Author Topic: Health Insurance or save and pay?  (Read 3955 times)

cody1awesome

  • 5 O'Clock Shadow
  • *
  • Posts: 20
Health Insurance or save and pay?
« on: March 06, 2017, 12:14:34 PM »
My wife and I have a 2 year old. For the 3 of us, Anthem health insurance is $628.14. 

Recently I used an online dermatologist and paid $50 (insurance wouldn't cover any) and was prescribed 2 creams. My insurance will not pay for them, and together the cost is $420, which I can't afford. At the end of the month we are taking my son to an allergist because he has eczema and possibly a skin allergy. He has been prescribed the same medicine last year at a cost of 15 dollars. If he needs it this year, we will have to pay out of pocket anyway.

My question is, would it be cheaper to just poclet the insurance money and pay out of pocket? We could save 7500 dollars a year if we didn't have insurance, and just pay when we needed it. None of us go to the doctor often as we are all young, but I worry about what would happen if we didn't have insurance and someone had a serious injury. I don't really know what to do, because as orly this month, if I buy my medicine that I can't really afford, I will have paid 50 for the visit, 420 for the meds, and 628.14 for the insurance, meaning in one month I would be out almost 1100 bucks for one visit.

I'm at a loss, so any help is appreciated. Also, I'm in KY, and pre-tax my wife and I make a little over 90K a year. After tax is substantially less.

MrGville

  • Stubble
  • **
  • Posts: 117
  • Age: 29
Re: Health Insurance or save and pay?
« Reply #1 on: March 06, 2017, 12:24:14 PM »
I would never be comfortable without health insurance.  Quick story: My best friend from high school was a perfectly healthy guy, maybe went to the doctor once a year for an annual physical.  When he was 25 he was diagnosed with testicular cancer....had to get two surgeries and chemo.  This would have cost tens of thousands of dollars for someone without health insurance.  He's now cancer free and his only doctors visits are his quarterly surveillance tests for cancer.  Health is a funny thing..you may be perfectly healthy, and then one day you get unlucky.  My sister just got diagnosed with a rare heart condition, she was seemingly healthy as well.  You never know.

rubybeth

  • Handlebar Stache
  • *****
  • Posts: 1402
  • Location: Midwest
Re: Health Insurance or save and pay?
« Reply #2 on: March 06, 2017, 12:24:52 PM »
At least for 2017, with the Affordable Care Act still in effect, you'd likely pay a tax penalty for dropping coverage. Is this an employer plan that you're on? If so, you also might be stuck with it. It's probably too late to make changes to the plan you chose, but in the future, compare your options. I wouldn't drop coverage altogether even if it's not legally mandated--get a policy with a high deductible that would cover you if disaster struck so you wouldn't be bankrupt.

If you can't afford the medicine, unless it's absolutely needed for life, you have a couple options: a) see if the provider (doctor) will give you an Rx for a medication that is covered by insurance, b) don't fill the Rx.

And start saving for health care stuff. Find out how much doctor visits are and budget for them. If possible, use an HSA so your health savings are untaxed.


ltt

  • Pencil Stache
  • ****
  • Posts: 740
Re: Health Insurance or save and pay?
« Reply #3 on: March 06, 2017, 12:39:43 PM »
Keep your insurance; you never know what might happen.  I agree that our system is not working as it is, but to not have it and need it for an unexpected emergency/surgery/disease would probably bankrupt most people.

Rocket

  • 5 O'Clock Shadow
  • *
  • Posts: 99
  • Location: Los Angeles
Re: Health Insurance or save and pay?
« Reply #4 on: March 06, 2017, 12:50:59 PM »
Keep it for the reasons others have mentioned.  Another reason to keep is continuous coverage exclusions might be a reality in the future.

BlueHouse

  • Magnum Stache
  • ******
  • Posts: 3043
  • Location: WDC
Re: Health Insurance or save and pay?
« Reply #5 on: March 06, 2017, 01:00:38 PM »
Doesn't matter how broke I've been -- I NEVER let insurance lapse.  ever.  One of my parents went from chopping trees to lung cancer in a matter of weeks.  Non-smoker

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4570
  • Age: 11
  • Location: USA
Re: Health Insurance or save and pay?
« Reply #6 on: March 06, 2017, 01:06:15 PM »
Don't make everyone else pay for you when you are in a bad accident.

If you don't like the price of insurance, find an employer that covers it, or move somewhere else.

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #7 on: March 06, 2017, 01:16:48 PM »
once the repubs change the ACA and there is no requirement i would just find a catastrophic plan to be on and self insure.  if the individual mandate doesnt go away i'd just use health share.

