The Money Mustache Community
General Discussion => Welcome and General Discussion => Topic started by: markbike528CBX on October 08, 2016, 10:02:58 PM
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I been thinking about self-insurance, health insurance, specifically.
the new thread
http://forum.mrmoneymustache.com/welcome-to-the-forum/mmm-decides-to-self-insure-his-house/
Got me off my duff and started this thread.
QUESTION: at what point can you call yourself insurance-free?
My call is $ 1M per person stache, as if you spend 1M on health issues, you probably might be done (dead) after spending that much.
The partners/spouse should be able to make it on the 1M remainder.
(puts on flame suit )
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One of the major benefits of insurance is negotiated costs. The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company. If you have a 20 percent co-pay, your out of pocket is $400. Without insurance, you will be billed for $10,000. You might get that down somewhat if you have no money, but not to the insurance company's price. Have money? You will pay $10,000.
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Eh, I'd prefer to always carry some form of catastrophic coverage insurance.
You probably could do it at $1M/person, but that'd kind of suck if you lived through it. Unless you mean "$1M/person, independent of other funds."
That said, at least in the US, if you earn the right amount, your health insurance is mostly free. To the best of my current understanding there's only an income check, not a wealth check, so subsidy away! At least, that's my long term plan (given current situations).
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My friend was a pedestrian hit by a car. Her hospital bill was $240,000. She negotiated it down to $75,000.
This comes after an extensive cancer treatment and illness of several years. That had to be a pretty big bill.
She considers herself self insured. I guess she will ignore any bill frm the Internal Revenue Service for the penaltynfor not having health insurance.
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What are you deductibles gonna be with this plan?
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My friend was a pedestrian hit by a car. Her hospital bill was $240,000. She negotiated it down to $75,000.
This comes after an extensive cancer treatment and illness of several years. That had to be a pretty big bill.
She considers herself self insured. I guess she will ignore any bill frm the Internal Revenue Service for the penaltynfor not having health insurance.
Yeah, how does that work? I thought someone told me the penalty is like, $600 if you don't have health insurance. And I think the marketplaces are different in different states...People on the coast seem to have an easier time getting policies but around where I am, it always seems super expensive for people who have to get Obamacare. I'm worried once I FIRE that health insurance will be a big issue.
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One of the major benefits of insurance is negotiated costs. .
I agree with Another Reader, on the negotiated costs, which is one big reason for me.
However, when does the "shared reponsibility" penalty and the lack of insurance become a "whatever" shrugg-off?
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I been thinking about self-insurance, health insurance, specifically.
the new thread
http://forum.mrmoneymustache.com/welcome-to-the-forum/mmm-decides-to-self-insure-his-house/
Got me off my duff and started this thread.
QUESTION: at what point can you call yourself insurance-free?
My call is $ 1M per person stache, as if you spend 1M on health issues, you probably might be done (dead) after spending that much.
The partners/spouse should be able to make it on the 1M remainder.
(puts on flame suit )
I'm not sure this is comparable to the other thread. There is almost no upper bounds to what continued healthcare costs can run you, whereas home insurance and car collision insurance have a very definite loss limit. In the United States there is also the ACA penalties to consider, which adds another layer to the equation.
I'm glad you've found a number that works for you though. Hopefully everyone's health will remain so that there is no need for insurance, or the $1MM backstop!
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I personally wouldn't risk it but just for informational purposes, it's not hard to rack up million dollar medical bills. I work for an insurance company that sells workers comp. Just last week i stumbled across a claim that we had paid over a million for medical losses alone and the claim was still open and active. From what I read the claimant was alive and well and had been for years since the claim opened.
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It is far too risky to not have it. Even a week in the hospital can be $100,000. Who wants to take that risk?
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My friend was a pedestrian hit by a car. Her hospital bill was $240,000. She negotiated it down to $75,000.
This comes after an extensive cancer treatment and illness of several years. That had to be a pretty big bill.
She considers herself self insured. I guess she will ignore any bill frm the Internal Revenue Service for the penaltynfor not having health insurance.
Yeah, how does that work? I thought someone told me the penalty is like, $600 if you don't have health insurance. And I think the marketplaces are different in different states...People on the coast seem to have an easier time getting policies but around where I am, it always seems super expensive for people who have to get Obamacare. I'm worried once I FIRE that health insurance will be a big issue.
The annual fee for not having insurance in 2016 is $695 per adult and $347.50 per child (up to $2,085 for a family), or it's 2.5% of your household income above the tax return filing threshold for your filing status – whichever is greater. So it's a lot more than $600 for most people. You're exempted if the lowest cost plan available to you is greater than 8.05% of your household income.
The subsidies and fines are based purely on your income, not your wealth, so if you're FIRE'd and only drawing a modest amount, you'll qualify for the ACA subsidy or medicaid depending on how little you're withdrawing annually. Essentially, because of the 8.05% affordability calculator, you need to just build in 8% extra each year into your FIRE number - that will more than cover you because if it's >8.05% of your income then you won't pay a fee.
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I think it makes more sense to grab the cheapest possible ACA plan than it does to completely self-insure. If you don't qualify for subsidies, then the penalty for not having insurance is quite high, making it so that your cost of having that basic health insurance may not be substantial.
If you do qualify for the subsidy, I think you'd be hard pressed to find a situation where it makes sense to self-insure and take the penalty rather than take the subsidy on insurance.
Personally, I wouldn't want to come out on the other end of cancer or an injury with a $1,000,000 hospital bill and need to go back to work.
There are ways to mitigate that damage, of course - if you can make it to open enrollment, you can't be denied coverage. Or your spouse could get a job (if you're married) with insurance as soon as you became ill. But you're rolling the dice that the catastrophic event isn't sudden (like an accident). I also think that self-insuring probably increases the likelihood that you'll delay care, or be forced into treatment options that are cheaper, but don't have the best outcomes.
