Hello

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
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DiehardDoc
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Hello

Post by DiehardDoc »

Hello
Last edited by DiehardDoc on Tue Apr 26, 2022 9:30 pm, edited 1 time in total.
oldfatguy
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Re: Ok to go without health insurance?

Post by oldfatguy »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am
Have total assets in mid 7 figure range in case something unexpected in terms of health care happens.
Why put your assets at risk when it seems like you can easily afford to pay for insurance?
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sleepysurf
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Re: Ok to go without health insurance?

Post by sleepysurf »

You're physicians, and seriously considering this? :confused

Certainly you've both seen catastrophic accidents or unanticipated bad diagnoses!
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KlangFool
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Re: Ok to go without health insurance?

Post by KlangFool »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am
Will cost ~16K with family deductible of 12 K to stay in PPO network.

Have total assets in mid 7 figure range in case something unexpected in terms of health care happens.


Is it too risky to go bare?
DiehardDoc,

1) Yes. Do not be penny wise pound foolish. Spending 38K per year to protect the Mid-7 figures portfolio is a good deal.

2) Make sure that you have good umbrella insurance too.

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Nate79
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Re: Ok to go without health insurance?

Post by Nate79 »

NO it is not ok. Are you ok if your entire net worth gets drained due to a major illness? Medical is the number one reason for bankruptcy. I assume you must have a decent income and can easily afford the premiums. Penny wise and pounds (or even tons!) foolish.
adamthesmythe
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Re: Ok to go without health insurance?

Post by adamthesmythe »

You gotta be kidding.

You're really a doctor?
mhalley
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Re: Ok to go without health insurance?

Post by mhalley »

Might as well cancel your life insurance, home owners insurance, disability insurance and everything but liability on the autos, as op thinks he is invincible. That will be a ton of savings!
I was paying 28k a year for my wife and I with 6k deductible, never thought about going bare for a second. I wish there was a truly catastrophic plan for hnw people that didn’t kick in till 50k. Wonder what that would cost?
Last edited by mhalley on Tue Oct 22, 2019 11:02 am, edited 2 times in total.
WildBill
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Re: Ok to go without health insurance?

Post by WildBill »

Howdy

I do not think that you will find anyone who will encourage you to go uninsured.

That is because it is a very bad idea in your circumstances.

W B
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Re: Ok to go without health insurance?

Post by junior »

This is like asking "I have a net worth of 5 million dollars, is it okay to gamble a million dollars on blackjack?"

My answer is, it's a really stupid idea, and I can't imagine why someone would want to do this, but you can afford to, so go ahead.
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Re: Ok to go without health insurance?

Post by denovo »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am
Worst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation.

This doesn't seem accurate.
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simplesimon
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Re: Ok to go without health insurance?

Post by simplesimon »

denovo wrote: Tue Oct 22, 2019 10:59 am
DiehardDoc wrote: Tue Oct 22, 2019 10:44 am
Worst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation.

This doesn't seem accurate.
+1. I'd like to know how this would be accomplished.
aristotelian
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Re: Ok to go without health insurance?

Post by aristotelian »

May I just point out that it is a sad irony that we have a physician couple seriously considering going without health insurance.

I don't see any connection between the risk of medical expense and the price of health care stocks. Investing the premiums seems like the worst part of this plan. Instead, you should increase your emergency fund.

I don't get what you mean by "hsa eligible" and "Can't contribute ~6900 to HSA". Do you have an HDHP option with lower premium?
daheld
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Re: Ok to go without health insurance?

Post by daheld »

My folks have, FOR YEARS, paid $1000/month for mediocre health insurance on a teachers income + a construction workers income.

I'm not sure what the actual intent of this post is, but my brain will not allow me to believe that you actually think your premium, while expensive, is so much that you should forego health insurance for your dual physician income family.
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DiehardDoc
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Re: Ok to go without health insurance?

Post by DiehardDoc »

Only as an individual one has to wait for open enrollment.

