Author Topic: Should my family forgo health insurance?  (Read 7841 times)

NeonPegasus

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Should my family forgo health insurance?
« on: December 08, 2016, 08:48:51 AM »
I have a family of 5 - DH (44), me (38) + 3 girls (9, 7, 3). We are self employed so income is not completely predictable. We have family partnership and a trust that provides income and we also have 2 rental properties that we bought 12/15. Last year, total income was $168k and AGI was $141k. MAGI was not significantly more. This year, income may be $178k due to rental property income. AGI should be closer to $122k due to $25k SIMPLE contribution. I would expect income next year to be similar or higher.

The cheapest plan we can get on the exchange is $1065.79/mo with Kaiser. We would have to change all of our doctors, including the ped all of my girls have seen since birth. I have considered simply paying out of pocket for them to continue seeing their doc in the interest of continuity of care. With that premium, we could make up to $156.7k and still avoid paying a penalty for not having insurance as the insurance premiums would be more than 8.16% of our MAGI.

In addition to all the premiums we paid this year, we paid $6.9k for medical costs. These costs included physical therapy, orthodontics, dental cleanings, and a tooth pulling that are not covered by my policy. Another $1.2k is for our portion of an emergency room visit where we were concerned DH was having a heart attack (he did not and is fine). Had we not had insurance, it would have cost $3.6k. So, we paid just under $18k for medical costs this year - most of which was for insurance that cost us far more than it saved. :(

If we did not have insurance next year, we would lose the self employment deduction for $12.8k health care premiums. We would also lose the ability to put away $6750 in an HSA. Adjusting 2015's numbers to see what those deductions would have saved me in taxes, it looks like they saved me $4.9k. We would gain $12.8k to pay for actual health care. Net would be $7.9k. We would have to pay for the girls' well visits and our annual visits but we would still probably be up $7k.

We would have to get our income below $113,750 to qualify for any subsidies so that's probably not gonna happen. Also, we are agnostics so a health sharing ministry is out.

Of course, the major downside of not having health insurance is, well, not having health insurance in the event of a catastrophe. DH is a welder so on the job injury is a possibility. We have worker's comp for our business but have always excluded him because he had health insurance. I'm worried about what we'd do in the event of a car accident or serious unforeseeable medical problem (we are all in good health). Is saving $7k worth the risks involved with no coverage?

WWYD?

Paul der Krake

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Re: Should my family forgo health insurance?
« Reply #1 on: December 08, 2016, 08:58:17 AM »
You are out of your mind.

Pay the insurance premium, and change doctors. Your kids' well being is not predicated on seeing that one doctor.

You can also have one spouse get a W-2 job with health coverage for the family.

Daleth

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Re: Should my family forgo health insurance?
« Reply #2 on: December 08, 2016, 09:06:52 AM »
Absolutely no way, not a chance, especially with your husband being in a relatively high-risk profession.

And I'm not someone who would say NEVER to do this. I did go without insurance for my family for a month, but that's because I had just left a job and had the option of COBRA. I didn't want to use it if we didn't need it, and with COBRA you can get insurance retroactively, so I forwarded my husband the email with all the instructions and the plan was that if we had a medical catastrophe that month, whichever one of us was able to would send in the COBRA paperwork and the $1400-ish premium so that we'd be covered. Then on the first of the following month, we started an ACA/Obamacare plan that was less than $800 month. You can't get insurance retroactively under Obamacare, or basically anything other than COBRA, which is why we did things this way. We didn't have a medical catastrophe that first month so we just never filed the COBRA paperwork and are now insured again.

I'm just mentioning that to show that I get the concept of saving money by not having insurance.

But if you're spending almost $13k/year on premiums AND another $7k for medical costs (not even including the unexpected $1.2K ER visit that would cost $3.6k without insurance), one thing to look into is whether an HSA is the right type of plan for you. I had an HSA plan at work (that's what would have cost $1400/mo to COBRA!!!), because the HSA was like $450/mo cheaper for my family than regular insurance was and that's a lot of damn money (almost $6000/year savings on premiums, all of which I could pour into an HSA). But on the ACA in my state, the cost difference between an HSA and a regular insurance plan (with PCP visits costing $10, specialist visits $70, etc.) was only like $30/month, so it made no sense at all to continue with an HSA. I mean, with the HSA, it was costing over $200 just to get both kids looked at when it seemed like they had ear infections. Now it will cost $20. And we only have two kids--you have three!

So I hear that the cheapest ACA plan you guys can get is $1065.79/mo, but is that actually the best ACA plan for your needs? What if there's another one for $100/mo or $200/mo more that would spare you a significant chunk of the $7k medical costs? It makes sense to spend an extra $2k on premiums if it saves you more than $2k on medical costs.

Also, re continuity of care, do any of your children have complicated medical issues or huge phobias around going to the doctor? If not, does it really make sense to pay out of pocket to keep seeing the same doctor? What if you looked at the doctors available on the ACA plan, googled them to find patient reviews, asked around among friends, and basically "shopped" for a good pediatrician for the kids and PCP for the adults? Just because your existing doctors are good doesn't mean they're the only good ones available.
« Last Edit: December 08, 2016, 09:09:48 AM by Daleth »

therethere

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Re: Should my family forgo health insurance?
« Reply #3 on: December 08, 2016, 09:09:08 AM »
I have a family of 5 - DH (44), me (38) + 3 girls (9, 7, 3). We are self employed so income is not completely predictable. We have family partnership and a trust that provides income and we also have 2 rental properties that we bought 12/15. Last year, total income was $168k and AGI was $141k. MAGI was not significantly more. This year, income may be $178k due to rental property income. AGI should be closer to $122k due to $25k SIMPLE contribution. I would expect income next year to be similar or higher.

