Author Topic: FIRE, but ALREADY sick (prior to)...  (Read 10947 times)

lordrtype1

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FIRE, but ALREADY sick (prior to)...
« on: April 04, 2014, 05:02:49 AM »
I will say this to start: I welcome everyone to comment, since the concensus can help form a sound course of action.  However, realize that by commenting on this matter when you do not have serious health concerns, or present day major health expenses (or potentially expensive, should present healthcare options disappear) is like a 10 year old explaining the best defensive driving techniques in a given situation, to a group of experienced Formula One drivers.  You will be seen for your wisdom, or ignorance, very quickly, whether it is acknowledged by the parties (us sick folk) you speak to or not.

I have, what I think, are serious health issues, and I've tried coping with them without insurance, when I wasn't working.  I haven't looked into ACA, since I'm working now, so I can't say how my health would affect the current insurance cost, but I can't tell you that prior to, I either wasn't going to be able to get it at all (even high deductible-I could still max out a 3500-4500 dollar deductible in a year, sometimes in 6-9 months), or it would be insanely high (one quote was 1200/month, not counting going to the doctor, prescriptions, etc.  Just the policy!!--And it was only slightly cheaper than NOT having insurance...).  I did read a MMM article about if you are afraid of getting sick what you could do, and I understand the reasoning, but I'm about 15 years past that 'if I get sick' point, with (hopefully) another 50+ years left of 'already being sick.'

Now I can work, and I do now.  I've even done construction work for years, as a way to stay a little better off (being more active).  But, while I wasn't working, I went to the hospital 4 times in 3 years.  Since I was for all purposes broke, I fell on the mercy of the hospital, since they had to at least keep me alive, and push me out once they did that. But I know a visit like that can run about 5k around here (2-4 days tops), when I did have insurance.

Here is my question:

1) If you are FIRE, how were you able to plan for your expenses (regular doctor visits, the odd hospital 'vacation, etc.), and did it work/would you add/subtract anything?

2) If you are nearing FIRE, what insurance options (if any) are you considering, and how does that affect your budget planning in FIRE (i.e., planning for the 'big one' vs. spreading the cost evenly vs. some other method)

3) If you are starting to plan for FIRE, what would you like to happen, to maybe help make this easier:  Is ACA putting you at ease on your FIRE planning? Is some rate of return on your investments helping to stay ahead of those projected healthcare costs? Are your expenses elsewhere low enough that having insurance won't slow you down? Is some diet/exercise/holistic approach you found minimizing the health needs you have?

You don't have to comment on what ailments you suffer (unless you want to), because I probably won't, only because my health issue is one that diet and exercise do help, but it will not go away even if I do everything recommended perfectly. I'm dependent on technology for the improvements I have today, even though technology is substantially more expensive than using a less effective and progressively more debilitating approach (for me, anyway), and I will have to update periodically (every 5-10 years, at a 4-5 figure expense, even WITH insurance!)

Thanks in advance.

MayDay

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #1 on: April 04, 2014, 06:30:14 AM »
We have health issues (200k bill for a surgery two years ago, so self insuring is not an option!)

We are counting on the ACA to give us access to affordable insurance. I know the definition of affordable varies wildly but having experienced paying cobra for a year at 1500 per month plus a 6 or 8k deductible, I would say ACA rates are pretty affordable! we will just assume in our budget that we will reach the OOP max every year. We are also maxing our HSA now in hopes of saving up some money in that (not working very well since we tend to spend it every year. Oh well.)

For reference if it is relevant to anyone, my h has heart issues, I have a cancer causing syndrome (no cancer yet but basically a 100% chance of getting it), and we have a special needs kid.

dcheesi

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #2 on: April 04, 2014, 06:46:18 AM »
I'm interested in this topic as well. My gf hates her job, but she  has a chronic health issue that pretty much requires insurance benefits, and this job/company is one of the few she's currently qualified for that provides that. I'm hoping that the ACA will work out, so that people like her have the flexibility to find other employment that's more suitable.

kkbmustang

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #3 on: April 04, 2014, 07:25:09 AM »
I have a chronic degenerative condition related to my spine such that sitting for more than 4-5 hours causes sharp, shooting pain down my back, butt and, at times, legs. I've had more surgeries than I can honestly count in the last two years and more coming up. I may never get better. I'm hopeful, but realistically, it's possible this is as good as it's gonna get.