If you are a business, business can shop for coverage any time.

Information from insurance company and brokers.

While we ( physicians) have been working harder each year for less money without any increase in our reimbursements, health insurance companies have been raising premiums in double digits every year.

Has helped several patients who are self pay / ins w high deductible navigate complex and often egregious hospital billing practices.

Often it can be advantageous to negotiate on your own rather than through middlemen like your insurance company.
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gr7070
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Re: Ok to go without health insurance?

Post by gr7070 »

I don't quite understand the outrage. Surely, many folks understand the concept of self-insuring. We do it all the time for things we can afford - like cell phones, and everything else we reject the extended warranty.

Large corporations self insure, for health and others, all the time, as well.

Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?

So I don't understand why everyone is aghast at the question. Seems a very reasonable question to me.

While a reasonably inquiry, I doubt I'd be inclined to do so myself. Not for four people, not with that "low" a net worth. You cannot afford to pay for a couple million dollars in care costs and come out the other end not feeling the financial effects. Especially if you spend a little bit like your income might allow.

I'll second the above question about the investing part. Simply because if invested if want it in an appropriate investment, one that's diversified.
Last edited by gr7070 on Tue Oct 22, 2019 11:27 am, edited 1 time in total.
daheld
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Re: Ok to go without health insurance?

Post by daheld »

gr7070 wrote: Tue Oct 22, 2019 11:24 am I don't quite understand the outrage. Surely, many folks understand the concept of self-insuring. We do it all the time for things we can afford - like cell phones, and everything else we reject the extended warranty.

Large corporations self insure, for health and others, all the time, as well.

Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?

So I don't understand why everyone is aghast at the question. Seems a very reasonable question to me.

While a reasonably inquiry, I doubt I'd be inclined to do so myself. Not for four people, not with that low a net worth.

I'll second the above question about the investing part. Simply because if invested if want it in an appropriate investment, one that's diversified.
It is reasonable to self-insure or self warranty an appliance or a car, but not the healthcare of an entire family. One person could rack up a million dollars of medical care in an accident that happens in the blink of an eye, and the cost to cover expenses related to that accident are worth it.
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simplesimon
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Re: Ok to go without health insurance?

Post by simplesimon »

gr7070 wrote: Tue Oct 22, 2019 11:24 am Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?
No, the Affordable Care Act did away with lifetime maximums. Does that change your answer?

OP, if you really can get health insurance on short notice mid-year, then it's not really a question of if you're going without health insurance. What do you perceive as the risk of your plan then?
sedna273
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Re: Ok to go without health insurance?

Post by sedna273 »

Not at all recommended to go it alone, surely in your profession you've seen how quickly medical expenses can add up! The past general good health of your family shouldn't be an indicator of how your future healthcare expenses play out.

An unforeseen event could arise that easily drains your assets: what if, god forbid, the whole family gets into a car accident and each member suffers massive trauma requiring multiple surgeries and long-term care? Furthermore, what if you are found to be liable for the other parties' expenses too because you were tired from work and ran a red?

Insurance companies are for-profit and do take on risk in the hope that they will not need to pay out often. But that shouldn't stop you from protecting yourself from a catastrophic event.
getthatmarshmallow
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Re: Ok to go without health insurance?

Post by getthatmarshmallow »

Medical bankruptcies ruin people. $16k is nothing for you. This should be an easy call.
arsenalfan
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Re: Ok to go without health insurance?

Post by arsenalfan »

Get health insurance.
I empathize. You don't get much for your $16k...and you pray you don't, I guess.
Like disability, Health is expensive because it's used often. I would get it.
Last edited by arsenalfan on Tue Oct 22, 2019 12:45 pm, edited 1 time in total.
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gr7070
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Re: Ok to go without health insurance?

Post by gr7070 »

simplesimon wrote: Tue Oct 22, 2019 11:29 am
gr7070 wrote: Tue Oct 22, 2019 11:24 am Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?
No, the Affordable Care Act did away with lifetime maximums. Does that change your answer?
No.