The cheapest plan we can get on the exchange is $1065.79/mo with Kaiser. We would have to change all of our doctors, including the ped all of my girls have seen since birth. I have considered simply paying out of pocket for them to continue seeing their doc in the interest of continuity of care. With that premium, we could make up to $156.7k and still avoid paying a penalty for not having insurance as the insurance premiums would be more than 8.16% of our MAGI.

In addition to all the premiums we paid this year, we paid $6.9k for medical costs. These costs included physical therapy, orthodontics, dental cleanings, and a tooth pulling that are not covered by my policy. Another $1.2k is for our portion of an emergency room visit where we were concerned DH was having a heart attack (he did not and is fine). Had we not had insurance, it would have cost $3.6k. So, we paid just under $18k for medical costs this year - most of which was for insurance that cost us far more than it saved. :(

If we did not have insurance next year, we would lose the self employment deduction for $12.8k health care premiums. We would also lose the ability to put away $6750 in an HSA. Adjusting 2015's numbers to see what those deductions would have saved me in taxes, it looks like they saved me $4.9k. We would gain $12.8k to pay for actual health care. Net would be $7.9k. We would have to pay for the girls' well visits and our annual visits but we would still probably be up $7k.

We would have to get our income below $113,750 to qualify for any subsidies so that's probably not gonna happen. Also, we are agnostics so a health sharing ministry is out.

Of course, the major downside of not having health insurance is, well, not having health insurance in the event of a catastrophe. DH is a welder so on the job injury is a possibility. We have worker's comp for our business but have always excluded him because he had health insurance. I'm worried about what we'd do in the event of a car accident or serious unforeseeable medical problem (we are all in good health). Is saving $7k worth the risks involved with no coverage?

WWYD?

See bolded. You mentioned the cost of the visit if you hadn't had in insurance. But the real question is..... What would the cost be out of pocket if you had no insurance and DH did have a heart attack?!

HoundDog

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Re: Should my family forgo health insurance?
« Reply #4 on: December 08, 2016, 09:13:34 AM »
If something catastrophic happened and you had no insurance, your assets would be at risk. It's possible to lock them down pretty tight with asset protection strategies, but it's probably worth it just to carry the insurance.

Dicey

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Re: Should my family forgo health insurance?
« Reply #5 on: December 08, 2016, 09:22:11 AM »
No.

catccc

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Re: Should my family forgo health insurance?
« Reply #6 on: December 08, 2016, 09:29:13 AM »
hell no.  Please keep your family insured.  If it goes to "waste" because nobody got sick, count your blessings and move along...  Since you already have an HSA, I assume this is a HDHP, but does Kaiser do those?  Kaiser's kinda a weird one, isn't it?  If it isn't an HDHP, can you look into one?

Another Reader

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Re: Should my family forgo health insurance?
« Reply #7 on: December 08, 2016, 09:34:50 AM »
I'm surprised Kaiser offers an HSA compliant plan.  Kaiser is an HMO and those plans are generally not compliant. 

In your shoes, I would find an ACA insurance provider that includes your doctors in their network.  I would not go without insurance with three kids and a husband in a dangerous occupation.

wenchsenior

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Re: Should my family forgo health insurance?
« Reply #8 on: December 08, 2016, 09:45:35 AM »
NO. NO. NO.

Once, as a college student I went without insurance for less than 2 months. Guess what happened in that time? I got gently sideswiped by a bicyclist on campus (didn't even knock me down), and blew out my right ACL, which meant I needed surgery and then rehab for several months.

I was dirt friggin poor, and the only way I was saved from about 15K of bills was because I was able to squeak onto the very generous student insurance program, which allowed you to jump on with all conditions covered if you had been covered in the last 90 days (I had been previously covered on my father's policy).  As it was, the couple thousand in co pays were practically impossible for me at that time of life.

Don't be dumb, like I was. This is your kids' health you are talking about.

pbkmaine

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Re: Should my family forgo health insurance?
« Reply #9 on: December 08, 2016, 09:49:47 AM »
Nope.

ysette9

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Re: Should my family forgo health insurance?
« Reply #10 on: December 08, 2016, 09:53:12 AM »
Absolutely positively not. A million times no.

BTW, I have Kaiser and absolutely LOVE it. They are fantastic for having a preventative philosophy and encouraging a healthy lifestyle. I also had Kaiser through my very high-risk pregnancy, early C-section delivery, and NICU stay for my preemie and they were fabulous for all of it. My daughter is alive and healthy today because of Kaiser. I'll stop my rant now; you get the point.

NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #11 on: December 08, 2016, 10:26:41 AM »
W-2 job is out of the question. We're overworked as it is and I'd rather pay for the health insurance. That may be an idea for another time of life.

All of the plans on the exchange are HMOs. The next non-Kaiser plan is $300/mo more. And yeah, all it takes to make a plan HSA compliant is a huge deductible and no copays.

