Meet the ‘semi-rich’: Millions of high-income Americans may not feel wealthy but

[Dicey]

I turned 65 a few short weeks ago, finally qualifying for Medicare. Alas, since then I have had three outpatient procedures, including a breast cancer diagnosis and lumpectomy. My total OOP for everything is way under $100, including genetic testing and Oncotype Dx testing. In fact, during today's procedure, the doctor ordered a prescription for 10 tablets of Oxycodone. While I was out, this message was sent to the pharmacy and DH was sent to pick it up.* It cost a whopping thirty three cents. (Not a typo.)

In all the years I stressed about future medical costs, I never understood how freaking amazing Medicare is. The gorilla in the Medical Room of the Future is certainly a lot less frightening, based on my current real-time experience. I am utterly gobsmacked and incredibly relieved.

*In pre-op, I told them I did not want Oxycodone. Apparently during the procedure the doctor decided I was going to need it and ordered it anyway. I can't exactly be pissed if it only cost thirty three cents OOP. FWIW, I don't intend to use it, but we'll see how the next few days go. Edit: I just read the label: it specifically states that it's to be used "for severe pain if other pain medications are ineffective. Use sparingly." Wow, I can't begrudge that thirty three cents at all.

I cannot emphasize how much I worried about future medical costs along the path to FIRE. I know Medicare doesn't cover everything, but I cannot believe what it does cover.

Fun note: When the pre-op nurse asked me if I was retired, I told him I'd been retired for 11 years. He then said he had a friend who was into something called FIRE and I literally started laughing. We had a nice conversation after we got all the medical stuff out of the way.

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Ouch! Your thinking hurts my heart. At my age, mammograms are advised by my provider at up to 24 month intervals, but allowed at 12 months or anywhere 8n between. During the pandemic, I switched let it drag from 12 to 24. I do have concerns about lifetime exposure to radiation + pandemic. I had my latest mammogram at "only" 23 months, but only because the last one happened at 25 months and I wanted to get back in the habit of making it a birthday present to myself. I had no symptoms, or any reason to be particularly concerned. Qualifying for Medicare had zero influence on my timing.

PLEASE do not be penny wise and pound foolish. Your life is worth far more than that.

[Dicey]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Ouch! Your thinking hurts my heart. At my age, mammograms are advised by my provider at up to 24 month intervals, but allowed at 12 months or anywhere 8n between. During the pandemic, I switched let it drag from 12 to 24. I do have concerns about lifetime exposure to radiation + pandemic. I had my latest mammogram at "only" 23 months, but only because the last one happened at 25 months and I wanted to get back in the habit of making it a birthday present to myself. I had no symptoms, or any reason to be particularly concerned. Qualifying for Medicare had zero influence on my timing.

PLEASE do not be penny wise and pound foolish. Your life is worth far more than that.

Oh I definitely don't skip the lady appointments or even an annual skin check! 

But my general GP and rheumatology "checkups" often feel like they are created to just charge me money. After several sub 10 minute, multi-hundred dollar visits to "monitor"* me, I now just go if I notice an actual problem -  my baseline hasn't changed in ages.

*Basically monitoring and high deductible insurance do not play well together.

Whew!

[mm1970]

My step-father has cancer (and Medicare, as well as supplemental insurance from his pension plan).

He's had cancer for 7 years.

He's had multiple rounds of 1-2 weeks in hospital, including a stem cell transplant and T cell transplant.

This is well over a million dollars at this point.

[Dee18]

I thought Medicare would be great.  I now have it and a supplemental insurance.  To my dismay, two out of three medical practices recently recommended to me do not accept any patients on Medicare.  And Medicare has already rejected claims that were routinely covered by my previous insurance, such as tissue sent to a pathologist for evaluation.

[Psychstache]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Ouch! Your thinking hurts my heart. At my age, mammograms are advised by my provider at up to 24 month intervals, but allowed at 12 months or anywhere 8n between. During the pandemic, I switched let it drag from 12 to 24. I do have concerns about lifetime exposure to radiation + pandemic. I had my latest mammogram at "only" 23 months, but only because the last one happened at 25 months and I wanted to get back in the habit of making it a birthday present to myself. I had no symptoms, or any reason to be particularly concerned. Qualifying for Medicare had zero influence on my timing.

PLEASE do not be penny wise and pound foolish. Your life is worth far more than that.

Oh I definitely don't skip the lady appointments or even an annual skin check! 

