How many of you go without health insurance?

[FiveSigmas]

As Pete notes, it was possible to go without health insurance in 2019 without incurring a tax penalty. I’m curious how many forum-ites chose to do so and the reasons behind those decisions. If you went without, was the lack of a tax penalty a meaningful incentive?

Edit: correct title.

[Bourbon]

Thread title may be problematic.

[FiveSigmas]

Thread title may be problematic.

Uh... oops. Fixed. Thanks!

[use2betrix]

Lol. Currently at 0 yes, 16 no. Unsurprising.

Anyone in the US that can reasonably obtain health insurance, would be foolish not too. Especially if you have a high net worth.

[Omy]

I would be surprised if it tops 10%.

[Zamboni]

I have always had health insurance.

However, I grew up poor and had many friends who did not have health insurance for various lengths of time, almost always due to poverty, unemployment, and sometimes a thought that healthy young people don't need it. Real things that happened to three individuals among my uninsured friends:

Non-Hodgkins lymphoma in his 20's

Ruptured spleen (weird accident involving a ski pole to the mid-section . . . don't kid yourself: he is a better skier than you are)

Blood clot in leg that led to hospitalization and then a rehab center stay (an older friend in his 50's)

The first one was the scariest . . . friend right out of college was unemployed, couldn't find a job and so decided to run for congress, and while he was running found out he needed chemotherapy. Pretty awful situation. Spleen guy was saved by ski patrol realizing it was truly an emergency situation. Last guy ended up homeless because he couldn't pay his rent while in rehab, but once he was released found a friend to let him room for free in exchange for letting the landlords dogs out and feeding them during the day.

All of these people thought they were perfectly healthy and didn't need insurance. Only the ruptured spleen guy ever did anything especially risky in terms of becoming injured. Passing on health insurance is a bad call. Basically if you have enough for minimal food and have even a leaky a roof over your head, then health insurance is next in the USA.

[Omy]

The only way I'd consider passing on health insurance is if 1) I was single or 2) I had the money to self insure (which would probably mean well over $10 million to me). Without that kind of money, I'd be concerned about leaving my family to pay my medical bills for an expensive illness or accident.

[MayDay]

A friend of mine in her 50's took a calculated risk and didn't get it (and didn't save the cost of premiums). She shattered her ankle on NYE. Even if she had insurance she would have had thousands in expenses over two calendar years which she "couldn't afford" either......   

[Dicey]

I was diagnosed with a rare cancer in my very early twenties. NFW would I be without it. In fact, it was while trying to figure out decently affordable pre-Obamacare health insurance so I could .FIRE that a random guy I knew became my DH. If I ever get caught up on my journal, I'll finish telling the story. Hint: you're welcome to visit/hang out, especially 8f you're nice, but breath holding is not recommended ;-)

[DeniseNJ]

Ha.  My son has ADHD, Asperger's, food allergies, asthma---and that's just the As.  My daughter has diabetes since age 4.  They are both anaphylactic to peanuts.  He has depression and OCD; she has anxiety.  The diabetes alone costs a fortune.  NO WAY would I go wo insurance--NEVER!  Her first insulin pump was $6,000. 

Then last summer we killed a bat in our house and the doc said go to ER since you can't tell if it bit you.  So all four of us went to ER to get rabies shots.  Bill was $20K EACH.  They wanted us to come back 3 more times but we went to Passport Health instead for $400 per shot per person instead.  This could have costs hundreds of thousands of dollars.

I did go with a much cheaper insurance plan last year though so that was a blessing.

[Sibley]

Would you go sky diving without a parachute? If no, then you shouldn't forego health insurance in the US. The US does not have a robust safety net. The risk of you falling through the very wide gaps in the safety net is too high. If you can afford insurance, then you need to have it.

[Oroadsm]

I am doing taxes in a pretty low income area. Almost everyone here has insurance. Usually through an employer or Medicare / Medicaid. Surprisingly few through the marketplace.

[RedmondStash]

You're only immortal when you're young, and only until you or someone close to you (and also young) proves fallible to illness or injury.

