Would you FIRE or wait if possible health issues?

[SunniD]

I just hit my FIRE number and was planning to RE in April or May latest (moved up from June plans). But now I find myself facing health issues, my doctors are still running tests to try to figure it out. But who knows how long that's going to take, it's been a couple of months already. Not knowing how serious it might be and what kind of long term treatments I might need my brain is telling me to cling onto the job and company insurance long enough to find out first. But I am so ready to be done, just the thought of another day of work depresses/stresses me. The work is not difficult but the work environment is stressful. But I've also read countless times on this forum how people should get that final all clear health check before pulling the trigger. So what do you do if don't get that "all clear"? My plan was/is to FIRE ASAP and use cobra for the rest of the year (since I already reached my OOP max) and probably until it runs out in 18 months, then the ACA. Even if diagnosed with a condition I should have no issues getting covered right? Am I missing something? Would you pull the trigger or wait?

[Fishindude]

I would not put off retirement.   Use your COBRA for 18 months, then purchase ACA insurance, they have to take you.
Best wishes on your medical issues, hopefully it's nothing too serious.

[MaybeBabyMustache]

Is it possible to take medical leave, while you wait? That might buy you some time & reduce your anxiety about leaving during this time of angst, but not require you to go back to the office.

[Rdy2Fire]

Is it possible to take medical leave, while you wait? That might buy you some time & reduce your anxiety about leaving during this time of angst, but not require you to go back to the office.

My thinking exactly. If you're thinking of just retiring and being done you have nothing to lose going to HR and Management and explaining (not in detail obviously HIPAA says you don't need to nor should you) you have a medical issue and need to request a medical leave.

[NotJen]

But I've also read countless times on this forum how people should get that final all clear health check before pulling the trigger. So what do you do if don't get that "all clear"?

Is the advice to get an "all clear" before quitting?  I've never actually seen that.  My interpretation of what I've read is to intelligently use the services available to you before you quit - not that you have to be clear of health issues.

If you are depressed/stressed because of work, quitting sounds like it would benefit your health.  You seem to have a good plan for healthcare in the near future - assuming your FIRE number accounts for the costs of COBRA/ACA coverage.

[Dicey]

Cobra is expensive. Why not just go straight to ACA?

[ixtap]

Cobra is expensive. Why not just go straight to ACA?

In this case, OP is weighing that they have already met their deductible, and probably want to stay within the same health system at least until they have a diagnosis.

OP, is this something that you are likely to get a diagnosis for? Would any of the diagnosis being considered result in disability eligibility?

[Metalcat]

I'm in Canada, so I can't comment on the ins and outs of insurance.

However, I can comment on being very, VERY sick during retirement.

It is a HUGE privilege not to have to worry at all about your career while dealing with serious health issues. Over the past two weeks, my health has been at the most problematic it's ever been. I celebrated heavily that I was finally able to take a shower the other day. I'm that fucked up right now.

Still, every morning that I've woken up these past two weeks, I have been filled with gratitude that k don't have a job to worry about anymore. I don't a boss to call in sick to and explain that I don't know when I'll be better. I don't have work to reassign, I don't have deadlines to worry about. The only thing I need to worry about is doing whatever I can to manage whatever health crap I'm dealing with that day. I absolutely LOVED my job, and would go back in a second if I could, but even loving it, it was too much while trying to focus on my health.

It makes it A THOUSAND TIMES EASIER to be sick when having to stay in bed for a few days just really isn't that big a deal.

So yeah, if you are facing something potentially serious, I strongly recommend finding a way to remove the hassle of work from your life so that you can focus on your well being as much as possible.

[dougules]

When planning for your FIRE spending, how much did you budget for health expenses?  Could you cover the out-of-pocket maximum of an ACA plan indefinitely on top of your other expenses?

[SunniD]

Is it possible to take medical leave, while you wait? That might buy you some time & reduce your anxiety about leaving during this time of angst, but not require you to go back to the office.

My thinking exactly. If you're thinking of just retiring and being done you have nothing to lose going to HR and Management and explaining (not in detail obviously HIPAA says you don't need to nor should you) you have a medical issue and need to request a medical leave.

I'm currently on the last week of several weeks of medical leave. The thought of going back stresses me and I don't think I can get it extended anymore. 

[SunniD]

Cobra is expensive. Why not just go straight to ACA?

In this case, OP is weighing that they have already met their deductible, and probably want to stay within the same health system at least until they have a diagnosis.

That's correct, with the recent issues I've already met my max Out Of Pocket deductibles so it makes sense to go with Cobra for the reminder of this year. I will reevaluate for next year.

OP, is this something that you are likely to get a diagnosis for? Would any of the diagnosis being considered result in disability eligibility?

I'm assuming not. But I don't actually know what are the requirements for disability.

ETA: just went through the disability eligibility guidelines... I don't think so.

[SunniD]

When planning for your FIRE spending, how much did you budget for health expenses?  Could you cover the out-of-pocket maximum of an ACA plan indefinitely on top of your other expenses?

YES, that was part of my FIRE planning. 

[SunniD]

I'm in Canada, so I can't comment on the ins and outs of insurance.

However, I can comment on being very, VERY sick during retirement.

It is a HUGE privilege not to have to worry at all about your career while dealing with serious health issues. Over the past two weeks, my health has been at the most problematic it's ever been. I celebrated heavily that I was finally able to take a shower the other day. I'm that fucked up right now.

Still, every morning that I've woken up these past two weeks, I have been filled with gratitude that k don't have a job to worry about anymore. I don't a boss to call in sick to and explain that I don't know when I'll be better. I don't have work to reassign, I don't have deadlines to worry about. The only thing I need to worry about is doing whatever I can to manage whatever health crap I'm dealing with that day. I absolutely LOVED my job, and would go back in a second if I could, but even loving it, it was too much while trying to focus on my health.

It makes it A THOUSAND TIMES EASIER to be sick when having to stay in bed for a few days just really isn't that big a deal.

So yeah, if you are facing something potentially serious, I strongly recommend finding a way to remove the hassle of work from your life so that you can focus on your well being as much as possible.

THIS^ (and Malcat, I'm so sorry to read about your health issues)

I find having to call in sick or for time off for doctor's appointments so anxiety inducing. Even on medical leave these last few weeks I find I can't or at least my subconscious can't let go of work. I still dream about it.

[Metalcat]

I'm in Canada, so I can't comment on the ins and outs of insurance.

However, I can comment on being very, VERY sick during retirement.