I'm fortunate that I had long term disability at the time the first disc fracture occurred, so I'm at least getting 60% of my former income from the disability policy which will continue until I can either work full time (right now I work part time from home, from bed a lot of the time) or reach SS retirement age. However, in order to receive benefits, I have to work part time because if I earn above a certain amount, that offsets the LTD payment. If I don't at least work part time the LTD carrier rightfully can choose not pay on the policy. I have absolutely no objection to this requirement. Besides, I like the work that I'm doing for my clients. Had I not had long term disability coverage, we honestly would have been screwed. I am so incredibly thankful that I had this. Usually, I'm not a big fan of over-insuring, but GO GET DISABILITY INSURANCE IF YOU ARE YOUNG AND/OR NEED TO BE ABLE TO EARN AN INCOME. I had no indication that I would need it until I did. The injury was a complete surprise to me.

We've been taking advantage of COBRA because the rates/co-insurance/deductibles end up being less out of pocket than I can get on the Exchange, directly from the insurance providers, or from my husband's (small company) employer provided health plan. However, I've researched the policies and know that I can get a policy from my current insurance carrier, but I need to confirm that all of my surgeons/doctors will take it. None of the anesthesiologists here are on any network, so I know that we will reach the OOP max.

For us, our FIRE calculations have to include the assumption that we will reach the OOP, Out of network Max each year for me. It's good to know that we can't be denied coverage, but the coverage that is offered is IMO really expensive considering the OOP costs, not just the premiums. But I am a high user of medical services and have no reason to think that won't continue. I hit my OOP max on January 8th of this year. A new, unfortunate record.

Like others have said, I'm funding the HSA now, filing away receipts, and trying not to tap into it to pay for current medical bills. I think of it as our FIRE medical fund. And, to the extent we are entitled to SS in the future, I think of those benefits as the medical expense fund after we reach traditional retirement age.

oldtoyota

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #4 on: April 04, 2014, 07:37:45 AM »
I am replying because I want to hear what others say. I'm sorry you are in this position.

A friend of mine has to keep working due to a health issue--to get the insurance to deal with a health issue that has already cost more than $1MM and, like yours, will cost more in the future since the technology will likely need to be updated at some point.


MandyM

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #5 on: April 04, 2014, 08:17:30 AM »
My 2 cents on ACA: My sister has a chronic health issue that puts her on very expensive meds (+$6K/month w/o insurance) and on the road to an eventual lung transplant (she's 32 and a non-smoker FWIW). She is able to work and is currently employed, but she actually opts to buy her own insurance so she has better control of her insurance and isn't in fear of losing her job/insurance.

Her premiums this year (post-ACA) are HALF of what they were last year, for superior coverage. I think she is now in the $400/month range for premiums and just commented to me last weekend about how much she was paying out of pocket last year compared to this year.

Long story short, ACA will be a pretty big help to you, IMO.

Good luck to you - I know that it is hard enough to keep healthy, let alone deal with all the extra non-sense of insurance, paperwork, etc.

**Edited to correct improper use of the term self insure. Oops.
« Last Edit: April 04, 2014, 01:41:01 PM by MandyM »

Argyle

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #6 on: April 04, 2014, 08:25:52 AM »
I had understood "self insure" to mean "pay out of one's own savings" rather than "buy insurance directly rather than through an employer."    Maybe we should clarify terms because I'm not sure we're all talking about the same thing.

The ACA has certainly made a huge change in how I see ER.  Before it was impossible, as I have a chronic condition and support someone with a chronic condition.  I had already tried to get insurance on the open market and couldn't.  Now I am insurance through my employer, but supposedly I am now guaranteed insurance through ACA.  What worries me a bit is that a good proportion of the country reportedly loathes the idea of the ACA and wants to repeal it.  What happens if I FIRE and the ACA is repealed and my insurance option goes away?  I'm in a profession where getting a job is very hard, probably impossible for me.  Starting over in a new insurance-providing career at age 60 or so well, I don't know how doable that sounds.  It does worry me.

TrMama

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #7 on: April 04, 2014, 09:45:49 AM »
I think the first step is to look into ACA. Run the numbers on how much you need to FIRE that includes paying whatever your ACA premium will be.

If that doesn't work out, then start to worry. Right now you're worrying about what will happen while ignoring the most simple possible solution.

Mister Fancypants

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #8 on: April 04, 2014, 12:01:55 PM »
I had understood "self insure" to mean "pay out of one's own savings" rather than "buy insurance directly rather than through an employer."    Maybe we should clarify terms because I'm not sure we're all talking about the same thing.