But my general GP and rheumatology "checkups" often feel like they are created to just charge me money. After several sub 10 minute, multi-hundred dollar visits to "monitor"* me, I now just go if I notice an actual problem -  my baseline hasn't changed in ages.

*Basically monitoring and high deductible insurance do not play well together.

Relevant Article: https://time.com/5095920/annual-physical-exam/

"One large-scale review, published in 2012, found that annual physical exams do nothing to improve a person’s disease and mortality risks. Another recent study found a little evidence that annual physicals could reassure some people of their good health, and therefore reduce worry. But it did not find that these exams save lives or prevent disease."

[farmecologist]

Yup. I've always made a game of it. Now that it's no longer necessary,  it's still easy to do.
...
To that I'll add that I always made time to do the important things. I went to the weddings, kissed the babies, dressed well, lived in a nice home and satisfied my wanderlust, all for less than it seemed like I was spending. It might have taken me longer to FIRE, but it was a great ride getting there.

It's only work when it's a change, I think. Those of us in the habit just think of it as regular living & the benefits are both pervasive & decrease the effort it takes to keep going. Like exercise. Neither does it stop you pursuing your joys. I could probably have done with more of your style of balance, though.

A 'game of it' is a great way to put it.  Exactly what we do as well.  I also have an active disgust of those that flaunt their 'belongings'.   Notice that I said 'belongings'...because many of them are NOT wealthy/rich...but are doing the "Joneses" thing.   For us, 'stealth wealth' is the way to go.

As for us, we have been in the two-comma-club (with >=2 before the first comma), and completely debt free, for quite some time.  However, we don't feel 'wealthy' at at all...and it seems this is a common feeling for people in our situation.   Healthcare still is a major concern, since one of us has a chronic condition.  A suitable healthcare plan would be extremely costly, and is the sole reason we are still working.   I really wish we had a sane healthcare system here in the USA...it sucks.  Maybe I need to be more of an optimist and just pull the trigger and retire early...

Healthcare here is a horror, both ethically in consideration of human welfare & in the staggering waste it generates. In the system's efforts to skim profit off every step of the care process, it also amplifies waste & costs to the Nth degree. The more of it you see the more sick it's shown to be. No wonder our doctors are paid more than in most nations; it has largely become a miserable job no one would put up with otherwise. People who get into it to help people aren't always the sort to be consoled by a paycheck when the system is designed to defeat that impulse, so suicide rates are extremely high in the profession.

I have substantially less to my name - though I feel very wealthy on a daily basis! Health care access is my personal terror, too. But the amount of wealth required to be safe from medical need in this country is astronomical. Anyone short of the decamillionaires is aware that their life's savings could be wiped out overnight with a single diagnosis, & if the money stops, so does the treatment. I'm astounded that there hasn't been more public pressure for universalizing health care when a majority of the public supports it.

Despite a dwarf 'stache, I've reached the point where I'm realizing that the probable wealth cost alone of diminished health via continued work is not worth the assured wealth increase, & I need to hurry up & quit already.

The odds of requiring medical care that would cost millions of dollars is vanishingly small. And a high-deductible health insurance plan would help protect against some of that risk. I can't even fathom health care that would cost tens of millions of dollars. A $100,000 for a major surgery or hundreds of thousands for cancer treatment is certainly not a rare occurrence - but if you have a net worth of millions that's not going to wipe you out. Especially if you have any sort of health insurance. I mean that's exactly what it's for - those very rare but very expensive occurrences. Not paying only $50 for a 15-minute visit to your doctor (which they billed insurance $200 - knowing they would actually collect $100).

I turned 65 a few short weeks ago, finally qualifying for Medicare. Alas, since then I have had three outpatient procedures, including a breast cancer diagnosis and lumpectomy. My total OOP for everything is way under $100, including genetic testing and Oncotype Dx testing. In fact, during today's procedure, the doctor ordered a prescription for 10 tablets of Oxycodone. While I was out, this message was sent to the pharmacy and DH was sent to pick it up.* It cost a whopping thirty three cents. (Not a typo.)

In all the years I stressed about future medical costs, I never understood how freaking amazing Medicare is. The gorilla in the Medical Room of the Future is certainly a lot less frightening, based on my current real-time experience. I am utterly gobsmacked and incredibly relieved.

