Author Topic: Health insurance...ridiculous for 25 y/o non-smoker/drinker?  (Read 21220 times)

protostache

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #50 on: November 05, 2015, 02:27:59 PM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.

I was young and healthy and full of vigor until I missed a step and fell eight feet off our porch (totally sober, for the record), breaking my back and requiring a CT and an MRI.

Then a year later I was diagnosed with a (luckily very treatable) cancer, total bills approaching $100k with all the follow-up scans.

Shit happens when you least expect it. If I hadn't have had insurance I would be bankrupt and/or dead.

Ocelot

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #51 on: November 05, 2015, 02:58:52 PM »
I've never had insurance for anything in my life up until this point, so the idea that I'll be paying hundreds of dollars for something I'm used to receiving cheap or free is a big shock.
I don't want to debate the merits of one country's healthcare system vs. another's, but the health care you've been getting is not really free.

Absolutely, but the net end result is that you end up far more out of pocket in the US. The difference it makes in my taxes is nowhere near the cost of equivalent insurance in the US. If you want absolutely top-notch care you can get private insurance and use private hospitals here too, and the most expensive plans are still less than the minimum premiums discussed in this thread, and that's without any govt funding except on drugs.

kite

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #52 on: November 05, 2015, 04:00:53 PM »
I've got 4 loved ones who do without.  Two have zero assets, and get by on a cash basis in all things, basically mooching off others.  These are middle-aged guys, and they've really never had insurance.  There are plenty of others like them, who got sick and finally proposed to that woman who wanted to get married like a decade ago, because she's got wicked good health insurance.   In your 50s, you'll see some confirmed bachelor friends suddenly get hitched.  It's when they learn that untreated hypertension and sugar lead to erectile disfunction, and they need insurance to see the doctor and take care of all those nagging things they've neglected.
The others have Uber type jobs where they've earned enough to buy homes, but are gambling. 
When you go without insurance, you're gambling.  The most you have to lose is your assets, perhaps a limb.  Yes, one of those healthy twenty-something guys got a little staph infection from a scratch on his knuckle.  No insurance to see a doctor led to blood infection and an amputation. 
My premiums in 2009 were $13,000.   
The quote you have is excellent.
Welcome to adulthood. 

TheDudeReturns

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #53 on: November 05, 2015, 06:04:37 PM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.

This dude's right. Honestly, the more I lurk on this site, seems to me its just a bunch of people bickering over inane concepts (a la Bogleheads)...

Fact is, the reason medical insurance is so expensive is that "mommy and daddy" don't want to pay $300 for little Timmy to have a checkup; they'd rather pay $0 or, GASP, $20 in co-pay. If medical insurance was actually used like actual *insurance*, as in "Help, I've ripped my arm off with a chainsaw!", costs for everyone else would be down.

Medical insurance is so high because of payouts on these stupid little things. Auto insurance would be crazy expensive too if you turned in claims every time you had to change a lightbulb.

Yes, it's nice that the pre-existing condition element was removed, but otherwise, looks like insurance has just gotten more expensive for less benefits. Before, for someone in the age range of OP, you could get catastrophic plans (you know, plans that actually act like insurance should) for about $50 a month. The deductibles were *lower* than what they have now on say the lowest price Bronze Obamacare plan. Oh, but now the costs are x5 - x10 or more monthly with fewer options (what is ehealthinsurance for anymore, as you can't get Obamacare credits through the site).

The best part is the scam they are perpetrating on college students as part of this. You are now *required* to have health insurance to go to school, but don't worry, you can use magic student loan money to pay for your premiums. These plans are *worse* than what Obamacare offers and you can't get payment credits. While a student really could be getting low cost or free insurance through Obamacare (or wait, they are forced to get Medicaid as they have too little income for the tax credits, cause that sure as hell makes a lot of sense - not!), the schools offer these overpriced plans with a $100k lifetime cap usage. I saw one that, if you wanted it for the whole year, would cost around $5k for a garbage plan! Sure, you can get your own insurance, but kids are dumb and you know a large chunk are taking out loans for this junk instead of searching on their own.

Oh, and on those weird plans like Liberty HeathShare and the like, just don't do it. Their plans are pretty much the same cost as Obamacare, but with them, you risk not getting paid out (you were in a wreck and have one drink in your system - have you broken their biblical code and now are on the hook for all of it?). Also, if you're going to deal with the medical industry parasites, do you really want to try to get pricing information and/or get billed directly? I have tried getting pricing data, and it is amazing how little of it there actually is. You can ask a doctor, secretary, or nurse point blank how much something basic would cost, and they couldn't tell you. Even with insurance, almost every time I do go to a doctor, they screw up billing in some way. For example, I got a $500 bill for my annual checkup (was supposed to be free thanks to Obama). Rather than dealing with the idiots in billing (many who are in different states/countries), I let the insurance take care of it. So I'm supposed to use some weird ass plan and be on the hook for say $20k, $30k, or more and then just "hope" that Christian Ministries comes through and sends me multiple checks/deposits (yes, I heard they do this, can you imagine how much of a hassle that would be doing at your bank?).

Anyway, back to talking about insurance...

 

Orvell

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #54 on: November 05, 2015, 06:20:03 PM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.

This dude's right. Honestly, the more I lurk on this site, seems to me its just a bunch of people bickering over inane concepts (a la Bogleheads)...

Fact is, the reason medical insurance is so expensive is that "mommy and daddy" don't want to pay $300 for little Timmy to have a checkup; they'd rather pay $0 or, GASP, $20 in co-pay. If medical insurance was actually used like actual *insurance*, as in "Help, I've ripped my arm off with a chainsaw!", costs for everyone else would be down.

Medical insurance is so high because of payouts on these stupid little things. Auto insurance would be crazy expensive too if you turned in claims every time you had to change a lightbulb.

Yes, it's nice that the pre-existing condition element was removed, but otherwise, looks like insurance has just gotten more expensive for less benefits. Before, for someone in the age range of OP, you could get catastrophic plans (you know, plans that actually act like insurance should) for about $50 a month. The deductibles were *lower* than what they have now on say the lowest price Bronze Obamacare plan. Oh, but now the costs are x5 - x10 or more monthly with fewer options (what is ehealthinsurance for anymore, as you can't get Obamacare credits through the site).

The best part is the scam they are perpetrating on college students as part of this. You are now *required* to have health insurance to go to school, but don't worry, you can use magic student loan money to pay for your premiums. These plans are *worse* than what Obamacare offers and you can't get payment credits. While a student really could be getting low cost or free insurance through Obamacare (or wait, they are forced to get Medicaid as they have too little income for the tax credits, cause that sure as hell makes a lot of sense - not!), the schools offer these overpriced plans with a $100k lifetime cap usage. I saw one that, if you wanted it for the whole year, would cost around $5k for a garbage plan! Sure, you can get your own insurance, but kids are dumb and you know a large chunk are taking out loans for this junk instead of searching on their own.

Oh, and on those weird plans like Liberty HeathShare and the like, just don't do it. Their plans are pretty much the same cost as Obamacare, but with them, you risk not getting paid out (you were in a wreck and have one drink in your system - have you broken their biblical code and now are on the hook for all of it?). Also, if you're going to deal with the medical industry parasites, do you really want to try to get pricing information and/or get billed directly? I have tried getting pricing data, and it is amazing how little of it there actually is. You can ask a doctor, secretary, or nurse point blank how much something basic would cost, and they couldn't tell you. Even with insurance, almost every time I do go to a doctor, they screw up billing in some way. For example, I got a $500 bill for my annual checkup (was supposed to be free thanks to Obama). Rather than dealing with the idiots in billing (many who are in different states/countries), I let the insurance take care of it. So I'm supposed to use some weird ass plan and be on the hook for say $20k, $30k, or more and then just "hope" that Christian Ministries comes through and sends me multiple checks/deposits (yes, I heard they do this, can you imagine how much of a hassle that would be doing at your bank?).

Anyway, back to talking about insurance...