To "self-insure" is to pay out of one's own savings, not. We are fortunate enough to have "Cadillac" employer health insurance, however over the last year we incurred a $115k+ medical expense that was not covered by our employer sponsored plan, so we self-insured, we paid out of pocket, we are in a position that we can afford to cover the unforeseen medical expenses.

I take advantage of the employer benefits offered to me, but never rely on them, especially when health it concerned, I will make sure I can afford whatever healthcare expenses I might incur insured or self-insured, that is part of my FIRE planning.

-Mister FancyPants

Thegoblinchief

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #9 on: April 04, 2014, 03:26:19 PM »
I fit in #3 category. Medical spending is a black hole in my budget, with just a placeholder number based on a few threads I've read here as well as some other ER blogs.

Currently we have access to an inexpensive, fairly comprehensive insurance through my DW. Her company does not do an HDHP with HSA, only FSA. Next year we will look into options now that some of the dust from ACA has settled.

Long-term, my plan is to use a HDHP with HSA. I will budget the full OOP max in my FIRE number, but hopefully we won't need that. We have had some chronic conditions in the past, but exercise on my part and a very long remission (lupus) on my wife's end has kept medical spending quite low. And luckily my kids are all healthy as well.

We have 10-15 years before FIRE, so a lot of time to adapt as the health market changes.

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #10 on: April 04, 2014, 05:45:45 PM »
I would guess from your user name that you are a type 1 diabetic?  If that is the case (or something similar) I can surely see that your medical expenses wil never really decrease, insulin is expensive!  I have a few diabetic friends, and one of them is beyond thrilled with the ACA and how it makes her meds affordable.  It is expensive yes, but before this there was a time when working as a temp without insurance offered that she was needing to spend more than half of her pay just on meds, crazy! 

tipster350

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #11 on: April 04, 2014, 09:35:00 PM »
I don't have a chronic illness, but I am planning my FIRE to include enough money to cover health-related expenses as if I will. I am in the biz and am acutely aware that one never knows when one will become ill and need a good stash of money to cover expenses. If I never need the money for healthcare I'll have a little more fun when I am old. I see a lot of underestimating on this site, with people thinking because they are young and healthy and take care of themselves, they will not need a lot of money for healthcare. A person's life and health can change in the blink of an eye despite all their best efforts. And it happens with enough frequency that planning for high healthcare costs is warranted.

I also see some very misguided thoughts about self insurance. Unless you are Bill Gates you cannot afford to self-insure your healthcare. One event can easily run into hundreds of thousands and even millions of dollars.

As many posters have mentioned, check the ACA plans. Assume you will pay out of pocket max every year. Assume you will pay a few thousand a year for technology, even if it's a high estimate. You don't want to be left with a compromised quality of life because you underestimated expenses and can't pay for the better options. I would assume at least a 5% increase in health insurance and healthcare costs per year. There is a cap on increases insurance companies can implement; however there is room for exceptions when insurance companies can explain why the increase is more.

frugalmom

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #12 on: April 04, 2014, 10:47:09 PM »
Timely topic

First my mother:  When I went off to college 20+ years ago she decided to take a hobby job (her words) at a local department store.  Fast forward a few years and my parents divorced, ending her access to spousal health insurance.  At this point she is 69 and still chooses to work 24 hours a week.  She does not now, nor never did need the money.  She works because her private insurance is better and CHEAPER than Medicare.  Every year we ask her if she will be quitting this year.  Each year she hears her friends complain of the problems getting quality doctors to see them on Medicare and has decided to keep working.  Now know, her choices are also driven by having had a breast cancer like diagnosis in her late 50's; but ultimately she knows her doctor choices are excellent with BCBS and dismal with Medicare.

Now me & my husband.  I am a medical disaster.  I had cancer and was successfully treated before I was 30 (try getting life insurance with that baggage).  I now have multiple chronic endocrinological issues.  They are all managed and I lead an excellent quality of life, but that could turn at any moment.  My husband is in better general health but has drug managed genetic high blood pressure.  Financially, we could be FI now if we wanted to live like church mice or within 5 years if we wanted to upgrade to just cheapskates.  Unfortunately due to our health issues (mostly mine) we will alway work, preferably for a large corporation who can bury my sucky health in a pool of healthy people.  Now we probably both won't always work.  Right now he works and I hang out with our 3 year old, but our REAL plan is to never give it all up because of the rising costs of healthcare. 