I would never willingly go without health insurance in the U.S. The stakes in that game of Russian Roulette are just too high.

[Alternatepriorities]

I could have been your first yes vote if you hadn't specified a year.

Several years ago due to a questionable policy by DW's employer we were left with a 3 month insurance gap. The cheapest ACA plan in AK at the time was more then $800 a month each and cobra was similar. We spent the summer in Europe rather that shell out ~$5k in insurance premiums... Even paying after paying the ACA penalty and paying some minor health expenses out of pocket while there we basically had a free vacation.

The problems with the US system run much deeper than who pays for it. In the US it took two trips to urgent care at a cost of more than $500 to get treatment for a heat rash. In Spain it took a trip across the street to the pharmacia and, google translate to look up the medicine (prednisona) and $2 to get the same damn results.

[MrThatsDifferent]

Hmm, it surprises me that MMM would want to write an article defending his no insurance stance. Clearly that’s something that only someone very poor or very rich (like, very) can afford to take in the US. He can cover virtually any medical issue, which is great and rare. It’s not something that I think should be advocated or encourage because the even the disciples of MMM won’t hit that level of wealth. MMM is in a rather unique situation. But geez, it only takes one reckless drunk person in a car, when you’re on a bike to possibly send you into long term coma. Crazy.

[DaMa]

I did go 60 days without insurance in 2017.  I had the COBRA paperwork signed, a check made out and signed, and clear instructions to my son to submit them if anything happened.  It's nice the COBRA can be retroactive.

[afox]

The only way I'd consider passing on health insurance is if 1) I was single or 2) I had the money to self insure (which would probably mean well over $10 million to me). Without that kind of money, I'd be concerned about leaving my family to pay my medical bills for an expensive illness or accident.

And what if you were on the opposite end of the spectrum with little to no savings? Would you be more likely to go without insurance? I would.

The way I see it the very poor have an economic incentive to not pay for health insurance. They can get medical care at an emergency room or doctors office and just not pay and soon as the debt collector realizes they have no money/no income they will stop pursuing the debt collection.

The very rich that can afford to pay out of pocket for any medical expenses (no idea how much would be a safe amount to have) also have an economic incentive to go without insurance.

Myself and I assume the vast majority of us on this forum have savings (but not enough for the inevitable) and income. We fall into the category of person that a debt collector is most likely to pursue and file judgements/etc to the fullest extent of the law to recover those medical expenses. Thus, we have the most to lose (financial ruin) if we incur major medical expenses. Anyone with assets/income thinking about going without insurance should read up on asset protection strategies, some pots of money are harder for debt collectors to access than others, its very complicated and the laws are very different for each state.

Then there is the issue of the level of care you receive if you don't have insurance. Of course those without insurance or the ability to write large checks do not receive the same level of care from medical professionals.

[Omy]

I've never had a gap in insurance - and I've paid for it myself for most of my 35+ year working history since I've been mostly self employed. Probably to the tune of $250+k for premiums alone since I never qualified for ACA subsidies.

It's a racket, and I am all in for a health care system that is affordable for everybody. Between Medicaid and ACA subsidies, there should be no reason that the poor are unable to afford health insurance (if it had been implemented uniformly across the country.)

[HeadedWest2029]

One missing option is healthshare ministries.  It's not technically insurance, so I guess maybe I'm a "yes", but for all practical purposes it functions like insurance, although the ministries are under no legal obligation to pay (but they do).  So I'd say riskier than traditional insurance, but much less risky than truly no insurance. 

[Villanelle]

I can't imagine a scenario where I'd go without health insurance before sacrificing nearly everything else beyond basic shelter and food.

Or maybe if I was ridiculously wealthy (like, $25m+, maybe?) and self-insured.  Even then, I'm not sure I'd do it because at that point the premiums would be pocket change. 

[EscapeVelocity2020]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

This was a real eye-opener when my son had to go for stitches - walking past a room full of uninsured with much more severe injuries and getting a bed right away.