DocMcStuffins

  • Stubble
  • **
  • Posts: 110
Re: Health Insurance or save and pay?
« Reply #8 on: March 06, 2017, 02:53:50 PM »
If a Christian then look at sumaritan or liberty Christian care . I think radical financial did a health care episode on it. Saves cash.  A good option and keeps you off of tax issues.

Beriberi

  • Stubble
  • **
  • Posts: 137
Re: Health Insurance or save and pay?
« Reply #9 on: March 08, 2017, 05:18:16 AM »
This may not matter now, but in the future you should let your health care provider know that you are paying cash for prescriptions and would really prefer the least expensive products.  Usually there are multiple answers to the medication question and some are far cheaper.

Antiviral medications can vary wildly in price. Most docs prescribe the one that is 2 times per day. People prefer taking it compared with the one that is 5 time per day. However, there can be a cost difference of $400 between the options.

It may also help to know what is "formulary" for your insurance (this should be online).  It may be that pantoprazole is much cheaper with your plan than fomeprazole - or vice versa.  Relatively interchangeable agents.  Your doc won't know what is on your plan.

And to just pile on - medical bills can be devastating (and are responsible for a huge share of bankruptcies).  Even a broken arm for your two year old could easily have care that exceeds your annual insurance premium. I'm also curious why your insurance wouldn't cover a visit to a dermatologist - it that because your primary care provider didn't think it was necessary? I suspect that conditions that can be diagnosed for $50 by an online dermatologist can be handled quite well by your PCP. And is the medication not covered because it was prescribed by an out of network provider? Perhaps you can follow up with PCP and have them re-write the prescription (though they will likely require an office visit for this).

goatmom

  • Bristles
  • ***
  • Posts: 290
Re: Health Insurance or save and pay?
« Reply #10 on: March 08, 2017, 05:45:03 AM »
Your health insurance actually sounds pretty reasonable.  Was the cream not covered by your insurance?  Usually if it is needed and there is no other option, the doctor needs to fill out a prior authorization (PA).  If doctor submitted at PA and it was denied it usually will offer less expensive option you need to try first.  50 dollars for a visit with a dermatologist?  That is really cheap.  Why would a derm do a consult for such a low fee?  Interesting.

rubybeth

  • Handlebar Stache
  • *****
  • Posts: 1402
  • Location: Midwest
Re: Health Insurance or save and pay?
« Reply #11 on: March 08, 2017, 06:52:22 AM »
Your health insurance actually sounds pretty reasonable.  Was the cream not covered by your insurance?  Usually if it is needed and there is no other option, the doctor needs to fill out a prior authorization (PA).  If doctor submitted at PA and it was denied it usually will offer less expensive option you need to try first.  50 dollars for a visit with a dermatologist?  That is really cheap.  Why would a derm do a consult for such a low fee?  Interesting.

I'm guessing it's a High Deductible Health Plan, and so it's likely that nothing is "covered" until the deductible is met. "Covered" means different things on different plans.

neophyte

  • Pencil Stache
  • ****
  • Posts: 560
  • Location: A wretched hive of scum and villainy
Re: Health Insurance or save and pay?
« Reply #12 on: March 09, 2017, 05:58:50 AM »
I'm at a loss, so any help is appreciated. Also, I'm in KY, and pre-tax my wife and I make a little over 90K a year. After tax is substantially less.

I'm going to get a little face-punchy here.  You haven't indicated that you have any chronic conditions. If you can't afford an additional $500 for healthcare every now and then on a little over $90k a year, that seems to be the problem to me. I'd suggest a case study. We can probably help you find enough.  Earning $29k a year I was able to afford about $2000 in unexpected medical expenses a couple years in a row. I didn't want to afford it, and I wasn't happy about it, but I could make it happen.

I kind of suspect that if you dropped insurance for $7500 /year, you still wouldn't be able to afford a surprise $5000 bill.
« Last Edit: March 09, 2017, 06:55:01 AM by neophyte »

MerryMcQ

  • Stubble
  • **
  • Posts: 131
Re: Health Insurance or save and pay?
« Reply #13 on: March 09, 2017, 07:25:37 AM »
When my son was 2, he fell at a park on some cement, knocked himself out, and got an impressive head injury. The ER visit, CT scans, and stitches were waaaay expensive. "Healthy" two year olds are just accidents waiting to happen. What is your plan when you are uninsured and get a 20k ER visit bill?

