Cancel my health insurance?

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celia
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Re: Cancel my health insurance?

Post by celia »

Why are you carrying homeowners insurance if your house has never burned down?

Why do you have car insurance if your car has never been totaled?


The whole point of any insurance is to share the risk with others since a small percentage of the group will have a catastrophe that they can't afford. How do you know you won't be that person?


I would much rather pay for insurance and end up not needing it than not having insurance and later wishing I had it. So far, I've been fairly lucky and grateful I haven't needed to file many claims.

What does your spouse think?
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nisiprius
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Re: Cancel my health insurance?

Post by nisiprius »

Boglerocks, there's something I want you to be clear on, which is the cost of medical care in the US once you get beyond office visits, blood panels, etc.. The numbers I'm going to give are not any kind of extreme horror stories out of the news, they are just sort of normal, everyday typical things. And they are things that can happen at any age, not just to the old and frail

Because the crazy billing and negotiation stuff is part of the problem, I am going to give the costs that were billed, because that's what you would see without insurance. Insurers pay a quarter to a half that. How easy it is for individuals to negotiate the prices down yourself is something I've had no experience with. For sure it would take hours on the phone during the day, talking to medical business offices.

So... costs. Last winter, taking a solitary walk in the evening, I tripped on a misaligned sidewalk slab, broke my nose slightly, and very briefly lost consciousness so I dialed 9-1-1 when I came to. The ambulance ride to the ER cost $600. The hospital charge for the ER, including a CT scan of my head and an X-ray of the hand I had put out to break my fall, $6,000, plus about $700 in individual doctors' fees. None of these are way out of the ordinary. I mean, maybe that's a pricey ER visit (level I trauma center at a major teaching hospital*), but at the local community hospital it would still have been thousands of dollars, not hundreds. And that's when everything was OK! Nothing was broken except my nose, and you couldn't see it and the plastic surgeon said there was no need to do anything about it.

Three days in a hospital for an abdominal hernia repair cost about $15,000.

An air ambulance ride to a big-city hospital, on one occasion where a community hospital ER had stabilized me, $10,000. (That's cheap for an air ambulance. The scare stories about air ambulances are $100,000 stories).

A fair number of reasonably well-off people could afford $6,000 here and $20,000 there.

These particular incidents were handled under Medicare and Medicare Supplemental and I did not pay anything out of pocket. My best guesses based on decades of employment is that the employers' plans would have covered everything and they would have paid the claims OK, but that there would have been a few hundreds of dollars in various co-pays. I've had claims denied a few times but in every case I was able to resolve it and get the claims paid--it sometimes took an infuriating amount of time in phone calls and waiting on hold, and I don't know how people do it if they have jobs where they can't do that while.

Of course, the high-end possibilities ought to be scary to almost anyone. Breaking a leg while skiing is one easy, common way for healthy people to run up a six-figure bill if orthopedic surgery is required. Multiple sclerosis hit a friend of mine in his late twenties.

*Believe it or not I actually asked them to take me to a local community hospital ER, and they said "If you insist we can but our standing orders are to take any head injury to a trauma center."
Last edited by nisiprius on Sat Jan 20, 2024 4:40 pm, edited 1 time in total.
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Northern Flicker
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Re: Cancel my health insurance?

Post by Northern Flicker »

PaunchyPirate wrote: Fri Jan 19, 2024 3:10 pm
boglerocks wrote: Fri Jan 19, 2024 2:49 pm If I want to choose my treatment, hospital, and doctor, could I end up paying out of pocket anyway?
That would depend on what your insurance plan covers. If you buy a cheap plan, probably yes. If you buy a better plan, probably no.
Should pick a plan for which the network includes providers one would use.
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nisiprius
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Re: Cancel my health insurance?

Post by nisiprius »

Everything changes. Insurance is regulated by state law and plans vary in different markets, so it's hard to say anything definite.

The cheaper plans are cheaper because they restrict your choice of provider. If the provider is not in network, you pay the full bill yourself.

Around here, a fairly common option is a more expensive plan that covers "out of network" doctors, but charges you a 20% co-pay. Even so, that's not so bad because that's 20% of what the insurer is paying, i.e. the negotiated rate, not 20% of what the doctor is billing.
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NotWhoYouThink
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Re: Cancel my health insurance?

Post by NotWhoYouThink »

“you’ve gotta ask yourself one question: “Do I feel lucky?” Well, do ya, punk?”

That's about it. Great money saver if you stay mostly healthy. Financially devastating if you don't.
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

boglerocks wrote: Fri Jan 19, 2024 12:43 pm I'm self-employed and health insurance for my family seems to cover very little of our (small) medical expenses.
Should I consider canceling the policy?
No. Even if I had $100M, I would still carry health insurance.
boglerocks wrote: Fri Jan 19, 2024 12:43 pm Could I run into a scenario that would require me to have health insurance?
You get in a car accident. It wasn't your fault. But it requires 25 days in ICU.
And then skilled nursing care, rehab, etc. You are easily looking at $1M in costs.
Even if you can afford that [say you have $10M in assets], do you really want to weigh treatment cost vs your life?

And the reality is, it is your next of kin [or medical power of attorney] who has to make those decisions. In times of stress and incapacity, it is hard enough to make good medical decisions without trying to justify costs.
I've been there.

And there are many other scenarios.
Bottom line: Everyone needs medical insurance.
nonnie
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Re: Cancel my health insurance?