It is a HUGE privilege not to have to worry at all about your career while dealing with serious health issues. Over the past two weeks, my health has been at the most problematic it's ever been. I celebrated heavily that I was finally able to take a shower the other day. I'm that fucked up right now.

Still, every morning that I've woken up these past two weeks, I have been filled with gratitude that k don't have a job to worry about anymore. I don't a boss to call in sick to and explain that I don't know when I'll be better. I don't have work to reassign, I don't have deadlines to worry about. The only thing I need to worry about is doing whatever I can to manage whatever health crap I'm dealing with that day. I absolutely LOVED my job, and would go back in a second if I could, but even loving it, it was too much while trying to focus on my health.

It makes it A THOUSAND TIMES EASIER to be sick when having to stay in bed for a few days just really isn't that big a deal.

So yeah, if you are facing something potentially serious, I strongly recommend finding a way to remove the hassle of work from your life so that you can focus on your well being as much as possible.

THIS^ (and Malcat, I'm so sorry to read about your health issues)

I find having to call in sick or for time off for doctor's appointments so anxiety inducing. Even on medical leave these last few weeks I find I can't or at least my subconscious can't let go of work. I still dream about it.

Thanks.
Yeah, I took a few months off, and I was never able to let go of thinking about work, it felt like a countdown until I had to deal with all of the crap I knew was building up while I was off of work.

It's really profound how hugely different my thinking has been about my state of health since retiring.
There is no treatment for my condition, so this is just my reality, and bad spells like this week just aren't as big a deal anymore. A week in bed is unpleasant, but it's really not nearly as big a deal when there's no rush to get back to functioning "properly".

While working there was this constant pressure to feel better, to get back to function. Sick periods always felt like a debt that needed to be made up. Now if I feel shitty, my only job is to focus on taking care of myself, that's it. If I need a day in bed, that's fine. If I need two weeks in bed, that's fine too. No one is waiting on me to get back onto my feet, so I can just chill and cut myself some much needed slack.

[Rdy2Fire]

Is it possible to take medical leave, while you wait? That might buy you some time & reduce your anxiety about leaving during this time of angst, but not require you to go back to the office.

My thinking exactly. If you're thinking of just retiring and being done you have nothing to lose going to HR and Management and explaining (not in detail obviously HIPAA says you don't need to nor should you) you have a medical issue and need to request a medical leave.

I'm currently on the last week of several weeks of medical leave. The thought of going back stresses me and I don't think I can get it extended anymore.

Well not sure your specifics but even FMLA, by law, is up to 12 weeks. Granted it's unpaid but by law they have to hold your job and you would still have your insurance, even if you have to pay for it.

Then you could potentially go on short term disability depending on your medical condition and if you have short term disability insurance get 60% of your salary.

[Dicey]

Cobra is expensive. Why not just go straight to ACA?

In this case, OP is weighing that they have already met their deductible, and probably want to stay within the same health system at least until they have a diagnosis.

That's correct, with the recent issues I've already met my max Out Of Pocket deductibles so it makes sense to go with Cobra for the reminder of this year. I will reevaluate for next year.

Unless the OOP max that you've already met is gigantic and even if it is, have you actually run the numbers? If your income drops precipitously, ACA could still be cheaper, which might factor into the decision making process.

Also, is there any chance what you're experiencing might be allieviated just by the relief from work stress? That would be another point in favor of leaving sooner than later.

[dougules]

When planning for your FIRE spending, how much did you budget for health expenses?  Could you cover the out-of-pocket maximum of an ACA plan indefinitely on top of your other expenses?

YES, that was part of my FIRE planning.

Do you think your illness might increase your spending in other areas not covered by insurance? 

It would be nice to hear from somebody who has a deeper knowledge on the ACA, but it sounds like you've probably got this covered from a money standpoint.  If so, why would there be any reason to stick around at your job?

I hope things go well and you get a diagnosis quickly.  The process of getting answers on something hard to diagnose would be taxing enough on a healthy person, so it's ironic you generally have to face that when you're not. 

[nirodha]

Have you already burned your 12 weeks of FMLA? If not, I'd try to get this. Your doctor will have to provide a note to a 3rd party contracted with the company. You probably won't get paid and might have to burn all vacation time, but it gives you 12 weeks of medical coverage and protects your job.

It's hard to touch you right after returning, since it will look like retaliation. That might let you coast to year end.


Have you already picked the ACA plan you want after COBRA? My concern would be ensuring there is a plan available with the doctors of interest in network, and drugs of interest on their formulary. Quality of ACA plans varies wildly by state.

I'd also want to be confident in your plan for both subsidy optimization and taking advantage of cost sharing (or not). Without cost sharing, you're looking at an approximately $8k expense for a year of active medical care. You'll either eat on the premiums for a low deductible plan, or on the deductible for a lower premium plan.


It doesn't sound like working to the old standard is your best answer. I'd try to avoid that.

[Dr Kidstache]

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

[SunniD]

I'm currently on the last week of several weeks of medical leave. The thought of going back stresses me and I don't think I can get it extended anymore.

Well not sure your specifics but even FMLA, by law, is up to 12 weeks. Granted it's unpaid but by law they have to hold your job and you would still have your insurance, even if you have to pay for it.

Then you could potentially go on short term disability depending on your medical condition and if you have short term disability insurance get 60% of your salary.

Have you already burned your 12 weeks of FMLA? If not, I'd try to get this. Your doctor will have to provide a note to a 3rd party contracted with the company. You probably won't get paid and might have to burn all vacation time, but it gives you 12 weeks of medical coverage and protects your job.

It's hard to touch you right after returning, since it will look like retaliation. That might let you coast to year end.

I'm on short term disability right now (for a specific treatment). Unpaid FMLA did not occur to me as an option. Thanks for the suggestion, I will give it some thought and talk to my doctor about it.
My hesitation with FMLA is voiced perfectly by Malcat's posts, not only am I unable to let go of work, I have the added "guilt" of being sick and not contributing to my team. This feeling adds it's own level of stress.

Have you already picked the ACA plan you want after COBRA? My concern would be ensuring there is a plan available with the doctors of interest in network, and drugs of interest on their formulary. Quality of ACA plans varies wildly by state.

I'd also want to be confident in your plan for both subsidy optimization and taking advantage of cost sharing (or not). Without cost sharing, you're looking at an approximately $8k expense for a year of active medical care. You'll either eat on the premiums for a low deductible plan, or on the deductible for a lower premium plan.

It doesn't sound like working to the old standard is your best answer. I'd try to avoid that.

No I have not picked the ACA plan yet. Without a diagnose I don't know what specialists or drugs I might need in the future.