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #14 on: March 09, 2017, 07:38:46 AM »
If a Christian then look at sumaritan or liberty Christian care . I think radical financial did a health care episode on it. Saves cash.  A good option and keeps you off of tax issues.

you dont have to be a christian.. you just have to sign something saying you believe in a higher power.  doesnt matter what that power is or how you choose to worship or not worship it.  personally the big meat ball in the sky is my favorite higher power. 

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #15 on: March 09, 2017, 07:50:36 AM »
If a Christian then look at sumaritan or liberty Christian care . I think radical financial did a health care episode on it. Saves cash.  A good option and keeps you off of tax issues.

you dont have to be a christian.. you just have to sign something saying you believe in a higher power.  doesnt matter what that power is or how you choose to worship or not worship it.  personally the big meat ball in the sky is my favorite higher power.

...and you have to agree to live their lifestyle.

Oh, and about the "don't have to be a Christian..."
Quote
To become a member you must meet all the requirements of this section and submit an application, including a pastor’s verification. As long as you continue to meet these requirements and fulfill all membership duties as determined by the Board of Directors, your membership will continue. If at any time you no longer meet all these membership requirements, you must notify SMI immediately, and your membership and all privileges will be suspended unless otherwise indicated.

Quote
A. Be a professing Christian according to Biblical principles. Romans 10:9-10, John 3:3

B. Be in agreement with the following member statement of faith:

    I believe in the triune God of the Bible. He is one God Who is revealed in three distinct Persons—God the Father, God the Son, and God the Holy Spirit.I believe Jesus Christ was God in the flesh—fully God and fully man. He was born of a virgin, lived a sinless life, died on the cross to pay the penalty for our sins, was bodily resurrected on the third day, and now is seated in the heavens at the right hand of God, the Father.I believe that all people are born with a sinful nature and can be saved from eternal death only by trusting in Christ’s atoning death and resurrection to save us from our sins and give us eternal life.

There are all sorts of clauses on if you can drink, how much you can drink, having sex outside of marriage, etc. 

If you're living the life they describe, it probably works.  Otherwise, one excessive night out that is documented (arrest, ticket, venereal disease, pregnancy, etc) ... and you might lose your health care.

---

Back to the OP:  From the description of "not using the doctor much"... I'd find the highest deductible plan I could find (bonus if it is HSA compatible) and go with that.  I would not eliminate insurance ever, but especially I would not eliminate insurance if I had kids.   

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #16 on: March 09, 2017, 07:56:48 AM »
alright maybe those 2 specifically require christian beliefs but the big 2 liberty and medishare basically just use the religion loop hole.

i'm married and dont over drink so its pretty simple to follow the rest of what most ask.

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #17 on: March 09, 2017, 08:09:30 AM »
alright maybe those 2 specifically require christian beliefs but the big 2 liberty and medishare basically just use the religion loop hole.

i'm married and dont over drink so its pretty simple to follow the rest of what most ask.

Liberty:
Quote
We believe every individual has a fundamental religious right to worship the God of the Bible in his or her own way. ... We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease.

So... if they can determine your spagetti monster is not the god of the bible... you can lose coverage.  If you happen to get a disease that was caused by diet... you can lose coverage.  I'd be particularly worried about the latter, since there are nutrition theories that range from vegan to Atkins... I'd want to know which theory they want me to follow.

Medishare:
Quote
Each adult member must attest to a personal relationship with the Lord Jesus Christ and profess the Statement of Faith to join.

Both go into Biblical detail what "Faith" means to them with lots of explicit definition with biblical quotes and require you to attend church regularly.

Again: if this is your thing... maybe this isn't a problem.  I would definitely not count on a "religious loop hole". 

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #18 on: March 09, 2017, 08:16:20 AM »
alright maybe those 2 specifically require christian beliefs but the big 2 liberty and medishare basically just use the religion loop hole.

i'm married and dont over drink so its pretty simple to follow the rest of what most ask.

Liberty:
Quote
We believe every individual has a fundamental religious right to worship the God of the Bible in his or her own way. ... We believe it is our spiritual duty to God and our ethical duty to others to maintain a healthy lifestyle and avoid foods, behaviors or habits that produce sickness or disease.

So... if they can determine your spagetti monster is not the god of the bible... you can lose coverage.  If you happen to get a disease that was caused by diet... you can lose coverage.  I'd be particularly worried about the latter, since there are nutrition theories that range from vegan to Atkins... I'd want to know which theory they want me to follow.

Medishare:
Quote
Each adult member must attest to a personal relationship with the Lord Jesus Christ and profess the Statement of Faith to join.

Both go into Biblical detail what "Faith" means to them with lots of explicit definition with biblical quotes and require you to attend church regularly.