Post by nonnie »

I just happen to have some EOB paid insurance claims in front of me so I'll give OP some examples of costs, this is HCOL CA and the payments are from Medicare. Average ambulance bill under 5 miles--$2000. Amounts below are what is billed, not what Medicare actually paid.
New Specialist Consult: $500; PCP visit $300-$350; Physical Therapy- 1hr- $275. Lumbar MRI- $4,000* 100% paid

My DH had a "procedure" by an interventional radiologist-kyphoplasty- for a broken vertebrae in his lower spine from a fall. It wasn't called surgery, it was a procedure but under general anesthesia and took 35 minutes. It was what I call "drive-by" but the technical name is "outpatient or ambulatory"-NO hospital stay
Hospital charge -- $42,000-- this included OR & Recovery rooms
Anesthesiologist $1,800

If I could possibly afford it, no matter my age, I would NEVER go without health insurance. With kids and broken bones, always. For those w/o insurance, lower prices can often be negotiated but look at the hospital outpatient charge of $42K and spin the wheel on negotiation.
Last edited by nonnie on Sun Jan 21, 2024 3:27 pm, edited 1 time in total.
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

boglerocks wrote: Fri Jan 19, 2024 1:16 pm Part of the problem is that if the policy provides the same degree of real world coverage for a catastrophic event that it does for minor stuff then I'll be paying for the vast majority of it out of pocket anyway. Should I assume/hope that a catastrophic event will be covered to a much greater extent than minor stuff is?

And if there is a catastrophic event will I be forced to use a treatment or doctor or hospital which is not my first choice if I want my PPO insurance to cover it? From what I've observed as a policy holder, "coverage" is complex and if I want to make my own choices I feel like I'll be paying out of pocket even if I still have the policy.
So now you are talking about which medical insurance policy and coverage is best for you.
Which is a legitimate concern. Do your research.

"Catastrophic" insurance will have high deductibles, but should have the lowest premiums.
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

Scorpion Stare wrote: Fri Jan 19, 2024 7:21 pm
boglerocks wrote: Fri Jan 19, 2024 1:16 pm Part of the problem is that if the policy provides the same degree of real world coverage for a catastrophic event that it does for minor stuff then
Why are you wondering “if” it provides catastrophic coverage? Look at your policy and find out what actual coverage it offers. I don't understand why you are trying to make decisions about your insurance when you don't even know what insurance you have.
+1
[Unnecessary comment removed - moderator ClaycordJCA].
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

GreendaleCC wrote: Sat Jan 20, 2024 9:22 am
howard71 wrote: Sat Jan 20, 2024 8:53 am As for your actual question, I went without health insurance for me and my adopted granddaughter for about two years and never ran into any situation where I couldn't get service without health insurance. As a matter of fact, most doctors I went to offered discounts. My granddaughter even broke her arm and had to go to the hospital and have therapy afterwards. Still came out WAY ahead financially over that period.
You were lucky.
Yes. Statistically, some people will win when they "roll the dice". Others will lose.
The whole point of insurance is to avoid "rolling the dice".
Katietsu
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Re: Cancel my health insurance?

Post by Katietsu »

boglerocks wrote: Fri Jan 19, 2024 1:16 pm Part of the problem is that if the policy provides the same degree of real world coverage for a catastrophic event that it does for minor stuff then I'll be paying for the vast majority of it out of pocket anyway. Should I assume/hope that a catastrophic event will be covered to a much greater extent than minor stuff is?

And if there is a catastrophic event will I be forced to use a treatment or doctor or hospital which is not my first choice if I want my PPO insurance to cover it? From what I've observed as a policy holder, "coverage" is complex and if I want to make my own choices I feel like I'll be paying out of pocket even if I still have the policy.
I will directly address your points. If you have a catastrophic event, it is very unlikely that you will be paying for “a vast majority of it”. There are so many policy types that I can not address how much of the total billed that you would pay for, say, treatment related to a broken ankle. However, know that ACA compliant insurance policies have an out of pocket(OOP) maximum. The OOP max is slightly different depending on policy type, but is less than $10000 for an individual and $20000 for a family for the full policy year, not even just one incident. As others have discussed, even a relatively minor incident can exceed these numbers with no insurance, particularly if imaging, procedures or expensive pharmaceuticals are needed. So if you had a $60,000 accident or a $500k cancer treatment, you have the opportunity to get the medically necessary care with your portion never exceeding the OOP max.

PPO stands for preferred provider organization. That means that the insurance company has contracted for rates with in network providers and you will usually pay less by using an in network service. But a PPO will also have coverage out of network. So you can choose to go out of network and still have some level of. overage. The feasibility using a provider that is not part of the PPO is dependent on the insurance company policy and the service provider and lots of questions should be asked upfront. Note that emergency coverage will be the same regardless of where you go.

Insurance companies can and will pay for care out of the PPO network if the needed care is unavailable in network. Most bogleheads can probably afford to pay any physician fee for an outpatient visit, out of pocket. This is especially true when with a PPO where insurance will pick up part of the bill. The vast majority of treatments and types of pharmaceuticals covered will be the same regardless of the specific insurance coverage. Therefore, when choosing a policy, I would focus first on which facilities are covered so that you may use the institution that you think is most likely to be your first choice.

Given the complexity of health insurance and billing in the US, if I have made any misstatements, I hope another forum member corrects me.
Northern Flicker
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Re: Cancel my health insurance?

Post by Northern Flicker »

nisiprius wrote: Sat Jan 20, 2024 4:38 pm Everything changes. Insurance is regulated by state law and plans vary in different markets, so it's hard to say anything definite.

The cheaper plans are cheaper because they restrict your choice of provider. If the provider is not in network, you pay the full bill yourself.

Around here, a fairly common option is a more expensive plan that covers "out of network" doctors, but charges you a 20% co-pay. Even so, that's not so bad because that's 20% of what the insurer is paying, i.e. the negotiated rate, not 20% of what the doctor is billing.
If a provider is out network there typically will not be a contractual rate. Insurers generally have contracts for negotiated rates for providers in their network-- it generally is what defines the network.

Emergency care is treated as in-network regardless of provider under ACA rules. The insurer won't have a contract with an out-of-network provider but will set some sort of "customary" in-network rate, and pay the claim accordingly. The provider may try to bill the insured for the balance to the extent that still is legal.
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Re: Cancel my health insurance?

