roth gains, and taxable investments with lower cost basis.
4. You would most likely keep bonds in TIRA

You could draw 100k a year off of taxable but have very little of it capital gains. During your working years you periodically sell and reinvest at a higher cost basis. Theoretically you could liquidate a $3 million taxable portfolio but have very little income that year.

Dividends in taxable would be your main source of magi income. but at some point you might have to bunch your capital gains and forgo the ACA subsidy once Every several years

jhh9327
Posts: 272
Joined: Sat Mar 31, 2007 9:06 am

Re: Ultra High Deductible Health Insurance?

Post by jhh9327 » Wed Feb 12, 2020 1:14 pm

I just moved to paying for insurance on my own in January and my premiums are less than $1,200/mth for a family plan with a $10k family deductible and then 50% co-insurance up to $13k. Based on last 5 years, I expect the the total out of pocket for the year to be somewhere between $15k and $20k which includes the $2k for the annual heart specialist visit one of my kids has each year. HSA eligible and no government subsidies for those wondering. Way cheaper than staying on my former employer's self-insured options.

Topic Author
atomicsquirrel
Posts: 43
Joined: Tue Feb 28, 2017 8:53 am

Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 1:35 pm

jhh9327 wrote:
Wed Feb 12, 2020 1:14 pm
I just moved to paying for insurance on my own in January and my premiums are less than $1,200/mth for a family plan with a $10k family deductible and then 50% co-insurance up to $13k. Based on last 5 years, I expect the the total out of pocket for the year to be somewhere between $15k and $20k which includes the $2k for the annual heart specialist visit one of my kids has each year. HSA eligible and no government subsidies for those wondering. Way cheaper than staying on my former employer's self-insured options.
Cheapest I saw this morning on Healthcare.gov for 2 people was a bronze plan with $16,300 deductible was $1459/ mo. \

Is Healthcare.gov the sole place to purchase medical insurance here in the US?

User avatar
dm200
Posts: 23133
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Ultra High Deductible Health Insurance?

Post by dm200 » Wed Feb 12, 2020 1:36 pm

atomicsquirrel wrote:
Wed Feb 12, 2020 1:35 pm
jhh9327 wrote:
Wed Feb 12, 2020 1:14 pm
I just moved to paying for insurance on my own in January and my premiums are less than $1,200/mth for a family plan with a $10k family deductible and then 50% co-insurance up to $13k. Based on last 5 years, I expect the the total out of pocket for the year to be somewhere between $15k and $20k which includes the $2k for the annual heart specialist visit one of my kids has each year. HSA eligible and no government subsidies for those wondering. Way cheaper than staying on my former employer's self-insured options.
Cheapest I saw this morning on Healthcare.gov for 2 people was a bronze plan with $16,300 deductible was $1459/ mo. \
Is Healthcare.gov the sole place to purchase medical insurance here in the US?
No, you can purchase such insurance through a broker or directly from the insurance company.

jhh9327
Posts: 272
Joined: Sat Mar 31, 2007 9:06 am

Re: Ultra High Deductible Health Insurance?

Post by jhh9327 » Wed Feb 12, 2020 1:39 pm

atomicsquirrel wrote:
Wed Feb 12, 2020 1:35 pm
jhh9327 wrote:
Wed Feb 12, 2020 1:14 pm
I just moved to paying for insurance on my own in January and my premiums are less than $1,200/mth for a family plan with a $10k family deductible and then 50% co-insurance up to $13k. Based on last 5 years, I expect the the total out of pocket for the year to be somewhere between $15k and $20k which includes the $2k for the annual heart specialist visit one of my kids has each year. HSA eligible and no government subsidies for those wondering. Way cheaper than staying on my former employer's self-insured options.
Cheapest I saw this morning on Healthcare.gov for 2 people was a bronze plan with $16,300 deductible was $1459/ mo. \

Is Healthcare.gov the sole place to purchase medical insurance here in the US?
I'm in NY and used my state exchange. I have a bronze plan with BCBS.

User avatar
dm200
Posts: 23133
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Ultra High Deductible Health Insurance?

Post by dm200 » Wed Feb 12, 2020 1:50 pm

I do not know the details, but I believe that any such plan/policy should provide that the full amounts you pay before the deductible kicks in are using the insurance company costs and charges -- which we know can be a fraction of the list price.

I talked to a friend recently who had some kind of leg injury. He told be the "list price" was about $16,000 and Medicare paid in full for about $1,600!! :confused

JonnyB
Posts: 147
Joined: Sun Jan 19, 2020 5:28 pm

Re: Ultra High Deductible Health Insurance?

Post by JonnyB » Wed Feb 12, 2020 2:01 pm

dm200 wrote:
Wed Feb 12, 2020 1:36 pm
No, you can purchase such insurance through a broker or directly from the insurance company.
Yes, but in many states the plans inside and outside the exchange are the exact same plan with the exact same premium.

If that is the case, you have nothing to lose and possibly much to gain by purchasing through the exchange.