Also, I have looked at ACA.  I really think that in many ways the true policy rates are not being reflected in year one.  I am supremely curious what rates will look like at year 5 and 10; and the access people report.  Perhaps it will offer an option for walking away in the future. Unfortunately the discussions I've had with doctor friends are less than encouraging. 

As for now, we stay the course, bulk up the reserves, and hope to stay healthy forever.

EngineerMum

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #13 on: April 05, 2014, 12:08:41 AM »
I'm not saying this flippantly, but no one seems to have raised - maybe you could move? I have a chronic health problem (actually technically 3, but only one of them is really a problem, the haemochromatosis is so mild that it's fixed by being a lady, and sleep apnoea is fine while I have access to a CPAP, which I can replace when required by putting a way a few hundred per year at most). The third issue is far more serious, it took my doctors about 8 years to get me to a point they could call it remission, through trying every drug (generally requiring hospital to administer) and diet based treatment (I'm not talking - eat less meat or something, I'm talking -eat nothing but this medical supplement that costs $50 per day, see how that goes for a few months) they could access for me over that time. The meds I'm on now cost $800 per dose and I will likely require a dose a fortnight for the rest of my life. That's just when I'm well - if it flares in spite of medication I'll need specialist appointments, flaring medications, access to out newly developed treatments, and if it gets bad, major surgery and potentially expensive disposable equipment for the rest of my life.

Aside from the first specialist appointments that I went to a private clinic, I have paid, on average, around $50 a month for all my medication (remember that's been a value of $1600 per month for the last 7 years or so and double that for a few years prior on weekly doses, plus years of taking up to 35 tablets a day of various things, though that period was probably a lot cheaper than $50 / month). I see one of the best specialists in the country and pay $0, if I need hospitalisation I pay $0 per admission, if I need any new treatments, I'll pay a max of $25 per script and nothing ever for the hospital appointments. The bi-annual surgical investigations cost nothing.
I have private health insurance, but they have covered none of this, I have PHI for my DH in case he ever needs voluntary psych admission (family history suggests it's a possibility) and in case DD ever needs anything with a  waiting list. However, ALL of the above is paid for by medicare - the Australian version, which every permanent resident and citizen gets as part of the package. The NHS in England is even better - no out of pocket for anything ever.
The fact that you chose to live in the US makes this a risk for you, and you can choose to change that if you want to. It may be harder to move to a country with good public health if you are already needing the really expensive stuff rather than being a good contributing citizen at least at the start.

lordrtype1

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #14 on: April 07, 2014, 05:09:32 AM »
The insights provided are very helpful.  I would like to address a couple points brought up, just to clarify:

Quote
I'm not saying this flippantly, but no one seems to have raised - maybe you could move?

I wish this were an option.  I'm a US citizen by birth, so many of the benefits you speak of are not options, as far as moving, barring a countries' unconditional acceptance of my citizenship, and Australia is one of the worst for obtaining it.  England may be easier, but many countries with universal healthcare require you to pay in (thru taxes) for a time before you can get benefits. So at the very least, I would need to have a work visa to even get into most, and attain somthing like the US equivalent of permanent residency to secure benefits.  If I'm going to do that just to get insurance, I may as well stay in the US and work till normal retirement, and draw SS medicare, etc.  I'm not dismissing the benefits of these healthcare systems out of hand; you have to realize this endeavor requires an investment of my time, and confidence that it will achieve a result better than what's set before me at present.  I don't have that, mostly since I've never left the states, so I would need to take that step before even considering moving abroad.

Quote
Now me & my husband.  I am a medical disaster.  I had cancer and was successfully treated before I was 30 (try getting life insurance with that baggage).  I now have multiple chronic endocrinological issues.  They are all managed and I lead an excellent quality of life, but that could turn at any moment.  My husband is in better general health but has drug managed genetic high blood pressure.  Financially, we could be FI now if we wanted to live like church mice or within 5 years if we wanted to upgrade to just cheapskates.  Unfortunately due to our health issues (mostly mine) we will alway work, preferably for a large corporation who can bury my sucky health in a pool of healthy people.  Now we probably both won't always work.