Sorry, I'm not as well-versed in the ACA plans as I should/need to be, by cost sharing do you mean subsidies? If I understand it correctly the income limit for ACA subsidies is $51k for individuals. I'm not expecting to be able to qualify for subsidies. unfortunately.

Is the $8k a year  premium + OOP max? You're saying that's the average, not max it can go to?

[SunniD]

Also, is there any chance what you're experiencing might be allieviated just by the relief from work stress? That would be another point in favor of leaving sooner than later.

And sadly a point against taking medical leave, paid or unpaid.

[SunniD]

When planning for your FIRE spending, how much did you budget for health expenses?  Could you cover the out-of-pocket maximum of an ACA plan indefinitely on top of your other expenses?

YES, that was part of my FIRE planning.

Do you think your illness might increase your spending in other areas not covered by insurance? 

It would be nice to hear from somebody who has a deeper knowledge on the ACA, but it sounds like you've probably got this covered from a money standpoint.  If so, why would there be any reason to stick around at your job?

I hope things go well and you get a diagnosis quickly.  The process of getting answers on something hard to diagnose would be taxing enough on a healthy person, so it's ironic you generally have to face that when you're not.

I'm not sure, could you give examples of expenses that might not be covered?
 
Thank you. The not knowing and constant doctor's appointments and multitude of tests is definitely exhausting. 

[SunniD]

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

The bolded. This is what I'm most afraid of.
Would you be open to sharing any more details on your ACA experience? What types of things were not covered? Would a different plan have made a difference?

[Dreamer40]

I don’t really have any advice but wanted to express my sympathy. That sounds like a tough decision to make under challenging circumstances. It’s easy to say that maybe you should wait a little just to avoid risk and health benefits change. But it also sounds totally miserable and I see all the benefits to FIREing now so you can focus on your health. Whatever you decide, I hope things feel easier soon.

[Metalcat]

When planning for your FIRE spending, how much did you budget for health expenses?  Could you cover the out-of-pocket maximum of an ACA plan indefinitely on top of your other expenses?

YES, that was part of my FIRE planning.

Do you think your illness might increase your spending in other areas not covered by insurance? 

It would be nice to hear from somebody who has a deeper knowledge on the ACA, but it sounds like you've probably got this covered from a money standpoint.  If so, why would there be any reason to stick around at your job?

I hope things go well and you get a diagnosis quickly.  The process of getting answers on something hard to diagnose would be taxing enough on a healthy person, so it's ironic you generally have to face that when you're not.

I'm not sure, could you give examples of expenses that might not be covered?
 
Thank you. The not knowing and constant doctor's appointments and multitude of tests is definitely exhausting.

Oh, there are all sorts of costs that come with being sick, like home care supplies, requiring a house cleaning service, meal prep service, I'm stuck taking Uber everywhere right now because I can't drive at the moment, etc, etc. Not being able to work often comes with not being able to do a lot of shit.

[Life in Balance]

I don't know if my experience will help, but I was in a similar situation Fall 2019.  I had been struggling with health issues (and burnout due to trying to balance work + health) for several years before I decided to leave work.  I had 18x expenses saved (aiming for 25x) at the time.  I was without a clear diagnosis since I displayed symptoms over several different conditions and lab work was not conclusive.  I was given a "placeholder" diagnosis (which basically is used to say you have a rheumatological something, but we don't know what).  This diagnosis is not listed as condition that is approved routinely for disability.

Knowing that I couldn't continue how I was (working with no energy for anything else), I took unpaid FMLA for the full 12 weeks in order to keep health insurance.  My supervisor and his supervisor were very aware that I would not be returning. Timing-wise, this gave me work health insurance coverage January-April.  During that time, I applied for benefits from my LTD insurance.  The LTD company went out of their way to stretch out the process and make it as difficult, draining, and time-consuming as possible.  The lack of a clear diagnosis did not help either.  (Skipping ahead a bit in time, ultimately, after a year of paperwork and exams and appeals, I was denied benefits. My doctor remains bitter about this to this day.  I have moved on, but the experience left me with the impression that no one should assume that LTD insurance will kick in when needed as a good Plan B).

After my FMLA ended in May, I started with an ACA plan.  My ACA coverage has been very equivalent to my work insurance.  Apart from having to re-start the deductible and OOP max mid-year, the plans' coverages were very comparable.  The only difference is that I had to pay out of pocket for my annual eye exam on the ACA plan.  I couldn't have afforded the Cobra premiums (over $900/month + my remaining deductible/OOP).  My ACA premiums were heavily subsidized as my income went to zero and I hadn't earned much for the year.   All of my providers accepted my ACA plan (it was with Blue Cross) and my meds were covered.  You can check this online through the ACA website, but I also verified it with each provider. 

I continue to not work and to have an ACA plan.  This year, due to my anticipated low income, I went with a Silver Plan on the ACA.  I am eligible for both premium subsidies and cost sharing.  Cost sharing is separate from the premium subsidies that are available to a wider range of incomes.  Cost sharing is available to those under 200% (or 250%?) of the poverty line, I believe.   For a single person, it's around an AGI of $25,500.  With cost sharing, the OOP maximum is greatly reduced, deductibles can be lower, etc.  My OOP max is $1500 this year.  Premiums were $205/month, but went down with the recent Covid Relief bill.  All total, I had budgeted $4000 for healthcare/insurance this year as I knew I would max it out. 

I've been unemployed (retired?) for 16 months now.  I continue to not have a diagnosis or a defined treatment plan.  My investments have grown to 21x expenses.  I know I will not be working full-time again because my health has improved (even with the mess that was 2020) and I want to continue to recover.  Lots of rest, lower stress, a growing capacity to just live in the present, and continued work with physical therapy were key.  I consider myself coast-fire now.  I have the good fortune to earn book royalties for the next several years that will help me keep my withdrawals from the stash around 2-3%.  By the time they run out, I'm hoping to be at 25x (or more).  Since my house is paid off, I can live quite comfortably on my income. I do NOT regret leaving work at all!

[dougules]

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

Do you have any advice on how to either avoid insurance plans that have too many exceptions to coverage, or if not how to plan for uncovered expenses?  Unfortunately this sounds like a risk that has both a more-than-low probability and a fairly high potential cost. 