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It seems like a very stupid idea.
Some sort of catastrophic event coverage is needed when talking about health, as anything VERY bad would most certainly 1- wipe you out and 2- negatively affect your ability to bring home any income.
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I agree that this sounds like a penny wise, pound foolish sort of proposition. Get the least expensive, highest-deductible plan out there and invest the difference, but for god's sake, don't go without insurance. You may be young and healthy, but there is no guarantee you will stay that way. I am only in my 30s but I have seen friends 1) get brain cancer and die, 2) crash a motorcycle and get airlifted out of a canyon 3) get thyroid cancer and live to see another day, 4) in my own case had a very risky pregnancy after two late losses, give birth early, and have a baby in the NICU. Personally, I don't want to avoid cool things in life like surfing, backpacking, volunteering for Habitat for Humanity because I might injure myself and need to go to the hospital. I imagine that my behavior would change quite a bit if I knew I didn't have that safety net.
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Unfortunately we have a big government regulated health insurance system which results in extortionate charges for minor services. Ask for pricing up front and you can be waiting months to get a quote and shop around. There are some free market hospitals like the Surgery Center of Oklahoma that advertise pricing which is fair and competitive, often cheaper than the rates insurance will negotiate. Yes you can negotiate the same rates insurance pays, but unless you have intimate knowledge of what an appropriate price is for every obscure procedure and service, you're shooting in the dark.
Your best bet is probably an obscenely expensive catastrophic coverage high deductible insurance plan. These used to be cheap before government regulated healthcare and insurance more than it was, but at least the government will steal less from you if you use a HSA. Honestly it's not uncommon to be out a few hundred thousand dollars for something you might think is minor. Having a known cap of what it will cost is helpful, even if it means your government regulated and controlled insurance company declines to pay for services that may save your life. In usch case you can always go the free market route either in the country or outside of the country. Regardless, as someone who has spent a fairly large amount on healthcare in the past year, it's prudent to have some sort of insurance for the big health events.
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If your health insurance is $5000 a year, you'd need $125K to cover that at a 4% SWR. To account for increases above inflation, I'll use a 2.5% SWR, so $200K. That's a fair whack less than $1M. Are you prepared to take the risk (and work longer to do so)?
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If your health insurance is $5000 a year, you'd need $125K to cover that at a 4% SWR. To account for increases above inflation, I'll use a 2.5% SWR, so $200K. That's a fair whack less than $1M. Are you prepared to take the risk (and work longer to do so)?
I don't think the OP was suggesting this; just pointing out that a very wealthy person may choose to do so, if they had a 1mm stash per individual.
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I'm a breast cancer survivor. Between all the testing, biopsies, 8 rounds of chemo, rads, a year of Herceptin, hormonal therapies and follow up, I'm sure it was over a million dollars. I was young for it and otherwise healthy. Self insuring sounds like a terrible plan. When something like this happens, I can't imagine having to try to negotiate with dozens of providers, many of whom will expect to be paid up front.
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Another thing to keep in mind is disability after the hospitalization/illness may limit your ability to earn afterwards. This isn't specifically related to self insurance vs group, but having that money available afterwards would be beneficial.
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I have had patients of mine die waiting to be listed (just listed, never mind actually getting one) for an organ transplant because they did not have insurance/good enough insurance to fully cover the necessary lifelong medications. Our transplant committee considers it irresponsible to give that patient an organ until they have all their ducks in a row, because their chances of 100% following the very expensive protocol while paying out of pocket is almost nil and there are plenty of people already on the list with perfect insurance. Just food for thought.
There are many other scenarios where not being insured could result in poorer or at least delayed medical care, which is terrible.
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One of the major benefits of insurance is negotiated costs. The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company. If you have a 20 percent co-pay, your out of pocket is $400. Without insurance, you will be billed for $10,000. You might get that down somewhat if you have no money, but not to the insurance company's price. Have money? You will pay $10,000.
This is sort of misleading, since I think places bill "cash payments" differently too. I called about this for a voluntary procedure recently and it sounded like the "net" cost to me might be similar if I paid out of pocket entirely vs through insurance (though naturally insurance would be billed 3x and I'd only get charged the same, or some otherwise completely stupid convoluted thing).
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Re "negotiating costs": what if one is too incapacitated - say for instance in a coma or serious chemo brain - to make deals with the health provider? Bills for MRI, CAT scans, lab work, drugs and multiple surgeries could pile up. This is where wishful thinking and reality don't always align.
While I fully understand that many think insurance is a needless gamble, there's no way I'd be without decent coverage on my house, rental properties, life, and health.
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OP here,
At the very least, I'll have to revise the minimum stashe upward (2millon per person?)
If one can say
meh, pay the penalty and self insure,
one could also say
meh, pay the insurance.
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I'm in the camp of "horrible choice". Even if you have 1-2 million per family member, that could literally be wiped out after an encounter with a drunk driver or a stint with cancer -- and you can't avoid those awful things.
On the other hand, paying out of pocket when you catch strep throat or your kids need vaccinations -- while maintaining a high-deductible catastrophic illness policy -- makes sense financially.
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Completely different than self-insuring a house... damage to a house is a fixed maximum loss at the cost of the dwelling, health costs are almost infinite in comparison. You should have health insurance.
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Completely different than self-insuring a house... damage to a house is a fixed maximum loss at the cost of the dwelling, health costs are almost infinite in comparison. You should have health insurance.
Not to mention that the non-financial stakes are considerably different.
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If your health insurance is $5000 a year, you'd need $125K to cover that at a 4% SWR. To account for increases above inflation, I'll use a 2.5% SWR, so $200K. That's a fair whack less than $1M. Are you prepared to take the risk (and work longer to do so)?
$5000/year? I wish, at our age in the early 50s we are looking at around $15,000/year, assuming no subsidies, which is likely given what we would like to have income-wise. Add another $5000/year for the deductible for at least one of us, which is pretty likely given our medical history, and you are at roughly $20,000/year, close to MMM's total spending on everything.