 
Look, I don't claim to be an expert here... but you can gamble with cars (notice MMM doesn't say "don't get liability insurance" for your car btw, which would be a truly equitable comparison) but gambling with your health and life is a different game.
Fuck up (or even don't fuck up but have a bad luck day) with a car, and you're out a car.
Have a bad luck day (or fuck up) with your body, and suddenly that's a whooooole different game. The whole point of being fiscally responsible is to enjoy life. Yes, you can mitigate your risk for cancers etc., but you can't *know* you won't come down with something weird. MS, cancer, lupus, these diseases DO happen. And THAT is what you are insuring against. One year of MS drugs is well over 30K out of pocket, and that's *just* for the drugs.
It's not the same as renters insurance or if you get robbed or if you total your car. It's just not.

Trudie

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #55 on: November 05, 2015, 06:58:50 PM »
You NEED health insurance at any age.  This is not something you can afford to self insure, unless you are a billionaire.

Truth!

$180/month is a bargain.  My employer's coverage (a HDHP) for single is close to $600/month -- not age rated.

I had an unexpected outpatient surgery three years ago -- not life threatening, but necessary.  Total bills?  $40,000.  With insurance I paid $2000.

You cannot afford to be uninsured... at any age.  There are things I'd skimp on before health insurance coverage.

Rural

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #56 on: November 06, 2015, 04:55:35 AM »
Wanna know one reason lifespans have increased in the last 150 years or so? We now know how to do appendectomies without killing the patient. Wanna know how much one costs in the U.S.? I don't.


The 'old school' alternative to health insurance was an early death. The newer one is bankruptcy. Me, I'll take door #3 and buy the insurance (and I won't be retiring until things have stabilized).

MandalayVA

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #57 on: November 06, 2015, 07:24:22 AM »
Wanna know one reason lifespans have increased in the last 150 years or so? We now know how to do appendectomies without killing the patient. Wanna know how much one costs in the U.S.? I don't.

Not only that, but medical technology has advanced tremendously.  As an example, Richmond had one of the highest number of murders per capita in the country back in the early nineties (yay, crack epidemic).  That number has dropped dramatically--not because people have stopped shooting each other, but because the technology exists to save more of them.

As far as insurance goes, get it.  This summer I had a health episode that put me in the hospital for three days, the first time since I was born (I'm 49) and required aftercare.  The hospital bill was high five digits and the aftercare wasn't cheap.  Insurance and a HSA took care of it all.

Schaefer Light

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #58 on: November 06, 2015, 07:46:02 AM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.

This dude's right. Honestly, the more I lurk on this site, seems to me its just a bunch of people bickering over inane concepts (a la Bogleheads)...

Fact is, the reason medical insurance is so expensive is that "mommy and daddy" don't want to pay $300 for little Timmy to have a checkup; they'd rather pay $0 or, GASP, $20 in co-pay. If medical insurance was actually used like actual *insurance*, as in "Help, I've ripped my arm off with a chainsaw!", costs for everyone else would be down.

Medical insurance is so high because of payouts on these stupid little things. Auto insurance would be crazy expensive too if you turned in claims every time you had to change a lightbulb.
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

bogart

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #59 on: November 06, 2015, 07:56:59 AM »
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

Because people don't pay up front for preventive care (for either our bodies or our cars).  As a culture, we're OK with telling people, "Sorry, your car won't run anymore, too bad, you should have changed the oil," and not providing charitable help but not, e.g. (true example based on a family member), "Sorry you have stage 4 cancer, too bad, you should have gotten the recommended mammograms," and not providing charitable help.  Personally, I'm comfortable with that; as others have pointed out, losing a car is one thing, losing your body/life another, but like it or not, that's the reason (IMO) for what you describe.

BeanCounter

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #60 on: November 06, 2015, 08:03:14 AM »
One of the expense lines buried in your insurance premium is "network cost". It pays for a team of people at the insurance company to go out and credential and contract with various providers to build the "network" of providers at "discount rates". That is something that has never made any sense to me and I wonder what our insurance costs would look like if we could eliminate that expense. The solution seems to be to let CMS set the rates, but whenever that is mentioned everyone starts screaming that we'll put the providers out of business. There is a small % over cost built into CMS rates to keep providers from declining Medicare & Medicade patients. And if we didn't have to pay premiums to the insurance companies we could likely all pay a bit more for services and/or tax to cover the plan.
I guess I think we should just go to a single payor system. The platform for it already exists, we just have to convince everyone that they'll still get quality care in a timely manner.

BeanCounter

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #61 on: November 06, 2015, 08:13:22 AM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.


This dude's right. Honestly, the more I lurk on this site, seems to me its just a bunch of people bickering over inane concepts (a la Bogleheads)...

Fact is, the reason medical insurance is so expensive is that "mommy and daddy" don't want to pay $300 for little Timmy to have a checkup; they'd rather pay $0 or, GASP, $20 in co-pay. If medical insurance was actually used like actual *insurance*, as in "Help, I've ripped my arm off with a chainsaw!", costs for everyone else would be down.

Medical insurance is so high because of payouts on these stupid little things. Auto insurance would be crazy expensive too if you turned in claims every time you had to change a lightbulb.

You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

So part of the reason that your health insurance covers preventive care is because they want to get you into a PCP and seen so they can get a baseline on your health. They use that information for a mired of things. Including capitated arrangements with physicians to help mitigate the insurance companies claims costs. They also believe that they can use the information from your visit to help do "managed care" and decrease claims cost. If you have a Medicare Advantage plan, they use the information from your well visit to rate you and get the correct premium payment from CMS.
« Last Edit: November 06, 2015, 08:15:27 AM by BeanCounter »

dramaman

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #62 on: November 06, 2015, 08:18:52 AM »
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

Because people don't pay up front for preventive care (for either our bodies or our cars).  As a culture, we're OK with telling people, "Sorry, your car won't run anymore, too bad, you should have changed the oil," and not providing charitable help but not, e.g. (true example based on a family member), "Sorry you have stage 4 cancer, too bad, you should have gotten the recommended mammograms," and not providing charitable help.  Personally, I'm comfortable with that; as others have pointed out, losing a car is one thing, losing your body/life another, but like it or not, that's the reason (IMO) for what you describe.

My thought exactly. People are not rational and make stupid decisions such as foregoing basic maintenance/check ups, which can prevent or catch early more expensive and catastrophic problems. If we let a car's maintenance go and it falls apart, we can replace it. Not so with a person. Thus it makes economic sense to build in a certain amount of basic healthcare maintenance into the price of insurance.


Guses

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #63 on: November 06, 2015, 11:31:10 AM »
I'm moving to the US from New Zealand next month, and the healthcare system is the scariest thing about it. Like many here, I've never had insurance for anything in my life up until this point, so the idea that I'll be paying hundreds of dollars for something I'm used to receiving cheap or free is a big shock. Obviously this system is ingrained in US culture, and despite "socialized" (read:"sane") systems working extremely well in many (most?) other developed countries, any attempt to change it would be political suicide.

At the end of the day, it doesn't cost any more to provide care in the US than it does in Canada or the UK or NZ. Those countries prove that state-funding doesn't result in a gigantic tax bill. All this is funding is a giant insurance industry, with hugely inflated hospital bills for everyone uninsured.

It actually does cost quite a bit more in the US to provide similar healthcare than those countries with coverage.

Americans are totally getting fleeced.....


Nola584

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #64 on: November 06, 2015, 11:44:58 AM »
You NEED health insurance at any age.  This is not something you can afford to self insure, unless you are a billionaire.

Truth!

$180/month is a bargain.  My employer's coverage (a HDHP) for single is close to $600/month -- not age rated.

I had an unexpected outpatient surgery three years ago -- not life threatening, but necessary.  Total bills?  $40,000.  With insurance I paid $2000.

You cannot afford to be uninsured... at any age.  There are things I'd skimp on before health insurance coverage.

Debates on the current state of healthcare aside, please get coverage, to the OP and anyone else in this position. You truly never know, and don't want to be saddled with financial stress when you should only be worried about recovery.