[MayDay]

Afix the issue is that if you are diagnosed as a poor person with an ongoing issue you are screwed. If you are diagnosed with cancer for example- most oncologists require either insurance or prepayment.  Same with stuff like orthopedic surgery- my friend without insurance who shattered her ankle had to make. 25% down payment on surgery before they'd schedule it.

[afox]

Afix the issue is that if you are diagnosed as a poor person with an ongoing issue you are screwed. If you are diagnosed with cancer for example- most oncologists require either insurance or prepayment.  Same with stuff like orthopedic surgery- my friend without insurance who shattered her ankle had to make. 25% down payment on surgery before they'd schedule it.

good point, then the only no-insurance option is to be rich, really rich. Although if you are willing to go poor there is medicaid, in some states at least.

[Not There Yet]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

I was between jobs (a week off between leaving one job and beginning another) when I broke a bone and needed surgery.  My emergency care was covered under my previous insurance.  The surgery should have been covered under my new insurance - it was supposed to cover pre-existing conditions as long as I had no gap in coverage.  However, they denied coverage.  I couldn't have surgery for two weeks because of this and ended up paying out-of-pocket.  I'm certain I would have had a better result if the surgery hadn't been delayed. 

After that small sample of what it was like to be uninsured, I'll sacrifice just about anything to pay for insurance coverage.

[RedmondStash]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

This was a real eye-opener when my son had to go for stitches - walking past a room full of uninsured with much more severe injuries and getting a bed right away.

I'd never heard about this before. I didn't realize patients with insurance got preferential treatment in the ER over those without; I thought it was all based on triaging and urgency.

Anybody know if some types of insurance get even more preferential treatment? Like, employer vs. ACA? Gold vs. Silver or Bronze?

[Fomerly known as something]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

This was a real eye-opener when my son had to go for stitches - walking past a room full of uninsured with much more severe injuries and getting a bed right away.

I'd never heard about this before. I didn't realize patients with insurance got preferential treatment in the ER over those without; I thought it was all based on triaging and urgency.

Anybody know if some types of insurance get even more preferential treatment? Like, employer vs. ACA? Gold vs. Silver or Bronze?

My guess it is kind of triaging.  So in a Mass casualty incident there are 4 levels of triaging, life threatening (red), urgent (orange or yellow), walking wounded (green) and dead (black).  My guess is those with insurance in the Green section, which covers a lot of ground, get moved up to first seen but if a urgent or life threatening came in with no insurance they'd go ahead.

[EscapeVelocity2020]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

This was a real eye-opener when my son had to go for stitches - walking past a room full of uninsured with much more severe injuries and getting a bed right away.

I'd never heard about this before. I didn't realize patients with insurance got preferential treatment in the ER over those without; I thought it was all based on triaging and urgency.

Anybody know if some types of insurance get even more preferential treatment? Like, employer vs. ACA? Gold vs. Silver or Bronze?

From what I understand, a hospital must stabilize someone if they show up at the ER (so they don't have people dying in the waiting room), but beyond that, it is at the hospital's discretion in what order they treat the patients.  There definitely were sick and people in pain that we jumped the line in front of.  My son's head wound was bloody but not life-threatening.  He had stopped crying and the bleeding was under control.

I felt really guilty getting immediate attention once the paperwork went through, even though it was a quick procedure and surely very profitable for the ER (which helps make up for uninsured patients that cannot pay).

And maybe this was just a regional, one time, anecdotal experience though.  Houston probably has it worse than other places.

[maisymouser]

I can't imagine a scenario where I'd go without health insurance before sacrificing nearly everything else beyond basic shelter and food.

Or maybe if I was ridiculously wealthy (like, $25m+, maybe?) and self-insured.  Even then, I'm not sure I'd do it because at that point the premiums would be pocket change.

Yeah, my insurance is a basic need for me at this point. I have two chronic autoimmune health conditions (very well managed, I might add- thanks new medicine and technology!). If the health care system doesn't improve in the US, I may not be able to RE based on my medical needs. I have had them since I was 20.