The answer is very simply based on can one afford the event(s) their insuring against. I posted my answer, as well.

The max limit doesn't really affect that answer. I was just pointing out that we were all self-insuring for a certain amount regardless. I doubt most others were getting added coverage for that.

It's the outrage to the possibility of self-insuring I have an issue with.
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DiehardDoc
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Re: Ok to go without health insurance?

Post by DiehardDoc »

simplesimon wrote: Tue Oct 22, 2019 11:29 am
gr7070 wrote: Tue Oct 22, 2019 11:24 am Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?
No, the Affordable Care Act did away with lifetime maximums. Does that change your answer?

OP, if you really can get health insurance on short notice mid-year, then it's not really a question of if you're going without health insurance. What do you perceive as the risk of your plan then?
Trying to calculate risk. In the past until 2018, it was not possible to go bare as penalty was 2.5% of one's AGI which was often more than the premiums.
Admiral
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Re: Ok to go without health insurance?

Post by Admiral »

If you have mid-7 figures in the bank, health insurance premiums should be pocket change. Get a HDP to save a little money but with kids, please don't go without. It's not worth it.

I honestly can't believe that you posted that you could negotiate for a "better deal" when paying out of pocket. Is that what you want to deal with when a kid's in intensive care?

:oops:
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gr7070
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Re: Ok to go without health insurance?

Post by gr7070 »

daheld wrote: Tue Oct 22, 2019 11:27 am
gr7070 wrote: Tue Oct 22, 2019 11:24 am I don't quite understand the outrage. Surely, many folks understand the concept of self-insuring. We do it all the time for things we can afford - like cell phones, and everything else we reject the extended warranty.

Large corporations self insure, for health and others, all the time, as well.

Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?

So I don't understand why everyone is aghast at the question. Seems a very reasonable question to me.

While a reasonably inquiry, I doubt I'd be inclined to do so myself. Not for four people, not with that low a net worth.

I'll second the above question about the investing part. Simply because if invested if want it in an appropriate investment, one that's diversified.
It is reasonable to self-insure or self warranty an appliance or a car, but not the healthcare of an entire family. One person could rack up a million dollars of medical care in an accident that happens in the blink of an eye, and the cost to cover expenses related to that accident are worth it.
Let's be clear, it is reasonable for a wealthy individual to self-insure, as well. It's simply about the ability to financially handle such events without significant impact. One just needs more wealth than the OP. Especially when insuring four individuals.
Last edited by gr7070 on Tue Oct 22, 2019 11:45 am, edited 1 time in total.
DonIce
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Re: Ok to go without health insurance?

Post by DonIce »

I think liquid assets in the mid 7 figure range is high enough that considering self-insuring is not outrageous, especially given that you now can't be prevented from getting insurance on the basis of a pre-existing conditition and you can sign up for insurance year round.
cmublitz
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Re: Ok to go without health insurance?

Post by cmublitz »

I think I get it. Between whatever medical situations you can handle between you, your spouse, and colleagues (via professional courtesy?) that probably covers a ton of cases. You could also handle cases of long term issues or anything that can wait a couple days to 1 week because of your business application out of cycle + no exclusions for pre-existing conditions.

However, how would you handle an actual immediate emergency like a car accident? I assume you could theoretically rack up $100Ks+ of medical bills before your newly applied insurance kicks in. I doubt any newly acquired insurance would retroactively cover you during the days you are applying for coverage. Is the plan to effectively self-insure that risk?
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Re: Ok to go without health insurance?

Post by nisiprius »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am...Worst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation...
1) I wouldn't be so sure about this. You would need to be an insurance expert in the laws of your own state (insurance is state-regulated), check all the fine print with a fine-toothed comb, be sure you know exactly what the ACA plans are required to cover, and be sure you stay constantly alert for any changes in health insurance laws. Furthermore, if you are the one that's sick you might not be in great shape to jump nimbly through bureaucratic hoops so you need to be certain you know someone sophisticated, well-informed, energetic, and ready to do that for you.