When I was a freshman in college (at the normal age, 18) I had a (thankfully low grade) brain tumor and subsequent surgery. The medical and hospital bills were well over $100k. I was otherwise very healthy and had no reason to believe that would happen to me. It would have been catastrophic to be saddled with so much medical debt before I even began a career, and the bills could have been much, much higher had I needed more treatment.

And I agree that the premiums, while high, are in line with current expectations. My employer offers a $1500 HDP, with non-age related premiums of around $500/mo for a single person.

Sibley

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #65 on: November 06, 2015, 01:11:13 PM »
For whomever mentioned single payer... Medicare and Medicaid are single payer. Guess who actually does the work? The private insurance companies. The VA doesn't use private insurance companies. I know I've been out of touch, but I have heard about major scandals at the VA.

Also, not all insurance companies are for profit. Some are non-profit, some are mutual legal companies (owned by the policy holders), etc. There is a mix.

And I will agree that the system as a whole is messed up. Until it changes, we have to deal with what we have. No country's system is the best. There are pros and cons to everything, including the mess that is healthcare in the US. I'd be willing to bet that innovation and research breakthroughs have historically come from the US much more often than other countries.

Schaefer Light

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #66 on: November 06, 2015, 01:34:32 PM »
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

Because people don't pay up front for preventive care (for either our bodies or our cars).  As a culture, we're OK with telling people, "Sorry, your car won't run anymore, too bad, you should have changed the oil," and not providing charitable help but not, e.g. (true example based on a family member), "Sorry you have stage 4 cancer, too bad, you should have gotten the recommended mammograms," and not providing charitable help.  Personally, I'm comfortable with that; as others have pointed out, losing a car is one thing, losing your body/life another, but like it or not, that's the reason (IMO) for what you describe.
We're just going to have to agree to disagree.  I feel that health insurance should be for really terrible and expensive things...like a torn ACL or cancer.  I'd gladly pay the bill for my yearly physical or eye exam to keep my insurance costs down.

Dicey

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #67 on: November 06, 2015, 01:35:50 PM »
It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

So many personal stories have been shared on this forum over the years, in this thread and others, by people who were healthy right up until the moment they unexpectedly weren't. Few things will shave a burgeoning 'stache faster than massive medical bills.

I'm in the wealth accumulation phase and even if I were healthy (and I'm not, I lost the genetic lottery, have been sick my entire life, and repeatedly incurred medical costs as a child that would've bankrupted my parents had they not been insured), having health insurance of some sort would be one of my highest financial priorities.

I've seen too many "young and healthy" acquaintances get injured in freak accidents, or receive a cancer diagnosis out of the blue, to feel comfortable jeopardizing my family's financial security over not wanting an extra monthly bill. I'm mustachian enough that I can find a way to make that payment (and also mustachian enough that I wouldn't want to unnecessarily burden others with my healthcare costs by not carrying insurance).
Yup, I had a "harmless cyst" removed and diagnosed as cancer when my non-smoking/non-drug using/minimal drinking/healthy self was 21. My cancer was extremely rare (<1%) and there was no family history or other indicators. I daresay I would not be FIRE now had I not had health insurance then. And some uninsured asshole can always crash into your car/bike/pedestrian self (>1%) and drive off.  Not worth the risk, however remote it seems.
 
I agree that overspending on insurance is silly, but there's also the case of being penny-wise and pound foolish, not to mention compliance with ACA laws. It won't happen to you until it does. You can't buy insurance after you need it. Don't be the one caught without a chair when the music stops.

forummm

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #68 on: November 06, 2015, 01:56:47 PM »
For whomever mentioned single payer... Medicare and Medicaid are single payer. Guess who actually does the work? The private insurance companies. The VA doesn't use private insurance companies. I know I've been out of touch, but I have heard about major scandals at the VA.

I don't understand the point here. Medicare does have some contracting with private insurers (Parts C and D). But Parts A and B are administered by Medicare. People love A and B. And the VA is a very different system. It's not even insurance--it just provides certain kinds of care to certain people who qualify.

UnleashHell

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #69 on: November 06, 2015, 02:03:47 PM »
Wanna know one reason lifespans have increased in the last 150 years or so? We now know how to do appendectomies without killing the patient. Wanna know how much one costs in the U.S.? I don't.


The 'old school' alternative to health insurance was an early death. The newer one is bankruptcy. Me, I'll take door #3 and buy the insurance (and I won't be retiring until things have stabilized).

Removal of appendix - just a shade over 21K about 6 years ago. a total of 18 hours in hospital.
My son had suspected appendicitis and had to go to hospital. Had the barium meal and a scan - $10k (was just inflamed from gastroenteritis)


Better than dying but so expensive... doesn't need to be that much.

BeanCounter

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #70 on: November 06, 2015, 02:15:14 PM »
For whomever mentioned single payer... Medicare and Medicaid are single payer. Guess who actually does the work? The private insurance companies. The VA doesn't use private insurance companies. I know I've been out of touch, but I have heard about major scandals at the VA.

I don't understand the point here. Medicare does have some contracting with private insurers (Parts C and D). But Parts A and B are administered by Medicare. People love A and B. And the VA is a very different system. It's not even insurance--it just provides certain kinds of care to certain people who qualify.
Yes. this is what I was trying to say. The Medicare/Medicaid system is in place and for the most part works. At lease if we went that route the rates for services would be already negotiated and would be consistent regardless of where you went for care. And much of the extra expense created by the insurance giants could go to actually providing care. I know that the single payor module isn't perfect either, but it's better than what we've got. And the ACA unfortunately is not sustainable as it's currently written.

TheOldestYoungMan

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #71 on: November 06, 2015, 02:15:59 PM »
Well, to the OP, yea, you're pretty much screwed.  You just have to bite the bullet.  There's some really good writeups on various early retirement blogs about ACA (I think go curry cracker had a good one).  The thing to do is manage your money as well as you can to qualify for a bigger subsidy (pre-tax retirement contributions, IRA, etc).  Doing that, you can maximize your benefits and get as much protection from catastrophic situations as is available (tho it's way less than people seem to think).

To everyone else, as to the value of having health insurance:

1.  In the event you suffer a physical injury, like say, a car accident, health insurance won't necessarily pay (happened to me).  Because it was in a car, my health insurance company said it wasn't "health" related.  I happened to have a rider on my auto policy for it, but otherwise I would have had to pay $12,000 out of pocket.

2.  I was born in such horrible shape that I only survived because of miraculous technological breakthroughs available only in my area at the time (Life flight, newspaper stories, the whole 9 yards).  Despite having health insurance through a huge company, my parents still ended up in bankruptcy because the first payment from the insurance company did not arrive for over four years.

3.  More recently, when my mother got cancer, the insurance company didn't send any payments for more than 22 months, and when they did they sent 26 different checks.  My dad still has a framed picture of them hanging near the toilet.  That was almost their second medical bankruptcy DESPITE having excellent health insurance their entire marriage.

So accidents, circumstances of birth, and disease, there's 3 reasons cited in this thread for having health insurance where the insurance company, given the slightest wiggle room/suspicion you aren't the suing type, and you're still screwed.

Health insurance as a concept is fine.  The health insurance you can actually get in this country is totally screwed up.  It does not provide as much protection as folks here seem to think it does.  It is slightly better than having your plans ruined, but my dad still would have been better off financially not having the insurance and just taking the bankruptcy hits/wipeouts when the major hits happened.  Even as a senior citizen now, mom had a heart attack, and the total costs of the bypass and the rehab he could fund out of pocket for less than what his insurance costs.  That's, his mandatory legally required insurance.  Their life experience has led to their directives to their children: they would rather die than receive medical care in excess of a certain $ amount.  "I don't want your inheritance going to some fucking doctor and his fucking bureaucrat friends."

Eat right, exercise, look both ways before you cross the street, and die in your own fucking bed.

