Anybody have an expensive chronic illness and buy their own health insurance?

[Adam Zapple]

I don't need to know what you have just how it effects the cost of your insurance.  I see a lot of people assuming they will be healthy when figuring their FI number but not everyone will be so lucky.

[protostache]

Medical underwriting for health insurance went away in 2014 as part of ACA. When you buy a plan, the only variables they can take into account are age, gender, and tobacco use.

[hops]

Posting to follow. While the preexisting condition monkey is off our backs now (and I'm supremely happy about that), I still feel tethered to my job because my employer offers a (fantastic) plan with an extremely low deductible and covers the premium, two things that are lifesavers (or at least 'stache-savers) with an expensive illness.

[Samala]

Right - preexisting conditions are no longer a variable but a chronic illness still factors majorly into how you should choose your plan because you will be using the HECK out of your insurance.

Having a chronic illness, even something considered common and treatable like say IBS or thyroid disorders, factors majorly into overall healthcare spending.  You automatically know you will be visiting a doctor and/or specialist several times in a year and in many cases will be on some type of maintenance drug.  These are not small costs in the long run. 

The most important variables I considered when choosing an insurance plan were the out of pocket maximum, the cost of my prescriptions and where they fell in the formulary (were they generic, preferred, not preferred, outright not covered?), overall deductible, and whether my providers were in their network.  (That last consideration was huge because it's taken YEARS to find great specialists!)

The only way I finally contrived to really compare plans was to take my spreadsheets for medical expenses over the last three years and recalculate my costs based on the features of the plans I was considering.  The plan that wound up being the lowest cost overall (out of my pocket plus cost of premiums) was the winner.  Note this is not wholly accurate, because if the new insurer or plan has wildly different contracted rates with any of my providers, then the calculations are imperfect because the deductible/out of pocket limits wouldn't be calculated completely accurately.  I'm certain there are people here smarter than me that would analyze this a different way and would arrive at more accurate calculations and therefore a better decision.  Plus, three years of data is just that; a very small window actually. 

All that said, chronic illnesses still manage to keep many people in jobs they don't particularly like in order to access health plans that help them manage costs by covering some of the premium. 

[Jschange]

Yes.

I was heading to a career change because of my disability, and chose a public college and to go back to school full-time, so that I'd switch to the college insurance. It is less generous than my old plan, but still something.

I graduated in August, and because I'm Canadian, continuing my college plan was the only way to maintain coverage at a decent rate without having my epilepsy (and maybe my asthma and other minor stuff) excluded from coverage

$130/ month insurance, $40/month to pay 20% of my $200 meds. These meds are one of the cheaper options for my condition, and I tend to need a medication switch every few years. I have limited optometrist and glasses I'll also have coverage for, as well as other prescriptions. I waived the dental, because it added $480/year to my policy, and they pay out a maximum of $500. Fees will go up, with a big leap as I jump age bands .

There is no birth control coverage whatsoever, which was covered (badly) under  the school plan and most employer plans.

My doctors etc. are covered by my provincial health plan.

[Cathy]

Medical underwriting for health insurance went away in 2014 as part of ACA. When you buy a plan, the only variables they can take into account are age, gender, and tobacco use.

This isn't quite right. For individual plans and small group plans, the exclusive list of permissible variables is (i) "whether such plan or coverage covers an individual or family", (ii) "rating area", (iii) " age", and (iv) "tobacco use". Gender is not a permissible variable. See § 2701 of the Public Health Service Act, PL 78-410, 58 Stat 682 (1944), as amended by the Patient Protection and Affordable Care Act, PL 111-148, § 1201(4), 124 Stat 119, 155-56 (March 23, 2010), codified at 42 USC § 300gg.

The above requirements also apply to large group plans offered through "the State Exchange" (other than "self-insured group health plans"). 42 USC § 300gg(a)(5). Although the term "State Exchange" is rendered with leading capitals, the statute apparently does not contain a definition for it, potentially leading to a similar issue as was litigated in King v. Burwell, 576 US ___, 135 S Ct 2480, 192 L Ed 2d 483, 2015 US LEXIS 4248, but this is not the same provision and not the same language that was at issue in that case. To be clear, the "State Exchange" issue applies only to large group plans, not individual plans or small group plans.

Note also that certain plans are exempt from these requirements, but I won't discuss that here. See, e.g., 42 USC § 300gg–21.

[lauren214]

I see a lot of people assuming they will be healthy when figuring their FI number but not everyone will be so lucky.

Yep, I see this a ton. It's definitely discouraging when ones spending (and thus necessary FI number) is increased dramatically due to chronic illness. On the other hand, the future uncertainty associated with chronic illness is one of my main drivers towards becoming FI.

I buy my own health insurance (self employed), and agree with the other posters to do the math and see which plan works best for your unique set of circumstances.

[Adam Zapple]

Amazing how a change in health can thwart the best laid plans.  I know so little about health insurance.  My wife is in HR so I tend to defer all that stuff to her.  Its the one aspect of our finances I have absolutely no knowledge of.  Part of that is because my employer offers such a great benefits package I really don't have to pay attention at all.  The one and only downside of that, of course, is I also feel tethered to my workplace and may end up working longer than anticipated, especially with my recent change in health.

Do any of you figure an annual increase in costs when budgeting future healthcare costs?  What % do you use?