[Mrs. Healthywealth]

Talking to an health insurance broker, a trust worthy one, is helpful. Our person made several good suggestions on how to set up either ACA or COBRA. This person can also tell you how much you may receive in subsidies. She is having us fill out the ACA form to get a better idea of which gives us more bang for our buck-ACA or COBRA, but I still have to wait 60 days till employer's insurance ends to get actual results. Now that I have a ballpark figure on the subsidy, it makes more sense to go with ACA, blue cross gold for me and silver for the rest of the family. The subsidy is going to be around $550, so total cost will be $1100/mos; otherwise COBRA would've been $1678 for a famiy of 4.

I also have a chronic medical problem, as a result insurance has been the scariest piece to navigate and ensure we have enough.

There are folks you can call for ACA that will help, perhaps if you call them, it'll provide comfort.
Wishing you all the best in your health.

To answer your question, I would and I am RE'ing with medical problems. It's totally worth it. Stress during the transition is totally normal, and I had major flare ups prior to making this decision official. But, it didn't deter me, and now I know I made the right decision.

[ixtap]

Oh, there are all sorts of costs that come with being sick, like home care supplies, requiring a house cleaning service, meal prep service, I'm stuck taking Uber everywhere right now because I can't drive at the moment, etc, etc. Not being able to work often comes with not being able to do a lot of shit.

Dear lord, I don't know how DH would cope if he were single. He doesn't require any direct care, but I run the logistics of the household, including driving him to his appointments.

[nirodha]

My hesitation with FMLA is voiced perfectly by Malcat's posts, not only am I unable to let go of work, I have the added "guilt" of being sick and not contributing to my team. This feeling adds it's own level of stress.

I took FMLA for 12 weeks last year. The company distributed some duties, then hired a contractor to cover the rest - about $6k a week. When I left this year, they were prepared and brought him back. I wasn't cheaply replaced, but business kept going. Caring for a team that loses someone is part of running an organization.

It does seem a little weird the employer would have put you on leave with STD, without starting the FMLA clock as well.

But if so, FMLA is your right, as a worker in the US. It's intended for situations just like this. Supporting the benefit is a cost of doing business. If doctor recommended full FMLA is approved, the employer is not able to legally contact you during that period. Communication drops to administration of the FMLA. Benefits are paid by the employer.

There's also the option of partial FMLA. You can stretch that 12 weeks leave over 24, working half time with full benefits. Or even the full year. Anything but full FMLA does introduce an annoying ongoing documentation burden. But, terminating your employment becomes an extremely sensitive topic for HR. They probably won't be willing to risk the legal exposure.

If you are in the top 10% of earners at the company, you can be let go during FMLA. The benefits would continue through the 12 week period. Benefits typically cover the entire month, so if you time the leave period to end on the 2nd, you may stretch protected benefits to 16 weeks.

No I have not picked the ACA plan yet. Without a diagnose I don't know what specialists or drugs I might need in the future.

Sorry, I'm not as well-versed in the ACA plans as I should/need to be, by cost sharing do you mean subsidies? If I understand it correctly the income limit for ACA subsidies is $51k for individuals. I'm not expecting to be able to qualify for subsidies. unfortunately.

Is the $8k a year  premium + OOP max? You're saying that's the average, not max it can go to?

If you are over the subsidy limit, cost sharing is irrelevant. There's a sweet spot, with MAGI between 1.5 and 2x the poverty limit, where cost sharing kicks in. If you are on a silver plan, the max out of pocket drops to a couple grand and the per visit copay is much lower. Hitting it with a mid-year job change is unlikely, but depending where assets come from next year, managing income could be worth consideration. Insurers do price silver plans accounting for this (called silver loading), so if you're not getting cost sharing, silver plans are to be avoided.

ACA sets a maximum allowed out of pocket - $8,550 for 2021, assuming no cost sharing. I was loosely referring to that. In my state, that number plus the unsubsidized bronze premium is a reasonable upper estimate for annual medical care. In network, anyways. Even if you pick a platinum plan, because they are actuarially balanced, costs come out about the same (for an active consumer of medical care).

The hard part is making sure care you'll need is in network. I'm hedging this with a PPO, which carries some premium, but preserves flexibility. I am fortunate to live in a state that still has individual consumer PPO's available. My ACA plan ends up through the same insurer, using the same doctor network as my prior employer insurance.

Without knowing the specifics of your upcoming care, you can still evaluate ACA plans, looking at breadth of network coverage. In short, you get what you pay for. The cheap plans (at each metal level) are likely terrible.

Once you prune those, there will be a few options to choose from. The metal level isn't what matters - it is the carrier and their network. Informal conversations with your doctors can tell you who to avoid (ie approvals from Cigna are problematic in my area). A given insurer will typically offer a couple network options. You can make a list of local providers, then check each network to see if they are included.

My biggest concern with an ACA plan would be - is there something available in your state, that includes all the major local medical systems in network? Especially in rural areas and red states, carriers have been abandoning the exchange. The available options aren't always great. Conversely - an urban area in a blue state? You might meet or exceed your employer coverage. If you can carefully manage income, to maximize subsidies and cost sharing, it could be at a small fraction of the COBRA cost.

[Metalcat]

Oh, there are all sorts of costs that come with being sick, like home care supplies, requiring a house cleaning service, meal prep service, I'm stuck taking Uber everywhere right now because I can't drive at the moment, etc, etc. Not being able to work often comes with not being able to do a lot of shit.

Dear lord, I don't know how DH would cope if he were single. He doesn't require any direct care, but I run the logistics of the household, including driving him to his appointments.

Lol, I'm not even single! I have an extremely supportive spouse, but he works full time and a big part of me enjoying my life despite being very sick is my quality time with him when he's not working, so I would rather pay for a housekeeper and food prep than have him take all of it on when I'm not doing well. We have plenty of money so it's not a burden.

He usually drives me places, even during work hours, but if he has a meeting and I have an appointment, I'll Uber. This not being able to drive thing is just the last two weeks, but it's given me a sense of what it would be like if I lost the ability forever. I would have to budget for more Uber because I'm not about to base my life around his schedule.

Suffice to say, being sick often requires support, and for the sake of budgeting, one has to know how much of that support they can get from loved ones and also whether that's the support they prefer. I personally prefer more paid support even though my loved ones are more than willing.

[Dr Kidstache]

ACA plans do vary from state-to-state and even county-to-county so my experience won't be that informative for your experience. I was in a particularly terrible county in a particularly terrible state (TX). The single plan that was available to me did not include any specialists that I required nor did it cover many other expenses like specialty neuroimaging and neurorehab. The plan also did not cover some expensive medications that I required. Because almost all of my expenses were denied by the plan, they did not count towards my OOP max. I had approx $20,000/year in medical expenses while on that plan and that's without any hospitalizations and just routine care. Medicare is not cheap but dramatically better.