And as to the cost discussions, nobody seems to know what they're talking about.  Most healthcare spending is coming from CMS.  Old people use the most healthcare and almost all of them are on Medicare.  CMS sets the price they are willing to pay at some percentage, less than 100%, of what the provider charges on average to non CMS customers.  So, just to stay open for business, the providers have to jack up their prices so the CMS payout comes closer to being what they really need to charge.  The lowest price you'll get, therefore, is not the insurance price.  It's the cash price from a smaller facility that doesn't mind recording your "cash" price as a far higher invoice that was only partially paid.  It's fraud yes, but the CMS payout rate has gone as low as 68% of average.  Can you imagine?  If it's a choice between starving to death and breaking the glass, it's right to break the glass.  The consequence is the "spiraling costs of care" fake problem you think is happening.

Total shitshow.

TheDudeReturns

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #72 on: November 06, 2015, 02:17:42 PM »
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

Because people don't pay up front for preventive care (for either our bodies or our cars).  As a culture, we're OK with telling people, "Sorry, your car won't run anymore, too bad, you should have changed the oil," and not providing charitable help but not, e.g. (true example based on a family member), "Sorry you have stage 4 cancer, too bad, you should have gotten the recommended mammograms," and not providing charitable help.  Personally, I'm comfortable with that; as others have pointed out, losing a car is one thing, losing your body/life another, but like it or not, that's the reason (IMO) for what you describe.
We're just going to have to agree to disagree.  I feel that health insurance should be for really terrible and expensive things...like a torn ACL or cancer.  I'd gladly pay the bill for my yearly physical or eye exam to keep my insurance costs down.

Health insurance is just too "touchy feely" for people to be rational about it. I have insurance and was telling OP to get insurance (and not one of those weird "healthshare" plans).

Anyway, the information, research, and data is out there that you can see payment of all those little medical costs is what makes health insurance crazy expensive. I'm sorry, but health insurance should not cost more than someone's mortgage. The absolute cheapest ACA approved plan without tax credits for a couple with the OP's information is well over the cost of a decent mortgage, scaled to where they live.

I mean, the math is simple. Look at your car insurance with just liability coverage vs. liability + comprehensive (value of the car). The 2nd one is probably x2-x4 or more more expensive. Most people are stupidly paying thousands more yearly to cover a $5k or so potential loss. A year or two of reduced premiums takes care of that. If you look at the insurance that covers just the "big" events, it really isn't that much and has never been as the insurers know they were rarely have to pay out.

Since we started with an ill-conceived model, you now have ACA plans with $10k in deductible, but $400-$500 or more a month in costs. So they have to pay $500 a month in premiums (let's just call it at $10k a year) and have a $10k deductible before the insurance starts acting like insurance? What a great deal! The free market showed that someone like OP could get the same crummy plan for $50 or so a month before they were disallowed.     

Sorry, even if the current model helps keep grandma alive so she can make you fresh-baked cookies, it is a scam :) 


TheDudeReturns

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #73 on: November 06, 2015, 02:31:37 PM »
For whomever mentioned single payer... Medicare and Medicaid are single payer. Guess who actually does the work? The private insurance companies. The VA doesn't use private insurance companies. I know I've been out of touch, but I have heard about major scandals at the VA.

I don't understand the point here. Medicare does have some contracting with private insurers (Parts C and D). But Parts A and B are administered by Medicare. People love A and B. And the VA is a very different system. It's not even insurance--it just provides certain kinds of care to certain people who qualify.
Yes. this is what I was trying to say. The Medicare/Medicaid system is in place and for the most part works. At lease if we went that route the rates for services would be already negotiated and would be consistent regardless of where you went for care. And much of the extra expense created by the insurance giants could go to actually providing care. I know that the single payor module isn't perfect either, but it's better than what we've got. And the ACA unfortunately is not sustainable as it's currently written.

Forcing Medicaid on people is the absolute worst part of this ACA thing. Go online and read numerous posts from people who are willing to pay the $50-$100 monthly for insurance (which is more than what they would be paying anyway if their income was just $1k more and were getting the tax credits), but are unable to pay the $400-$500 a month for the plan without tax credits. That without a doubt is the dumbest part of this whole thing. At a certain income range, the silver plans have only a $500-$1000 deductible like a lot of the employer plans, so to turn away people willing to pay is the height of idiocy.

...Total shitshow...

Read this. Insurance companies are like evil genies.

Looks like this dude is also actually looking at the pricing info. Medicine does not need to cost that much. Why can you have medical tourism to a 5 star resort with the most doctors in the world for $10k when the same procedure in the states would be $50k-$100k or more? Why is it that doctors can close their current practice and more to "cash only" and still make a profit?

 


bryan

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #74 on: November 06, 2015, 02:39:23 PM »
I'm a healthy 27yo male. for me, health insurance is absolutely, obviously not worth it. the same coverage from a couple of years ago is now more than double the price. the health insurance company is literally showing me it's not worth it for me based on their previous business/cost/risk models of making money on me at the previous premium.

but I still have health insurance because 1) employer pays like 90% of the premium (and would not offer me that money after tax in lieu of insurance) 2) if I didn't have insurance, there is a 1% income penalty (and with my current income, it's worth it to pay the higher price)

sorry guys, insurance companies in the USA are still for profit and are assumingly the best at figuring out how to make a profit off of each of their holders, within the law (careful if breaking the law and getting caught is anyway cheaper for them, let alone considering the probability they get caught/punished)

Sailor Sam

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #75 on: November 06, 2015, 03:16:42 PM »
Debates over the the ACA always seem to boil down to emotions, mostly where each debater feel the greater justice lies. I agree with the folks who say ACA costs too much, especially for the young and healthy like the OP. I concede that you are absolutely correct, and you have a true reason to be righteously pissed off. I don't think anyone decrying the costs is an uncaring monster, you're just reacting to different emotional triggers than I am. Because for me, the injustices allowed in the pre-ACA days were so rampant and so disgusting that they bordered on true evil. So I'm for the ACA's abolishment of pre-existing conditions and lifetime caps.

OP, I'd recommend getting insurance. It costs a lot, and that blows hairy monkey balls. But as many have pointed out, you're healthy until you aren't. Happened to me. Might happen to you. If it helps, everytime that charge hit's your bank account, think of a cancer patient surviving.

kite

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #76 on: November 06, 2015, 04:52:11 PM »
You are preaching to the choir.  I can't tell you how many times I've used a similar analogy about car maintenance (I always ask people if their auto insurance covers oil changes).  Why health insurance should pay for a regular doctor's visit is beyond me.

Because people don't pay up front for preventive care (for either our bodies or our cars).  As a culture, we're OK with telling people, "Sorry, your car won't run anymore, too bad, you should have changed the oil," and not providing charitable help but not, e.g. (true example based on a family member), "Sorry you have stage 4 cancer, too bad, you should have gotten the recommended mammograms," and not providing charitable help.  Personally, I'm comfortable with that; as others have pointed out, losing a car is one thing, losing your body/life another, but like it or not, that's the reason (IMO) for what you describe.
We're just going to have to agree to disagree.  I feel that health insurance should be for really terrible and expensive things...like a torn ACL or cancer.  I'd gladly pay the bill for my yearly physical or eye exam to keep my insurance costs down.

You can buy such a plan.  I have a high deductible plan for just that reason.  It's cheaper than the low copay office visit kind of plan.
It's bloody stupid that they jack the rates on everyone but dangle the free birth control carrot so no one notices the sleight of hand.  But people (for and against) are idiots and we can do little about it. 

mulescent

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #77 on: November 07, 2015, 03:58:38 PM »
I haven't had health insurance up until this point. It's became even more unaffordable since Obamacare. I can technically afford it, I'm just hesitant about paying as much as even the basic catastrophic plan is.

My cheapest option as a 25 y/o non-smoker/drinker with no subsidy is $180/mo. This is with a $6,850 deductible/max out of year cost. That just seems silly. What are others similar in age/no subsidy seeing? I'm assuming the same, but man...

I'll strongly agree with everyone suggesting you get insurance.  Unless you are wealthy, you can't self insure against even one accident or small and very common health problem (e.g. appendicitis).  Something like cancer or a serious injury would wipe out even a massive stache.  Plus, if you are insured you'll use the preventative care the insurance affords you.  That increases the chances that you'll be healthy later in life.