2) The (apparent) fact that the present system allows you to wait to buy health insurance until you need it is not the way it is supposed to work. It is a byproduct of a cleverly designed system intended to shape a free-market based system of private insurance to serve most of population in a reasonably fair way. It is somewhat fragile and unstable. The elimination of the penalty has made it more so. You're planning to use a loophole. Since it's not intended to work that way, there's a danger that the loophole might snap shut suddenly and with little warning. Since insurers do not want sick people buying insurance, if the loophole snaps shut they are not going to spend money on ads telling people quick, jump through the loophole while there's time. You will need to be constantly vigilant.

3) It seems to me that what you're proposing isn't a nice thing to do, but you weren't asking about that and I won't pursue that thought.
Last edited by nisiprius on Tue Oct 22, 2019 11:48 am, edited 1 time in total.
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gr7070
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Re: Ok to go without health insurance?

Post by gr7070 »

DonIce wrote: Tue Oct 22, 2019 11:44 am I think liquid assets in the mid 7 figure range is high enough that considering self-insuring is not outrageous,
Agreed. Exactly my point.

Though I don't think it's nearly high enough, and especially not for four.

I'd want enough *excess* that it wouldn't impact retirement planning. $5M *remaining* after an incident(s) might be enough???
Last edited by gr7070 on Tue Oct 22, 2019 11:51 am, edited 1 time in total.
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cheese_breath
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Re: Ok to go without health insurance?

Post by cheese_breath »

sleepysurf wrote: Tue Oct 22, 2019 10:50 am You're physicians, and seriously considering this? :confused

Certainly you've both seen catastrophic accidents or unanticipated bad diagnoses!
+1
You beat me to it.
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simplesimon
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Re: Ok to go without health insurance?

Post by simplesimon »

gr7070 wrote: Tue Oct 22, 2019 11:48 am
DonIce wrote: Tue Oct 22, 2019 11:44 am I think liquid assets in the mid 7 figure range is high enough that considering self-insuring is not outrageous,
Agreed. Exactly my point.

Though I don't think it's nearly high enough, and especially not for four.

I'd want enough *excess* that it wouldn't impact retirement planning. $5M *remaining* after an incident(s) might be enough???
How can one predict what an incident costs? If costs continue to bleed your cash to say about $3M remaining without a real end in sight, do you then pull the plug?
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Re: Ok to go without health insurance?

Post by Admiral »

I would also add that as someone with kids, they do many, many activities (sports, anyone? Camps? Trips?) that make you provide proof of insurance. If you're planning on telling whomever that you're self insured, you should be prepared to lay out your financial life for them to prove it. No thanks!
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DiehardDoc
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Re: Ok to go without health insurance?

Post by DiehardDoc »

cmublitz wrote: Tue Oct 22, 2019 11:45 am I think I get it. Between whatever medical situations you can handle between you, your spouse, and colleagues (via professional courtesy?) that probably covers a ton of cases. You could also handle cases of long term issues or anything that can wait a couple days to 1 week because of your business application out of cycle + no exclusions for pre-existing conditions.

However, how would you handle an actual immediate emergency like a car accident? I assume you could theoretically rack up $100Ks+ of medical bills before your newly applied insurance kicks in. I doubt any newly acquired insurance would retroactively cover you during the days you are applying for coverage. Is the plan to effectively self-insure that risk?
Thinking something like this.

Based upon all responses so far, monetary and emotional risks at time of crisis far outweigh potential minuscule rewards of saving recurrent annual premium expenses.

We started with premiums of $250 per month approximately 9 years ago. Each year insurance company states so and so among your group has reached certain age and therefore premium is 12-15 % higher. When is this going to stop?
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simplesimon
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Re: Ok to go without health insurance?