LTD insurance is a pyramid scheme. No one should ever apply without the assistance of a specialist in dealing with the companies. I am one of the lucky few who has successfully been paid and it has been a total nightmare. The fraud and harassment is impossible to believe unless you've been through it. If I had any alternative, I wouldn't deal with them.

Being disabled is expensive. I call it the "disability premium". I have to pay all sorts of higher costs in order for things to be easier. I can't shop around, I can't DIY, I can only live certain places, etc. I pay premiums for ease. And that's separate from direct health care expenses.

[ixtap]

Oh, there are all sorts of costs that come with being sick, like home care supplies, requiring a house cleaning service, meal prep service, I'm stuck taking Uber everywhere right now because I can't drive at the moment, etc, etc. Not being able to work often comes with not being able to do a lot of shit.

Dear lord, I don't know how DH would cope if he were single. He doesn't require any direct care, but I run the logistics of the household, including driving him to his appointments.

Lol, I'm not even single! I have an extremely supportive spouse, but he works full time and a big part of me enjoying my life despite being very sick is my quality time with him when he's not working, so I would rather pay for a housekeeper and food prep than have him take all of it on when I'm not doing well. We have plenty of money so it's not a burden.

He won't stop working, even though we are FI :( But I try to stay on top of logistics so that we can spend his good moments doing enjoyable things. I worry about the spending because I assume that as long as he chooses to continue working, I figure he must be worried and every penny I can save is one less that he feels he needs to earn. I stopped my median income job to follow him for his high income, then stopped a measly income job to run logistics so that all he does is work, deal with pain and maybe once in awhile do something fun like go for a bike ride or sailing.

I would have to deal with all of the organizing of pais help, anyway. He just doesn't have any spoons left for decision making.

[Bateaux]

I'd wait for FIRE.  Increasing health issues and the need for health care was a big factor in our choosing to work longer.

[Metalcat]

I'd wait for FIRE.  Increasing health issues and the need for health care was a big factor in our choosing to work longer.

I think this really depends on the health issues.

I would have been MUCH better off had I quit just two or three years earlier. Like, enormous quality of life improvement over how I am now.

[SunniD]

I want to thank all the posters for your advice and for sharing your experiences. In the last few months, as I continued to deal with the health issues I have reread every contribution to this thread.

A couple of points that kept running through my head every time I just wanted to call it quits:

Someone asked can this lead to disability?
The thought was always once the doctors have a diagnosis it would be followed by treatment and full recovery. It was only a question of time. Permanent disability was never on my radar. And now it has to be.

Can my FIRE stache handle the extra costs of a disability?
I'm not sure? Being mostly healthy and oblivious up to this point in my life, I need to figure out how much that "disability premium" (as one poster called it) might be now and in the future. This cost is unaccounted for in my current FIRE number and I imagine it will only keep increasing. As a point of pride and independence, (like Malcat) I would prefer more paid support than from family, no matter how much they are willing to help. Care giving is hard in every way and I would not want to become a burden to them. 

Which leads me to keep coming back to this post and the bolded from Dr Kidstache:

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

He's right, in wanting to just quit I was letting my anxiety over both the health issues and the thought of trying to navigate the disability process influence my decision making. It just felt so stressful when every insurance claim story seems to be a horror story, whether it gets accepted or rejected.   
But these are options open to me and meant to be safety nets for these scenarios. Why else have I been paying for LTD premiums year after year? Plus now I have to account for the "disability premiums" and how much it can grow to is still an unknown to me.
But I did take the negative experiences to heart and followed the advice of a number of people who suggested I work with a specialist. I hired the best one I could find and they've helped me with the short term disability and are now working on the long term claim.
This has really helped with the stress level.

[Metalcat]

I want to thank all the posters for your advice and for sharing your experiences. In the last few months, as I continued to deal with the health issues I have reread every contribution to this thread.

A couple of points that kept running through my head every time I just wanted to call it quits:

Someone asked can this lead to disability?
The thought was always once the doctors have a diagnosis it would be followed by treatment and full recovery. It was only a question of time. Permanent disability was never on my radar. And now it has to be.

Can my FIRE stache handle the extra costs of a disability?
I'm not sure? Being mostly healthy and oblivious up to this point in my life, I need to figure out how much that "disability premium" (as one poster called it) might be now and in the future. This cost is unaccounted for in my current FIRE number and I imagine it will only keep increasing. As a point of pride and independence, (like Malcat) I would prefer more paid support than from family, no matter how much they are willing to help. Care giving is hard in every way and I would not want to become a burden to them. 

Which leads me to keep coming back to this post and the bolded from Dr Kidstache:

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

He's right, in wanting to just quit I was letting my anxiety over both the health issues and the thought of trying to navigate the disability process influence my decision making. It just felt so stressful when every insurance claim story seems to be a horror story, whether it gets accepted or rejected.   
But these are options open to me and meant to be safety nets for these scenarios. Why else have I been paying for LTD premiums year after year? Plus now I have to account for the "disability premiums" and how much it can grow to is still an unknown to me.
But I did take the negative experiences to heart and followed the advice of a number of people who suggested I work with a specialist. I hired the best one I could find and they've helped me with the short term disability and are now working on the long term claim.
This has really helped with the stress level.

A few things:

1: I don't know what your health issues are, but there are very few chronic illnesses where there's a magical treatment that makes you better. The vast majority of these disabling illnesses have treatments that focus on symptom management and slowing progression.

It took me decades to be diagnosed and once I was...nothing changed. So you have to be aware of that possible reality.

2: get yourself a disability lawyer NOW!
I'm not kidding, consult a disability lawyer well before submitting anything. I just went through this and I wish I had consulted a lawyer before even mentioning my symptoms to my doctor.

Dealing with LTD insurance is a fucking monster process where nothing is reasonable, and very little makes any damn sense.

I cannot overstate this, consult a disability lawyer NOW, yesterday would have been better.

Also, start getting in the habit of asking for copies of your doctor's clinical notes and all reports a few days after any and all appointments. If you see any discrepancies with what you said vs what they wrote, submit a clarification in writing and ask for it to be included in your official chart, then follow up a week later to make sure it has been entered into your chart.

PM me if you want more details, I can't talk about all of it because of the NDA, but I can explain a lot of what I wished I had known about the process before starting.

[Dr Kidstache]

I want to thank all the posters for your advice and for sharing your experiences. In the last few months, as I continued to deal with the health issues I have reread every contribution to this thread.