We had a recent posting from someone who purchased their plan outside the exchange and had an unexpected change in their finances during the year such that they would have been eligible for subsidies. However, they could not receive the subsidies because they did not purchase their plan through the exchange, even though it was the identical plan.

Northern Flicker
Posts: 5251
Joined: Fri Apr 10, 2015 12:29 am

Re: Ultra High Deductible Health Insurance?

Post by Northern Flicker » Wed Feb 12, 2020 2:50 pm

There typically are a few plans off-exchange that don’t qualify for an exchange-based plan like HSA-eligible silver plans which don’t work with ACA subsidies because cost sharing defeats HSA-eligibility. You may be able find a non-HSA-eligible very high deductible plan.

I belong to a professional society that used to offer plans before ACA with 25K or 50K deductibles. They had lifetime maximum payouts of $1M, and were not available in all states. Today, I think bronze HSA plans have the lowest fixed cost before the first dollar is spent on care. Finding a plan with a higher deductible than is HSA eligible will just replace the HSA tax deduction with a lower premium and increase deductibles and out-of-pocket maximums probably without saving much net fixed cost.
Last edited by Northern Flicker on Wed Feb 12, 2020 3:15 pm, edited 1 time in total.
Index fund investor since 1987.

aristotelian
Posts: 6854
Joined: Wed Jan 11, 2017 8:05 pm

Re: Ultra High Deductible Health Insurance?

Post by aristotelian » Wed Feb 12, 2020 3:00 pm

simplesimon wrote:
Wed Feb 12, 2020 10:07 am
atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm
Jags4186 wrote:
Tue Feb 11, 2020 7:09 pm


This is the crux of the matter. You can FIRE and live very cheaply until Medicare or you can FIRE and have a ton of money that this stuff doesn’t matter. It’s hard to FIRE if you have a $3mm portfolio and $120k annual expenses if you don’t have the healthcare figured out.
Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
You'd need significant Roth assets.
Not even. Roth assets would be helpful to stay under the subsidy cliff, but not essential. 400% of Federal Poverty Line is $68K. If your stocks are half gains, you could actually spend close to $140K without touching your Roth. With Roth accounts you could withdraw even more.

Folks in the FIRE community spend less so it is even easier for them.

1130Super
Posts: 220
Joined: Thu Nov 07, 2019 8:59 am
Location: Minnesota

Re: Ultra High Deductible Health Insurance?

Post by 1130Super » Wed Feb 12, 2020 4:09 pm

aristotelian wrote:
Wed Feb 12, 2020 3:00 pm
simplesimon wrote:
Wed Feb 12, 2020 10:07 am
atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am
atomicsquirrel wrote:
Tue Feb 11, 2020 8:05 pm


Bingo!

If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
You'd need significant Roth assets.
Not even. Roth assets would be helpful to stay under the subsidy cliff, but not essential. 400% of Federal Poverty Line is $68K. If your stocks are half gains, you could actually spend close to $140K without touching your Roth. With Roth accounts you could withdraw even more.

Folks in the FIRE community spend less so it is even easier for them.
Most of the FIRE community probably have an income level inside the 0% LTCG tax bracket

talzara
Posts: 896
Joined: Thu Feb 12, 2009 7:40 pm

Re: Ultra High Deductible Health Insurance?

Post by talzara » Wed Feb 12, 2020 4:19 pm

NotWhoYouThink wrote:
Wed Feb 12, 2020 10:52 am
No, the reason is that Congress in their wisdom outlawed these plans for people over 30 in the ACA.

Congress knew that many people would want these plans, otherwise they wouldn't have bothered to outlaw them. They are prohibited because Congress wanted to force people to buy pre-paid medical plans that were called insurance. It's not a bug of ACA, it is a feature.
It is impossible to have catastrophic plans, guaranteed issue, and universal coverage.

If you have catastrophic plans and guaranteed issue, then you cannot have universal coverage. Healthy people would buy catastrophic plans, and sick people would buy low-deductible plans. The low-deductible plans would go into a death spiral, and sick people would not be able to afford the premiums.

To have both guaranteed issue and universal coverage, catastrophic plans have to be banned.

It is possible to offer catastrophic plans to people under the age of 30 because very few of them have chronic diseases. This is not true of people aged 50-60.

Health insurance works as a system. Because of adverse selection, you have to make sure that healthy people cannot opt out of the system. You need to have them in the risk pool to subsidize the sick people. Allow catastrophic plans, and the healthy people drop out, causing the universal risk pool to go into a death spiral. Drop the mandate, and this happens even faster. Dropping the mandate is equivalent to an infinite deductible.

talzara
Posts: 896
Joined: Thu Feb 12, 2009 7:40 pm

Re: Ultra High Deductible Health Insurance?