But if you're spending almost $13k/year on premiums AND another $7k for medical costs (not even including the unexpected $1.2K ER visit that would cost $3.6k without insurance), one thing to look into is whether an HSA is the right type of plan for you.
Thanks for that perspective. The cheapest plan that offers an emergency room copay before the deductible is ~$600/mo more so that's out of consideration. Last year we had 9 specialist visits but 7 were for physical therapy that is no longer needed. Our teeth and eyes aren't covered at all so copays wouldn't help there. Cheapest plan with specialist copays is $35/mo more. It would cost $420/year more plus a loss of $2000 in tax deductions for no HSA (that seems high but that's what my spreadsheet is saying), so $2.4k total. It looks like the HSA is still the better deal.

Also, re continuity of care, do any of your children have complicated medical issues or huge phobias around going to the doctor?
Thankfully, no real issues. Convenience is a large factor as the doctor's office is literally 3 min down the street. There have been many times where they've been able to fit me in because I was able to get there immediately. The doctor understands our family and who I am as a parent and we have developed a good relationship over time that I'd like to keep.

See bolded. You mentioned the cost of the visit if you hadn't had in insurance. But the real question is..... What would the cost be out of pocket if you had no insurance and DH did have a heart attack?!
Oh duh. Yeah, great point.

Thanks for the responses, all. I really don't like the idea of going without insurance. It helps to have other people reinforce what a bad idea it is. I was listening to a Radical Personal Finance podcast about health insurance that got me questioning whether we should have it. Now I'm questioning that podcast, lol. While researching this stuff this morning, I think my 2 person, husband/wife business can get a business plan from Aetna. It's only a little more per month but has all of our doctors.

This nation's health insurance situation is ridiculous. Why on earth can't a person over 30 get a catastrophic plan? I may be prone to more problems but I also can better afford it. Why can't EVERYBODY get HSAs to help save for medical costs? Why can't we have an HSA and a plan that allows for a couple of copay visits a year? So much craziness.

ysette9

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Re: Should my family forgo health insurance?
« Reply #12 on: December 08, 2016, 10:32:23 AM »
Quote
This nation's health insurance situation is ridiculous.

Yep, our healthcare system in this country is completely fucked up. We have a serious problem on our hands. Obamacare made it better in that it allowed everyone to get insurance, but it didn't address the problem of it being ridiculously expensive because there are zero incentives in the system to reduce cost. Pretty much every other developed country has figured this out and yet we collective wring our hands and say it is impossible.

Honestly, my back-up plan in case Obamacare is gutted is to move out of the country. It's a shame we are in this situation. Just remember this when next you vote.

LadyFI

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Re: Should my family forgo health insurance?
« Reply #13 on: December 08, 2016, 10:33:49 AM »
I'm glad to see your most recent post! Please don't go without insurance!

Our family has an HSA plan through Kaiser (we are in a different state from you, but they offer such a plan here). Yes, we will have high out of pocket costs if something catastrophic happens, but a large OOP is still better than infinite costs if we were uninsured. It's simply not worth the risk.

I honestly wouldn't give a second thought about the fact that you would need to change doctors. it's really not a big deal. DD is four and has had three pediatricians - her initial one, a new one when we switched to Kaiser and now a third because we moved about a year ago. It hasn't had any affect at all on her health or well-being.

Lastly, I agree with ysette - Kaiser is fantastic! It's so nice to not have to worry about whether or not something is covered or if the specialist you've been referred to is in network.


Spork

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Re: Should my family forgo health insurance?
« Reply #14 on: December 08, 2016, 10:39:20 AM »
Good advice above and pretty consistent.  I'm with the majority: buy insurance.

One thing you probably don't count is: the negotiated price with an insurer.(*see note)  You mention a $1200 ER visit you had to pay.  But had you not had insurance and negotiated cost, that might have been double or triple that.  The ER is where a majority of uninsured go when they are sick and the hospitals really ratchet up their fees there for uninsured -- as they are assuming they are going to write off that expense.

And yeah, all it takes to make a plan HSA compliant is a huge deductible and no copays.

Off topic, but no.  There are a few other things.  Max OOP of $13,100/family is one of them.  My 2017 plan has a high deductible, but gets disqualified for Max OOP being too high.


*note: You CAN actually do some of the price negotiations yourself if paying cash... but the ER isn't the place to do that.  That would be for things you plan ahead for.

doneby35

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Re: Should my family forgo health insurance?
« Reply #15 on: December 08, 2016, 11:01:00 AM »
Short answer: Hell nah son!

Catbert

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Re: Should my family forgo health insurance?
« Reply #16 on: December 08, 2016, 01:10:09 PM »
No.

TVRodriguez

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Re: Should my family forgo health insurance?
« Reply #17 on: December 08, 2016, 01:22:03 PM »
"Should my family forgo health insurance?"

No. 

And personally, I would not even go with the lowest possible premium.

My family of five will be paying a monthly premium of over $2,000 so that I can keep a PPO Blue Cross/Blue Shield plan.  That comes with a $6350 deductible per person.  It's a lot of money.  But it's our health. 

NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #18 on: December 08, 2016, 02:01:53 PM »
"Should my family forgo health insurance?"

No. 