Post by BalancedJCB19 »

boglerocks wrote: Fri Jan 19, 2024 12:43 pm I'm self-employed and health insurance for my family seems to cover very little of our (small) medical expenses. Should I consider canceling the policy? Could I run into a scenario that would require me to have health insurance?
No, never ever do this. You will always be one illness away from getting wiped out. Have you looked at the Affordable Care Act a/k/a Obamacare. I was recently let go of my job and I am currently on the ACA Marketplace and oddly enough it is the best health coverage I ever had with any of my jobs.

However you decide to obtain health insurance you can't take that chance. I was in the hospital for one night and the bill was 177,000. My dad had a long illness and if it wasn't covered by his insurance, he would have lost everything.
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Re: Cancel my health insurance?

Post by Katietsu »

Northern Flicker wrote: Sat Jan 20, 2024 9:43 pm
nisiprius wrote: Sat Jan 20, 2024 4:38 pm Everything changes. Insurance is regulated by state law and plans vary in different markets, so it's hard to say anything definite.

The cheaper plans are cheaper because they restrict your choice of provider. If the provider is not in network, you pay the full bill yourself.

Around here, a fairly common option is a more expensive plan that covers "out of network" doctors, but charges you a 20% co-pay. Even so, that's not so bad because that's 20% of what the insurer is paying, i.e. the negotiated rate, not 20% of what the doctor is billing.
If a provider is out network there typically will not be a contractual rate. Insurers generally have contracts for negotiated rates for providers in their network-- it generally is what defines the network.
This is correct for the OP. I will just add for the benefit of others that if one is in a Medicare associated plan, nisiprius’ statement is more likely to be applicable. But like all US insurance issues…it’s complicated.
GreendaleCC
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Re: Cancel my health insurance?

Post by GreendaleCC »

At this point, I’m not sure what else could be said in this thread. If these posts don’t convince OP, then I’m not sure what would.
kd2008
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Re: Cancel my health insurance?

Post by kd2008 »

OP, can you get group insurance through small business associations specific to your industry? It *may* be cheaper.

Yes, the headline number of premium is very large. Depending on where you happen to land in a population group, *health insurance* costs vary dramatically. My megacorp plan for self- only coverage cost them just $3000 annually. My current small business employer pays probably $20,000 for something similar and I pay zero premiums. My self-employed BIL has been receiving $0 to him healthcare ( in insurance and actual out of pocket) in NM State under Ryan White Care act based on income limits for decades. NM is super generous in this regards while the state where I live is inhumanely cruel. BIL is smart in the way he reduces income to qualify. He is a millionaire now.

This is to say, yes, your situation sucks. But instead of thinking going without health insurance, think about how you can get coverage for less. It is the best money you would have ever spent if things ever go south.
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whodidntante
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Re: Cancel my health insurance?

Post by whodidntante »

rob wrote: Fri Jan 19, 2024 12:45 pm A serious accident or health scare could wipe out savings.... I understand most plans are pathetic and feel like they cover nothing, and they don't if you don't need a lot of serious care.
I think you're making an important point, but given how my megacorp health insurance with a major provider doesn't cover much day to day medical expenses, I do worry that it will not pay for serious expenses, either. I may be overconfident in my safety net. There is an out of pocket maximum that is acceptable, but even that isn't helpful if the insurance constantly evades responsibility to pay.
howard71
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Re: Cancel my health insurance?

Post by howard71 »

JoeNJ28 wrote: Sat Jan 20, 2024 1:50 pm
howard71 wrote: Sat Jan 20, 2024 10:14 am
GreendaleCC wrote: Sat Jan 20, 2024 9:22 am
howard71 wrote: Sat Jan 20, 2024 8:53 am Everybody is warning you about the potential catastrophes of not having health insurance as if you never thought of that.
It doesn’t sound like OP knows how insurance even works. OP made it sound like he’s not sure whether insurance will pay more for a catastrophe than routine care.
howard71 wrote: Sat Jan 20, 2024 8:53 am As for your actual question, I went without health insurance for me and my adopted granddaughter for about two years and never ran into any situation where I couldn't get service without health insurance. As a matter of fact, most doctors I went to offered discounts. My granddaughter even broke her arm and had to go to the hospital and have therapy afterwards. Still came out WAY ahead financially over that period.
You were lucky.
The odds were in my favor.

BTW, I am not recommedning anything to the OP, just answering what I perceived to be his question.
How were the odds in your favor?
The odds are always in your favor and also the favor of the insurance company. If they weren't, there would be no profit in the health (or any) insurance business.

You can mitigate further with a healthy lifestyle, safe driving, etcetera.

In the years 2000-2001 my insurance premiums would have been around 17k for me (age 50) and my granddaughter (age 3). Probably spent about 6k altogether on my granddaughter's broken arm and a couple of other doctor visits. Spent zero on me so I came out 10k ahead.

Guessing those numbers would be at least double today.

Again, not recommending this. Just stating the fact.

(Oh, and I should add that while all of this was going on I had 3 hospitals trying to collect hundreds of thousands of dollars from me for my wife's lung cancer treatment, not because i owed them anything (I didn't) but because of problems getting the insurance company to pay. So I just said screw them all).
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Re: Cancel my health insurance?

Post by BarbBrooklyn »

exodusing wrote: Fri Jan 19, 2024 1:23 pm
boglerocks wrote: Fri Jan 19, 2024 1:16 pm Part of the problem is that if the policy provides the same degree of real world coverage for a catastrophic event that it does for minor stuff then I'll be paying for the vast majority of it out of pocket anyway. Should I assume/hope that a catastrophic event will be covered to a much greater extent than minor stuff is?

And if there is a catastrophic event will I be forced to use a treatment or doctor or hospital which is not my first choice if I want my PPO insurance to cover it? From what I've observed as a policy holder, "coverage" is complex and if I want to make my own choices I feel like I'll be paying out of pocket even if I still have the policy.
It depends on the terms of your insurance. For example, an ACA marketplace plan will have an out-of-pocket maximum, provided you stay in network. Other plans have other terms. No way to know what you have, or what other plans might be available to you, from here.
OP, do you have a High Deductible plan? Is that why the small charges aren't being paid, or are they being denied?