What worries us is the accelerating rate of premium increases for the ACA plans in most states, I think it averages 25% this year, and Tennessee, an otherwise popular retirement state approved between 40% and 62% for their remaining insurers. It only takes a few years of that kind of rate increases before premiums have doubled, and we are looking at $30-40,000 per year just for medical insurance. That is the main reason I am still working, we would like to see some kind of longer term stabilization of health care system costs so we can project expenses better, though fortunately I don't mind my job.
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My friend was a pedestrian hit by a car. Her hospital bill was $240,000. She negotiated it down to $75,000.
This comes after an extensive cancer treatment and illness of several years. That had to be a pretty big bill.
She considers herself self insured. I guess she will ignore any bill frm the Internal Revenue Service for the penaltynfor not having health insurance.
Yeah, how does that work? I thought someone told me the penalty is like, $600 if you don't have health insurance. And I think the marketplaces are different in different states...People on the coast seem to have an easier time getting policies but around where I am, it always seems super expensive for people who have to get Obamacare. I'm worried once I FIRE that health insurance will be a big issue.
The annual fee for not having insurance in 2016 is $695 per adult and $347.50 per child (up to $2,085 for a family), or it's 2.5% of your household income above the tax return filing threshold for your filing status – whichever is greater. So it's a lot more than $600 for most people. You're exempted if the lowest cost plan available to you is greater than 8.05% of your household income.
The subsidies and fines are based purely on your income, not your wealth, so if you're FIRE'd and only drawing a modest amount, you'll qualify for the ACA subsidy or medicaid depending on how little you're withdrawing annually. Essentially, because of the 8.05% affordability calculator, you need to just build in 8% extra each year into your FIRE number - that will more than cover you because if it's >8.05% of your income then you won't pay a fee.
Thank you, that really helps! By the way, off topic, but what do you think of your Xtracycle? Is it very heavy?
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My parents both got different forms of cancer, and both are still alive and well with minimal side effects. I think combined the cost was well over a million for the two of them. My aunt has had cancer on and off for the last 20 years, I'm sure she's well into the millions by now, and is still relatively young and has many years left to go.
There is no upper limit on healthcare costs, that's why the ACA mandates that there are no lifetime limits to health insurance. Sure, you can find that you PROBABLY won't have to pay more than a million dollars, but there are a non negligible number of people every day who do pay that much, some a whole lot more.
You also have the risk of your health issue happening during a down market. If your investments are down 20% when you have the issue, you're in quite a bit of trouble. With a normal withdrawal it doesn't matter too much as you're taking out 3-5% of your portfolio per year. If you have a health issue that requires you withdraw 50% of your portfolio, that 20% drop is going to reduce your remaining portfolio to 30% of its original instead of 50%. Instead of having $1 million to live on you'll have $600,000, a 40% difference.
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I would not self-insure.
I had a CT scan a few months ago:
(http://i.imgur.com/xv2OFfx.png)
The negotiated rates are ridiculously low compared to the list price.
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Self insuring is great when you do not find yourself ever going to the doctors. It is a terrible idea when you find out you need it and meet road blocks at trying to get it.
The epipen battle that came out was citing that the charge for an epipen was around $600 for two. However, insurance companies buy them at a discount of $150. There is an incredible markup without using the insurance companies which would rule this out for me. I mean when I get older I would expect my need of health insurance rising. Also the insurance company sets the price for the medical industry. An industry that has no caps on costs for medicine, medical procedures, etc.
My aunt passed away 3 years ago from treatable cancer and since she didn't have insurance to do the operations. The doctors were constantly pushing out the treatment dates until it was too late. Everyone was trying to find some way that the costs.
Telling a doctor or surgeon that you are 'uninsured' I believe would have a negative connotation even if you are willing to pay out of pocket.
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Thank you, that really helps! By the way, off topic, but what do you think of your Xtracycle? Is it very heavy?
I love it, I commuted 20+ miles a day on it for several years. It's not a "light" bike by any stretch- it's a cargo bike- but it's great for hauling things around town. If you're trying to win a road race, I wouldn't get an xtracycle. If you're trying to move some chairs, photography equipment, small children, a recording studio, 8 bags of groceries, then it's probably the lightest strong cargo bike on the market.
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Thank you, that really helps! By the way, off topic, but what do you think of your Xtracycle? Is it very heavy?
I love it, I commuted 20+ miles a day on it for several years. It's not a "light" bike by any stretch- it's a cargo bike- but it's great for hauling things around town. If you're trying to win a road race, I wouldn't get an xtracycle. If you're trying to move some chairs, photography equipment, small children, a recording studio, 8 bags of groceries, then it's probably the lightest strong cargo bike on the market.
Sweet. Do you think it would work well as a commuter bike? I have been looking for a car alternative I could use to get to work (7 miles) on nice weather days. I like the idea of an electric bike that can carry things I would normally have in my car (lunches, gym clothes, etc.). Are you using the folding one or some other version?
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Thank you, that really helps! By the way, off topic, but what do you think of your Xtracycle? Is it very heavy?
I love it, I commuted 20+ miles a day on it for several years. It's not a "light" bike by any stretch- it's a cargo bike- but it's great for hauling things around town. If you're trying to win a road race, I wouldn't get an xtracycle. If you're trying to move some chairs, photography equipment, small children, a recording studio, 8 bags of groceries, then it's probably the lightest strong cargo bike on the market.
Sweet. Do you think it would work well as a commuter bike? I have been looking for a car alternative I could use to get to work (7 miles) on nice weather days. I like the idea of an electric bike that can carry things I would normally have in my car (lunches, gym clothes, etc.). Are you using the folding one or some other version?
We're sufficiently derailing this thread ;) Sorry!