And personally, I would not even go with the lowest possible premium.

My family of five will be paying a monthly premium of over $2,000 so that I can keep a PPO Blue Cross/Blue Shield plan.  That comes with a $6350 deductible per person.  It's a lot of money.  But it's our health.

Assuming your stats are reasonably close to my family's, that's an extra $900 a month, or  $10800/yr just for insurance. And that doesn't include the tax savings you forgo by not having an HSA compatible account (I'm assuming that an insurance plan that expensive must have low co-pays, and therefore is not HSA compatible). Do you use so much medical care that it is financially worth it?

Choosing the lowest price health plan doesn't mean that I don't care about my health. It means that I would rather self-insure to the extent that I am financially able. Philosophically, I believe the point of insurances is to pick up financially at the point where the losses are too much for you to reasonably withstand.


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Daleth

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Re: Should my family forgo health insurance?
« Reply #19 on: December 08, 2016, 02:29:48 PM »
Thanks for that perspective. The cheapest plan that offers an emergency room copay before the deductible is ~$600/mo more so that's out of consideration.

$600/mo is $3600/year (I know you know this, just spelling it out for simplicity's sake). That's what you would have spent on a SINGLE ER visit if you hadn't had insurance when your husband had his heart attack scare, and it's a fraction of what you would've spent--with an HSA or without insurance--if he actually had had a heart attack. Ditto the cost if anyone in your family has a car accident or other ER-worthy health scare.

Plans that cover ER visits before the deductible generally also cover a whole lot more (e.g., $10 to see a PCP or pediatrician, $50 to see a specialist, discounts on mail-order prescription drugs, etc.). So let's say you have another 9 specialist visits this year, like you did last year. Those typically run $150 and up when you're on a high-deductible plan, but more like $50-$70 when you're on normal insurance. So right there you're saving $720-$900/year. How many PCP/pediatrician visits did you have last year? Let's say 10, for easy math? Those could be $10-$20 on normal insurance, vs. $90-$125 (in my area, let me know what it is in yours) on a high-deductible plan (and, of course, more if you're not insured at all). So there's another $1200 or so savings over a high-deductible plan.

And if you didn't spend down your entire HSA from this year/previous years, you can still use it next year for dental and eye care (though in my state at least Obamacare plans include dental and basic vision for children, just not for adults--is it different where you are?).

Cheapest plan with specialist copays is $35/mo more. It would cost $420/year more plus a loss of $2000 in tax deductions for no HSA (that seems high but that's what my spreadsheet is saying), so $2.4k total. It looks like the HSA is still the better deal.

Not sure that's true. See above paragraph about ER visits, specialists, etc.: if you have 9 specialist visits and 10 PCP/pediatrician visits that are not the free kind (i.e., not the well baby/annual physical stuff), you're already close to saving $2.4k/year by having traditional insurance vs. a high-deductible plan. And that's just routine stuff. If any of you need prescription drugs, an ER visit, physical therapy (I know you don't anticipate needing that but there's no way to be sure), etc., you're better off with that $35/mo more plan.

Also, are you guys deducting your insurance premiums from your taxes? Are you factoring that into your calculations? As self-employed people you ought to be able to deduct premiums. Read this thread, for instance:
http://forum.mrmoneymustache.com/taxes/starting-an-llc-or-s-corp-to-avoid-self-employment-taxes/?topicseen

Convenience is a large factor as the doctor's office is literally 3 min down the street. There have been many times where they've been able to fit me in because I was able to get there immediately. The doctor understands our family and who I am as a parent and we have developed a good relationship over time that I'd like to keep.

Are none of the Kaiser HMO doctors conveniently located? And is convenience worth the extra, what, $1000+ a year?

While researching this stuff this morning, I think my 2 person, husband/wife business can get a business plan from Aetna. It's only a little more per month but has all of our doctors.

This nation's health insurance situation is ridiculous. Why on earth can't a person over 30 get a catastrophic plan? I may be prone to more problems but I also can better afford it. Why can't EVERYBODY get HSAs to help save for medical costs? Why can't we have an HSA and a plan that allows for a couple of copay visits a year? So much craziness.

The Aetna thing sounds worth looking into. I agree that HSAs should be available to people on any type of plan. Maybe with lower limits to reflect the lower out of pocket cost of traditional insurance plans, but they shouldn't just be UNAVAILABLE.
« Last Edit: December 08, 2016, 02:33:13 PM by Daleth »

choppingwood

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Re: Should my family forgo health insurance?
« Reply #20 on: December 08, 2016, 04:46:44 PM »
My answer is anecdotal, but insurance is to cover you for catastrophic events. These happen even if you have a history of good health.

I know one family of four, all of whom were seriously and some permanently injured in a car accident returning from vacation. It is decades later and they are still requiring medical care.

My older sister, with no family history and no abuse of alcohol, developed liver disease in her early forties. She was ill for many years and required home care and a liver transplant. It developed complications and she spent a year in hospital afterwards, because of that and badly breaking her arm the same year.

My middle sister has developed three chronic conditions, all of which require medication. Some have had crazy costs, fortunately covered by insurance.