Do you understand your in-network and our of network benefits?
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ResearchMed
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Re: Cancel my health insurance?

Post by ResearchMed »

BarbBrooklyn wrote: Sun Jan 21, 2024 10:09 am OP, do you have a High Deductible plan? Is that why the small charges aren't being paid, or are they being denied?

Do you understand your in-network and our of network benefits?

Despite many our our attempts to help OP, I don't think they have returned to answer several of our questions about just what type of coverage they are referring to or how they understand health insurance to work.

I think a lot of us are spinning our wheels.
If OP refuses to tell us what type(s) of coverages they are thinking about/worried about, or lack of coverages, or specific policy wordings, then there's little more that we can do to help.

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boglerocks
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Re: Cancel my health insurance?

Post by boglerocks »

You all are great as usual. Thank you for taking the time.

Everyone is pointing out how expensive health care can be and I would love to know that I'm covered if I'm ever subject to that type of expense, but I don't think it's fair to make that assumption just because I have insurance. Here are a couple examples from this thread:
There is an out of pocket maximum that is acceptable, but even that isn't helpful if the insurance constantly evades responsibility to pay.
Oh, and I should add that while all of this was going on I had 3 hospitals trying to collect hundreds of thousands of dollars from me for my wife's lung cancer treatment, not because i owed them anything (I didn't) but because of problems getting the insurance company to pay.

The negotiated rates thing makes sense to me but it sounds like that only applies to in-network care. I can't look into a policy's network now because as a healthy person I have no idea what I'll want if something happens down the road.

I don't mind paying a high premium to know I'll be well and predictably covered in the event of a catastrophe according to my own choices even though today I don't know what those choices would be. Is there a health insurance company and/or policy type that I can trust for that type of coverage in exchange for paying a high premium? I'll also mention that I'm fine paying small (and maybe medium) medical expenses out of pocket if I know large expenses will be covered broadly.

There were some interesting suggestions above:
Qualified High Deductible Health Plan. You would get access to a HSA
Is this a piece of the puzzle?
Around here, a fairly common option is a more expensive plan that covers "out of network" doctors, but charges you a 20% co-pay. Even so, that's not so bad because that's 20% of what the insurer is paying, i.e. the negotiated rate, not 20% of what the doctor is billing.
Is this a good choice? I'm fine with a more expensive plan.
Last edited by boglerocks on Wed Feb 21, 2024 3:34 pm, edited 1 time in total.
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

boglerocks wrote: Tue Jan 23, 2024 12:47 pm Everyone is pointing out how expensive health care can be and I would love to know that I'm covered if I'm ever subject to that type of expense, but I don't think it's fair to make that assumption just because I have insurance. Here are a couple examples from this thread:
You can be 100% certain that nothing will be covered if you are uninsured. Hopefully that answers your question about going without insurance altogether.

If the question is now "which insurance should I choose", then that is much more complex question, and will depend on where you live and on your individual and family situation.
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Re: Cancel my health insurance?

Post by KBR »

mhalley wrote: Fri Jan 19, 2024 1:32 pm There seems to have been a breakdown in people’s minds about what insurance is for. Insurance is there for catastrophic expenses that would cause severe financial hardship. CANCELLING health insurance could result in catastrophic bills at any time. A slip in the shower, @ car wreck, an illness can happen at any time. Especially health insurance expectations have increased to thinking it should pay for every little expense. If you don’t like the health insurance not paying for much, switch to an Hsa plan so you can save money on the premiums and fund an HSA.
Absolutely. Insurance for everything is there to prevent financial catastrophe and completely wiping you out. That’s the reason you have homeowners insurance. It should be the way that you have medical insurance also but USA introduced bizarre labor laws, camping salaries, and one of the ways to improve a salary package was to provide insurance. at some point insurance in America something that’s going to cover every single expense. That’s not how it works for car insurance. That’s not how it works for homeowners insurance. Most people the best choice would be to have a high deductible policy so that if catastrophe happens, you are capped out at $6500 or $10,000 expense for the year , and then you just pay your doctor as you go along otherwise in the absence of catastrophe. I work as a physician. We give discounts for cash payments. So instead of getting rid of insurance, I would consider high deductible policy. That way you can attach an HSA to it. Then when you have any medical costs, call the doctor in advance. Ask how much he charges. Ask how much he would charge Cash discount. The phrase I tell people to use “what is the good guy price?“ Tell them you are paying cash and would like a discount. Your choice of insurance really depends on your situation, but if you’re considering discontinuing insurance that sends you into the hospital Will take a substantial part of your net net worth. Better at least to have a high deductible policy to limit your loss.
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Re: Cancel my health insurance?

Post by cubs1999 »

boglerocks wrote: Fri Jan 19, 2024 12:43 pm I'm self-employed and health insurance for my family seems to cover very little of our (small) medical expenses. Should I consider canceling the policy? Could I run into a scenario that would require me to have health insurance?
If you're self employed, then the premiums are coming right off the top of gross income which is a benefit for us self employed.

As already explained by others, you need health insurance in case there's health emergency, and that can happen to anyone no matter how health they've been or how healthy a life style they live. I mentioned this in other threads, but I played around with a Blue cross calculator and it claims I'd pay $5500 for cardiac bypass.surgery $2500 deductible and $3000 out of pocket max for in network) and it claims the procedure would be $60-80k depending on which hospital I had it done. This actually seems cheap if Jack's hand surgery billed $100k to insurance.

When my late mother went to the ER which turned out to be fatal heart failure that she didn't recover from, the ER plus ICU bill that Medicare and Medicare Advantage paid for about $90k.