A couple of points that kept running through my head every time I just wanted to call it quits:

Someone asked can this lead to disability?
The thought was always once the doctors have a diagnosis it would be followed by treatment and full recovery. It was only a question of time. Permanent disability was never on my radar. And now it has to be.

Can my FIRE stache handle the extra costs of a disability?
I'm not sure? Being mostly healthy and oblivious up to this point in my life, I need to figure out how much that "disability premium" (as one poster called it) might be now and in the future. This cost is unaccounted for in my current FIRE number and I imagine it will only keep increasing. As a point of pride and independence, (like Malcat) I would prefer more paid support than from family, no matter how much they are willing to help. Care giving is hard in every way and I would not want to become a burden to them. 

Which leads me to keep coming back to this post and the bolded from Dr Kidstache:

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

He's right, in wanting to just quit I was letting my anxiety over both the health issues and the thought of trying to navigate the disability process influence my decision making. It just felt so stressful when every insurance claim story seems to be a horror story, whether it gets accepted or rejected.   
But these are options open to me and meant to be safety nets for these scenarios. Why else have I been paying for LTD premiums year after year? Plus now I have to account for the "disability premiums" and how much it can grow to is still an unknown to me.
But I did take the negative experiences to heart and followed the advice of a number of people who suggested I work with a specialist. I hired the best one I could find and they've helped me with the short term disability and are now working on the long term claim.
This has really helped with the stress level.

It's good to get an update. I hope your health has been holding steady for the past 6 months while you work through these issues.

If you're in the process of applying for LTD, you have my sympathy.  It's an ugly process but remember that it's not really about you or about medicine - it's about risk management at a faceless company. They will use any tactic they can to deny claims, stack the deck for a trial, or persuade you to drop your claim. They only pay if they believe the that cost & likelihood of prevailing at a trial outweigh the cost of paying you. I recommend Linda Nee at Disability Claims Solutions https://disabilityclaimssolutions.com to manage LTD claims. She has a blog with lots of good info about LTD as well. Disability lawyers are necessary if you are the point of appealing a denial. But they are not great at the initial applications or maintaining claims to prevent them from getting denied. Linda is an LTD wizard. I've worked with disability lawyers and with Linda and Linda is so much better.

Applying for SSDI doesn't need a lawyer or specialist to help with. SSDI is bureaucratic but it's not malicious or fraudulent like LTD. The key to SSDI is understanding how they evaluate applications and structuring yours to make it clear you meet their requirements. I was approved on my initial application for SSDI. The money isn't much but the big deal about SSDI is being able to get on Medicare after 24 months.

Good luck! Oh, and I don't think there's really any great way to anticipate how much the crip tax is gonna cost you. If you need equipment or paid help or home renovations, you can start budgeting for that. But it's just a guess to say how your medical condition or needs might change in the future. But, hey, that's true for everybody disabled or not. We never know what's around the corner and just plan the best we can. The best decisions you can make right now are the ones that benefit your health and preserve your future options.

[SunniD]

A few things:

1: I don't know what your health issues are, but there are very few chronic illnesses where there's a magical treatment that makes you better. The vast majority of these disabling illnesses have treatments that focus on symptom management and slowing progression.

It took me decades to be diagnosed and once I was...nothing changed. So you have to be aware of that possible reality.

2: get yourself a disability lawyer NOW!
I'm not kidding, consult a disability lawyer well before submitting anything. I just went through this and I wish I had consulted a lawyer before even mentioning my symptoms to my doctor.

Dealing with LTD insurance is a fucking monster process where nothing is reasonable, and very little makes any damn sense.

I cannot overstate this, consult a disability lawyer NOW, yesterday would have been better.

Also, start getting in the habit of asking for copies of your doctor's clinical notes and all reports a few days after any and all appointments. If you see any discrepancies with what you said vs what they wrote, submit a clarification in writing and ask for it to be included in your official chart, then follow up a week later to make sure it has been entered into your chart.

PM me if you want more details, I can't talk about all of it because of the NDA, but I can explain a lot of what I wished I had known about the process before starting.

Thanks, checking doctors' notes for discrepancies is a great idea. I'm going to start asking for copies.

As for the disability lawyer, I'm working with one now, but probably should've engaged him sooner. So far he seems to be giving good advice.
And thank you for the offer, I sent you a PM.

[SunniD]

It's good to get an update. I hope your health has been holding steady for the past 6 months while you work through these issues.

If you're in the process of applying for LTD, you have my sympathy.  It's an ugly process but remember that it's not really about you or about medicine - it's about risk management at a faceless company. They will use any tactic they can to deny claims, stack the deck for a trial, or persuade you to drop your claim. They only pay if they believe the that cost & likelihood of prevailing at a trial outweigh the cost of paying you. I recommend Linda Nee at Disability Claims Solutions https://disabilityclaimssolutions.com to manage LTD claims. She has a blog with lots of good info about LTD as well. Disability lawyers are necessary if you are the point of appealing a denial. But they are not great at the initial applications or maintaining claims to prevent them from getting denied. Linda is an LTD wizard. I've worked with disability lawyers and with Linda and Linda is so much better.

Applying for SSDI doesn't need a lawyer or specialist to help with. SSDI is bureaucratic but it's not malicious or fraudulent like LTD. The key to SSDI is understanding how they evaluate applications and structuring yours to make it clear you meet their requirements. I was approved on my initial application for SSDI. The money isn't much but the big deal about SSDI is being able to get on Medicare after 24 months.

Good luck! Oh, and I don't think there's really any great way to anticipate how much the crip tax is gonna cost you. If you need equipment or paid help or home renovations, you can start budgeting for that. But it's just a guess to say how your medical condition or needs might change in the future. But, hey, that's true for everybody disabled or not. We never know what's around the corner and just plan the best we can. The best decisions you can make right now are the ones that benefit your health and preserve your future options.

Thank you.

Wow. Thanks for the Linda Nee recommendation, I've just spent hours reading some of her blogs and will spend many more to finish the rest. Wish I had known about her sooner but I'm already working with a disability lawyer (he seems pretty knowledgeable so far and very on top of the situation).

[mistymoney]

I'd wait for FIRE.  Increasing health issues and the need for health care was a big factor in our choosing to work longer.

I think this really depends on the health issues.

I would have been MUCH better off had I quit just two or three years earlier. Like, enormous quality of life improvement over how I am now.

Malcat, I know you've said you've loved your job previously.

Are you saying quality of life now would be better if you had bowed out of working 2 years earlier? Can you explain the mechanism?