It really pisses me off when people say they don't want to subsidize others in the market. If I weren't able to obtain insurance in the current market due to my preexisting conditions, I would likely be disabled as a young-ish person. But because I am able to obtain the treatments that make my diseases basically nonexistent, I lead a completely normal and rather productive life. It causes me a lot of mental grief knowing that others out there feel I am taxing the system and/or that I am a burden to society. But, you know... haters gonna hate.

[Paul der Krake]

Even if you are very, very rich, if you end up at the ER with no insurance, you are going to be waiting around like the rest of the uninsured.  Maybe not a problem if you have some relationship with an ER or are willing to go to an ER that isn't busy (probably not a good sign), but there are other complications to being uninsured in addition to the added expenses.

This was a real eye-opener when my son had to go for stitches - walking past a room full of uninsured with much more severe injuries and getting a bed right away.

I'd never heard about this before. I didn't realize patients with insurance got preferential treatment in the ER over those without; I thought it was all based on triaging and urgency.

Anybody know if some types of insurance get even more preferential treatment? Like, employer vs. ACA? Gold vs. Silver or Bronze?

I doubt that hospital staff can even see the metal level of an ACA plan. My ACA insurance card from the local BigInsurer is indistinguishable from a BigInsurer employer plan, and nobody has ever mentioned that it's an ACA plan. But everyone always asks whether it's BigInsurer Medicaid, because they do not take that one.

[brooklynmoney]

My friend is so rich he is on the board of his local hospital. He has no job so he buys insurance. So yes even the rich have insurance in America.

[DeniseNJ]

It really pisses me off when people say they don't want to subsidize others in the market. If I weren't able to obtain insurance in the current market due to my preexisting conditions, I would likely be disabled as a young-ish person. But because I am able to obtain the treatments that make my diseases basically nonexistent, I lead a completely normal and rather productive life. It causes me a lot of mental grief knowing that others out there feel I am taxing the system and/or that I am a burden to society. But, you know... haters gonna hate.

That's actually exactly what insurance IS--everybody who doesn't use it is paying for those who do.  The entire system is based on this idea of subsidy.  It's ridiculous to say you shouldn't pay for ppl who are sick since you never use it.  You don't know if you will be one of the ppl who end up using it.  That's the whole point.  And yet the insruance companies still cash in.

Also ppl need to keep in mind that nobody actually wants to use insurance.  I'd prefer to pay and NOT be sick than to pay and get to use my insurance frequently on my diabetic child.  I also prefer NOT to get into car wrecks even though I have car insurance.  And I had a 20 yr life insruance policy that I didn't get to cash in on before it expried.  Woohoo.

[DrinkCoffeeStackMoney]

I went about 5 years in my mid-20's with no insurance. Now that I'm older and dare I say wiser, I'd never go without insurance.
All it would take is one major illness to bankrupt most.
Example: A family member had a massive heart attack about 8 years ago and spent 5 years on a transplant list before she passed. Total doctor bills for that totaled a little over $2.4 million dollars. Needless to say her spouse is now widowed at 60 years old, and broke after filing bankruptcy and pretty much losing everything.

[Padonak]

Following

[thesis]

This is a really valuable thread, and is way more informative than the doom and gloom threads that occasionally pop up. In some ways it makes me wonder if being able to afford health insurance isn't perhaps some sort of FI "baseline". If your stash never gets any higher than what it takes to pay for health insurance, then you've still done very well. However, there's a lot of BS insurance options out there that are designed to screw you out of your money. This makes me want to understand the insurance industry better. It is one of the most important things to understand in the modern world (especially the US, as health care is concerned), but rarely is it well understood except through unfortunate anecdotal incidents. I know there's a wealth on information on this forum, too.

[JSMustachian]

I did elect to go 3 months without health insurance because our open enrollment periods were different. I did not have to go to the doctor during that time and I saved $900. The risk is prob too high to keep doing this but I did come out ahead.

I would not go without health insurance for a full 12 months.