Any serious illness of any duration has many non-medical care costs associated with it, including travel, lost work time for multiple family members, and supplies. If you can afford insurance for the medical care costs, then do it. I hope that it is a complete waste of money and that you and your family never need it!

luminajd

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Re: Should my family forgo health insurance?
« Reply #21 on: December 08, 2016, 10:15:22 PM »
I'm so glad it sounds like you are deciding against forgoing insurance. My 8 year old fell off the monkey bars a month ago and broke her arm badly enough that she required an ER visit, surgery where a plate and screws were implanted in her arm, and an overnight stay at the hospital. Her bills so far are over $30,000. For falling off the monkey bars. $30,000!!!
I get it, our system is broken, but I would never consider going without some type of plan.

former player

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Re: Should my family forgo health insurance?
« Reply #22 on: December 09, 2016, 02:44:59 AM »
Average health costs in the USA are $10,000.  Per person.  Your insurance is pretty cheap compared to that.

ltt

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Re: Should my family forgo health insurance?
« Reply #23 on: December 09, 2016, 04:51:23 AM »
Absolutely not worth the risk----get the insurance!

NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #24 on: December 09, 2016, 08:58:37 AM »
Thanks for that perspective. The cheapest plan that offers an emergency room copay before the deductible is ~$600/mo more so that's out of consideration.

$600/mo is $3600/year (I know you know this, just spelling it out for simplicity's sake). That's what you would have spent on a SINGLE ER visit if you hadn't had insurance when your husband had his heart attack scare, and it's a fraction of what you would've spent--with an HSA or without insurance--if he actually had had a heart attack. Ditto the cost if anyone in your family has a car accident or other ER-worthy health scare.

At this point, it is absolutely understood that we will be getting insurance so that is a given. Now we're only debating what level of plan. Under the cheapest ins plan, I still get the discounts my insurance co has negotiated. So, going back to the ER visit last year - we paid $1200 out of pocket for the visit. If I'd had the more expensive plan, I would have only paid maybe $200 but I also would have paid an additional $3600 in premiums so I would have come out over $2.6k worse.

Plans that cover ER visits before the deductible generally also cover a whole lot more (e.g., $10 to see a PCP or pediatrician, $50 to see a specialist, discounts on mail-order prescription drugs, etc.). So let's say you have another 9 specialist visits this year, like you did last year. Those typically run $150 and up when you're on a high-deductible plan, but more like $50-$70 when you're on normal insurance. So right there you're saving $720-$900/year. How many PCP/pediatrician visits did you have last year? Let's say 10, for easy math? Those could be $10-$20 on normal insurance, vs. $90-$125 (in my area, let me know what it is in yours) on a high-deductible plan (and, of course, more if you're not insured at all). So there's another $1200 or so savings over a high-deductible plan.
So going with your figures and including the ER visit above, I saved another $1200 in PCP visits + $1200 at the ER but that's still less than the $3.6k I'd spend on extra premiums.

Considering that we have no ongoing health issues and are in good health, we don't need a plan that makes ongoing visits cheaper. When we went to the ER for the potential heart attack, the docs were going through all the risk factors and made us feel like dolts - DH is relatively young, slim, decent cholesterol, etc. My brother had a heart attack at 39 (sedentary, overweight) so we were spooked. 1 out of 3 kids ends up needing to go to the doc outside of well checks every year and that's usually just once. My PT was for a non-recurring issue (related to childbirth, which ain't never gonna happen again).

Also, are you guys deducting your insurance premiums from your taxes? Are you factoring that into your calculations? As self-employed people you ought to be able to deduct premiums.
Oh yes. Definitely. Running the figures now to see what the tax difference would be... Ok, adding $3.6k to the premiums drops taxes from $5132 to $4052, so a savings of $1080. BUT, I wouldn't be able to contribute to an HSA so removing that, taxes would go to $6077. So I'd actually be paying another $945 in taxes, meaning that the plan would cost me $4145 extra a year. So if it saved me 2400/yr, I'd still be paying $2145 extra. And again, last year was pretty extraordinary for us so the savings would likely be much less unless we have a catastrophe.

Are none of the Kaiser HMO doctors conveniently located? And is convenience worth the extra, what, $1000+ a year?
They are located about 6 miles away. On the surface, that sounds okay. But they happen to be building a new baseball stadium near the Kaiser offices (the rest are pretty far away). When they open the stadium next year, games will cause traffic problems on two major interstates, 1 highway and multiple local roads. So, with little traffic, it takes about 5 min extra to get there. At 4 pm on a regular weekday, it would take 20-30 min extra to get there + 45 min more to get home. At 4 pm on a day when the Atlanta Braves are playing, it could take 1+ hrs more to get there. I hadn't actually thought about the proximity to that stadium so now I DEFINITELY won't be getting Kaiser.

NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #25 on: December 09, 2016, 09:05:17 AM »
Off topic, but no.  There are a few other things.  Max OOP of $13,100/family is one of them.  My 2017 plan has a high deductible, but gets disqualified for Max OOP being too high.
This appears to be so. According to healthcare.gov, "TIP: The maximums are slightly lower on HSA compatible plans. This has to do with the fact that the rates are raised by different mechanisms. The difference allows for non-HSA compatible high deductible plans, so make sure that, if you want an HSA, your plan is “HSA Eligible.”"

Seems to be another example of the ridiculousness of our system, IMO.

I'm a red panda

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Re: Should my family forgo health insurance?
« Reply #26 on: December 09, 2016, 09:31:51 AM »
NO!

