We're a healthy (no chronic conditions or long-term medications) family of four serving in a European country - I work in the US Foreign Service.
After reading the Mad Fientist's blog post calling Health Savings Accounts (HSA) "The Ultimate Retirement Account" (
http://www.madfientist.com/ultimate-retirement-account/), I decided to compare our Platinum health insurance plan with a High Deductible Health Plan (HDHP) offering. So far, the HDHP costs us less and provides access to the HSA, without any change in access to medical care (since we're overseas, all medical care is considered "in-network").
Premiums:Platinum Plan: $148.25 / pay period => $3,854.50 / year with no access to an HSA (though I made use of the use it or lose it Flexible Spending Account (FSA))
HDHP: $116.18 / pay period => $3,020.68 / year minus my employer's $1,500.00 contribution to the HSA => $1,520.68
Deductibles / Co-Pays:Platinum Plan: $500 family deductible, then 10% copay (for most services), max family out-of-pocket $5,000
HDHP: $3,000 family deductible, then 5% copay (for most services), max family out-of-pocket $12,000, which we could cover without difficulty
Benefits of the Platinum Plan not available in the HDHP:Orthodontia covered 50% up to $1,000 per child vs. no coverage at all.
Massage Therapy 40 visits / person / year vs. no coverage at all.
Chiropractic 40 visits / person / year vs. 12 visits / person / year.
...and a few others that we don't use...
Since my wife is an EU citizen and can work in our host country, she is also taxed by and contributes to the host country national health care system. Fortunately, this system does cover orthodontia with some limits (I have two teenagers, both of whom needed orthodontia. The older one is done, the younger one just started). I also could have enrolled in a Limited Expense Health Care FSA (LEX HCFSA), which covers out-of-pocket dental and vision care expenses. I didn't realize this until after the FSA enrollment period was over, and may re-enroll next year.
Our particular HDHP uses HSABank for the HSA, and has negotiated a sweet no-fee deal, so we don't need a minimum balance in the HSA to avoid fees. In addition to the employer contributions, I've had my HSA contributions deducted directly from my pay, reducing my Federal, State, OASDI and Medicare taxes. Though this also reduces my Social Security benefits over the long term, we're planning our retirement without considering SS at all.
HSABank allows me to invest my HSA funds in TDAmeritrade, which gives me access to most investment products. I've chosen to invest in the no-fee ETFs in the following ratio (though I'm considering using Dual Momentum):
IVV (S&P 500 Equivalent) 25%
VO (US Mid-Cap) 25%
VB (US Small-Cap) 25% - yes, I know I'm overweighting small- and mid-cap stocks compared to a Total Stock Market ETF
VEA (International Developed Markets) 15%
VWO (International Emerging Markets) 10%
I'm down a little bit, but not worried about short-term sideways or declining markets.
I've scanned all our medical expenses this year and tracked them on a spreadsheet. I'll only submit them to the insurance company if we meet the $3,000 deductible; in the meantime, I can let our investments grow and then withdraw the cash when I need it (the MadFientist blog post discusses this further).
Obviously the math can change if you visit the chiropractor frequently or need medication or services for a chronic condition. For us, this has worked great, increased our forced savings, and reduced our taxes. Furthermore, I can always change plans again during Open Season if I need to. YMMV.
FIRE-wise I have a little more than 10 years to go to qualify for a government pension, after which I see no reason not to retire.
Cheers,
Elysian Fields