Post by simplesimon »

DiehardDoc wrote: Tue Oct 22, 2019 11:59 am
We started with premiums of $250 per month approximately 9 years ago. Each year insurance company states so and so among your group has reached certain age and therefore premium is 12-15 % higher. When is this going to stop?
When the government steps in, again.
DonIce
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Re: Ok to go without health insurance?

Post by DonIce »

DiehardDoc wrote: Tue Oct 22, 2019 11:59 am We started with premiums of $250 per month approximately 9 years ago. Each year insurance company states so and so among your group has reached certain age and therefore premium is 12-15 % higher. When is this going to stop?
Never. It will only ever keep going up.
FreemanB
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Re: Ok to go without health insurance?

Post by FreemanB »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 amWorst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation.
This isn't the worst case, because you assume you are still physically and mentally able to purchase the health insurance. How will you handle the worst case scenario where both parents are severely injured and hospitalized in a car accident, possibly both kids as well? Who will purchase the insurance at that point? In the weeks/months before you can purchase insurance and have it take effect, how much would be paid out of pocket? Why risk it?

If you could be sure of getting the insurance within 1-2 days of needing it, great, drop it for now. But I don't see how you can assume that this will be an option before racking up large medical bills.I also have no idea if new coverage would cover current injuries.
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Re: Ok to go without health insurance?

Post by niceguy7376 »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am Back ground:

Physician couple, self employed, family of 4, 2 adults( 46, 43) 2 kids ( 9,15), S corp.
Will cost ~16K with family deductible of 12 K to stay in PPO network.
Cheapest Option ~ 13K with family deductible of 13.5K for restricted in state network without access to most major teaching hospitals.
Worst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation.
Which state are you in? That also would answer the quotes that you are getting.
Are you and your physician spouse the only two employer/employee of the S Corp?

In our state, we need to have two employees to get S Corp insurance. With our small staffing company of 6 to 10 employees and only two participating (One employer and one employee), we have Humana HSA (2019 rates) for us (around 40ish and two kids < 10) of $1250 per month with 8K limit. No restriction of local doctors/hospitals.
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Re: Ok to go without health insurance?

Post by Shallowpockets »

OP. you are not going to be able to negotiate OTC insurance rates. It’s not buying a car.

Two, you are not going to be able to buy insurance when you need it. No insurance company is going to have a policy that covers you when you are already in the hospital or have an existing and immediate diagnosis before you had bought the insurance.
Last edited by Flyer24 on Tue Oct 22, 2019 12:26 pm, edited 1 time in total.
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Re: Ok to go without health insurance?

Post by Jack FFR1846 »

I don't think you've considered worst case. Say one of you breaks a finger badly. Needs a couple pins. Of course, some time later, back in the OR to remove the pins. Silly broken finger. $75k. I broke my finger and saw the bills. One silly finger.

What if something actually major happens? 6 figures isn't going to take all that long.
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Re: Ok to go without health insurance?

Post by oldfatguy »

DiehardDoc wrote: Tue Oct 22, 2019 11:18 am
While we ( physicians) have been working harder each year for less money without any increase in our reimbursements, health insurance companies have been raising premiums in double digits every year.
Sounds like just about every other person I know.
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Re: Ok to go without health insurance?

Post by daheld »

gr7070 wrote: Tue Oct 22, 2019 11:44 am
daheld wrote: Tue Oct 22, 2019 11:27 am
gr7070 wrote: Tue Oct 22, 2019 11:24 am I don't quite understand the outrage. Surely, many folks understand the concept of self-insuring. We do it all the time for things we can afford - like cell phones, and everything else we reject the extended warranty.

Large corporations self insure, for health and others, all the time, as well.

Do not most health insurance policies have a maximum lifetime payout? So aren't we all self-insuring for any amount over, say, the $1M max limit?

So I don't understand why everyone is aghast at the question. Seems a very reasonable question to me.