[tipster350]

This is a really valuable thread, and is way more informative than the doom and gloom threads that occasionally pop up. In some ways it makes me wonder if being able to afford health insurance isn't perhaps some sort of FI "baseline". If your stash never gets any higher than what it takes to pay for health insurance, then you've still done very well. However, there's a lot of BS insurance options out there that are designed to screw you out of your money. This makes me want to understand the insurance industry better. It is one of the most important things to understand in the modern world (especially the US, as health care is concerned), but rarely is it well understood except through unfortunate anecdotal incidents. I know there's a wealth on information on this forum, too.

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

[afox]

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

Yes, I took a look at the ACA plans for my state and it was a reasonable task to compare plans. The problem is few people use ACA plans, the vast majority get health insurance from their employer. My employer offers a dozen or so different plans from many different companies. Comparing them is nearly impossible. If they only used the same metrics for comparison it might be possible. So, you might qualify what you wrote to include that comparing ACA plans is an approach that only works for the 10% or so of people that are using them.

[Paul der Krake]

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

Yes, I took a look at the ACA plans for my state and it was a reasonable task to compare plans. The problem is few people use ACA plans, the vast majority get health insurance from their employer. My employer offers a dozen or so different plans from many different companies. Comparing them is nearly impossible. If they only used the same metrics for comparison it might be possible. So, you might qualify what you wrote to include that comparing ACA plans is an approach that only works for the 10% or so of people that are using them.

If your employer offers many options, it almost certainly:
1) is self-insuring, with the insurance company only providing claim processing services
2) provides plans that meet or exceed ACA standards
3) structures options so that they're all roughly equivalent on an actuarial basis

The bottom line is that your employer is in all likelihood doing a fine job, so don't worry about it too much. Pick whichever looks best for you, and find something more enjoyable to do than comparing health plans. :)

[EscapeVelocity2020]

Wait a minute, someone voted yes but didn't leave a comment?  Or was it a 'part time non-insured' in 2019 response?

[hops]

In a good year my insurance is billed $50k to $75k for various services. In bad years it's six figures. My prescriptions alone usually add up to another $75k. I'm in my thirties and this has gone on for much of my life, and will probably continue until I die. I've never gone without insurance, but needlessly lost a couple relatives who did.

A story that's always stuck with me, from years ago, was that of a former vendor. He was in his fifties and thought he was perfectly healthy. Wasn't going to be "forced" into buying health insurance by anyone. He had a massive heart attack one day while mowing his yard. Spent weeks in the hospital. He lost his small business, exhausted his savings. Stood there later telling my boss "I wish they'd just left me in the yard to die." Not because of his prognosis, which was fine after receiving proper care. Because of money.

[tipster350]

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

Yes, I took a look at the ACA plans for my state and it was a reasonable task to compare plans. The problem is few people use ACA plans, the vast majority get health insurance from their employer. My employer offers a dozen or so different plans from many different companies. Comparing them is nearly impossible. If they only used the same metrics for comparison it might be possible. So, you might qualify what you wrote to include that comparing ACA plans is an approach that only works for the 10% or so of people that are using them.

If your employer offers many options, it almost certainly:
1) is self-insuring, with the insurance company only providing claim processing services
2) provides plans that meet or exceed ACA standards
3) structures options so that they're all roughly equivalent on an actuarial basis

The bottom line is that your employer is in all likelihood doing a fine job, so don't worry about it too much. Pick whichever looks best for you, and find something more enjoyable to do than comparing health plans. :)

Yes, usually true. However, there have been exceptions (and I know you couched your statements in "almost always"). For example, casinos have been known to self-insure to then exempt coverage of treatment for conditions that generally affect smokers, such as lung disease/cancer....knowing that their workers spend all day in smoke-filled casinos.

So, most of the time...your employer's plans are decent enough. You'd probably have heard horror stories, most of a similar issue, by now if your employer plans left you open for bankruptcy.

[Paul der Krake]

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

Yes, I took a look at the ACA plans for my state and it was a reasonable task to compare plans. The problem is few people use ACA plans, the vast majority get health insurance from their employer. My employer offers a dozen or so different plans from many different companies. Comparing them is nearly impossible. If they only used the same metrics for comparison it might be possible. So, you might qualify what you wrote to include that comparing ACA plans is an approach that only works for the 10% or so of people that are using them.