I do see the frustration with insurance. I went to ophthalmology for dilated pupil exam as my primary care doctor said he say something abnormal in the basic eye exam he does at the physical. I got the insurance coverage papers: I owe like $200 something even though it was "covered" by insurance as I owe the deductible. I could see how one might think this would be cheaper to just pay out of pocket. It wouldn't be bc the bill.contained insurance discounts, so it would have been more if I had no insurance (though supposedly one can negotiate better cash rates). I also keep in mind that I'm not saving anything if I end up with a 5-6 figure bill in the future for an emergency.
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Re: Cancel my health insurance?

Post by vnatale »

KBR wrote: Wed Jan 24, 2024 2:39 pm It should be the way that you have medical insurance also but USA introduced bizarre labor laws, camping salaries, and one of the ways to improve a salary package was to provide insurance.
This originated during World War II when there was a freeze put on pay raises. Paying for workers' health insurance was a way of increasing their compensation.
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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vnatale
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Re: Cancel my health insurance?

Post by vnatale »

cubs1999 wrote: Wed Jan 24, 2024 4:04 pm

If you're self employed, then the premiums are coming right off the top of gross income which is a benefit for us self employed.

Although not as good as employees paying for their share of premiums with pre-tax money, which also saves on Social Security / Medicare.

Paying health insurance premiums don't help the self-employed on self-employment tax.

So an inequity there between employees and the self-employed.

Then if you are not getting it paid as self-employed or an employee it's the worse as there will be probably no tax benefit due to few people now itemizing and even if they do it is only the excess over 7.5% Adjusted Gross Income.
Above provided by: Vinny, who always says: "I only regret that I have but one lap to give to my cats." AND "I'm a more-is-more person."
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Re: Cancel my health insurance?

Post by BarbBrooklyn »

boglerocks wrote: Tue Jan 23, 2024 12:47 pm You all are great as usual. Thank you for taking the time.

Everyone is pointing out how expensive health care can be and I would love to know that I'm covered if I'm ever subject to that type of expense, but I don't think it's fair to make that assumption just because I have insurance. Here are a couple examples from this thread:
There is an out of pocket maximum that is acceptable, but even that isn't helpful if the insurance constantly evades responsibility to pay.
Oh, and I should add that while all of this was going on I had 3 hospitals trying to collect hundreds of thousands of dollars from me for my wife's lung cancer treatment, not because i owed them anything (I didn't) but because of problems getting the insurance company to pay.

The negotiated rates thing makes sense to me but it sounds like that only applies to in-network care. I can't look into a policy's network now because as a healthy person I have no idea what I'll want if something happens down the road.

I don't mind paying a high premium to know I'll be well and predictably covered in the event of a catastrophe according to my own choices even though today I don't know what those choices would be. Is there a health insurance company and/or policy type that I can trust for that type of coverage in exchange for paying a high premium? I'll also mention that I'm fine paying small (and maybe medium) medical expenses out of pocket if I know large expenses will be covered broadly.

There were some interesting suggestions above:
Qualified High Deductible Health Plan. You would get access to a HSA
Is this a piece of the puzzle?
Around here, a fairly common option is a more expensive plan that covers "out of network" doctors, but charges you a 20% co-pay. Even so, that's not so bad because that's 20% of what the insurer is paying, i.e. the negotiated rate, not 20% of what the doctor is billing.
Is this a good choice? I'm fine with a more expensive plan.

Could Sansum play a part in this? Recently a friend told me she had to go to the ER. She called Sansum first who called ahead to the ER and because of that they were expecting her and she didn't have to wait or go through any of the typical pain of an ER visit. That is extremely appealing to me. This might be more appropriate for a separate discussion but I'm mentioning it in case it could be part of a larger strategy. Do people pair Sansum access with conventional coverage to have both operational efficiency and choice of provider?
OP, have you read your policy?

Do you only have catastrophic insurance? I have that. It kicks in after $50k in eligible expenses.

Are claims being denied because you are still in the "OOP" hole?

Or are they being denied because they have been deemed ineligible expenses?

Unless you understand what your insurance covers, you are totally in the dark.

I arrived early for a PT appointment yesterday. Listened to the receptionist call three different insurance companies for 4 different patients to find out what the deductible was, how much had been satisfied, what the OOP was, how many sessions were covered. And she got a reference number for each call.

Start by reading your policy. Then come back here and ask us what to do.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
Topic Author
boglerocks
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Re: Cancel my health insurance?

Post by boglerocks »

Are all of the health insurance companies more or less the same or are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay? I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.

I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.
gtrplayer
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Re: Cancel my health insurance?

Post by gtrplayer »

boglerocks wrote: Fri Jan 19, 2024 12:43 pm Could I run into a scenario that would require me to have health insurance?
Getting seriously ill or injured.

I admit this question flummoxed me when I read it. Getting cancer or getting in a car accident could easily cost an uninsured person everything they have. And not having insurance could prevent you from getting care you need.
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

boglerocks wrote: Sat Feb 10, 2024 7:39 pm Are all of the health insurance companies more or less the same or are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay? I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.

I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.
Insurance companies are very different in terms of coverage and network. I use an HMO, Kaiser Permanente Northern California, which is both an insurance company and a closed network of providers. I never have to submit a claim, which is very convenient. I just pay the copay at point of service. There is no issue of getting reimbursed. There is no out-of-network coverage, though, except for emergencies when traveling outside the area that Kaiser serves. In this case, you do have to pay upfront and submit a claim for reimbursement. I have had emergencies both in other states and abroad and they were all covered eventually. I never got a an insurance denial, but it took a while to get the check (many months).

As far as situations that can be expensive, it is not just emergencies. Many chronic conditions require expensive prescriptions. I have been living with HIV for 17 years, as has has my husband. The prescriptions run about $60k a year for each of us. We could never afford them without insurance. There are government programs (ADAP and others) that cover them, but there are certain conditions to qualify, in particular, income limitations.
Doctor Rhythm
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Re: Cancel my health insurance?

Post by Doctor Rhythm »

You generally pay higher premiums to get broader “in-network” coverage. Most working-age people are covered under HMO or PPO plans. Here’s some info on differences between types of plans. I would do my own research on your local coverage options rather than get anecdotes from an anonymous forum for what’s best for you.
Dottie57
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Re: Cancel my health insurance?