It depends on what kind of xtracycle you are looking at/how hilly your commute is. Mine is a trek frame from the 80's I converted with the xtracycle kit. Not electric, just regular burrito-powered. I would say if you're not carrying large objects or children regularly, the xtracycle is way overkill and a decent commuter bike with a good set of panniers will be lighter, faster, and much easier to park at home and work. I carry everything I need for a long day at the office + gym in regular panniers.
My SO has the folding xtracycle, which I would NOT describe as a "folding bike" - it's really just an "apartment sized cargo bike". It folds down to about regular-bike length + 1/2 foot of extra width. Absolutely an unnecessary luxury unless you 1) need a cargo bike over a regular bike (hauling construction equipment or chicken feed or kids or something) and 2) live somewhere small.
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A couple weeks after my DH celebrated his 30th birthday he woke up to a numb arm. He thought he must have slept on it funny. It was still numb a couple days later so he went to a chiropractor, thinking he had a pinched nerve. The chiropractor aligned him but told him that the issue he was having was not related to a pinched nerve, he recommended that my DH find an neurologist.
A month and a spinal tap, MRI, several office visits, and blood test later my 30 year old healthy DH was dx'd with Multiple Sclerosis. His family has no history of MS. This was a couple years before ACA fully kicked in. Luckily he was insured through my work or those bills would have completely ruined us. If he didn't have insurance at the time of the dx'd than he would have fallen into the pre-existing illness and not have been able to get coverage, this is not an issue now because of the ACA.
His drugs for MS, without insurance or rx assistance programs would cost $5-8k a month, with insurance and the rx assistance program we have paid anywhere between $0-$50/month for his medicine. He has experienced several symptoms of MS. His attitude started to get pretty negative, so they put him on antidepressants. His sleep patterns were irregular, so he now has a C-PAP (which help him get off the antidepressants). He gets an MRI every 2-3 years, blood tests every 6 months, and sees a neurologist every 6-12 months. He is still working and active (no disabilities) and without insurance it would take less than 10 years for his medical treatment to reach $1M.
MS is not fatal and it is said that people with MS can experience a normal lifespan. Life expectancy for people with MS has increased over time. Some believe this is due to treatment breakthroughs, improved healthcare and life style changes. This is important to your point that one would probably not make it through $1-2M in medical cost. The average age to be dx'd with MS is 30, if my DH lives to the average life expectancy of 76 years old he will have lived with (and been treating) MS for 46 years. If it takes approximately 10 years (without insurance) to reach $1M in medical care we would need to be prepared to pay $4.5M in medical care for him (without insurance).
Stay insured, you never know what might happen tomorrow.
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I would not self-insure.
I had a CT scan a few months ago:
(http://i.imgur.com/xv2OFfx.png)
The negotiated rates are ridiculously low compared to the list price.
For kicks, I'd call them and ask if you had a cash, non-insurance plan how much you could get it for - though are you on a HDHP? If not, that $100 might be some level of coinsurance too.
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I would not self-insure.
I had a CT scan a few months ago:
(http://i.imgur.com/xv2OFfx.png)
The negotiated rates are ridiculously low compared to the list price.
For kicks, I'd call them and ask if you had a cash, non-insurance plan how much you could get it for - though are you on a HDHP? If not, that $100 might be some level of coinsurance too.
I do have a HDHP.
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The tax penalty is another deterrent to being self-insured.
In 2017 and beyond, the penalty goes up to $695 plus a cost-of-living adjustment, or 2.5 percent of your household income, whichever is greater. Over time this could go up as a hidden tax and a push by congress for more individuals to be insured. So many lower class and middle class Americans are getting hit hard with this and are seeing their tax-refunds severely diminished.
If your wages are low anyway (retired) then the healthcare could be completely subsidized by the government and tax payer. If your wages are high during retired years then it will be a major blow due to the penalty.
Unlike property, you pay a penalty to go without paying insurance.
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You could go about being self-insured similar to how a company does. My company has a self-insured plan and we pay the costs of all claims, but we also have reinsurance which will cover costs in the event we have significant costs relating to a single claim/event. Not sure how this would apply to an individual since the ACA has seemed to eliminate the catastrophic health plans.
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Yeah no thanks.
Saw the medical bills for a guy involved in an industrial accident, about three pages of charges. A month in the hospital and multiple surgeries (burns). Total $1.7 million+. And this was a fairly "normal" blue collar workplace, not some super high-risk occupation. I can't imagine coming out of that and suddenly having zero (or less) to your name!
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What is the benefit to doing this?
Where is the up side?
It would make sense perhaps to a stereotypical teenager who thinks they are invincible.
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Every scenario that has been talked about, refers to a single incident. What happens if you get hit by a car, and the cost of that is say $750,000. Then 2 years later you are diagnosed with cancer. Cost TBD. I would bet that in two years you have not has the chance to replace the 750 K.
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I would not self-insure.
I had a CT scan a few months ago:
(http://i.imgur.com/xv2OFfx.png)
The negotiated rates are ridiculously low compared to the list price.
For kicks, I'd call them and ask if you had a cash, non-insurance plan how much you could get it for - though are you on a HDHP? If not, that $100 might be some level of coinsurance too.
This is a good point. I've found that generally you can negotiate rates if you don't have insurance. Granted, it's a pain in the ass, and depends on the doctor. You're also limited in how much you can negotiate on services already performed, so it doesn't help much with emergency services. That giant starting number is a smoke and mirrors game that every hospital and doctor seems to play, and I suppose there are some people who do pay it.
I seem to remember an article talking about this, and how so many hospitals have such high "donation" numbers to local areas due to this system. If they give 1000 residents flu shots, and technically their charge is $500 per shot, they can tell the tax man and the newspaper they donated $500,000 worth of services to the community. Of course, when they actually give flu shots to paying customers, virtually nobody pays $500 for it and it's likely closer to $20 ($20,000 doesn't sound quite as nice). This may be part of getting classified as a non profit as well, but I don't remember.