Post by talzara » Wed Feb 12, 2020 4:26 pm

JonnyB wrote:
Wed Feb 12, 2020 2:01 pm
We had a recent posting from someone who purchased their plan outside the exchange and had an unexpected change in their finances during the year such that they would have been eligible for subsidies. However, they could not receive the subsidies because they did not purchase their plan through the exchange, even though it was the identical plan.
Here is the post:viewtopic.php?f=2&t=303515

EnjoyIt
Posts: 3391
Joined: Sun Dec 29, 2013 8:06 pm

Re: Ultra High Deductible Health Insurance?

Post by EnjoyIt » Wed Feb 12, 2020 4:42 pm

1130Super wrote:
Wed Feb 12, 2020 4:09 pm
aristotelian wrote:
Wed Feb 12, 2020 3:00 pm
simplesimon wrote:
Wed Feb 12, 2020 10:07 am
atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am
1130Super wrote:
Wed Feb 12, 2020 8:03 am



If you plan carefully you can easily have 120K expenses and still stay under income threshold for ACA subsidies
Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
You'd need significant Roth assets.
Not even. Roth assets would be helpful to stay under the subsidy cliff, but not essential. 400% of Federal Poverty Line is $68K. If your stocks are half gains, you could actually spend close to $140K without touching your Roth. With Roth accounts you could withdraw even more.

Folks in the FIRE community spend less so it is even easier for them.
Most of the FIRE community probably have an income level inside the 0% LTCG tax bracket
We don't want to live on $40k/yr which means we need to manage our income in such a way as to get subsidies.

Just curious, lets just assume that we live on $68k/yr income which means we are at the top of the subsidy cliff. How does the subsidy work? How much would we have to pay?

I logged in my area and put in family at 50 years old and played around with the numbers. At $67k income we get a subsidy of $338/month and insurance would cost about $300/month with an $8k deductible. It still is not cheap if we actually need $8k worth of healthcare.

For early retirees with kids still at home who want an income above ACA subsidies insurance costs $800/month with a $16k deductible. Basically We spend about $10k a year and if things go wrong may need to spend as much as $26k per year. On the bright side, if we spend $16k in healthcare expenses with an income of $100k we can deduct $6k from our taxes because we spent more than 10% of AGI on healthcare. So in our area, if we want to live on income above ACA subsidies we should save up an additional $650k (4% SWR) so that we can cover health insurance and deductible. I suspect when we actually retire that number will be higher. If we are low utilizers of insurance we can probably save a little less and bank the difference for when we will need to hit our out of pocket max.

It definitely does not look pretty for the FAT FIRE crowd.

Topic Author
atomicsquirrel
Posts: 43
Joined: Tue Feb 28, 2017 8:53 am

Re: Ultra High Deductible Health Insurance?

Post by atomicsquirrel » Wed Feb 12, 2020 5:50 pm

EnjoyIt wrote:
Wed Feb 12, 2020 4:42 pm
1130Super wrote:
Wed Feb 12, 2020 4:09 pm
aristotelian wrote:
Wed Feb 12, 2020 3:00 pm
simplesimon wrote:
Wed Feb 12, 2020 10:07 am
atomicsquirrel wrote:
Wed Feb 12, 2020 9:32 am


Mathematically, how do you see that happening? I'm genuinely curious what that math would look like.
You'd need significant Roth assets.
Not even. Roth assets would be helpful to stay under the subsidy cliff, but not essential. 400% of Federal Poverty Line is $68K. If your stocks are half gains, you could actually spend close to $140K without touching your Roth. With Roth accounts you could withdraw even more.

Folks in the FIRE community spend less so it is even easier for them.
Most of the FIRE community probably have an income level inside the 0% LTCG tax bracket
We don't want to live on $40k/yr which means we need to manage our income in such a way as to get subsidies.

Just curious, lets just assume that we live on $68k/yr income which means we are at the top of the subsidy cliff. How does the subsidy work? How much would we have to pay?

I logged in my area and put in family at 50 years old and played around with the numbers. At $67k income we get a subsidy of $338/month and insurance would cost about $300/month with an $8k deductible. It still is not cheap if we actually need $8k worth of healthcare.

For early retirees with kids still at home who want an income above ACA subsidies insurance costs $800/month with a $16k deductible. Basically We spend about $10k a year and if things go wrong may need to spend as much as $26k per year. On the bright side, if we spend $16k in healthcare expenses with an income of $100k we can deduct $6k from our taxes because we spent more than 10% of AGI on healthcare. So in our area, if we want to live on income above ACA subsidies we should save up an additional $650k (4% SWR) so that we can cover health insurance and deductible. I suspect when we actually retire that number will be higher. If we are low utilizers of insurance we can probably save a little less and bank the difference for when we will need to hit our out of pocket max.

It definitely does not look pretty for the FAT FIRE crowd.
How do you get insurance for a family without subsidy for only $800/ mo?

User avatar
dm200
Posts: 23133
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: Ultra High Deductible Health Insurance?

Post by dm200 » Wed Feb 12, 2020 6:05 pm

How do you get insurance for a family without subsidy for only $800/ mo?
I wonder the same thing??

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