*In pre-op, I told them I did not want Oxycodone. Apparently during the procedure the doctor decided I was going to need it and ordered it anyway. I can't exactly be pissed if it only cost thirty three cents OOP. FWIW, I don't intend to use it, but we'll see how the next few days go. Edit: I just read the label: it specifically states that it's to be used "for severe pain if other pain medications are ineffective. Use sparingly." Wow, I can't begrudge that thirty three cents at all.

I cannot emphasize how much I worried about future medical costs along the path to FIRE. I know Medicare doesn't cover everything, but I cannot believe what it does cover.

Fun note: When the pre-op nurse asked me if I was retired, I told him I'd been retired for 11 years. He then said he had a friend who was into something called FIRE and I literally started laughing. We had a nice conversation after we got all the medical stuff out of the way.

Wow...that is pretty amazing.   I didn't realize that Medicare OOP expenses are so low!  That makes me feel a lot better...assuming Medicare stays around.

Planning for the "bridge years" looks to be a major hassle though, healthcare wise....especially when your spouse has a chronic condition. 

[Villanelle]

I thought Medicare would be great.  I now have it and a supplemental insurance.  To my dismay, two out of three medical practices recently recommended to me do not accept any patients on Medicare.  And Medicare has already rejected claims that were routinely covered by my previous insurance, such as tissue sent to a pathologist for evaluation.

I don't know if this would be an option for you, but my parents  somewhat recently signed up with a concierge doctor.  I thought that was something only for the rich and famous, but they got a recommendation from a friend and have been thrilled.  It cost them $1000 annually, so it isn't cheap, but that basically buys them access to the practice.  The doctor bills medicare (and their other insurance, for retired military) so the costs for visits are the same as with a regular doc, but they get easy, quick access to him.  They even have a 24/7 phone number that I think goes directly to him, though of course they are encouraged to only use that in emergencies.  When they were in Mexico and caught Covid, he spoke with them several times and advised them on what OTC meds to take and other concerns.  They are also super pleased with the billing and office staff.  Because the practice treats fewer patients than most offices, they are more able to focus on customer (patient) service and less on just churning people though in the minimum time possible so they can get to the next billable appointment.  They are thrilled with the experience and consider the buy-in to be money well spent. 

[Dee18]

Thanks Villanelle. I am going to look into that. 

[theninthwall]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Im originally from Australia and now live in the USA, where this exact thing baffles me. Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive. The only reason we go is so we can get a blood test.
I am yet to have a positive experience with our health insurance, which consumes thousands of dollars a year from us. Every visit to a specialist or interaction with the health system is confusing and non-sensical.

[Dicey]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Im originally from Australia and now live in the USA, where this exact thing baffles me. Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive. The only reason we go is so we can get a blood test.
I am yet to have a positive experience with our health insurance, which consumes thousands of dollars a year from us. Every visit to a specialist or interaction with the health system is confusing and non-sensical.

Welcome to the USA!

[ChpBstrd]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Im originally from Australia and now live in the USA, where this exact thing baffles me. Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive. The only reason we go is so we can get a blood test.
I am yet to have a positive experience with our health insurance, which consumes thousands of dollars a year from us. Every visit to a specialist or interaction with the health system is confusing and non-sensical.

Welcome to the USA!

We had a chance to fix this about 14 years ago, but didn't due to fears of "government death panels" and the inefficiency of "socialized medicine".

So enjoy our highly efficient system where you cannot possibly die from a lack of access to care! </s>

[dang1]

..

Im originally from Australia and now live in the USA, where this exact thing baffles me. ..

"Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive."


maybe switch GP

[Cassie]

Medicare is not cheap. Between Part B , my RX plan and medical supplement it costs 400/month and goes up yearly. Taking a Medicare advantage plan is often free but you get what you pay for and can be denied life saving treatments and prescriptions. Many people sign up for these without knowing the downside. In many states you can’t change back to regular Medicare if you can’t pass medical underwriting which is a problem for most people at that age.

[ixtap]

..

Im originally from Australia and now live in the USA, where this exact thing baffles me. ..

"Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive."


maybe switch GP

It's the coding. If they put in their notes that you talked about a concern, that gets coded as a specific visit. I once answered that I was taking care of an issue with another provider and considered myself lucky that I won the appeal when they coded that other issue into the visit for a mere $200.