To all those making arguments about insurance/the ACA pushing the costs of sick/old people onto young and healthy ones, I want to suggest an alternate way of looking at things.  OP is going to get old, sick and die just like everyone else.  By buying insurance now he is supporting the system that will take care of him when he is in need.  To me, that perspective is much easier to swallow than "this is a tax on me to support someone else."

dramaman

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #78 on: November 08, 2015, 06:41:03 PM »
To all those making arguments about insurance/the ACA pushing the costs of sick/old people onto young and healthy ones, I want to suggest an alternate way of looking at things.  OP is going to get old, sick and die just like everyone else.  By buying insurance now he is supporting the system that will take care of him when he is in need.  To me, that perspective is much easier to swallow than "this is a tax on me to support someone else."

Exactly. Young people feel like they are immortal, but you can't stay 25 and healthy forever, the healthcare piper will come calling, sooner or later.

bryan

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #79 on: November 09, 2015, 01:11:19 PM »
To all those making arguments about insurance/the ACA pushing the costs of sick/old people onto young and healthy ones, I want to suggest an alternate way of looking at things.  OP is going to get old, sick and die just like everyone else.  By buying insurance now he is supporting the system that will take care of him when he is in need.  To me, that perspective is much easier to swallow than "this is a tax on me to support someone else."

Exactly. Young people feel like they are immortal, but you can't stay 25 and healthy forever, the healthcare piper will come calling, sooner or later.

so it's not really insurance then...

TheDudeReturns

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #80 on: November 09, 2015, 05:48:19 PM »
To all those making arguments about insurance/the ACA pushing the costs of sick/old people onto young and healthy ones, I want to suggest an alternate way of looking at things.  OP is going to get old, sick and die just like everyone else.  By buying insurance now he is supporting the system that will take care of him when he is in need.  To me, that perspective is much easier to swallow than "this is a tax on me to support someone else."

Exactly. Young people feel like they are immortal, but you can't stay 25 and healthy forever, the healthcare piper will come calling, sooner or later.

so it's not really insurance then...

Bingo.

protostache

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #81 on: November 09, 2015, 06:20:34 PM »
To all those making arguments about insurance/the ACA pushing the costs of sick/old people onto young and healthy ones, I want to suggest an alternate way of looking at things.  OP is going to get old, sick and die just like everyone else.  By buying insurance now he is supporting the system that will take care of him when he is in need.  To me, that perspective is much easier to swallow than "this is a tax on me to support someone else."

Exactly. Young people feel like they are immortal, but you can't stay 25 and healthy forever, the healthcare piper will come calling, sooner or later.

so it's not really insurance then...

Bingo.

Health insurance in the US seems to (by necessity?) conflate two things. First, you have a what amounts to a stop-loss policy, which is definitely related to traditional ideas of insurance. You pay a regular amount as a premium, and in exchange your losses are capped at a certain amount. Second, bundled with the stop-loss premium are several cost sharing and discount plans. This is where your co-pays and co-insurance come in, along with things like vision hardware discounts and prescription co-pays.

So yes, it really is insurance in the traditional sense, but because of the way the plans are structured the insurance part can be somewhat hidden.

Axecleaver

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #82 on: November 10, 2015, 08:46:52 AM »
Just found some numbers on the cost for covering uninsured people. It's shockingly low: only 1.6% of your insurance premium goes to pay for the uninsured. Details here: http://theincidentaleconomist.com/wordpress/no-that-recent-nber-paper-does-not-say-theres-massive-cost-shifting/

TexasRunner

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Health insurance...To buy or not to buy. (Old Thread).
« Reply #83 on: January 14, 2019, 01:23:16 PM »
...
And as to the cost discussions, nobody seems to know what they're talking about.  Most healthcare spending is coming from CMS.  Old people use the most healthcare and almost all of them are on Medicare.  CMS sets the price they are willing to pay at some percentage, less than 100%, of what the provider charges on average to non CMS customers.  So, just to stay open for business, the providers have to jack up their prices so the CMS payout comes closer to being what they really need to charge.  The lowest price you'll get, therefore, is not the insurance price.  It's the cash price from a smaller facility that doesn't mind recording your "cash" price as a far higher invoice that was only partially paid.  It's fraud yes, but the CMS payout rate has gone as low as 68% of average.  Can you imagine?  If it's a choice between starving to death and breaking the glass, it's right to break the glass.  The consequence is the "spiraling costs of care" fake problem you think is happening.

Total shitshow.

Reviving this thread as I have gone back and done calcs on my insurance.

We decided to forego insurance in mid-2017 and haven't looked back.  Below is the breakdown of 6 years worth of 'life' on if we had been cash-only vs insured.  In 2013 and 2014, insurance (mostly) made mathematical sense.  In 2019 its a joke...

WHAT MOST PEOPLE DON'T PAY ATTENTION TO:

1)  The "Sticker Price" on healthcare is utter BS in order to make the insurance companies actually pay up.
2)  If you call ahead for "XX" procedure and state that you are paying in cashiers check, you will get insurance price or better.
3)  The hospital will let you extend the payments out over 12 months (or more) as long as you are making a reasonable payment.  I have found that even in an emergency, these payments could be less than monthly insurance premiums.
4)  This thing isn't getting 'fixed' until enough people opt out of the whole thing and pay cash.  It is nice to see more and more doctors going to a cash-based model.

Cross posted from here:
Post 2
Post 1


Good luck getting out of the hospital for $25k, though.

How much do you think cash payment would be for a 2-night stay with 3 X-rays and 1 MRI?  Back when we were on even better insurance, I paid $7,250 for that event in addition to the $8,400 paid in premiums throughout the year (that was early in the year, we cancelled insurance after that).  That was the only major medical event that year.  I had a long-time friend who worked in that hospital's billing department run through the numbers if we had agreed to pay in cash over 12 months.  Had there been no insurance in the equation, she would have been able to do 12 payments of $1629.00 without even getting supervisor's approval, lower with permission.  Considering that (and basically all other hospital stays for young people) is a statistical outlier, and we paid for 5 years of insurance with no major incidents other than that one, we come out WAY behind by having insurance.

People get sticker shock when they see a 84k bill for a hospital stay, but its artificially inflated pricing to get the numbers high enough to still turn a profit after the insurance companies pay out 1/3rd of that.  People can (and regularly do) get pricing at the same levels as the insurance companies, especially if you call ahead for agreed amount and pay in cash. 



FWI- I have done the math on his before.  Until the medical market and insurance markets get fixed, my family won't be doing insurance at all.


Insurance Breakdown

2013 - $1768 Principle (YAY!) - $950 Deductible Per Person - $3500 Deductible Total - 25% copays beyond
2014 - $2178 Principle (Eh...) - $1100 Deductible Per Person - $4500 Deductible Total - 30% copays beyond
2015 - $3248 Principle (Boo.) - $1100 Deductible Per Person - $4500 Deductible Total - 30% copays beyond
2016 - $4504 Principle (Yuck) - $2500 Deductible Per Person - $4500 Deductible Total (May have been 5k here, but unsure so I'm going with the lower number). - 30% copays beyond
2017 - $8376 Principle (Ugh.) - $5000 Deductible Per Person - $5000 Deductible Total (NOTE:  We didn't pay this.  This is the year we said FU to the medical insurance industry) - 30% copays beyond
2018 - $10380 Principle (....) - $5000 Deductible Per Person - $5000 Deductible Total then copay.  (Note:  Again, we aren't paying.) - 33% copays beyond

Medical Spending had it been cash totals:
2013 - 1 ER visit - 4 doctors visits - 0 Hosp stays - Cash cost would have been about $420 to $720.
2014 - 1 ER visit - 5 doctors visits - 0 Hosp stays - Cash cost would have been about $665 to $965.  ER was X-rays for broken collarbone.  Total cost without insurance would have been $380 as it was quick and there was no cast.  "Sticker price" was around $1200 but could have been drastically reduced per friend.
2015 - 0 ER visits - 5 doctors visits - 1 Hosp stays - Cash cost would have been about $225.  PLUS OBGYN and birth costs would have been $9500 pre-agreed (we considered it).
2016 - 0 ER visits - 6 doctors visits - 0 Hosp stays - Cash cost would have been $270.
2017 - 1 ER visit but rolled into a hospital stay - 8 doctors visits - 1 Hosp stay -  Cash cost would have been $19,550 for the hospital, MRIs and CAT scan.  Doctors visits were higher due to specialty.  $225 plus $495.  $20270 cash cost for the whole year.
2018 - 0 ER visits - 4 doctors visits - 0 Hosp stays - Cash costs (have) been $180.