Insurance is for the unexpected. If you really don't want to change doctors, you could just pay those out of pocket (though to me that's silly if you have coverage elsewhere; but I've paid out of pocket to stay with a specific doctor for some needs.)

I broke my neck when I was a teenager. It would have been many hundreds of thousands of dollars if I hadn't had insurance. That was with only 1 week in the ICU and 1 week in the in-patient therapy.  Other people with the same injury spend months in the ICU and months in in-patient therapy.  It would be millions.  Are you prepared to cover that?  Once you are stable, they don't have to keep treating you, so the therapy (that allowed me to walk again, use a pencil again, etc) wouldn't have been given to me if I couldn't pay.

(This was not a car accident.)
« Last Edit: December 10, 2016, 08:47:45 AM by iowajes »

TVRodriguez

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Re: Should my family forgo health insurance?
« Reply #27 on: December 09, 2016, 04:13:21 PM »
"Should my family forgo health insurance?"

No. 

And personally, I would not even go with the lowest possible premium.

My family of five will be paying a monthly premium of over $2,000 so that I can keep a PPO Blue Cross/Blue Shield plan.  That comes with a $6350 deductible per person.  It's a lot of money.  But it's our health.

Assuming your stats are reasonably close to my family's, that's an extra $900 a month, or  $10800/yr just for insurance. And that doesn't include the tax savings you forgo by not having an HSA compatible account (I'm assuming that an insurance plan that expensive must have low co-pays, and therefore is not HSA compatible). Do you use so much medical care that it is financially worth it?

Choosing the lowest price health plan doesn't mean that I don't care about my health. It means that I would rather self-insure to the extent that I am financially able. Philosophically, I believe the point of insurances is to pick up financially at the point where the losses are too much for you to reasonably withstand.


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I agree with a lot of what you said.  Our plan is HSA compatible. No copays. Nothing is covered (aside from annual preventive care visits) until the deductible is met. Then it's all covered 100% with no Co insurance.

My other options were HMOs where the networks basically completely and absolutely suck. Oh and they had coinsurance up to 50% and deductibles of only $5000.  We hope we won't have to use it for anything but well visits so we can build up the HSA, but then again, in three of the last four years one of us has needed surgery or been admitted to the hospital from an ER admit, so I'm not banking on it.

At least it's tax deductible since I have my own business. We used to have a plan through DH's business, and he used to cover his employees 100% including their kids and including paying their deductibles. Now that we're dropping that plan, because it was not sustainable, at least we'll save the cost of his employees healthcare.

FIREby35

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Re: Should my family forgo health insurance?
« Reply #28 on: December 10, 2016, 07:40:29 AM »
Quote
This nation's health insurance situation is ridiculous.

Yep, our healthcare system in this country is completely fucked up. We have a serious problem on our hands. Obamacare made it better in that it allowed everyone to get insurance, but it didn't address the problem of it being ridiculously expensive because there are zero incentives in the system to reduce cost. Pretty much every other developed country has figured this out and yet we collective wring our hands and say it is impossible.

Honestly, my back-up plan in case Obamacare is gutted is to move out of the country. It's a shame we are in this situation. Just remember this when next you vote.

BTW - This is the prime example of one of the major problems with Obamacare. If you are making money and self-employed it is crazy! I'm a self-employed lawyer and have had the same issues. Hyper expensive, super high out of pockets. I used to have insurance, now I have a Christian health ministry. I'd rather have health insurance.

Anyway, I'm not trying to derail and get all hyper political. It's just this is a clear example of shifting costs from one group to another and the shift was huge! Coming up with 20k (after tax) is no small feat, even for a high earner.

BTW- to everyone worried about costs related to treatment for car accidents, the cheapest and best way yo insure against that is through your auto insurance. You can also add an umbrella policy on top of that which would offer coverage in the event of an accident which causes significant medical bills/injuries. Check your coverage limits and make sure its 100k+. If you have assets, make it 500k and a 1 million umbrella.

Source: I am Personal Injury attorney who helps injured people after accidents.

handsnhearts

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Re: Should my family forgo health insurance?
« Reply #29 on: December 12, 2016, 02:53:16 PM »
Glad you are not going without insurance. I have seen the worst things happen to the best people. You don't want a financial catastrophe on top of a medical and emotional one.

Also, without insurance, that ER visit would have been about $5000+. The insurances get a lower negotiated rate. So paying cash in those circumstances is even more costly. Sometimes you can negotiate with the hospital, sometimes you can't.


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MVal

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Re: Should my family forgo health insurance?
« Reply #30 on: December 12, 2016, 03:09:41 PM »
NO. NO. NO.

Once, as a college student I went without insurance for less than 2 months. Guess what happened in that time? I got gently sideswiped by a bicyclist on campus (didn't even knock me down), and blew out my right ACL, which meant I needed surgery and then rehab for several months.

I was dirt friggin poor, and the only way I was saved from about 15K of bills was because I was able to squeak onto the very generous student insurance program, which allowed you to jump on with all conditions covered if you had been covered in the last 90 days (I had been previously covered on my father's policy).  As it was, the couple thousand in co pays were practically impossible for me at that time of life.

Don't be dumb, like I was. This is your kids' health you are talking about.