[Roadrunner53]

This information might be helpful for those considering joining Medicare Advantage:

https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html

[LaineyAZ]

This information might be helpful for those considering joining Medicare Advantage:

https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html

This makes me sad for those enrolled in Medicare Advantage but glad for the overall Medicare program. 
The AARP magazine recently published a great article on the differences between the two.  Its wording was neutral but anyone reading it carefully would know that the for-profit Medicare Advantage is a net negative for individuals and for the country.

[EchoStache]

There is a lot of discussion in this thread about income and wealth inequality, causes, effects, trends, etc.

I don't have this thought extremely well fleshed out, but let me just brainstorm a bit, and perhaps others can weigh in as to whether this makes sense or not.

I think a HUGE issue causing wealth inequality is how corporations have figured out how to access a massive percentage of peoples earnings without them having to physically go out and spend money on "stuff".

30 years ago, monthly bills were basically housing and utilities.

Now, its those plus subscriptions:
credit cards(used to purchase stuff, but pay monthly forever)
Cable
Internet
Cell phone
Netflix
Amazon Prime
Hulu
Spotify
HBO Max
Disney
Peacock
YouTube TV
Door Dash
Audible
Kindle
Grub Hub
Grocery store delivery
Fast food
Starbucks......$30/day here($1.1 million 30 years @ 7%) isn't causing any problems though.....it's someone else's fault.  And this is ONE line item in this list.

These expenses are all mostly *automated*....the lower income and even middle income folks who aren't paying attention(80%?) are literally spending millions on these subscription based services over their working lifetimes without even realizing they are squandering their wealth.  They think they are living the good life, "getting by" with the basic necessities, but in reality are living an extravagantly luxurious lifestyle without realizing it while complaining they can't afford to get ahead, purchase a nice hime, or send kids to school.

I'm not saying college costs haven't gotten out of control.  They have.  But there are also really good mid level jobs that can be acquired with VERY low cost community college degrees without debt.

I see the modern subscription nature of consumption as being a massive change in recent decades that is keeping the average person in voluntary serfdom. 

Now imagine an entry level worker earning $40,000/year putting 5% into their 401k with 100% company match.  That's $333/month.  A handful of the above subscriptions are easily preventing such a person from doubling or tripling their investing.

[eyesonthehorizon]

... I think a HUGE issue causing wealth inequality is how corporations have figured out how to access a massive percentage of peoples earnings without them having to physically go out and spend money on "stuff".
...
I see the modern subscription nature of consumption as being a massive change in recent decades that is keeping the average person in voluntary serfdom. ...

This is a pretty core Mustachian-classic argument, certainly one that I have always promoted. Anything recurring deserves huge skepticism, including installment plan payments (common for phones, cars, furniture.)

In personal finance circles especially I am often perplexed by discussion in terms of "weekly expenses." Almost every expense I have is approximately monthly (in the US but not in a highly walkable city, we get a big carload of groceries every third week or so, rarely more often.) When I started reviewing examples of other people's expense reports the thing that stood out to me was the sheer number of expense transactions. In a normal month, I only have ten to fifteen expense transactions, omitting investment-related activity, & absolutely cringe at the thought of adding anything else on more than a one-time basis. Many people had dozens of small dollar transactions, too many to ever recount from memory, whether automated on a transaction level or just automatic in the sense of habits.

[ChpBstrd]

Just talked with a spendy cousin of mine who told the story of a special trip he made to set up his parents' new TV. Silly me, I was thinking that meant plug all the cords in, but he meant setting up accounts with:

Amazon
Netflix
Peacock
HBO Max
YouTube subscription
Disney+
...

Honestly he rattled off so many services I kinda lost count, and got distracted by my own realization that we're talking about a reoccurring bill of over $150/month.

I couldn't stop thinking that's years of extra time at a job. Gobs of extra risk in case of a health problems forcing retirement, economic downturn, layoffs, a mental health issue, or expensive prescriptions needed to sustain life.

To. Watch. TV.

[Metalcat]

Just talked with a spendy cousin of mine who told the story of a special trip he made to set up his parents' new TV. Silly me, I was thinking that meant plug all the cords in, but he meant setting up accounts with:

Amazon
Netflix
Peacock
HBO Max
YouTube subscription
Disney+
...

Honestly he rattled off so many services I kinda lost count, and got distracted by my own realization that we're talking about a reoccurring bill of over $150/month.

I couldn't stop thinking that's years of extra time at a job. Gobs of extra risk in case of a health problems forcing retirement, economic downturn, layoffs, a mental health issue, or expensive prescriptions needed to sustain life.