I understand your feelings.  To be fair, I'll share my medical 'problems":

I was diagnosed Type I diabetic when I was 22.  I had the good circumstance of actually having a 'real' job at the time (fortune 100 company), with insurance so good, after going to the emergency room (sent there while on the clock) testing a 400+ Blood glucose, and after 2 weeks off work in the hospital (I recieved my regular pay while there), My part of an 12k bill was the 25 dollar emergency room copay.  If a doctor had sent me there, it would have been nothing.  That was nearly 20 years ago, and savings like that are grossly unrealistic, even with 'cadillac' insurance.  I don't expect that from having insurance, but given I have other issues beyond that (this is the fun one), I have the benefit of seeing what it would cost me without insurance, because my present insurer shows what I pay, and what they pay.  Insulin I always knew was expensive (about 600/mo wo ins.), but since I use a pump, the supply costs are actually MORE (about 1k/mo!). My part of that is like 60/mo with my insurance, but the issue is this: can I pretend to believe I can find insurance that will pay THAT much of my prescription costs!?!! it's like a 90/10 split at these amounts, in 90 day supply allotments!  Even if I fudge it with the supply costs (recycling--you didn't hear that from me!) I STILL have to buy them, and I can assure you, having a A1c of 7 isn't great, it's better than an A1c of 10.5 for the past 7 years, WITHOUT a pump. Insurers are unkind to cancer survivors; I know, I sold insurance riders for it.  But, they curse Type 1 Diabetics, simply because there aren't many, and the few there are recieve very poor care, if they don't have spectacular insurance, which leads to poor health and expensive complications.  Being FIRE won't help me, like actually being poor did with emergency room check ins if things go south one bad day, because of full disclosure of assets the hospitals around here require now (yay.) And, they could charge more if I don't have insurance (they could charge less-it's all a coinflip... makes long term planning fun!).  I'm trying not to exaggerate, but this has been my experience, and I've had a lot with hospitals recently.

Quote
I had understood "self insure" to mean "pay out of one's own savings" rather than "buy insurance directly rather than through an employer."    Maybe we should clarify terms because I'm not sure we're all talking about the same thing.

The ACA has certainly made a huge change in how I see ER.  Before it was impossible, as I have a chronic condition and support someone with a chronic condition.  I had already tried to get insurance on the open market and couldn't.  Now I am insurance through my employer, but supposedly I am now guaranteed insurance through ACA.  What worries me a bit is that a good proportion of the country reportedly loathes the idea of the ACA and wants to repeal it.  What happens if I FIRE and the ACA is repealed and my insurance option goes away?

Self insuring is actually an option, believe it or not, and depending on the resources I can commit, it could be the most realistic long term one.  When I was working in insurance, I learned that in the state I live in, I can actually set up a self funded policy pretty easy, and I can go a step further in having it managed by an insurer on my behalf, to take advantage of any discounts/dr networks they have.  Based on how I set it up, I may never actually have premiums; it would be self sustaining.

The issue is how much; 15 years ago, it took 500k-1MM to do a policy for one that required no premiums thereafter; the capital in the policy would accure at a rate high enough to cover medical expenses projected without depletion.  But, costs were less then, so I'm not certain if 1MM is enough now; for me, at least.  And, I'm not married, no kids, and I'd like to pretend this might be in my future yet.  And I wonder about if the insurance options could change, too, should there be a 'revision' to ACA.  I'm told SS and Medicare went thru the same, but I wasn't around to see, and I'm under the impression compromise was more prevalent in the past.

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Her premiums this year (post-ACA) are HALF of what they were last year, for superior coverage. I think she is now in the $400/month range for premiums and just commented to me last weekend about how much she was paying out of pocket last year compared to this year

Thanks for the numbers.  This is helpful for comparision.  My employer pays more than that, but I only pay about 70/mo for my part of my insurance, and I have the best policy they offer.  When I glanced at the exchanges, I couldn't find anything similar in 'gold' or 'platinum' to what I have (my insurance offers more than these), so I really don't know the exact comparision, and since I'm working, it's hard to get a number on healthcare.gov without revealing a lot more than I want to. And, I'm comparing the total cost, not just my part of the insurance cost with my employer.

Quote
We've been taking advantage of COBRA because the rates/co-insurance/deductibles end up being less out of pocket than I can get on the Exchange, directly from the insurance providers, or from my husband's (small company) employer provided health plan

I dealt with that when I left the employer that paid for my 2wk stay when I was diagnosed with Diabetes.  It was more than I could afford, they cut most of my benefits (just to make it that 'cheap'), and it would only last 24-36 months (I think-it's been a while), assuming I paid without missing (I did.  I was 40 percent of my unemployment! I had to choose between keeping my house, eating, and paying for insurance! I could only do 2 of 3!) Since this was around 9/11, it wasn't like it was raining jobs...