Post by Dottie57 »

howard71 wrote: Sat Jan 20, 2024 8:53 am
boglerocks wrote: Fri Jan 19, 2024 12:43 pm I'm self-employed and health insurance for my family seems to cover very little of our (small) medical expenses. Should I consider canceling the policy? Could I run into a scenario that would require me to have health insurance?
Everybody is warning you about the potential catastrophes of not having health insurance as if you never thought of that.

As for your actual question, I went without health insurance for me and my adopted granddaughter for about two years and never ran into any situation where I couldn't get service without health insurance. As a matter of fact, most doctors I went to offered discounts. My granddaughter even broke her arm and had to go to the hospital and have therapy afterwards. Still came out WAY ahead financially over that period.
I was in the hospital due to covid last year. Two weeks. Lots of blood tests and round the clock massive amount of intravenous fluids. Bill 91k. Medicare paid abou 15%. If I didn’t have medicare plus supplemental I would have been on the hook for the whole bill.
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

boglerocks wrote: Sat Feb 10, 2024 7:39 pm Are all of the health insurance companies more or less the same[?]..
No. You need to do research to find medical insurance that fits your needs and budget.
boglerocks wrote: Sat Feb 10, 2024 7:39 pm ..are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay?
That criteria sounds like you want the best of all worlds. If it exists in your area, it will be expensive.
boglerocks wrote: Sat Feb 10, 2024 7:39 pm I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.
Yet your OP questioned the wisdom of paying for medical insurance at all because you ONLY had small health expenses.
boglerocks wrote: Sat Feb 10, 2024 7:39 pm I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.
Personally I would rather choose a network with good care to obviate the need for out-of-network coverage.
You need to do research. Start here.
https://www.valuepenguin.com/health-ins ... ance-guide

You can't expect to get the "right answer" when nobody on this forum knows anything about you or your situation.

I can tell you what I do for medical insurance. But many posters on this forum have disagreed with me on this.
That's fine. Their situation is not my situation. What works for me might not work for them. And vice versa.
And what works for you might be something different again.

You need to act like an adult. Do research, get informed, ask questions, and make your decision.
Don't expect a simple, 1-solution answer from anonymous posters.

If you really want advice from this forum on choosing medical insurance, you need to enter all of your personal particulars, e.g. age, occupation, state you reside in, dependents, medical history, current premiums and coverage, etc.
Your failure to do so says you are not really serious about understanding and solving the problem.
You just want the "right answer" to the test question.

[This is the "tough love" version of advice. :) ]
PeninsulaPerson
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Re: Cancel my health insurance?

Post by PeninsulaPerson »

boglerocks wrote: Sat Feb 10, 2024 7:39 pm
Are all of the health insurance companies more or less the same or are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay? I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.

I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.


Did you say what state you're in? (Sorry if I missed that.)

Blue Cross Blue Shield of MA is amazing. Great coverage, great service. And they pay with no hassle. Their free "patient case manager" service is The Best!

And basically every Boston area doctor is in their network. Oh, yeah - people complain about MA taxes and weather. But the medical care options are A+++++++.
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ClevrChico
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Re: Cancel my health insurance?

Post by ClevrChico »

Insurance in general is for risk management, not a maintenance plan. Without health insurance, you'll be assuming all the risk yourself. Most GoFundMe campaigns seem to be for those that decided to go without insurance.
BarbBrooklyn
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Re: Cancel my health insurance?

Post by BarbBrooklyn »

Do you have a primary care physician?

The way I generally find highly qualified doctors is by choosing a teaching hospital that is accessible geographically.

You find a PCP who is affiliated with that hospital and who is in network with your insurance.

Your PCP recommends specialists who are affiliated with that hospital and in your network.

Every major hospital I know has a "find a doctor" option. You can check if your insurance is accepted by each doctor.
Last edited by BarbBrooklyn on Mon Feb 12, 2024 12:59 am, edited 2 times in total.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

ClevrChico wrote: Sun Feb 11, 2024 7:10 am Insurance in general is for risk management, not a maintenance plan.
Health insurance is an exception to that rule - 51% of Americans have a chronic medical condition. These can be costly and need to be covered by health insurance as well. It's not just for emergencies.
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ClevrChico
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Re: Cancel my health insurance?

Post by ClevrChico »

madbrain wrote: Sun Feb 11, 2024 11:32 pm
ClevrChico wrote: Sun Feb 11, 2024 7:10 am Insurance in general is for risk management, not a maintenance plan.
Health insurance is an exception to that rule - 51% of Americans have a chronic medical condition. These can be costly and need to be covered by health insurance as well. It's not just for emergencies.
And a majority of Americans are on an HDHP.
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

ClevrChico wrote: Mon Feb 12, 2024 5:53 am And a majority of Americans are on an HDHP.
That's incorrect. 36% of the US population is covered by Medicare, Medicaid or VA, which are not HDHPs.
The remaining 64% are in private plans, of which 53.4% are are HDHPs. Ie. HDHPs cover about 34% of Americans.
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ClevrChico
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Re: Cancel my health insurance?

Post by ClevrChico »

madbrain wrote: Mon Feb 12, 2024 4:39 pm
ClevrChico wrote: Mon Feb 12, 2024 5:53 am And a majority of Americans are on an HDHP.
That's incorrect. 36% of the US population is covered by Medicare, Medicaid or VA, which are not HDHPs.
The remaining 64% are in private plans, of which 53.4% are are HDHPs. Ie. HDHPs cover about 34% of Americans.
Okay *private health plans* like OP who asked the question.
Topic Author
boglerocks
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Re: Cancel my health insurance?

Post by boglerocks »

boglerocks wrote: Sat Feb 10, 2024 7:39 pm Are all of the health insurance companies more or less the same or are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay? I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.