You got that right. I had about a 6 month gap after college of not being on my parent's plan and no employer plan, so I got a little 6 month health insurance policy through my auto insurance company. It wasn't cheap, but BOY was I glad I had it. It just so happened it was discovered I had a huge tumor in my abdomen that had to come out immediately during those months. If I hadn't had that short term policy, I could have been on the hook for $20K or more.

I've learned my lesson to never go without some kind of health insurance.

bugbaby

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Re: Should my family forgo health insurance?
« Reply #31 on: December 12, 2016, 03:15:41 PM »
I would add that to me, among the most welcome proposed changes to ACA is opening all insurance markets beyond state lines. The other is dropping all the ridiculous regulations and coverage requirements. Why should every health plan cover birth control for instance? How about true bare bones  catastrophic insurance? If they also opened HSA to everyone and stop mandatory insurance and IRS involvement, the free market could take care of the rest.

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Proud Foot

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Re: Should my family forgo health insurance?
« Reply #32 on: December 12, 2016, 03:39:30 PM »
I would add that to me, among the most welcome proposed changes to ACA is opening all insurance markets beyond state lines. The other is dropping all the ridiculous regulations and coverage requirements. Why should every health plan cover birth control for instance? How about true bare bones  catastrophic insurance? If they also opened HSA to everyone and stop mandatory insurance and IRS involvement, the free market could take care of the rest.


IMO this would be big benefit as it would satisfy the religious objectors as well as potentially save money (probably not much) for those who no longer need birth control.  This would need to have a disclaimer front and center to keep from having issues of people signing up and thinking it was covered only to try to get it and it not be covered.

It would be nice to have the option to have some things not covered.  Make everything covered and then be able to opt out of certain coverage at open enrollment (events with a very low probability of occurring). ie: Childbirth.  Able to opt out if there are no females covered.  Women can opt out once they reach a certain age or if they have had a hysterectomy. 

I'm a red panda

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Re: Should my family forgo health insurance?
« Reply #33 on: December 12, 2016, 04:42:21 PM »
The problem with opting out of certain coverage is that coverage only works if you pay into a pool.  It otherwise becomes very expensive for the individuals who need coverage.

Let's take childbirth for instance. All men can opt out. Immediately, insurance becomes more expensive for women.  Women don't need childbirth coverage if there was never a man involved, and thus are unfairly penalized.  It is good for society as a whole to have maternity coverage. Women dying in childbirth, babies sick from lack of prenatal care is not good for society as a whole and has a cost far beyond insurance premiums.

TVRodriguez

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Re: Should my family forgo health insurance?
« Reply #34 on: December 13, 2016, 07:07:45 AM »
The problem with opting out of certain coverage is that coverage only works if you pay into a pool.  It otherwise becomes very expensive for the individuals who need coverage.

Let's take childbirth for instance. All men can opt out. Immediately, insurance becomes more expensive for women.  Women don't need childbirth coverage if there was never a man involved, and thus are unfairly penalized.  It is good for society as a whole to have maternity coverage. Women dying in childbirth, babies sick from lack of prenatal care is not good for society as a whole and has a cost far beyond insurance premiums.

+1 to all of this.

Proud Foot

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Re: Should my family forgo health insurance?
« Reply #35 on: December 13, 2016, 07:33:20 AM »
The problem with opting out of certain coverage is that coverage only works if you pay into a pool.  It otherwise becomes very expensive for the individuals who need coverage.

Let's take childbirth for instance. All men can opt out. Immediately, insurance becomes more expensive for women.  Women don't need childbirth coverage if there was never a man involved, and thus are unfairly penalized.  It is good for society as a whole to have maternity coverage. Women dying in childbirth, babies sick from lack of prenatal care is not good for society as a whole and has a cost far beyond insurance premiums.

I agree with what you said.  While I like the idea of being able to opt out of coverage, the actual implementation of it would not be easy depending on what coverage you did opt out of. 

webguy

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Re: Should my family forgo health insurance?
« Reply #36 on: December 13, 2016, 10:50:02 PM »
If it makes you feel any better I am self-employed and our family of 3 (31, 29, and 1) will be paying $1000/month this next year for insurance. A hefty increase from $630/month this year. Just had to suck it up and pay it unfortunately.

bugbaby

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Re: Should my family forgo health insurance?
« Reply #37 on: December 14, 2016, 08:13:58 PM »
OP have you found a reasonable option?

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NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #38 on: January 02, 2017, 11:57:53 AM »
The problem with opting out of certain coverage is that coverage only works if you pay into a pool.  It otherwise becomes very expensive for the individuals who need coverage.

Let's take childbirth for instance. All men can opt out. Immediately, insurance becomes more expensive for women.  Women don't need childbirth coverage if there was never a man involved, and thus are unfairly penalized.  It is good for society as a whole to have maternity coverage. Women dying in childbirth, babies sick from lack of prenatal care is not good for society as a whole and has a cost far beyond insurance premiums.

THANK YOU FOR THIS! Another way of looking at this is that every single one of us was the product of a pregnancy and so will be every future one of it. Every single person is affected by the quality of care their mothers receive.

I would add that to me, among the most welcome proposed changes to ACA is opening all insurance markets beyond state lines. The other is dropping all the ridiculous regulations and coverage requirements. Why should every health plan cover birth control for instance? How about true bare bones  catastrophic insurance? If they also opened HSA to everyone and stop mandatory insurance and IRS involvement, the free market could take care of the rest.