Again: if this is your thing... maybe this isn't a problem.  I would definitely not count on a "religious loop hole".

again why the hell do i personally care about it if i sign something ... good luck proving or disproving my beliefs.  if these companies werent paying the bills people wouldnt be joining them in droves. 

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #19 on: March 09, 2017, 08:43:19 AM »


again why the hell do i personally care about it if i sign something ... good luck proving or disproving my beliefs.  if these companies werent paying the bills people wouldnt be joining them in droves.

Because when you file a claim, the members are going to vote on whether they cover it... and if they don't believe you're following their doctrine, they are likely not going to cover.  They don't have to prove anything.

They don't have to disprove your beliefs.  You have to prove them.  You may have to prove you were sitting in church once a week.

I don't care if you go this route.  I just think it's a risk if you're trying to game their system.  I bet they've been down that path before.

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #20 on: March 09, 2017, 08:44:38 AM »


again why the hell do i personally care about it if i sign something ... good luck proving or disproving my beliefs.  if these companies werent paying the bills people wouldnt be joining them in droves.

Because when you file a claim, the members are going to vote on whether they cover it... and if they don't believe you're following their doctrine, they are likely not going to cover.  They don't have to prove anything.

They don't have to disprove your beliefs.  You have to prove them.  You may have to prove you were sitting in church once a week.

I don't care if you go this route.  I just think it's a risk if you're trying to game their system.  I bet they've been down that path before.

you dont have to sit in church once a week and there is little to no information i've been able to find on someone being denied ever.  thats fine if its not for you... i dont see it as gaming "their" system either

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #21 on: March 09, 2017, 10:31:36 AM »

you dont have to sit in church once a week and there is little to no information i've been able to find on someone being denied ever.  thats fine if its not for you... i dont see it as gaming "their" system either

"Regular attendance" is literally in the guidelines.  Whether that is "once a week" or "once a year"... it's there.
They all say something like "A church leader may be interviewed to verify their testimony".

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #22 on: March 09, 2017, 10:43:53 AM »

you dont have to sit in church once a week and there is little to no information i've been able to find on someone being denied ever.  thats fine if its not for you... i dont see it as gaming "their" system either

"Regular attendance" is literally in the guidelines.  Whether that is "once a week" or "once a year"... it's there.
They all say something like "A church leader may be interviewed to verify their testimony".

it says that nowhere on liberty's site it says they believe you can worship however you choose.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4570
  • Age: 11
  • Location: USA
Re: Health Insurance or save and pay?
« Reply #23 on: March 09, 2017, 10:46:49 AM »
What is your recourse if they don't like what you tell them?

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #24 on: March 09, 2017, 10:51:36 AM »
What is your recourse if they don't like what you tell them?

you sign something saying you believe in XYZ god blah blah blah. etc. 

Look it may not be for you but its sure the best healthcare system out there when compared to the health insurance companies. 

some people here pay off their mortgages b/c they dont understand math.  i dont see this as being a big deal that would cause them to not pay.

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #25 on: March 09, 2017, 11:06:23 AM »

you dont have to sit in church once a week and there is little to no information i've been able to find on someone being denied ever.  thats fine if its not for you... i dont see it as gaming "their" system either

"Regular attendance" is literally in the guidelines.  Whether that is "once a week" or "once a year"... it's there.
They all say something like "A church leader may be interviewed to verify their testimony".

it says that nowhere on liberty's site it says they believe you can worship however you choose.

They have the requirement to "Participate regularly in worship or prayer."  Now that's really broad.  I would be afraid they'd choose *their* version of that broad statement.

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #26 on: March 09, 2017, 11:36:10 AM »

you dont have to sit in church once a week and there is little to no information i've been able to find on someone being denied ever.  thats fine if its not for you... i dont see it as gaming "their" system either

"Regular attendance" is literally in the guidelines.  Whether that is "once a week" or "once a year"... it's there.
They all say something like "A church leader may be interviewed to verify their testimony".

it says that nowhere on liberty's site it says they believe you can worship however you choose.

They have the requirement to "Participate regularly in worship or prayer."  Now that's really broad.  I would be afraid they'd choose *their* version of that broad statement.

find any proof of someone not being covered under their healthsare for any reason and i'd love to see it article or otherwise b/c i cant find a single one. b/c until i see one it appears to be a great system. you can what if yourself to a 1% swr too.  and thats what this is IMO its a what if scenario b/c its different and if its not for you then its not for you.

researcher1

  • Stubble
  • **
  • Posts: 159
Re: Health Insurance or save and pay?
« Reply #27 on: March 09, 2017, 12:02:27 PM »
I'm in KY.
I make a little over 90K a year.
Together the cost is $420, which I can't afford.