If your employer offers many options, it almost certainly:
1) is self-insuring, with the insurance company only providing claim processing services
2) provides plans that meet or exceed ACA standards
3) structures options so that they're all roughly equivalent on an actuarial basis

The bottom line is that your employer is in all likelihood doing a fine job, so don't worry about it too much. Pick whichever looks best for you, and find something more enjoyable to do than comparing health plans. :)

Yes, usually true. However, there have been exceptions (and I know you couched your statements in "almost always"). For example, casinos have been known to self-insure to then exempt coverage of treatment for conditions that generally affect smokers, such as lung disease/cancer....knowing that their workers spend all day in smoke-filled casinos.

So, most of the time...your employer's plans are decent enough. You'd probably have heard horror stories, most of a similar issue, by now if your employer plans left you open for bankruptcy.

Is the casino example still possible in the ACA era? I was under the impression that aside from a couple hot-button issues (all related to women's vaginas and what they do with them), essential minimum coverage rules prohibited employers from pulling this sort of stunt. I'd love to hear other types of exceptions.

[DeniseNJ]

The other important reason to have even the crappiest insurance:  If you go to the doc, at least you get their contracted rate.  When my daughter spent 5 days in the hospital with asthma, the bill was like 50K.  The insurance only approved 7K.  We paid our small portion of that, but if we didn't have ins they would have charged us 50K, not the measly 7K that they had contracted with my insurance company.  You don't want to pay the sticker price.

[FIRE@50]

The other important reason to have even the crappiest insurance:  If you go to the doc, at least you get their contracted rate.  When my daughter spent 5 days in the hospital with asthma, the bill was like 50K.  The insurance only approved 7K.  We paid our small portion of that, but if we didn't have ins they would have charged us 50K, not the measly 7K that they had contracted with my insurance company.  You don't want to pay the sticker price.

This is a good point. I think you could probably discuss pricing with your dentist before services are rendered, but in most medical situations, you aren't in much of a position to negotiate. Sure, on 50k, you could probably get them to come down a bit but I doubt that you get it down to anywhere near 7k.

[tipster350]

Industry insider here. I have designed health insurance products, so I am offering more than opinion.

Yes, insurance is complicated. However, you don't have to study for years and mire yourself in endless details. The easy way to find a safe and comprehensive health insurance plan is to choose an ACA plan or one that is built to mirror an ACA plan. The ACA implemented a set of requirements on health insurance benefits and costs to assure a certain level of coverage and safety from healthcare costs that can bankrupt you. If you follow all the requirements, such as staying in network for services, your OOP costs will be contained. Still expensive, but not ruined for lifetime expensive.

Yes, I took a look at the ACA plans for my state and it was a reasonable task to compare plans. The problem is few people use ACA plans, the vast majority get health insurance from their employer. My employer offers a dozen or so different plans from many different companies. Comparing them is nearly impossible. If they only used the same metrics for comparison it might be possible. So, you might qualify what you wrote to include that comparing ACA plans is an approach that only works for the 10% or so of people that are using them.

If your employer offers many options, it almost certainly:
1) is self-insuring, with the insurance company only providing claim processing services
2) provides plans that meet or exceed ACA standards
3) structures options so that they're all roughly equivalent on an actuarial basis

The bottom line is that your employer is in all likelihood doing a fine job, so don't worry about it too much. Pick whichever looks best for you, and find something more enjoyable to do than comparing health plans. :)

Yes, usually true. However, there have been exceptions (and I know you couched your statements in "almost always"). For example, casinos have been known to self-insure to then exempt coverage of treatment for conditions that generally affect smokers, such as lung disease/cancer....knowing that their workers spend all day in smoke-filled casinos.

So, most of the time...your employer's plans are decent enough. You'd probably have heard horror stories, most of a similar issue, by now if your employer plans left you open for bankruptcy.

Is the casino example still possible in the ACA era? I was under the impression that aside from a couple hot-button issues (all related to women's vaginas and what they do with them), essential minimum coverage rules prohibited employers from pulling this sort of stunt. I'd love to hear other types of exceptions.