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What is the benefit to doing this?
Where is the up side?
It would make sense perhaps to a stereotypical teenager who thinks they are invincible.
The upside is thousands of dollars a year which would normally be paid as insurance premiums to be invested rather than paying them to the insurance company.
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What is the benefit to doing this?
Where is the up side?
It would make sense perhaps to a stereotypical teenager who thinks they are invincible.
The upside is thousands of dollars a year which would normally be paid as insurance premiums to be invested rather than paying them to the insurance company.
You're saving thousands in the short term. In the longer term you have the possibility of losing tens, hundreds, of thousands or more. As more years go by, the probability of this happening increases.
An extreme case of 'Penny wise, pound foolish'.
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What is the benefit to doing this?
Where is the up side?
It would make sense perhaps to a stereotypical teenager who thinks they are invincible.
The upside is thousands of dollars a year which would normally be paid as insurance premiums to be invested rather than paying them to the insurance company.
You're saving thousands in the short term. In the longer term you have the possibility of losing tens, hundreds, of thousands or more. As more years go by, the probability of this happening increases.
An extreme case of 'Penny wise, pound foolish'.
I'm not defending it... you asked what the upside was, I stated the upside. I agree, not worth the risk.
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
I think that would be the old system: "Can't pay your medical bills? Ok, you're dead." Only everyone saved money by not buying bracelets.
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
I think that would be the old system: "Can't pay your medical bills? Ok, you're dead." Only everyone saved money by not buying bracelets.
There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.
To someone from the UK, they are horrifying examples. Our system is a long way from perfect, but it has better and fairer outcomes than that.
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
I think that would be the old system: "Can't pay your medical bills? Ok, you're dead." Only everyone saved money by not buying bracelets.
There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.
To someone from the UK, they are horrifying examples. Our system is a long way from perfect, but it has better and fairer outcomes than that.
Well, to be fair, there does have to be some system for organ transplants. Until we can print enough of them for everyone, someone is going to not get the organ they need from the very finite supply available.
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
I think that would be the old system: "Can't pay your medical bills? Ok, you're dead." Only everyone saved money by not buying bracelets.
There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.
To someone from the UK, they are horrifying examples. Our system is a long way from perfect, but it has better and fairer outcomes than that.
Well, to be fair, there does have to be some system for organ transplants. Until we can print enough of them for everyone, someone is going to not get the organ they need from the very finite supply available.
I'm not sure I'd term this system as fair though.
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What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..
I think that would be the old system: "Can't pay your medical bills? Ok, you're dead." Only everyone saved money by not buying bracelets.
There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.
To someone from the UK, they are horrifying examples. Our system is a long way from perfect, but it has better and fairer outcomes than that.
Well, to be fair, there does have to be some system for organ transplants. Until we can print enough of them for everyone, someone is going to not get the organ they need from the very finite supply available.
I'm not sure I'd term this system as fair though.
I would argue it is (generally) fair to not give a valuable organ to someone who is unlikely to take care of it, if that organ could go to someone who is likely to take care of it.
Being unable to take care of a donated organ because one cannot get health insurance due to low income could be said to be unfair.
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OP here,
does the possible changes to ACA change anyones thinking?
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Who knows what will happen in the next few years.
If you do self-insure maybe look at medical tourism since a lot of countries have much lower drug and hospital costs.
You could always move (creating an open enrollment period) and buy insurance after the fact if you ever ever get sick.
As long as you never get an IRS refund you can avoid the penalty indefinitely.
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One of the major benefits of insurance is negotiated costs. The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company. If you have a 20 percent co-pay, your out of pocket is $400. Without insurance, you will be billed for $10,000. You might get that down somewhat if you have no money, but not to the insurance company's price. Have money? You will pay $10,000.
I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.
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One of the major benefits of insurance is negotiated costs. The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company. If you have a 20 percent co-pay, your out of pocket is $400. Without insurance, you will be billed for $10,000. You might get that down somewhat if you have no money, but not to the insurance company's price. Have money? You will pay $10,000.
I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.
The problem I see is that a free market health care system doesn't work like a 'regular' free market. For medical care that is routine, or elective, I suspect cutting the middle man WOULD bring prices down. But why would it for emergency care, or care for a potentially life threatening problem? In that case, the patient is 'captive'. They can't negotiate freely because they can't 'walk away' or choose not to purchase care.
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OP here,
does the possible changes to ACA change anyones thinking?
What are the possible changes?
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OP here,
does the possible changes to ACA change anyones thinking?
What are the possible changes?
It's almost certain to be repealed early in 2017. The question is what it will be replaced with, or if it will be replaced with anything.
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Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.
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OP here,
does the possible changes to ACA change anyones thinking?
What are the possible changes?
If the ACA is repealed then yearly / lifetime caps would most likely return. This would also effect employer based policies. So if you get leukemia and need a stem cell transplant, which could cost 800K to 1MM be prepared to die as your insurance cuts off before your treatment is finished.
The ACA closes the Medicare Part D 'donut hole' from 2013 - 2020, so the hole gets reopened as well.
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I'm with the majority in saying, Horrible idea.
My husband spent a single night in the hospital, and it was something like $9,000. I had outpatient surgery, and it cost as much as I earn in a whole year. These costs are huge and unpredictable, and -- unlike so many of our other costs -- cannot be managed through frugal living.
As for negotiating (either with the doctor, the hospital, or the insurance company), that's pretty much impossible. "The system" is so big, so complicated and contains so many "moving pieces" that most of us simply don't have the knowledge to negotiate effectively. Personally, I think the insurance companies want us to be "out of our element" here.
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One of the major benefits of insurance is negotiated costs. The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company. If you have a 20 percent co-pay, your out of pocket is $400. Without insurance, you will be billed for $10,000. You might get that down somewhat if you have no money, but not to the insurance company's price. Have money? You will pay $10,000.