Medical spending WITH insurance...
2013 - $1768 + 4x$30 (Dr Copay) = $1888.00
2014 - $2178 + $75(EM Copay) + 5x$30 (Dr Copay) + $450 x 25% procedural copay (ER XRay Copay) = $2515.50
2015 - $3248 + 5x$30 (Dr Copay) + 14x$45 (OBGYN Copay with ins) + 4500 x 30% (Birth procedural copay) = $5378.00
2016 - $4504 + 6x$30 (Dr Copay) = $4684.00
2017 - $8376 + 5x$30 (Dr Copay) + 3x$45 (Specialist Copay) + $5000 max deductible + $7500 x 30% copay beyond deductible = $15911.00
2018 - $10380 + 4x$30 (Dr Copay) = $10500.00


So a true comparison of all costs in on an insurance plans vs cash pay comes out as follows:

2013 - $1888.00 on insurance vs $720.00 (worst case)
2014 - $2515.50 on insurance vs $965.00 (worst case)
2015 - $5378.00 on insurance vs $9725.00 (includes birth costs in both)
2016 - $4684.00 on insurance vs $270.00
2017 - $15911.00 on insurance vs $20270.00 (worst case)
2018 - $10500.00 on insurance vs $180.00

2013 - Cash wins by $1168.00 (though, if anything had happened, 2013 insurance was MUCH better than now). (This includes an ER visit)
2014 - Cash wins by $1150.00 (This includes a broken collarbone ER visit...)
2015 - Insurance wins by $4347.00 (Due to childbirth being expensive... lol)
2016 - Cash wins by $4414.00
2017 - Insurance wins by 4359.00 (NOTE:  This includes an extremely expensive 2 night, CAT scan and MRIs hospital stay.  A "worst of the worst" by medical cost standards aside from something like cancer, and insurance still only wins out by 5k or so.  That should be VERY telling to people.  After this fiasco I started running the numbers and we killed off the insurance bill.  We paid a fee for it but it still came out ahead.)
2018 - Cash wins by $10320.00  (Note:  nothing happened to make insurance worth it.  Some people might claim that if we had insurance in 2018 that we might have made different choices but we really wouldn't.  We used regular kiddo's doctor when they got sick.  We wouldn't have gone to the ER either way, because thats expensive and wasteful.  Overall, I'm VERY glad we turned off the insurance leech...)








Overall, Cash would have won out by $8,746.00 but once you account for (just a few years) worth of compounding, you would have ended up with $9,734.50 more.  As such, we have been taking the exact same payment we would have made towards insurance and have been putting into investment accounts (IRAs and 401k mixed).  If anything happens, we will negotiate out with the hospital to make 12 (or however many) payments to pay off the bill.  As such, we could cash-roll the payments instead of paying insurance.  The only way we lose out is if we have multiple statistically rare events in the same year. 

Math doesn't work out in favor of that happening either...  If something has a 1:40,000 chance of happening.  The likelihood of that happening more than once is astronomically small (IE [1/40000]^2 or 1/1.6bil.  It may be more likely for one 'major event' to lead to extremely high costs (like early onset cancer, heart attack in your 20s, etc), but that is the whole point of insurance...  Insure against "reasonable" but unlikely events.  As is, reasonable events would cost almost the same paying cash as paying insurance while still being extremely unlikely.  So it doesn't make sense to buy insurance...

Note:  2018 isn't an outlier.  Considering that is the "new price to play the game", had the premiums been similar for 2016 and 2014, you would have seen numbers that were just as drastic.  That would be 30k in savings instead of just 8k...


It is the same as if I were to buy homeowners insurance to cover 165k house plus 45k of valuables.  BUT if there were a fire, I would have to pay 50k in deductibles and copays and the premium is 35k a year...  NO ONE WOULD PAY THAT.  Why on earth do we pay it (and allow the merry-go-round to keep spinning) when it comes to healthcare...?

/off-soapbox.

I'm a red panda

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #84 on: January 14, 2019, 01:30:50 PM »
Insurance of any kind is a bet against yourself.

It's very surprising so many Mustachains don't get this. We agree it's silly to carry excess insurance on a car, house, whatever. Medical insurance? well, gotta have that! why the inconsistancy, mustachios? You have been brainwashed by salesmen and are unworthy of your handlebar.

Young, healthy - consider going without, or with just true 'disaster' insurance (i.e. 25k deductible) if such a plan is available.

Why do I bet against myself? Because humans are extremely breakable, and not very replaceable.

I was an extremely healthy 17 year old when I broke my neck and had the bone hit my spinal cord.  If I did not have the health insurance I did, I would have been stabilized by the ER, and probably would still be alive, though the injury was life threatening, but I would likely have not been able to afford the rehab that allowed me to walk again.

In less drastic problems: I was 7 when I broke my wrist and elbow, 10 when I developed tendinitis in my ankles, I was 19 when I broke my ankle, I was 24 when I developed severe patellar tendinitis, I was 26 when I developed severe bursitis in my hips, I was 28 when I started having rotator cuff issues.  I was 31 (?) when I broke a different bone in my neck (extremely minor, nothing like the first time and unrelated) in a car accident- yes, the other person paid, but I had all the upfront costs through my insurance. Can everyone front $50k while waiting on reimbursement?

Whereas my car doesn't cost much money- less than my health insurance deductible. I can get a new one really quickly. I have liability coverage, but not collision.
Totaling myself would cost millions; totaling my car is a $5-10k loss.



beltim

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Re: Health insurance...To buy or not to buy. (Old Thread).
« Reply #85 on: January 22, 2019, 03:53:19 AM »
The only way we lose out is if we have multiple statistically rare events in the same year. 

Math doesn't work out in favor of that happening either...  If something has a 1:40,000 chance of happening.  The likelihood of that happening more than once is astronomically small (IE [1/40000]^2 or 1/1.6bil.  It may be more likely for one 'major event' to lead to extremely high costs (like early onset cancer, heart attack in your 20s, etc), but that is the whole point of insurance...  Insure against "reasonable" but unlikely events.  As is, reasonable events would cost almost the same paying cash as paying insurance while still being extremely unlikely.  So it doesn't make sense to buy insurance...

It depends on what you consider "statistically rare" but your 1:40,000 is crazy.  As I mentioned in this thread years ago, even in your age group the chance of you requiring hospitalization in any given year is 1:20.  The chance of cancer alone is 1:200 in a given year.  These can be very expensive, and you're not covered at all for expensive treatments.  On average, of course not paying for insurance is cheaper - the average difference is the costs of the insurance company.  The real question is what is the chance that you have a very expensive treatment that affects other aspect of your life.  And that's something you're not addressing at all.

frugaldrummer

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #86 on: January 22, 2019, 08:14:37 AM »
It's a fallacy often seen here on these boards that if you lead a healthy lifestyle you can go without insurance.  I know we all want to believe we can ward off catastrophe but many health issues are not preventable.
Just a short list of things that might cause a healthy 20-something to end up in the hospital (all of which I've seen):
ICU stay for rolling over an ATV or bicycle accident, or a vibrio infection from bad seafood causing acute respiratory failure, or a bad strain of influenza, or meningococcal meningitis, ruptured brain aneurysm

Hospitalization for Acute appendicitis, pneumonia, leukemia, testicular cancer, lymphoma

Expensive treatment for autoimmune disorders like Graves' disease, psoriasis, rheumatoid arthritis, crohns disease, ulcerative colitis.