Was there a lot of stress even though you loved it, that you attribute to poorer outcomes now?

[mistymoney]

I want to thank all the posters for your advice and for sharing your experiences. In the last few months, as I continued to deal with the health issues I have reread every contribution to this thread.

A couple of points that kept running through my head every time I just wanted to call it quits:

Someone asked can this lead to disability?
The thought was always once the doctors have a diagnosis it would be followed by treatment and full recovery. It was only a question of time. Permanent disability was never on my radar. And now it has to be.

Can my FIRE stache handle the extra costs of a disability?
I'm not sure? Being mostly healthy and oblivious up to this point in my life, I need to figure out how much that "disability premium" (as one poster called it) might be now and in the future. This cost is unaccounted for in my current FIRE number and I imagine it will only keep increasing. As a point of pride and independence, (like Malcat) I would prefer more paid support than from family, no matter how much they are willing to help. Care giving is hard in every way and I would not want to become a burden to them. 

Which leads me to keep coming back to this post and the bolded from Dr Kidstache:

Lots of good advice I just want to add that you absolutely should not quit your job IF you have short term or long term disability insurance. If your medical leave expires and you are still too unwell to return to work, get a letter from your doctor that states that and file a claim. If you quit (even because of medical issues) you won't be eligible for disability insurance.

I became suddenly disabled and permanently unable to work. I now have Medicare for health insurance through SSDI. But there's a 24-month waiting period for Medicare once you're approved for SSDI and the 2 years that I spent on ACA plans waiting for Medicare were brutal. They hardly covered any of my treatments and my health care expenses were enormous.

Nobody has a crystal ball and anyone can become ill/injured at any time so making decisions out of anxiety about what *could* happen is pointless. But you can certainly make decisions that protect your options if you have any. I hope that your medical issues are short and you feel better soon.

He's right, in wanting to just quit I was letting my anxiety over both the health issues and the thought of trying to navigate the disability process influence my decision making. It just felt so stressful when every insurance claim story seems to be a horror story, whether it gets accepted or rejected.   
But these are options open to me and meant to be safety nets for these scenarios. Why else have I been paying for LTD premiums year after year? Plus now I have to account for the "disability premiums" and how much it can grow to is still an unknown to me.
But I did take the negative experiences to heart and followed the advice of a number of people who suggested I work with a specialist. I hired the best one I could find and they've helped me with the short term disability and are now working on the long term claim.
This has really helped with the stress level.

It's good to get an update. I hope your health has been holding steady for the past 6 months while you work through these issues.

If you're in the process of applying for LTD, you have my sympathy.  It's an ugly process but remember that it's not really about you or about medicine - it's about risk management at a faceless company. They will use any tactic they can to deny claims, stack the deck for a trial, or persuade you to drop your claim. They only pay if they believe the that cost & likelihood of prevailing at a trial outweigh the cost of paying you. I recommend Linda Nee at Disability Claims Solutions https://disabilityclaimssolutions.com to manage LTD claims. She has a blog with lots of good info about LTD as well. Disability lawyers are necessary if you are the point of appealing a denial. But they are not great at the initial applications or maintaining claims to prevent them from getting denied. Linda is an LTD wizard. I've worked with disability lawyers and with Linda and Linda is so much better.

Applying for SSDI doesn't need a lawyer or specialist to help with. SSDI is bureaucratic but it's not malicious or fraudulent like LTD. The key to SSDI is understanding how they evaluate applications and structuring yours to make it clear you meet their requirements. I was approved on my initial application for SSDI. The money isn't much but the big deal about SSDI is being able to get on Medicare after 24 months.

Good luck! Oh, and I don't think there's really any great way to anticipate how much the crip tax is gonna cost you. If you need equipment or paid help or home renovations, you can start budgeting for that. But it's just a guess to say how your medical condition or needs might change in the future. But, hey, that's true for everybody disabled or not. We never know what's around the corner and just plan the best we can. The best decisions you can make right now are the ones that benefit your health and preserve your future options.

gosh - this is so upsetting to hear! I always felt so protected having STD and LTD protection through work, seems like if I ever needed to use them, it's be a very painful process, and then I might not benefit anyway. I am not very tenacious.

[Metalcat]

I'd wait for FIRE.  Increasing health issues and the need for health care was a big factor in our choosing to work longer.

I think this really depends on the health issues.

I would have been MUCH better off had I quit just two or three years earlier. Like, enormous quality of life improvement over how I am now.

Malcat, I know you've said you've loved your job previously.

Are you saying quality of life now would be better if you had bowed out of working 2 years earlier? Can you explain the mechanism?

Was there a lot of stress even though you loved it, that you attribute to poorer outcomes now?

I never had a problem with the stress of my job, I didn't quit because of burnout, I quit because of severe injury that was directly caused by my job.

I wouldn't be disabled today had I chosen a different career.

[Metalcat]

gosh - this is so upsetting to hear! I always felt so protected having STD and LTD protection through work, seems like if I ever needed to use them, it's be a very painful process, and then I might not benefit anyway. I am not very tenacious.

Yep, I had to go through the long and painful process of learning the truth about people in my profession who file for LTD with expensive "own occupation" policies, which are the easiest to prove disability for because we all do physical jobs.

Almost every single case ended in a lawsuit, and almost every lawsuit was settled for about 20% of the face value of the policy.

First, the policy isn't worth what you think. If you get disabled in your 30s and your policy is supposed to pay out until 65, you might just take the amount that you were supposed to get and multiple it by 30  and think that that's the amount of the policy, but no, they apply inflation to it. So in effect, the policy is only worth about 55% of its face value.

Then the insurance company will apply metrics of the probability of you recovering AND the probability of you dying. So even if you are totally disabled, they may only be willing to concede paying out 7-10 years of the policy, max. That brings down the value another 60-70%.

So by the time the industry standard adjustments are made, your policy isn't worth all that much. And THEN comes the negotiation of how many cents on the dollar they're willing to pay on that new value, which is likely to be 40-70% depending on the strength of your case, how willing you are to go to court, and how good of a witness you are. This can bring down the remaining pot another 30-60%   

So you could start out thinking that your policy is worth 1M, and then slowly come to realize that you can only realistically expect 200-250K.

Now, I don't know about the US, but if it's a workplace policy, here that's fully taxable.

So what's left?

Now this is for "own occupation" policies, which a lot of workplace plans don't even offer. If it's total disability, then the insurance company lawyers have an enormous range of leeway to argue that you could do *some* form of work, which could radically reduce even the small remaining sum because if it went to court then it would be a head to head battle of doctors with one side saying you're disabled and the other side saying that you could actually work as long as you had the right accommodations, even if it's totally unreasonable for any employer to accommodate you to that extent.