I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.
The problem I see is that a free market health care system doesn't work like a 'regular' free market. For medical care that is routine, or elective, I suspect cutting the middle man WOULD bring prices down. But why would it for emergency care, or care for a potentially life threatening problem? In that case, the patient is 'captive'. They can't negotiate freely because they can't 'walk away' or choose not to purchase care.
My grandfather once told me that the first health insurance that was available was called "Hospital" insurance and akin to what we would call catastrophic or emergency insurance. I think going back to this might be a good idea. My initial post was to point out that the prices of almost all healthcare in the U.S. are not real prices based on cost and competition; but, instead manipulated by corporations and the government. You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash. Further, I think self insuring for basic primary care needs would certainly motivate people to take a little more responsibility for preventative care. The interesting thing to me is that I rarely hear any mainstream politician talk about structural ideas like this one; but, instead small tweaks to protect their donors.
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I'm in the camp of "horrible choice". Even if you have 1-2 million per family member, that could literally be wiped out after an encounter with a drunk driver or a stint with cancer -- and you can't avoid those awful things.
On the other hand, paying out of pocket when you catch strep throat or your kids need vaccinations -- while maintaining a high-deductible catastrophic illness policy -- makes sense financially.
4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip. One is possibly now quadriplegic. Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.
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I'm in the camp of "horrible choice". Even if you have 1-2 million per family member, that could literally be wiped out after an encounter with a drunk driver or a stint with cancer -- and you can't avoid those awful things.
On the other hand, paying out of pocket when you catch strep throat or your kids need vaccinations -- while maintaining a high-deductible catastrophic illness policy -- makes sense financially.
4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip. One is possibly now quadriplegic. Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.
Yup. A close friend of ours had a backache a couple years ago. It got worse and worse, despite steroid shots and rest. After a week, one leg and his bladder became paralyzed and he was rushed to the emergency room for surgery on his spine...a rare incident had occurred where a minor bacterial infection had migrated to the bone of his spine, eaten it away, and collapsed it on his spinal chord. More than two years later, including ongoing rehab, etc. and he still is mostly wheel chair bound, with a catheter. He can walk slowly with a walker on even ground, but mostly uses his wheel chair for work because walking is too risky. Between the medical bills, the medications, the rehab, having to redo parts of their house for wheelchair access, and buying a new van for disabled drivers? The official bills ran about 1 million just for the first year (mostly covered by insurance) and a couple hundred thousand the second year, and I expect his lifetime bills will run middle double digits for life. Without insurance, that family (relatively high earners with some family money on top of that) would have been crippled by that first year's bills alone.
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I know a guy who knew this old man who was 82 then. He retired long time before then with $10mil in assets and didn't think he needed health insurance, so he thought it would be perfectly fine to self-insure. His wife got cancer, he paid for rounds of treatment out of his pocket, and at the end, she died, and he was left with nothing. He had to go work at Walmart as a greeter because at 82, no one else wanted to hire him, and he didn't have money to live if he didn't work again.
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When someone is sick you will use every dime you have to make them better... even if they never get better.
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You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash.
Yeah, you can plan medical tourism for some things, but you can't count on that working for you. For example, if you have chest pains or are injured in a car accident, you can't get yourself a quick flight to Mexico.
4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip. One is possibly now quadriplegic. Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.
That's terrifying, and not a single one of us can say, "That'll never be me."
To give a less dramatic example, a guy I know just in passing -- friend of a friend type -- was bitten by a Brown Recluse spider (at least I think it was a Brown Recluse). I had no idea a spider could affect a person this way. He was in a coma for weeks, and the skin around the bite literally died, and he had a giant wound with which to deal. I have no idea what his treatment cost, but I'm sure it was big bucks -- enough to put a big dent in even a lifetime saver's accounts. And, again, none of us can say, "That'll never be me."
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You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash.
Yeah, you can plan medical tourism for some things, but you can't count on that working for you. For example, if you have chest pains or are injured in a car accident, you can't get yourself a quick flight to Mexico.
4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip. One is possibly now quadriplegic. Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.
That's terrifying, and not a single one of us can say, "That'll never be me."
To give a less dramatic example, a guy I know just in passing -- friend of a friend type -- was bitten by a Brown Recluse spider (at least I think it was a Brown Recluse). I had no idea a spider could affect a person this way. He was in a coma for weeks, and the skin around the bite literally died, and he had a giant wound with which to deal. I have no idea what his treatment cost, but I'm sure it was big bucks -- enough to put a big dent in even a lifetime saver's accounts. And, again, none of us can say, "That'll never be me."
Right? It would be far superior for everyone if the USA moved towards universal provided healthcare.
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I see MMM has FINALLY caught up with me ( OP ) on this topic. :-)
http://www.mrmoneymustache.com/2017/11/05/when-your-shitty-health-insurance-doubles-in-price/
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Except that he determined going without would be a bad idea....
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hearing everyone,
it seems far easier to keep working (in USA) in order to stay on the predicatable health insur
is there a search engine that FIRE or self-employed people use to buy their own insurance ?
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Two Ideas-
1. If you attend church, you might want to look into Christian Healthcare Sharing Ministry
VERY inexpensive rates for a good amount of coverage.
5K deductible or get 5K worth of discounts on your bills which is generally really easy.
So I consider this no deductible insurance.
$45 per person per month for up to 125K of coverage per incident.- https://www.chministries.org/programs.aspx
$25 per person per mo- for coverage beyond that 125K- adding 100K coverage for each year until it caps out at one million dollars.-
Brothers keeper
https://www.chministries.org/catastrophicbills.aspxer
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$70 each
We've been members for 5 yrs so have 125K per incident + 500K = $625K coverage for one year
In 4 more years, coverage will be over 1 million and stay that way
Again, just $70 a month per person.
They are first or last payer, you're choice.