I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.
madbrain wrote: Sat Feb 10, 2024 10:25 pm Insurance companies are very different in terms of coverage and network. I use an HMO, Kaiser Permanente Northern California, which is both an insurance company and a closed network of providers. I never have to submit a claim, which is very convenient. I just pay the copay at point of service. There is no issue of getting reimbursed. There is no out-of-network coverage, though, except for emergencies when traveling outside the area that Kaiser serves. In this case, you do have to pay upfront and submit a claim for reimbursement. I have had emergencies both in other states and abroad and they were all covered eventually. I never got a an insurance denial, but it took a while to get the check (many months).
I like certainty. I don't like having emotional phone calls with call center reps. I wonder if I would be happier with something like Kaiser which does exist in my area. It sounds like they do what they say they do and if you don't like it you can pay the outside doctor yourself. From experience and from what I can gather from this thread, there is a lot of uncertainty associated with being covered by the conventional insurance companies and I've heard that having Kaiser at the center of things helps things to run much more smoothly and predictably.

If I switch to Kaiser I will be 100% covered (minus copay) no-questions-asked within their closed network which is large enough to cover me for anything that might happen?

Do I get anything like negotiated rates outside of the network?
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

boglerocks wrote: Wed Feb 21, 2024 3:08 pm If I switch to Kaiser I will be 100% covered (minus copay) no-questions-asked within their closed network which is large enough to cover me for anything that might happen?
Kaiser still has rules about which treatments they cover or not If you need some experimental treatment, or non-FDA approved, it may not be covered. But you will run into that with all insurers, not just Kaiser. I have not run into it myself.
Do I get anything like negotiated rates outside of the network?
No. You don't get negotiated rates outside Kaiser. You have to pay in full out of pocket. With Kaiser, you are only covered for emergencies when going out-of-network. In this case, you have to pay upfront, then get reimbursed by Kaiser. You will only responsible for the same copay that you would normally owe for the same service if it had been performed at a Kaiser facility. Kaiser will reimburse you for the remainder.
doobiedoo
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Re: Cancel my health insurance?

Post by doobiedoo »

madbrain wrote: Sat Feb 10, 2024 10:25 pm .. I use an HMO, Kaiser Permanente Northern California, which is both an insurance company and a closed network of providers. I never have to submit a claim, which is very convenient. I just pay the copay at point of service. There is no issue of getting reimbursed. There is no out-of-network coverage, though, except for emergencies when traveling outside the area that Kaiser serves. In this case, you do have to pay upfront and submit a claim for reimbursement. I have had emergencies both in other states and abroad and they were all covered eventually. I never got a an insurance denial, but it took a while to get the check (many months).
boglerocks wrote: Wed Feb 21, 2024 3:08 pm I like certainty. I don't like having emotional phone calls with call center reps. I wonder if I would be happier with something like Kaiser which does exist in my area. It sounds like they do what they say they do and if you don't like it you can pay the outside doctor yourself. From experience and from what I can gather from this thread, there is a lot of uncertainty associated with being covered by the conventional insurance companies and I've heard that having Kaiser at the center of things helps things to run much more smoothly and predictably.

If I switch to Kaiser I will be 100% covered (minus copay) no-questions-asked within their closed network which is large enough to cover me for anything that might happen?

Do I get anything like negotiated rates outside of the network?
I have used Kaiser for 45 years. From company-provided insurance to ACA Obamacare and now Medicare Advantage.

I live in SoCal. I generally hear good things about Kaiser SoCal and Northern CA. Don't know about the other regions.
It's not perfect. Every provider has good and poor doctors and even good and poor departments.

My suggestion is to try Kaiser for a year. You can always switch to something else.
And it's certainly better than completely foregoing medical insurance coverage!
dcabler
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Re: Cancel my health insurance?

Post by dcabler »

boglerocks wrote: Wed Feb 21, 2024 3:08 pm
boglerocks wrote: Sat Feb 10, 2024 7:39 pm Are all of the health insurance companies more or less the same or are there some that provide particularly good/broad coverage, excellent service, and don't give you the run-around when it's time for them to pay? I don't need small health expenses covered but if something big comes up I want to feel confident that I'll be covered according to my own choices.

I don't have any way of knowing now which doctors I would want to be in-network in case of a health catastrophe so maybe I need excellent out-of-network coverage.
madbrain wrote: Sat Feb 10, 2024 10:25 pm Insurance companies are very different in terms of coverage and network. I use an HMO, Kaiser Permanente Northern California, which is both an insurance company and a closed network of providers. I never have to submit a claim, which is very convenient. I just pay the copay at point of service. There is no issue of getting reimbursed. There is no out-of-network coverage, though, except for emergencies when traveling outside the area that Kaiser serves. In this case, you do have to pay upfront and submit a claim for reimbursement. I have had emergencies both in other states and abroad and they were all covered eventually. I never got a an insurance denial, but it took a while to get the check (many months).
I like certainty. I don't like having emotional phone calls with call center reps. I wonder if I would be happier with something like Kaiser which does exist in my area. It sounds like they do what they say they do and if you don't like it you can pay the outside doctor yourself. From experience and from what I can gather from this thread, there is a lot of uncertainty associated with being covered by the conventional insurance companies and I've heard that having Kaiser at the center of things helps things to run much more smoothly and predictably.

If I switch to Kaiser I will be 100% covered (minus copay) no-questions-asked within their closed network which is large enough to cover me for anything that might happen?

Do I get anything like negotiated rates outside of the network?
As I went through the ACA selection process back in November, the first thing that came me some comfort is the annual max out of pocket. This plus monthly premiums pretty much sets the maximum per year I'd have to pay if something catastrophic comes along. All plans I was considering were in a surprisingly narrow range. This was the certainty I needed to know that a catastrophic event would not likely derail our retirement, even if it went on for a few years.

I then started to narrow down my plan choices
- Wanted to make sure our primary docs were in network
- Wanted to make sure that as many of the specialist docs we've had over the years (the ones we like that is) were in network
- I then went through a list of common specialties for which we've never had need, but I wanted to see how many providers are in network within a reasonable driving range
- Nice to have would have been HSA eligible, but only a couple of plans were and they were inferior in pretty much every other way I cared about.