To. Watch. TV.

Actually, they're paying to NOT watch the bulk of TV that's available to them. That's way more TV access than anyone could possibly need, so by paying for them all at once instead of cycling through them, they are actually paying to NOT use all of the services very much.

It's like owning a bunch of cars. The more cars you own, the less you use any given vehicle.

So they're not even paying more to watch tv, they're paying more to watch proportionally less of the TV they pay to have access to. It's pretty insane, and so easily avoidable with cycling memberships.

[farmecologist]

Just talked with a spendy cousin of mine who told the story of a special trip he made to set up his parents' new TV. Silly me, I was thinking that meant plug all the cords in, but he meant setting up accounts with:

Amazon
Netflix
Peacock
HBO Max
YouTube subscription
Disney+
...

Honestly he rattled off so many services I kinda lost count, and got distracted by my own realization that we're talking about a reoccurring bill of over $150/month.

I couldn't stop thinking that's years of extra time at a job. Gobs of extra risk in case of a health problems forcing retirement, economic downturn, layoffs, a mental health issue, or expensive prescriptions needed to sustain life.

To. Watch. TV.

Actually, they're paying to NOT watch the bulk of TV that's available to them. That's way more TV access than anyone could possibly need, so by paying for them all at once instead of cycling through them, they are actually paying to NOT use all of the services very much.

It's like owning a bunch of cars. The more cars you own, the less you use any given vehicle.

So they're not even paying more to watch tv, they're paying more to watch proportionally less of the TV they pay to have access to. It's pretty insane, and so easily avoidable with cycling memberships.

I agree.  Many pay for all of these services and can't possibly watch everything.  On the other hand, I'm not a fan of "binging" shows either...as it encourages the "couch potato" lifestyle.

With that said, we have been guilty of having too many services...but that was back when they were relatively cheap.  We have cut back drastically...and surprisingly, after a small adjustment period for the better, we don't really miss them.

[Reynold]

..

Im originally from Australia and now live in the USA, where this exact thing baffles me. ..

"Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive."


maybe switch GP

We just did exactly this, going in for our annual free Wellness visits, we had to sign paperwork that if any "new" conditions came to light or were discussed they could charge as a regular office visit.  I told the doctor when I went in that he should tell me if that was going to happen, we discussed nothing new, no new prescriptions, he didn't think there would be any charge, but we got charged a copay.  Same with my wife.  So we are now changing practices to one that doesn't play games with billing like that. 

We are definitely seeing a trend, though, that even for in network doctors and offices they want you to sign paperwork that says they can bill you whatever they want despite the "contract" they have with the insurance company.  When it is physical paperwork I've actually modified it and initialed it, and usually they don't even look at it and just take it.  We actually left a surgical center where we had a minor procedure scheduled because they refused to accept our modification, I think it really surprised them, but they chose to sign a contract to be in network and accept my insurance, I'm not willing to give them an out.  With electronic paperwork you can't even modify it of course. 

[iris lily]

As someone who has started avoiding my annual appointments because I hate paying $200 out of pocket if I answer a question the wrong way or have bloodwork come make with a quirk (turning it from free annual to chargeable "problem visit") the medicare thing makes me happy! Only 25 more years to go :)  Medicare for all please!

Im originally from Australia and now live in the USA, where this exact thing baffles me. Not being allowed to ask specific questions in a GP visit strikes me as so counterproductive. The only reason we go is so we can get a blood test.
I am yet to have a positive experience with our health insurance, which consumes thousands of dollars a year from us. Every visit to a specialist or interaction with the health system is confusing and non-sensical.

Welcome to the USA!

More like, welcome to ACA dictated rules.

Like a poster above, I go to a direct care physician and pay around $1000 a year for that access  so we don’t play these nonsense games.

[eyesonthehorizon]

I seem to recall before the ACA that co-pays were standard for a wellness type exam, so either way you’d be paying if you have questions (which becomes a diagnostic visit). Whereas with the ACA it’s mandated there be nothing out of pocket if it’s a wellness exam, vs. having to pay a co-pay before ACA.

The issue isn’t the ACA there, it’s doctors fighting to be compensated by medical insurers, who have made the billing system unnavigable so that they pay as little as possible for any given patient. This costs the doctors’ offices a ton of billable hours for their staff, raising overall costs, & makes concierge medicine more attractive as a business model.