Now let's assume the case DOES go to court and you win. Or let's assume you aren't rejected in the first place. Well this outcome is actually worse than getting a shitty settlement. Because if you get approved or if you win in court, then you have to face the reality of actually being on their disability policy.

And guess what? They have a MILLION strategies for kicking you off of the policy. You have to see their doctors and have to go through their rehab, and if they decide that you can work, you are cut off, and end up in the legal battle allll over again.

At best, even if they *don't* manage to kick you off, then eventually they will try to settle with you, at which point you are forced into the miserable negotiation process I described above, and end up with a ~20% settlement anyway. Except, you've spent a few years abused by their system that is designed to wear you down, never being able to leave the house without knowing that that day, you might be followed by surveillance.

So yeah...don't feel too secure just because you pay a fortune for a policy to a company that makes a FORTUNE by perfecting the art of not paying you what you are entitled to.

Especially since you have to take on this fight WHILE DISABLED.

Now, sometimes it works out and they just pay you and leave you alone, but from my research and from the info from my very experienced lawyer, that's not the norm.

[Dr Kidstache]

gosh - this is so upsetting to hear! I always felt so protected having STD and LTD protection through work, seems like if I ever needed to use them, it's be a very painful process, and then I might not benefit anyway. I am not very tenacious.

Yes, many LTD policies aren't worth the paper they're printed on but it's not impossible to be successful in accessing the benefits, just tough & takes the right people in your corner.

Firstly, there are two different types of LTD policies, individual and employer-based. They are way more different than it seems. Employer-based policies are governed by ERISA, a federal law that is enforced through federal courts (that means lawyers for these cases are fewer and more expensive if you ever have the misfortune of having to go to court) and the law is heavily weighted towards insurers. The income from ERISA policies is taxable if your employer paid the premiums. They exclude pre-existing conditions and they limit payments pretty strictly. They have a time-period limit like 24 months on how long they pay for "mental & nervous" conditions (newsflash - they try to claim every medical condition is "mental & nervous"). And they also have a limited time period after which they change to only paying if you can't do ANY occupation and earn a policy-determined % of your pre-disability income. They deduct other types of disability payments you might be getting like SSDI, workers comp, or other ERISA LTD policies. Unless you're a high-earner, these policies are tough to make worth the fight because the offsets for SSDI/other payments may mean there's hardly anything actually getting paid by the insurer and/or the insurer has a lot of possible occupations to claim you could do that would earn the % of your former low pay income.

Individual LTD policies (often called IDI) are more valuable. The income is not taxed, they often don't have the mental & nervous limitations, they can be "own occupation, and the policies are not regulated by ERISA so the playing field is not as tilted towards the insurers. IDI policies generally don't have other types of disability payments deducted from them either. IDI policies can get undercut by riders that sound good but actually are worse for you like residual disability riders so don't buy any of that nonsense.

Neither type of policy is usually inflation-adjusted.

Yes, like Malcat said the net present value of a policy is discounted through formulas that take into account a bunch of variables. And yes settlements generally are at or below 60% NPV. But settlements are not the goal. The goal is to have them pay you fairly for whatever duration of the claim that you are owed. It's not always possible but that's the goal. The way to reach that goal is to have someone who understands how to manage your claim to prevent a denial ever happening so that you stay out of the courts and out of settlements. And it also requires having the stubborn willpower of a thousand mules to insist on keeping your claim despite the harassment, fraud, threats, and fake medical experts they throw at you in first few years. I have successfully been paid for years and I still get an acute stress response every time I see an envelope from them in my mail. I sometimes think wistfully about settling for the pennies on the dollar they would give me just to get out from under their thumb. But then I remember that I am at the other side of beating all their best tricks so I know that they don't have worse to throw at me anymore and while they might choose to pick a fight again at some point, I'm mostly already in their loss column. Plus, did I mention stubborn? At the end of the day those fuckers are going to pay me what they owe me ;-)

[Metalcat]

Please also note that both of us who are describing our experience with LTD policies are medical professionals, which gives us an enormous advantage in navigating this bullshit.

I knew *exactly* how to talk to my doctors, frame my concerns, monitor my records, and build a medically defensible case. I knew exactly how to network through the system to find the MOST credible medical professionals, and because I was also a doctor, they never once questioned the validity of my efforts. I could just come right out and say "I'm in a disability lawsuit and I need your help to make this airtight".

My doctors often even let me review their notes before they even finalized them.

This is not a level of trust and treatment that the average patient will get.

[dblaace]

Thanks for the update. I've been  facing a similar situation as well. I'm planning to retire 12/31. I have a final doctors appointment on 11/12 and I'll make my final decision on the prognosis and  time to treatment.

The thing I'm most worried about are the drugs and specialist doctors. It's a gamble on which ones would be needed and which ones are covered by an ACA plan.

[dougules]

Yes, like Malcat said the net present value of a policy is discounted through formulas that take into account a bunch of variables. And yes settlements generally are at or below 60% NPV. But settlements are not the goal. The goal is to have them pay you fairly for whatever duration of the claim that you are owed. It's not always possible but that's the goal. The way to reach that goal is to have someone who understands how to manage your claim to prevent a denial ever happening so that you stay out of the courts and out of settlements. And it also requires having the stubborn willpower of a thousand mules to insist on keeping your claim despite the harassment, fraud, threats, and fake medical experts they throw at you in first few years. I have successfully been paid for years and I still get an acute stress response every time I see an envelope from them in my mail. I sometimes think wistfully about settling for the pennies on the dollar they would give me just to get out from under their thumb. But then I remember that I am at the other side of beating all their best tricks so I know that they don't have worse to throw at me anymore and while they might choose to pick a fight again at some point, I'm mostly already in their loss column. Plus, did I mention stubborn? At the end of the day those fuckers are going to pay me what they owe me ;-)

Unfortunately some disabilities directly affect your willpower and actual ability to be stubborn. 

[ToTheMoon]

My sister has recently been deemed permanently disabled and her LTD payout was approved on the second go-round. I know that she said that the MS Society (we are in Canada) was extremely helpful in assisting her through the process.  Is there a group/society for your particular diagnoses that you could use as a resource?

[Dr Kidstache]

Unfortunately some disabilities directly affect your willpower and actual ability to be stubborn.

So true! That's why I pay a claim manager to be stubborn and prop me up when I can't handle the stress of the process myself.