IMO this would be big benefit as it would satisfy the religious objectors as well as potentially save money (probably not much) for those who no longer need birth control.  This would need to have a disclaimer front and center to keep from having issues of people signing up and thinking it was covered only to try to get it and it not be covered.

It would be nice to have the option to have some things not covered.  Make everything covered and then be able to opt out of certain coverage at open enrollment (events with a very low probability of occurring). ie: Childbirth.  Able to opt out if there are no females covered.  Women can opt out once they reach a certain age or if they have had a hysterectomy. 

Prior to ACA, women had to purchase riders if they wanted maternity coverage. But what most people don't know is that unplanned c-sections were required to be covered under the emergency care provision of the insurance policy. So a women could get a c-section covered without a maternity rider. So what that resulted in was women being denied ANY insurance if they had had a previous c-section since they had a 90+% chance of having a c-section should they get pregnant again. The insurer would only insure the woman if she had proof that she was sterilized. This happened to people I knew. And when I got pregnant unexpectedly at the same time I quit my job in 2013 (I was the sole insurance provider for my family), I found that not only could I not get insurance, but neither could my children (because they couldn't get individual policies) nor could my husband (because some states require the husband's policy to cover his newborn child). Luckily I was able to get COBRA and pregnancy Medicaid.

I continue to believe more and more strongly that our country needs to go to a single payer system. What we have now is an embarrassment.

NeonPegasus

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Re: Should my family forgo health insurance?
« Reply #39 on: January 02, 2017, 12:04:53 PM »
OP have you found a reasonable option?

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I sucked it up and enrolled with Kaiser when I saw that there were ZERO plans available on the exchange that had my doctors. Our income is such that we are on the edge of qualifying for subsidies. My rental properties need new siding so I think if I do that next year, I'll be able throw off income and stay just below the threshhold. Because of that, it really wasn't worth paying $500/mo extra + sacrificing $400/mo in subsidies to get a plan with our docs.

Then a week ago, I received a letter from Wellstar, the major medical group in the area that has all of our doctors. I guess the brain trust there finally realized that no exchange plans had their doctors on it and they'd be facing a mass exodus of patients. So, effective 1/1, they got their whole group on all of the BCBS exchange plans. Now I have to figure out how to switch plans. It'll be $200/mo extra but that'd be worth it to me to stick with our doctors and have the much larger network.

Daleth

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Re: Should my family forgo health insurance?
« Reply #40 on: January 05, 2017, 05:17:59 AM »
Then a week ago, I received a letter from Wellstar, the major medical group in the area that has all of our doctors. I guess the brain trust there finally realized that no exchange plans had their doctors on it and they'd be facing a mass exodus of patients. So, effective 1/1, they got their whole group on all of the BCBS exchange plans. Now I have to figure out how to switch plans. It'll be $200/mo extra but that'd be worth it to me to stick with our doctors and have the much larger network.

January 31 is the deadline for signing up for Obamacare plans this year. I don't know what you need to do to cancel your Kaiser plan (although not paying/stopping any autopayments you set up is a good way to lose coverage), but you definitely need to sign the family up for Obamacare by January 31. I wouldn't leave it to the last day because I bet a lot of people are doing that, and the server might get swamped and crash or be super slow.

Enigma

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Re: Should my family forgo health insurance?
« Reply #41 on: January 05, 2017, 07:05:48 AM »
Nope...  Do not forgo health insurance...  Worst case scale it back to an extremely high deductible even then I wouldn't go that far.

Livingthedream55

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Re: Should my family forgo health insurance?
« Reply #42 on: January 05, 2017, 02:00:51 PM »
Just echoing everyone else. I am relieved you will get the family insured.

When I was 22, perfectly healthy, I was out of work for a few months and so let my insurance lapse. This was years ago - so no staying on parent's plan. Anyway they retired out of country so they no longer had U.S. health insurance.

Luckily I got a job. ONE WEEK into the new job I needed emergency surgery and was hospitalized for two weeks. The insurance paid for my care. I was very, very lucky.

Bracken_Joy

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Re: Should my family forgo health insurance?
« Reply #43 on: January 05, 2017, 02:05:29 PM »
I'll echo everyone else, plus an anecdote:

During my leadership and management practicum in nursing school, I helped put together a spreadsheet about some of our ICU patients.

One guy was in there 5 days before passing away.

He racked up $1.85MILLION in 5 days.

Fuuuuuuuuuuuuuuuuuuck NO.

Spork

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Re: Should my family forgo health insurance?
« Reply #44 on: January 05, 2017, 03:16:09 PM »
I'll echo everyone else, plus an anecdote:

During my leadership and management practicum in nursing school, I helped put together a spreadsheet about some of our ICU patients.

One guy was in there 5 days before passing away.

He racked up $1.85MILLION in 5 days.

Fuuuuuuuuuuuuuuuuuuck NO.

Just to extend the analogy...  My dad had a surgery + 6 weeks very intensive ICU care + 6 weeks of long term hospital care + 1 week of hospice.  I never saw the total, but Medicare + supplemental insurance pretty much covered the lot of it.  I'm suspecting tens of millions of dollars.