You live in a comparatively low cost-of-living state, make over 90K, yet you can't afford a $420 expense?

It sounds like you need to start prioritizing what you spend your money on.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 4570
  • Age: 11
  • Location: USA
Re: Health Insurance or save and pay?
« Reply #28 on: March 09, 2017, 12:17:15 PM »
Don't get me wrong- I like exploiting loopholes as much as the next guy. Even better if I get to use other people's beliefs that I find idiotic for my own personal gain.

I'm not baptized or circumcised. I fit the stereotypical Christian profile in that I am white, well-spoken, and generally presentable, but that's it. I could probably study the Bible in a pinch if it came down to it, but there is no way anybody could look at my life and say I embrace Christian principles.

But I unsure against catastrophic, life-changing events. I am not willing to put much faith into the stated goals and intentions a group that literally believes that there's an omniscient guy levitating in the sky. The track record of these organizations is largely unknown. The uncertainty around catastrophic failure is unacceptable.

boarder42

  • Walrus Stache
  • *******
  • Posts: 7849
Re: Health Insurance or save and pay?
« Reply #29 on: March 09, 2017, 01:04:33 PM »
Don't get me wrong- I like exploiting loopholes as much as the next guy. Even better if I get to use other people's beliefs that I find idiotic for my own personal gain.

I'm not baptized or circumcised. I fit the stereotypical Christian profile in that I am white, well-spoken, and generally presentable, but that's it. I could probably study the Bible in a pinch if it came down to it, but there is no way anybody could look at my life and say I embrace Christian principles.

But I unsure against catastrophic, life-changing events. I am not willing to put much faith into the stated goals and intentions a group that literally believes that there's an omniscient guy levitating in the sky. The track record of these organizations is largely unknown. The uncertainty around catastrophic failure is unacceptable.

really we should start a mustachian health sharing group.  why it has to be religion based is beyond me.  i dont care what god you worship or dont ... as long as you meet the criteria to join.  but in most cases the religion criteria is what got them around the ACA.  maybe one will lax that part if the legislation changes.

Spork

  • Walrus Stache
  • *******
  • Posts: 5753
    • Spork In The Eye
Re: Health Insurance or save and pay?
« Reply #30 on: March 09, 2017, 04:02:53 PM »
Don't get me wrong- I like exploiting loopholes as much as the next guy. Even better if I get to use other people's beliefs that I find idiotic for my own personal gain.

I'm not baptized or circumcised. I fit the stereotypical Christian profile in that I am white, well-spoken, and generally presentable, but that's it. I could probably study the Bible in a pinch if it came down to it, but there is no way anybody could look at my life and say I embrace Christian principles.

But I unsure against catastrophic, life-changing events. I am not willing to put much faith into the stated goals and intentions a group that literally believes that there's an omniscient guy levitating in the sky. The track record of these organizations is largely unknown. The uncertainty around catastrophic failure is unacceptable.

really we should start a mustachian health sharing group.  why it has to be religion based is beyond me.  i dont care what god you worship or dont ... as long as you meet the criteria to join.  but in most cases the religion criteria is what got them around the ACA.  maybe one will lax that part if the legislation changes.

The main issue there is: the current Health Share loophole does not allow new groups.  It has to have been in existence since December 31, 1999.  The ones you have are the only ones to chose from.

I'll also say: My current ACA insurance is cheaper than the health shares I've seen (though it looks like they may have a lower "deductible). And insurance policies are contractually binding.  My understanding of the health shares is they explicitly are not. 
« Last Edit: March 09, 2017, 04:06:01 PM by Spork »

luminajd

  • 5 O'Clock Shadow
  • *
  • Posts: 40
Re: Health Insurance or save and pay?
« Reply #31 on: March 09, 2017, 08:18:01 PM »
Keep.the.insurance.
My 8 year old fell off monkey bars last year and broke her arm, the total bill was over $30,000 (she needed an overnight stay and surgery).
I feel your pain. I really, really, do. Premiums are a very hard pill to swallow if you don't need to use your insurance much. And even when you do, you have a big deductible, high out of pocket max, things aren't covered, etc. It SUCKS. But the alternative of not having insurance when something big happens-that is how people go bankrupt in the blink of an eye.

marion10

  • Bristles
  • ***
  • Posts: 303
Re: Health Insurance or save and pay?
« Reply #32 on: March 09, 2017, 09:15:58 PM »
It is one thing not to have insurance when it is just you- but you have a two year old now.  Besides childhood injuries- what if he had cancer? I had a friend whose 2 year old had leukemia and had a bone marrow transplant.