While a reasonably inquiry, I doubt I'd be inclined to do so myself. Not for four people, not with that low a net worth.

I'll second the above question about the investing part. Simply because if invested if want it in an appropriate investment, one that's diversified.
It is reasonable to self-insure or self warranty an appliance or a car, but not the healthcare of an entire family. One person could rack up a million dollars of medical care in an accident that happens in the blink of an eye, and the cost to cover expenses related to that accident are worth it.
Let's be clear, it is reasonable for a wealthy individual to self-insure, as well. It's simply about the ability to financially handle such events without significant impact. One just needs more wealth than the OP. Especially when insuring four individuals.
I agree.
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DiehardDoc
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Re: Ok to go without health insurance?

Post by DiehardDoc »

oldfatguy wrote: Tue Oct 22, 2019 12:13 pm
DiehardDoc wrote: Tue Oct 22, 2019 11:18 am
While we ( physicians) have been working harder each year for less money without any increase in our reimbursements, health insurance companies have been raising premiums in double digits every year.
Sounds like just about every other person I know.
Totally agree.
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Re: Ok to go without health insurance?

Post by Flyer24 »

Moderator Input: Please be helpful and considerate to the OP in your replies.
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Re: Ok to go without health insurance?

Post by Luckywon »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am

Worst case scenario: In case need arises, will have to purchase health insurance at a short notice. Can do it any time of the year and will not have to wait until open enrollment as will be purchasing through corporation.

What if both of you are in an accident and incapacitated? You may incur huge medical expenses before one of you is in a condition to secure medical insurance, if that is indeed an option at the time.

I'd get insurance if I were you, not just for the reason above. Not even a close call, IMO.
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Re: Ok to go without health insurance?

Post by willthrill81 »

I don't think that the OP's idea is nearly as bad as some here do. But I'm not sure that a net worth in the 'mid 7 figure range' is quite high enough to self-insure the risk. These days, I think that you probably need at least $10 million to self-insure healthcare.
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RickBoglehead
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Re: Ok to go without health insurance?

Post by RickBoglehead »

So the consensus is? :shock:

I can't imagine going without health insurance for more than a few days, i.e. bridging between two jobs and you don't want to pay retroactively for COBRA. No way would I consider this.

Let's assume someone did have say $50 million dollars. Health insurance cost is a pittance. Why risk anything?
Last edited by RickBoglehead on Tue Oct 22, 2019 12:41 pm, edited 1 time in total.
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rkhusky
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Re: Ok to go without health insurance?

Post by rkhusky »

Get catastrophic coverage and self-insure for the ordinary stuff.

Or look into healthcare sharing companies.
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whodidntante
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Re: Ok to go without health insurance?

Post by whodidntante »

Gambling can be fun and quite profitable.

If at all possible, get all of your expensive illnesses during open enrollment, so you can have an information advantage.
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willthrill81
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Re: Ok to go without health insurance?

Post by willthrill81 »

rkhusky wrote: Tue Oct 22, 2019 12:40 pm Get catastrophic coverage and self-insure for the ordinary stuff.
I thought that the ACA gutted 'catastrophic' plans.
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anon_investor
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Re: Ok to go without health insurance?

Post by anon_investor »

Just bite the bullet and get insurance, not worth the risk, especially since you obviously can afford it. Insurance is always a bad investment... until you need it!!!
furnace
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Re: Ok to go without health insurance?

Post by furnace »

DiehardDoc wrote: Tue Oct 22, 2019 10:44 am Back ground:
Physician couple, self employed, family of 4, 2 adults( 46, 43) 2 kids ( 9,15), S corp.
This year health insurance premium increase is almost 15%.
Will cost ~16K with family deductible of 12 K to stay in PPO network.
[cut]
Is it too risky to go bare?
One is never too rich to save money. Look into short term policies; they are made for people who are healthy like your family. One company in this space is Health Insurance Innovation (https://www.hiiq.com/).
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