I saw this one late, but I felt I should add it...

Quote
I would guess from your user name that you are a type 1 diabetic?  If that is the case (or something similar) I can surely see that your medical expenses wil never really decrease, insulin is expensive!  I have a few diabetic friends, and one of them is beyond thrilled with the ACA and how it makes her meds affordable.  It is expensive yes, but before this there was a time when working as a temp without insurance offered that she was needing to spend more than half of her pay just on meds, crazy!

LOL! To think, I came up with that LONG before I was!!  Your deduction is correct, though actually circumstancial. It's actually a video game association; I'm sure some on this Forum are old enough to remember R-Type.  That's partially where it comes from.  There's more, but suffice to say, I wasn't a diabetic when I came up with it, and the 1 had only been there as a placeholder, but it's stuck there because I've not changed it in a while.
Please continue to comment!  Everyone has been very helpful!  I had not looked at this post in a while, and I'm glad so many feel like I do!  Many hands make the load light!
« Last Edit: April 07, 2014, 05:18:02 AM by lordrtype1 »

rubybeth

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #15 on: April 07, 2014, 09:48:36 AM »
I think you should actually look at some ACA plans to see what the options are, or call an insurance broker in your state and get some quotes for 2015, or look on www.ehealthinsurance.com and compare options. It always helps to have real numbers. The biggest thing to pay attention to is going to be that annual out of pocket max, because you'll likely easily reach the deductible and out of pocket max each year for life.

Full disclosure, I bought my own individual HDHP this year on my state's exchange (MNsure - Minnesota), and am age 32, paying $153/mo for a $2,750 deductible, and I think it's a $6,350 out of pocket max.

My sister has Type 1 diabetes, as well, and the ACA is a huge relief, just knowing that if she lost her job for some crazy reason, she could still be insured. She's also got an insulin pump (OmniPod) and it is crazy how expensive those things are.

For the person who suggested moving, maybe just moving states would save you some money? You could look for a place with a relatively low cost of living, access to good health care, and good insurance exchange options.

SweetLife

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #16 on: April 07, 2014, 12:14:54 PM »
Not sure if this would help or not ... it depends on where you are in the US.  There are ALOT of people that come across the border here to buy their insulin in Canada as they say it is substantially cheaper here... but again if you are far from a border it wouldn't necessarily help you (it would only require a prescription).

Good luck with everything...

Abe

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #17 on: April 07, 2014, 09:49:27 PM »
Insulin in the US is more expensive because of minor tweaks to the chemical structure that alters the delivery kinetics. They make these every few years in order to keep charging high prices. Generic companies would have difficulty getting FDA approval anyway they would have to engineer a strain of bacteria that didn't infringe on the current patents of the major manufacturers, then prove it is safe.  My father and his very famous endocrinologist (who was lead author on a number of important clinical trials) says a vial of insulin now costs 10x what it did 30 years ago (when it was made from pig pancreas!), with only minor improvements in patients' quality of life.

This is the kind of profits-before-health setup that was not addressed by the ACA. Unfortunately, it is one of the three major causes of our runaway costs (the others - also unaddressed - being people unwilling to ration incredibly expensive ICU care for terminal diseases and physicians getting too many tests because of mostly unfounded lawsuit fears).

My recommendation - figure out how to get insulin from Canada. When retired, flying up there every few months may be cheaper than our craziness down here.

lordrtype1

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #18 on: April 08, 2014, 01:29:07 AM »
Here are some nice comments I wanted to clarify, with regards my situation:

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For the person who suggested moving, maybe just moving states would save you some money? You could look for a place with a relatively low cost of living, access to good health care, and good insurance exchange options.


I'll address this one first.  cost of living wise, there are basically only a few places cheaper than where I am: the South (pick a city/state under 400k, and it'll be close), Houston (renting) and Austin, TX.  Having said that, with any move, I would also have to factor where all my friends and family are, and minimize travel.  Since 90% of them are in the town presently live in (some only 2 hours away, the rest a little further), I would spend all my savings on medical (and then some) just visiting my mother.  This doesn't take into account that my skills don't travel well.  I'd make SUBSTANTIALLLY LESS in my field if I moved to those areas, and have WORSE insurance.  I checked, when I wasn't working for a couple years.  And, moving to a larger city is actually less desirable to me, than remaining in my not so small town.  Sorry, not a realistic option.