2. Check into Ambulance Helicopter insurance in the form of a yearly membership.
Our family membership is $65 a year/$5.41 month
The average life-flight helicopter flight is almost 100K right now.
This covers two life- flights per year, per person, for as many people as are in your family
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OP here- --
I've FIREd, now have COBRA until my wife's open enrollment period at work, where we might end up under her plan.
While COBRA is spendy, it was a way to get FIREd without depending on my wife's plan, so she could
1) Retire Early
2) change jobs without mental hindrance.
AND COBRA isn't that bad, as my former company is self-insured, which brings costs down some.
As to the exchanges, differs by state
https://www.healthcare.gov/marketplace-in-your-state/
For non-US and the acronym-phobics
COBRA
A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.
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Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.
Can someone please explain this scenario to me?
A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?
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Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.
Can someone please explain this scenario to me?
A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?
I can't speak to your state, but in NY they have SUM coverage, which is supplemental uninsured/underinsured coverage. My liability say was 300/300, that defaults to a SUM of 300/300, so if the guy who hits me only has 25/50 my own insurance covers me to 300/300. I tried to lower this and they require I sign a waiver to do it, some new law came in recently.
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Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.
Can someone please explain this scenario to me?
A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?
I can't speak to your state, but in NY they have SUM coverage, which is supplemental uninsured/underinsured coverage. My liability say was 300/300, that defaults to a SUM of 300/300, so if the guy who hits me only has 25/50 my own insurance covers me to 300/300. I tried to lower this and they require I sign a waiver to do it, some new law came in recently.
Thank you-- this explanation helps. I had started doing some Internet research on this topic, because my injured relative does not seem to understand that her own auto insurance will have any bearing on the outcome. She thinks that because the other driver has some insurance, her bills will be covered only to those limits. I thought that part of the reason one buys higher limits of auto insurance, specifically bodily injury and UM, is to protect your physical well-being against the random person who hits you. Right now, she's not buying it, but then again, she might have a concussion.
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This isn't true for every circumstance.
You must pre-plan depending upon where you live.
Tell the doctors you will pay in cash.
The hospital we used was affiliated with Sutter.
After getting hit by a car riding my bicycle about 5 yrs ago, I ended up taken to hospital unable to form coherent sentences.
They ran very expensive tests.
Doctor bill, I've forgotten the amount....but he was willing to cut it by 35% when I offered cash.
Telling him that is all I pay with
At his office, I noticed it needed painted.
My husband is a painting contractor so we painted for the entire amount.
He was VERY happy.
So were we! We worked together, 40 hrs that week, to complete the job
My indemnity policy only covered 10K of the hospital bill
2k of the Doctors bill.
The Hospital took $350 month payments cutting their fee by 50%. It was paid off within 1 yr with a few extra payments
Everything is negotiable.
What skills do you have?? offer them up!
Otherwise ensure you offer CASH to individual doctors
Unless you are involved in Kaiser, or some large HMO w(hich I do not recommend for this reason) then you could be screwed.
Our $65 family membership to Calstar, life-flight helicopter, covered my transport.
Where-as the indemnity plan covered just 2K of the 25k or so trip
Right after this incident, we joined Christian HealthCare Sharing Ministry for just $65 a piece per month. About 600K yr coverage.
5K deductible is satisfied when you get 5K in discounts.
Cost has not increased much at all, yet every year until it hits 1 million, they add on 100K of coverage.
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The problem is that what americans call health "insurance" isn't really health insurance at all, its actually health care. All human beings need HEALTH CARE. The idea of health insurance is problematic and inaccurate, its as if there is a chance that the human being would not need to make a claim. All human beings need health care not health insurance. An analogy would be like buying car insurance that covered oil changes and new tires, as you can imagine that type of car insurance would be expensive and wasteful and it would be hard to shop for your oil changes and tires.
This idea is not mine and is discussed in more detail by my favorite podcaster:
https://moneyfortherestofus.com/213-health-insurance-mess-2/
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Christian HealthCare Sharing Ministry sounds interesting.
But I don't attend church & drink an occasional beer, so that might might not work for me.
I've read about some world travelers that get their international insurance from Germany that is supposed to be good and it is affordable. I think they only need to visit Germany every year, or maybe it's every 2 years, to renew the policy.
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This may come across as snarky, but it is not meant to be. I wonder how many of us would be just the same as we are today without "healthcare" as most of us probably see it. If we treated healthcare as something to be used in emergencies only, my guess is that if we all self-insured from the day we became adults, a vast majority (but not all) of us would come out ahead.
I also wonder if I'm the only person who thinks we should have more choice on whether or not it is ok for us to die. Perhaps its the fact that I have lived through fairly long periods of illness that skews my opinion on this.
Like maybe someday, when I'm 65 years old or something, or I have a chronic illness that makes life terrible, I'll say to myself "I've had enough life for one person, I'd like to let nature take its course from now on." But this is almost impossible to carry out in real life. Even advanced directives don't matter if you are hit by a truck and nobody is around to tell the paramedics and doctors not to fix you. Wearing a "do not resuscitate" bracelet is useless without the actual paperwork available spelling out what level of care you will accept.
I guess I just feel that there's something wrong with the fact that somebody will fix you and charge you or your family $1 million without you having a say in the matter. I work in the healthcare field and see a lot of people being treated to preserve a life that they probably don't want to be living anymore. Since these people can't speak for themselves, care is continued. This is mostly because they were not aware that they had the option to die before they got sick. They also failed to plan for end-of-life care. Doctors, nursing homes etc will provide them care around the clock for days, weeks, months or years...all the time the meter is running and bills pile up that someone will have to pay. Even if they plan ahead and tell everyone they don't want care of any kind if they get sick, this probably won't happen because their family can face penalties for failing to provide them proper care.
We are expected to get care if we are sick but it should be a personal choice. I should be able to self-insure and say "I don't have insurance because I am willing to accept that I will die someday" and be left alone.