A young man of thirty that I know of is in a vegetative state in the hospital right now due to a hemorrhagic stroke



mountain mustache

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #87 on: January 22, 2019, 08:47:11 AM »
I think ACA is ridiculous, but I still pay (a lot) for health insurance. The most ridiculous thing is...I don't want to get a raise at work, because then my health insurance goes up. Every time I've gotten a raise in the past 3 years, it has been almost negated by the increased cost of health care. Of course, if I don't like it, I need to find a job that offers health care.

Anyway, I'm 28, healthy and super active by most standards, but last year I had a year of hell. Orthopedic injuries and other weird symptoms with no answers, which meant lots of tests, MRIs, and eventually two surgeries. I paid $300 a month for health care (that's after a substantial tax credit) that allowed me to see the best Ortho docs in the country. My bills by Dec 2018 totaled up to close to $200,000. 3 regular MRIs, 2 MRIs with dye injection, 1 heart Echo, 10+ full blood testing, at least 15 X-Rays, 2 steroid injections, 1 back surgery (outpatient), and 1 hip surgery (24 hour inpatient). Plus the countless PT sessions, regular Dr visits, etc...I paid $7000 for all of that. I consider it to be a pretty good deal...even though, $7k out of pocket max is pretty ridiculous when you are already paying $300 a month for insurance. But there is no way I could have paid cash prices for that entire list of procedures. I probably would have just done without, and I'd still be laying on my couch in constant and excruciating pain, depressed because my active life was taken away from me, and having no way out. So yeah, as much as it sucks to pay for health insurance, I don't think you can put a price on your health and well being.

jim555

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #88 on: January 22, 2019, 02:28:01 PM »
The ACA has "Catastrophic" policies for those under 30.  It might be cheaper than a Bronze plan.

dustinseth

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #89 on: January 22, 2019, 03:15:31 PM »
There are more and more direct primary care facilities popping up, like Surgery Center of Oklahoma, and AtlasMD in Kansas. This is the direction medical care should move it. They don't accept insurance, so prices are often reduced by like 90%+. Healthcare is so over-regulated that the prices do not reflect the real cost of the good/service.

TexasRunner

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #90 on: January 22, 2019, 04:08:56 PM »
The ACA has "Catastrophic" policies for those under 30.  It might be cheaper than a Bronze plan.

Yup.  Just looked it up on the marketplace.  $3387.48 a year premiums, $7,900 deductible, 20$ at primary doctor, full cost at all others.  Also have to screw with in-network vs out-of-network.

This version for the whole family of five?  $7,705.80 a year premiums, $15,800 deductible, Emergency room care: $950 Copayment with deductible/50% Coinsurance after deductible, Generic drugs: $15, Primary doctor: $40/50% Coinsurance after deductible, Specialist doctor: 50% Coinsurance after deductible.  Again with "In-Network" BS that they can't tell you ahead of time whether they will be or not. 

As posted upthread, the chance of you requiring hospitalization in any given year is 1:20...  Based on actual results, a real hospital visit with negotiated rates would run about 25k for a run of the mill hospitalization.  That puts the cost of insurance should be roughly < 1 / 20> times < $25,000 >, or $1,250.  The chances of cancer are 1:200 (as stated upthread, but probably much less for those under 30) so the cost of insurance should be roughly < 1 / 200 > times < 600,000 >, or $3,000.  However, I think the 1:200 number is way off.


Note about cancer statistics.  Between 20 and 39, about 60,000 people are diagnosed annually.  (Source).  The population for that age range in the US is about 88.7 million.  (Source).
That puts the likelyhood of cancer for 20-39 age range to be about 1:1478...  This is WAY lower than 1:200.  As such, it would change the true cost of insuring against cancer to be $405 annually for a 600k cancer treatment (true cost). 

It seems everyone here "for" insurance is accepting the sticker shock of "this treatment would have cost $85,000 Cold Hard Cash! if you didn't have insurance!!1!".  That's just not true, as regularly shown by health-sharing ministries (no comment on them, but they do prove that negotiating down is possible), and shown by pretty much anyone who has done it.

As mustachians, surely there is some point at which you guys would forgo insurance due to cost?  What if it was 20k a year?  What about 100k?  What about your entire 'stach annually?...
There is a mathmatical line.  Emotional arguments about "you need health insurance" is doing everyone a disfavor because the market won't self correct unless people get out.  That is largely what my generation has decided to do, and the marketplaces are tanking because of it.  (Surprise!  We don't want to pay more to subsidize older, costlier people.  Who'da thunk it?).

I'm all for solutions, but blindly accepting $10,380.00 each year through employer insurance or $12,699.72 through the marketplace for insurance is not always the right decision.

nedwin

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #91 on: January 23, 2019, 11:50:12 AM »
@TexasRunner, I understand your frustration and thought process, although we have come to a different conclusion.  Saving $8,700 over 6 years by foregoing health insurance just doesn't seem worth the risk to us.  You could have achieved the same result by cutting $120/month from other areas of your budget.

I'm no insurance actuary, but my understanding is that the premiums are driven by the pool (young and old, healthy and sick), not by the individual or a group with very similar characteristics.  I think state policies have a tremendous impact on premiums on the marketplace.  Texas probably takes a more libertarian approach to insurance regulation, where other states are more progressive, and those approaches result in different outcomes.  Texas has the highest number of uninsured people in the nation, which surely has an impact on premiums. 

I readily admit that my family's health insurance choices are much better than average.  Health insurance for my family of 4 through my wife's employer (large healthcare system) is something like $4,500/year in premiums with $250/$750 deductibles individual/family.  There is even a free option with an HSA.

This year my wife was one of the 1:1,478 20-39 y.o. with a cancer diagnosis.  The bill from the hospital alone was $130k, insurance paid $98k.  I believe insurance has paid around $150k or more, so far, with final reconstruction surgery scheduled for June.  In theory we could have negotiated the same or better if paying in cash, and my family could have paid this out of pocket by tapping home equity, retirement, savings, and income, but it would have been a very heavy burden and set us back in terms of savings by 5 years or more.  My son has also been hospitalized for enterovirus in 2014, ear tubes, tonsils removed, and a broken collar bone.  Given my family's history, foregoing health insurance would be foolish.

mm1970

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #92 on: January 23, 2019, 01:05:17 PM »
I think ACA is ridiculous, but I still pay (a lot) for health insurance. The most ridiculous thing is...I don't want to get a raise at work, because then my health insurance goes up. Every time I've gotten a raise in the past 3 years, it has been almost negated by the increased cost of health care. Of course, if I don't like it, I need to find a job that offers health care.

Anyway, I'm 28, healthy and super active by most standards, but last year I had a year of hell. Orthopedic injuries and other weird symptoms with no answers, which meant lots of tests, MRIs, and eventually two surgeries. I paid $300 a month for health care (that's after a substantial tax credit) that allowed me to see the best Ortho docs in the country. My bills by Dec 2018 totaled up to close to $200,000. 3 regular MRIs, 2 MRIs with dye injection, 1 heart Echo, 10+ full blood testing, at least 15 X-Rays, 2 steroid injections, 1 back surgery (outpatient), and 1 hip surgery (24 hour inpatient). Plus the countless PT sessions, regular Dr visits, etc...I paid $7000 for all of that. I consider it to be a pretty good deal...even though, $7k out of pocket max is pretty ridiculous when you are already paying $300 a month for insurance. But there is no way I could have paid cash prices for that entire list of procedures. I probably would have just done without, and I'd still be laying on my couch in constant and excruciating pain, depressed because my active life was taken away from me, and having no way out. So yeah, as much as it sucks to pay for health insurance, I don't think you can put a price on your health and well being.
$10,600 is a bargain compared to $200,000

mountain mustache

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #93 on: January 23, 2019, 01:56:24 PM »
I think ACA is ridiculous, but I still pay (a lot) for health insurance. The most ridiculous thing is...I don't want to get a raise at work, because then my health insurance goes up. Every time I've gotten a raise in the past 3 years, it has been almost negated by the increased cost of health care. Of course, if I don't like it, I need to find a job that offers health care.