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My recommendation - figure out how to get insulin from Canada. When retired, flying up there every few months may be cheaper than our craziness down here.

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Not sure if this would help or not ... it depends on where you are in the US.  There are ALOT of people that come across the border here to buy their insulin in Canada as they say it is substantially cheaper here... but again if you are far from a border it wouldn't necessarily help you (it would only require a prescription).



Canada is about 22 hours away by car (to the border-not a town), and at least 3 connections by plane. Even dismissing the plane hopping (it really doesn't matter how much the ticket is-I can get to the UK easier than Canada by plane.  It doesn't make sense to me, either), because you're talking about trying to take a weekend likely every 2-3months, spending (this is REALLY low!) 500 dollars on a round trip flight (i've rarely seen that on a domestic flight from this town, mind you!) to save, what, maybe 1k???  Take to heart, I'm in the Midwest.  Not the 'ohio' midwest; to me, everything east of St. Louis is 'back east.'  You look at a map, you're not going to see the city I live in, even though it is a Census MSA, like LA or NY.  So, flying is an adventure in itself here.

BTW-My doctor explained the differences with the insulin, between using the pig insulin and the stuff we have now, and it boiled down to the possibility of an allergic reaction, since a person can potentially be allergic to pork.  I asked the odds of the allergy, and it was like 3 million to 1. So, out of the number of insulin-taking diabetics in the US, this serves to protect about 6 people, assuming there are 30 million Diabetics in the US, and 10% are type 1, with a few Type 2 just for variety.  I didn't check ADA on this; this is meant as hyperbole.

I'm only commenting on this for me.  I don't want you to think I haven't considered these, or was ignoring it.  For me they may not work, but others I'm sure they are a valid an viable option.

Thegoblinchief

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #19 on: April 08, 2014, 06:11:44 AM »
Granted, I live considerably closer to Canada, but we have several pharmacies which import drugs from Canada, typically marketed to seniors.

I've never had to investigate this myself, but possibly the stuff could be shipped to you? Sounds like you've probably looked into it, but just in case I thought I'd share.

The one in my city is called "Canada Drug Service"

SweetLife

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #20 on: April 08, 2014, 07:04:19 AM »
Granted, I live considerably closer to Canada, but we have several pharmacies which import drugs from Canada, typically marketed to seniors.

I've never had to investigate this myself, but possibly the stuff could be shipped to you? Sounds like you've probably looked into it, but just in case I thought I'd share.

The one in my city is called "Canada Drug Service"

Wow ... I hadn't heard of this ... but goes to show that some things are pretty screwed up :(  if having drugs from another country delivered to you is cheaper than getting them in your own country ... sad...


rubybeth

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #21 on: April 08, 2014, 08:11:41 AM »
Here are some nice comments I wanted to clarify, with regards my situation:

Quote
For the person who suggested moving, maybe just moving states would save you some money? You could look for a place with a relatively low cost of living, access to good health care, and good insurance exchange options.


I'll address this one first.  cost of living wise, there are basically only a few places cheaper than where I am: the South (pick a city/state under 400k, and it'll be close), Houston (renting) and Austin, TX.  Having said that, with any move, I would also have to factor where all my friends and family are, and minimize travel.  Since 90% of them are in the town presently live in (some only 2 hours away, the rest a little further), I would spend all my savings on medical (and then some) just visiting my mother.  This doesn't take into account that my skills don't travel well.  I'd make SUBSTANTIALLLY LESS in my field if I moved to those areas, and have WORSE insurance.  I checked, when I wasn't working for a couple years.  And, moving to a larger city is actually less desirable to me, than remaining in my not so small town.  Sorry, not a realistic option.

Well, since you didn't state where you lived, I wasn't sure if it was a high COL area or what. Yes, this suggestion may not work for you due to other factors (husband and I both like being near family so it would take a lot to get us to move away from our area, as well, so I totally understand).

Since you are pretty well set on staying where you currently live, I'd contact insurance brokers in the area and find out what your actual out of pocket costs could be with one of your state's plans (or go on your state's exchange, as previously suggested). I was expecting my state's exchange to have at least one reasonably priced option, but I was really pleasantly surprised at the number of good options which were hundreds of dollars less than my employer's coverage. If you have great employer coverage now, but don't want to continue working until normal retirement age when Medicare kicks in, you'll have to find coverage elsewhere since self-insuring isn't a realistic option with diabetes.

lordrtype1

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Re: FIRE, but ALREADY sick (prior to)...
« Reply #22 on: April 09, 2014, 04:41:44 AM »
Quote
Quote from: lordrtype1 on April 08, 2014, 01:29:07 am
Quote
Here are some nice comments I wanted to clarify, with regards my situation:


Quote
For the person who suggested moving, maybe just moving states would save you some money? You could look for a place with a relatively low cost of living, access to good health care, and good insurance exchange options.