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Huh. This is America, you dont have to go to the doctor. You dont have to have health insurance, you can pay a small penalty and not have insurance. You CAN have an advance directive/DNR/etc. Yes, the ambulance and ER may have to treat you before they have a chance to review your advance directive orders but noone is forcing you to treat your cancer or long term injuries. You cant really expect the EMTs to be able to interpret the legality of your your DNR/directives. If you are conscious you certainly can wilfully deny any medical care.
Guess, Im not sure what you're complaining about?
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The most common ways to break the bank are chronic conditions (immediately leave the US for any other country to get care in cash), and if you get into a car accident (solved by uninsured motorist coverage which is usually something tiny like $1/mo extra).
That still leaves you open to catastrophic events where you don't have time to leave the country, but this should be far less likely than the above two categories. Personally it's not worth the risk for me.
Or you could just move to another country and get covered under their national healthcare. I bet that move would cost way less than $1M. If you have a long way before reaching 65, this may be your best option if you insist on being self-insured (which it sounds like it's not really by choice but because insurance + deductible is too expensive). If you are in the North, and not far from the Canadian border, perhaps it would be close enough that you could still drive down and visit family/friends and have it not impact your life too dramatically. Same goes if you're in the South and living in Mexico.
And the number on the bill that the insurance company 'negotiates' is an invented number. I had family members who self-insured and they never paid anything close to those made up numbers when they had cash. They did this for 30 years until the ACA (not wise IMO, but they did it). They went through surgeries and all sorts of medical procedures and have tons of experience. I also recently had a brief lapse in coverage where I paid $595 for an MRI that insurance would have been billed $1200 for.
Cash prices are very very likely to be way below the insurance 'negotiated' price if that's any consolation.
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Or you could just move to another country and get covered under their national healthcare. I bet that move would cost way less than $1M. If you have a long way before reaching 65, this may be your best option if you insist on being self-insured (which it sounds like it's not really by choice but because insurance + deductible is too expensive). If you are in the North, and not far from the Canadian border, perhaps it would be close enough that you could still drive down and visit family/friends and have it not impact your life too dramatically. Same goes if you're in the South and living in Mexico.
It is not that easy to move to another country. Visas MIGHT be given if your job is needed in the country of interest, but then out goes the retirement plan.
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it's not exactly 1980. in general, rich countries dont want americans unless they have certain skills
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Depends on the country, but many countries have provisions if you're rich and want to move there. This can take 2 forms in general, one is that you have a certain dollar amount net worth/investment income and can prove you won't be a burden on society; the other is that you either invest in or open a business that agrees to employ X people for Y years. Many countries have forms of both.
When we're talking in the $1M+ net worth range, I think in general either option would be viable. The problem would come if you had no money and just wanted to move there one day - then you would have to get in via the skilled worker provisions.
The details vary by country, but I'm not aware of any first world countries (let alone third world countries) that don't have some form of these provisions. Certainly you would have lots of options to choose from.
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once you get to being rich, that is true.
i currently dont want to lend latvia 300k in order to get a schengen visa, but i could see why someone would
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Canada will only take you if you have the skills they need or have a job that can get you a visa, or if you are willing to spend at least $2mil (not $1mil) and start a business and hire Canadians and improve their economy. If you have $100mil and you don't have any of the above, they still won't take you.
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For this reason I am very intrigued by the golden visa programs at many EU countries like Portugal and Greece. Portugal’s requires 500K EU real estate investment from what I understand.
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i'm not saying this is the greatest blog in the world, but he goes through the details of all of these issues
http://nomadcapitalist.com/second-passport/
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OP here again. Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.
I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.
Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots. I didn't think of asking for the GoodRx price.
Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan. However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).
Reason fora possible change of heart/plan? We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.
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Yup, self insuring works...until it doesn't! It's madness at any age, but when I read that you are in your 50s, I see that you are playing a game of Russian Roulette financially that has way more spaces filled with bullets than not. To say nothing of the burden on society you will become.
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OP here again. Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.
I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.
Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots. I didn't think of asking for the GoodRx price.
Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan. However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).
Reason fora possible change of heart/plan? We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.
Oh dear. Yes, mid-50s is when a lot of significant health problems start cropping up. It’s the age range when an acquaintance found out that he had metastatic prostate cancer (with a housewife and 3 teenagers at home), when my grandfather and a couple of uncles had heart attacks, when my uncle’s rheumatoid arthritis destroyed his lungs to the point that his options were double lung transplant or die (he chose the transplant and remains alive more than a decade later), and when my grandmother died of ovarian cancer.
In the US, it doesn’t seem prudent to consider self-health insurance unless your net worth is at least 8 figures. I agree that there’s not much reason to self-insure for dental coverage unless you’re expecting major dental surgery and want the discount. Routine dental care isn’t prohibitively expensive, and we wouldn’t bother with dental coverage if husband’s employer didn’t cover it.
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OP here again. Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.
I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.
Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots. I didn't think of asking for the GoodRx price.
Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan. However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).
Reason fora possible change of heart/plan? We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.
Oh dear. Yes, mid-50s is when a lot of significant health problems start cropping up. It’s the age range when an acquaintance found out that he had metastatic prostate cancer (with a housewife and 3 teenagers at home), when my grandfather and a couple of uncles had heart attacks, when my uncle’s rheumatoid arthritis destroyed his lungs to the point that his options were double lung transplant or die (he chose the transplant and remains alive more than a decade later), and when my grandmother died of ovarian cancer.
In the US, it doesn’t seem prudent to consider self-health insurance unless your net worth is at least 8 figures. I agree that there’s not much reason to self-insure for dental coverage unless you’re expecting major dental surgery and want the discount. Routine dental care isn’t prohibitively expensive, and we wouldn’t bother with dental coverage if husband’s employer didn’t cover it.
My close friend is in the 8 figure range and does not work. He pays for private health insurance.