I ultimately also went with certainty. The plan we decided on is sponsored by one of the largest medical groups in the area. And yet, provider choices don't consist solely of ones that are part of that medical group. In terms of coverage, it checked all of our boxes. It's a so-called zero deductible plan where there is no deductible for health care, but there is a deductible for prescriptions. Even then, the lowest 2 tiers are covered before the deductible is reached. It's an EPO plan and my primary physician is not a gatekeeper to specialists.

From a practical standpoint, I know what my copays are for just about everything before I make a visit. It's now getting to be late Feb, and we've already had several doc visits and prescriptions.
- We both had covid, but were able to get video-doc who are part of the practice as our primary docs. The copay was exactly as our plan documentation stated. The antiviral we were prescribed would have been subject to the prescription deductible, but the manufacturer had a discount resulting in a $0 cost for us.
- I had my annual physical.
- I saw a new specialist recently. Again, the copay was exactly as our plan description stated. I was given a prescription, but the prescription is not on our formulary. Again, the manufacturer had a discount resulting in a relatively low out of pocket cost for me. In this case, I didn't have to do anything - the pharmacy took care of it automatically at their end.

As I was narrowing down the plans, I had a golf-course conversation with a friend of mine. He's been on a plan from the same provider that I ultimately chose. He had no complaints. He had 2 emergency room visits, one to a hospital in-network and one to a hospital out-of-network. ACA plans have to cover emergencies in out-of-network scenarios and he said that there were a few hiccups there but were all quickly resolved, once the providers had his insurance info. Yeah, anecdotal evidence with all of the limitations that come with that.

We had the option to continue COBRA for 1 more year, so comparing ACA plans to that was appropriate. The network was hands-down larger than any ACA plan - as in nationwide vs statewide at best and, more commonly, a handful of counties. It was also HSA eligible. It came down to cost, at the end of the day. COBRA premiums would have been about 2X what the ACA plan is that we chose, when premium tax credits were considered. Compared to my portion of the premiums for the same plan when I was still working, the ACA plan is about 2X what that was.

So far, we're happy with our choice.

Cheers.
coachd50
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Re: Cancel my health insurance?

Post by coachd50 »

boglerocks wrote: Fri Jan 19, 2024 2:49 pm If I want to choose my treatment, hospital, and doctor, could I end up paying out of pocket anyway?
Respectfully, why do you keep asking anonymous people on an internet forum the questions you should be asking your current (as well as potential) health insurance providers?
bogleviewer
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Re: Cancel my health insurance?

Post by bogleviewer »

For my case, the last 15 years of being self employed and paying for my own health insurance has proven to be an incredibly terrible decision. However, this doesn't mean that the next 15 years will be an incredibly terrible decision.

Over the past 15 years:
  • I have spent $228,000 in insurance premiums rounded to nearest thousand.
  • I have had 0 years in which I've hit my deductible.
  • Insurance company has paid $0.00 in after deductible bills since I've never hit my deductible.
  • Insurance company has paid $5,000 in preventative maintenance bills.
Had I simply self-insured and went without health insurance I would be around $223,000 richer not including opportunity costs.

The whole "insurance provides discounts to medical billing" is total garbage even if it is indeed the truth. The whole "reprice" of the industry is a complete and utter joke that keeps the insurance companies relevant and medical facilities to be less transparent and frankly honest. It is completely anti-consumer is every single possible way. The insurance company is not some broker who told me to go see doctor X rather I planned on going to doctor X and checked first if it would be in-network.

I will say that I have frequently avoided "using" insurance (for the discount and to use against my deductible) all together because of the hassle. For example, for my dermatologist that i go and see once a year to be proactive I simply have a cash price which is reasonable: $100 for the visit. If this goes through insurance, then he will bill insurance $300 and end up with $100 anyway but then I will get a bill in regular mail between 5 and 50 weeks later asking for $100 and then I have to go and check out the EOB to even remember what in the world the bill is about and then go to the doctor's portal and pay and hope that it is all resolved. It is such a waste of time. The "reprice" is nonsense. However, they do get you in the world of not able to make choices upfront such as an emergency situation. You can't simply ask the ambulance driver "hey, so, do you have a cash price and is it competitive with insurance price?".... especially if you are unconscious.

The facts are as follows:
  • My family and I are healthy.
  • My DW and I have good genes.
  • My family and I eat healthy and exercise.
  • My family and I are LOW RISK for needing medical attention and yet we pay the same as a HIGH RISK and even chronically ill people.
  • My family and I are the juicest and best money makers for the health insurance industry
  • My family and I still have health insurance because of the extremely low probability fluke accident or illness that can easily run into the millions.
I know that the odds are in my favor but I hate long tail risks so I get the highest deductible plan which has the lowest premium but it is still wildly expensive for what my family and I personally get in return. Every year when I get the notice saying my premium has increased I get annoyed and then I continue on with life hating the industry and simply being thankful that I don't have to use it. My premiums have gone up 8 to 12% year over year ever since ACA/Obamacare was passed adding a bunch of nonsense that I don't want or need. :annoyed
madbrain
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Re: Cancel my health insurance?

Post by madbrain »

Again, as others said before, do you get upset at your home insurance paying nothing because your home never burned down ? Or your auto insurance because you never totaled a car ? Or liability insurance because you were never sued ?

Medical risk increases with age, which is a good part of why your premiums are increasing each passing year. Home insurance costs are skyrocketing because of climate change. Etc
erishera
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Re: Cancel my health insurance?

Post by erishera »

I think you should take the time to understand your insurance and other health insurance available to you. Just like any other purchase try to understand what you are getting and how much it is costing you and why you are buying what you are buying. Plan your healthcare needs like you plan your savings or any other worthwhile activity. If the product you paid for is not aligned to your plans make changes and seek out different plan like with different network.
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