I'll address this one first.  cost of living wise, there are basically only a few places cheaper than where I am: the South (pick a city/state under 400k, and it'll be close), Houston (renting) and Austin, TX.  Having said that, with any move, I would also have to factor where all my friends and family are, and minimize travel.  Since 90% of them are in the town presently live in (some only 2 hours away, the rest a little further), I would spend all my savings on medical (and then some) just visiting my mother.  This doesn't take into account that my skills don't travel well.  I'd make SUBSTANTIALLLY LESS in my field if I moved to those areas, and have WORSE insurance.  I checked, when I wasn't working for a couple years.  And, moving to a larger city is actually less desirable to me, than remaining in my not so small town.  Sorry, not a realistic option.

Well, since you didn't state where you lived, I wasn't sure if it was a high COL area or what. Yes, this suggestion may not work for you due to other factors (husband and I both like being near family so it would take a lot to get us to move away from our area, as well, so I totally understand).

Since you are pretty well set on staying where you currently live, I'd contact insurance brokers in the area and find out what your actual out of pocket costs could be with one of your state's plans (or go on your state's exchange, as previously suggested). I was expecting my state's exchange to have at least one reasonably priced option, but I was really pleasantly surprised at the number of good options which were hundreds of dollars less than my employer's coverage. If you have great employer coverage now, but don't want to continue working until normal retirement age when Medicare kicks in, you'll have to find coverage elsewhere since self-insuring isn't a realistic option with diabetes.

I live in the middle of it all, lol. I'm equally far from all coasts and borders, and while I'm not particularly close to a 'major' metropolis (i.e. Chicago or Houston size), I prefer not to be.  I do plan to retire when I'm about 50, so not super early, but it's that late because in the past I would get a decent job, start saving, lose the job and use the savings to keep from starving till the next job. I've changed career fields about 7 times in the last 20 years (food service, retail sales, auto sales, customer service (phone and in person), insurance, and skilled construction trades, to name a few) just to try to keep working, so it's not for a lack of trying I try to save money.

I was mostly curious about ACA, that's all.  To be fair, I won't be serious about ACA till I have to, and that won't be anytime soon.  And with what I pay for my meds with ins, it only benefits my insurer to go to Canada and buy them, not me.  That's why I don't try harder to look into that, either.  But, I know that you can save quite a bit; a friend of mine goes to Mexico to get their asthma meds, to save a fortune.  But, they also live an hour from the border, so it's no biggie.

The relative cost of living index here is between 92-95 (100 being U.S. average), and while that's not the lowest, two things (housing and food/clothing) are cheaper than most (i.e., I'm looking to buy a completely renovated condo for 11k, because another I liked better for 42k sold before I could get it) and I know where the best deals are with zero effort, because I've always been poor here (I was excited the first year I made 25k, with one job. I it took 3 to make 18k the year before...).

But, I am wanting to get everyone elses' feel on coping with the major medical stuff, just so as I save and plan, I know what things will help keep me in line with my goal, instead of getting to 50 and realizing suddenly it isn't going to work to retire. I've got the time, but I prefer to know too much and plan for the absolutely worst outcome, so even if that happens I can still retire on time.

The exchanges here were showing 190-260/mo for the fancier policies, but I take that with a grain of salt, since it's not taking into account my personal health (I may get a policy, it'll just likely be more than that).  And 10+ years from now, the costs could do anything, so I'm not budgeting yet for that, I just was curious how it affects everyone who is FIRE or about to be FIRE planning.  I've only been here (MMM) a month or two, so I'm basically adjusting the plans already in play.  I was already saving most of my wages (because I'm paranoid, not frugal), so I just have to fine tune some of the lifestyle stuff.  And please understand, I do a lot of research as it is, so a lot of the things that are being offered are not being dismissed; I've actually looked into them in greater depth than I should go into here.  So my succinct reply is the result of the previously completed research on the matter.  I'll try to limit my responses, bacause I do value the input of all.  Thanks!