Anyway, I'm 28, healthy and super active by most standards, but last year I had a year of hell. Orthopedic injuries and other weird symptoms with no answers, which meant lots of tests, MRIs, and eventually two surgeries. I paid $300 a month for health care (that's after a substantial tax credit) that allowed me to see the best Ortho docs in the country. My bills by Dec 2018 totaled up to close to $200,000. 3 regular MRIs, 2 MRIs with dye injection, 1 heart Echo, 10+ full blood testing, at least 15 X-Rays, 2 steroid injections, 1 back surgery (outpatient), and 1 hip surgery (24 hour inpatient). Plus the countless PT sessions, regular Dr visits, etc...I paid $7000 for all of that. I consider it to be a pretty good deal...even though, $7k out of pocket max is pretty ridiculous when you are already paying $300 a month for insurance. But there is no way I could have paid cash prices for that entire list of procedures. I probably would have just done without, and I'd still be laying on my couch in constant and excruciating pain, depressed because my active life was taken away from me, and having no way out. So yeah, as much as it sucks to pay for health insurance, I don't think you can put a price on your health and well being.
$10,600 is a bargain compared to $200,000

That's how I feel. I had two major surgeries, each at the tune of 50-75k, and I only paid $10k total for the year including insurance premiums. And the medical bills were on payment plans with no interest...totally worth it to me.

wenchsenior

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #94 on: January 23, 2019, 02:32:33 PM »
The problem with going without insurance is the tail end risk of the bell curve...in the days before preexisting conditions were covered, it was astronomically, life-destroyingly huge.  It's still really huge even now. 

When I think about our immediate family and social circle, almost no one has not dealt with huge medical bills at some point once they reached 40+.  A few lucky ones have skated by, but sooner or later most people get nailed with something.  Some of the resulting bills could no doubt have been managed by forgoing insurance and saving all that cash, but it's those tail-end bills that are just not doable for most people.  And leaving aside emergencies/accidents and heart disease/cancer, I've been thinking about all the autoimmune conditions that are increasing in all the western nations.  A big percentage of our immediate social circle/family deals with something autoimmune, and doctors don't even understand what causes autoimmune diseases, let alone how lifestyle choices might prevent them (or even if they could prevent them).  Most are manageable (though not necessarily cheaply).  But some cause disastrous quality of life impairment, or are fatal, without ruinously expensive treatment. One friend of ours was recently diagnosed with one such autoimmune condition where all the cheaper (not cheap, just cheaper) drug alternatives failed, and now he's on a chemo/biologic cocktail that costs more than he makes in a year (and he makes more than the median American household income).  There's hope that this will put the condition into remission and he can be weaned off it at some point in the future. But no guarantees, so he could be on it for the remainder of his life. Without it, he'll die. 


TexasRunner

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #95 on: January 23, 2019, 03:25:04 PM »
@TexasRunner, I understand your frustration and thought process, although we have come to a different conclusion.  Saving $8,700 over 6 years by foregoing health insurance just doesn't seem worth the risk to us.  You could have achieved the same result by cutting $120/month from other areas of your budget.

Note that I didn't say I went 6 years without health insurance, I said I dropped insurance mid 2017 and kept if off for 2018.

In the years before 2017, the costs were high and getting higher, but reasonable.  In 2018 we saved $10,320.00 by not having insurance.  If we were to have 2018's plan from 2013 through 2018, it would have been a savings of $30,870.00 without including compounding, including everything that did happen.

Had we chosen 2018's insurance plan for every year, we would have spent $10,380.00 each year in principle...  plus up to a $5000 deductible which would have been (under 2018's plan) $720 in 2013, $965 in 2014, $5000 in 2015, $270 in 2016, $5000 in 2017, and $180 in 2018...  In other words, we would have gained $4,725 insurance benefit in 2015 and $15,270 insurance benefit in 2017... BUT we would have spent $74,415.00 in premiums and deductibles to get there.  In other words, Having insurance would have cost us $54,420.00 MORE than the benefits we got out of it across a 6-year timeline.  Otherwise known as $9040.00 a year or $754.00 a month.

We had insurance up to mid-2017 and it was worth it...  But if the standard is 2018's plan moving forward (and back testing 2018's plan from 2013 forward), there is no way I consider it worth it.  And that is even with having a major hospitalization (which was very unlikely). 


TexasRunner

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #96 on: January 23, 2019, 03:30:11 PM »
I'm seriously wondering, how many people here would pay for the following homeowners insurance plan:

$1,000,000.00 Total Coverage

$45,000.00 Principle each year
$30,000.00 Deductible if something happens

Additional "Benefits"
-If your house burns down, we can get a guy to rebuild it for 1,000,000 whereas if you were to hire somebody it would cost 1,250,000
-If you need someone to mow your lawn, we can get that for $300 a month (you pay for it) while you would have to pay $450 a month yourself
-You can't go without insurance!!1!!!11! Think of the children!


That would be a total crap plan, and yet when it comes to healthcare we are all (apparently) willing to pay those same percentages?

I'm a red panda

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #97 on: January 23, 2019, 03:54:36 PM »
If something catastrophic happens to my house, I can move in with family or live in a car in the Walmart parking lot.

If something catastrophic happens to me, there isn't much I can do without medical insurance. I could go bankrupt, if I can even find a provider to care for me. Or I could die. That's also a good option.

CindyBS

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #98 on: January 23, 2019, 05:09:10 PM »
@TexasRunner, I understand your frustration and thought process, although we have come to a different conclusion.  Saving $8,700 over 6 years by foregoing health insurance just doesn't seem worth the risk to us.  You could have achieved the same result by cutting $120/month from other areas of your budget.

Note that I didn't say I went 6 years without health insurance, I said I dropped insurance mid 2017 and kept if off for 2018.

In the years before 2017, the costs were high and getting higher, but reasonable.  In 2018 we saved $10,320.00 by not having insurance.  If we were to have 2018's plan from 2013 through 2018, it would have been a savings of $30,870.00 without including compounding, including everything that did happen.

Had we chosen 2018's insurance plan for every year, we would have spent $10,380.00 each year in principle...  plus up to a $5000 deductible which would have been (under 2018's plan) $720 in 2013, $965 in 2014, $5000 in 2015, $270 in 2016, $5000 in 2017, and $180 in 2018...  In other words, we would have gained $4,725 insurance benefit in 2015 and $15,270 insurance benefit in 2017... BUT we would have spent $74,415.00 in premiums and deductibles to get there.  In other words, Having insurance would have cost us $54,420.00 MORE than the benefits we got out of it across a 6-year timeline.  Otherwise known as $9040.00 a year or $754.00 a month.

We had insurance up to mid-2017 and it was worth it...  But if the standard is 2018's plan moving forward (and back testing 2018's plan from 2013 forward), there is no way I consider it worth it.  And that is even with having a major hospitalization (which was very unlikely).



Ooo, ooo, Now do your calculations with our expenses.  We had $2,500,000 of medical expenses in the last 2.5 years.  Our worst month (30 days worth) was $789,000.  That total would be negotiated down - so let's cut 1/3 off, for a total of $1,675,000 .  This is for a condition that was not a pre-exisiting condition for an otherwise perfectly healthy 13 year old. Our medical expenses for the year before my son got sick was about $300. 

Do the same spread sheet with $40,000 of chemo every month for years.  That is the cost before you see any doctor, stay one night in the hospital or even use a band aid.  One month my son had $156,000 of just pharmacy charges (mostly all chemo). 

Still want to skip insurance b/c it will save money in an emergency?  Yes, insurance is fucked.  Yes, the system is very screwed up.  Yes, these catastrophic expenses are rare. 



But even if lightning rarely strikes, that doesn't mean shit if you are the one on fire when it happens.   Everybody needs catastrophic health insurance. 

pbkmaine

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Re: Health insurance...ridiculous for 25 y/o non-smoker/drinker?
« Reply #99 on: January 23, 2019, 05:28:06 PM »
The purpose of any kind of insurance is to cover you for very expensive low probability events. It does this by spreading risk over many lives. Is it likely that you will NEED any kind of insurance in the next year? No. But if you do need it, not having it just might wipe you out financially.