Exceptions in benefit offerings are possible for self-insured plans that have been grandfathered. The casino example was from pre-ACA days, but if the plan is grandfathered, I'm pretty sure they can continue.

[EscapeVelocity2020]

Wait a minute, someone voted yes but didn't leave a comment?  Or was it a 'part time non-insured' in 2019 response?

Now there are two votes for yes!  I'm really hoping someone sticks their neck out with a good arguement...  Even MMM's 'I'm healthy and take care of myself (and my son)' reasoning for being uninsured does not seem to have had much traction with the community that this was a frugal idea worth investigating.

[OtherJen]

I'd like to hear from the "yes" voters. It seems like incredible hubris to remain uninsured in the USA. I generally agree with Pete but I can't agree on this topic. I've seen a few high school friends deal with significant cancers (we're all in our 40s) and autoimmune diseases, etc. The costs of treatments for those illnesses would have been ruinous without health insurance.

My young nephew is facing multiple medical consults and probably surgery. My dad was just diagnosed with cancer. A young cousin went through leukemia treatment a few years ago. Without insurance, the associated costs would bankrupt each family.

[Alternatepriorities]

I'd like to hear from the "yes" voters. It seems like incredible hubris to remain uninsured in the USA. I generally agree with Pete but I can't agree on this topic. I've seen a few high school friends deal with significant cancers (we're all in our 40s) and autoimmune diseases, etc. The costs of treatments for those illnesses would have been ruinous without health insurance.

My young nephew is facing multiple medical consults and probably surgery. My dad was just diagnosed with cancer. A young cousin went through leukemia treatment a few years ago. Without insurance, the associated costs would bankrupt each family.

I didn't vote yes as explained above but I have gone without health insurance a couple of times when my finances and responcibilities were different than they are now. So here's an example of when the math might make sense.

Imagine you have significant assets in a 401k that won't be lost in bankruptcy, own a single mustachian vehicle with 200k+ miles and have a small stash of cash (let's call it $24k) that you'd like to spend taking a year off. Now imagine that you look at the price of insurance and see that it's slightly over $800 per month ($9.6k/year) for the most basic plan offered through the exchange and it comes with a $5,000 deductible. One might look at those numbers and decide to gamble there won't a medical bill that exceeds 14.6k but is less than 24k in the next year.

Honestly given the protections offered for retirement accounts and primary residences in bankruptcy I'm a little surprised that more mustachians don't gamble on it.

[OtherJen]

I'd like to hear from the "yes" voters. It seems like incredible hubris to remain uninsured in the USA. I generally agree with Pete but I can't agree on this topic. I've seen a few high school friends deal with significant cancers (we're all in our 40s) and autoimmune diseases, etc. The costs of treatments for those illnesses would have been ruinous without health insurance.

My young nephew is facing multiple medical consults and probably surgery. My dad was just diagnosed with cancer. A young cousin went through leukemia treatment a few years ago. Without insurance, the associated costs would bankrupt each family.

I didn't vote yes as explained above but I have gone without health insurance a couple of times when my finances and responcibilities were different than they are now. So here's an example of when the math might make sense.

Imagine you have significant assets in a 401k that won't be lost in bankruptcy, own a single mustachian vehicle with 200k+ miles and have a small stash of cash (let's call it $24k) that you'd like to spend taking a year off. Now imagine that you look at the price of insurance and see that it's slightly over $800 per month ($9.6k/year) for the most basic plan offered through the exchange and it comes with a $5,000 deductible. One might look at those numbers and decide to gamble there won't a medical bill that exceeds 14.6k but is less than 24k in the next year.

Honestly given the protections offered for retirement accounts and primary residences in bankruptcy I'm a little surprised that more mustachians don't gamble on it.

I'm not a gambler at all. Maybe that's why this doesn't make sense to me.

[Alternatepriorities]

I'm not a gambler at all. Maybe that's why this doesn't make sense to me.

Honest question that I'm afraid might sound like trolling.

How is spending ~$10k on something you don't expect to use not a gamble? To me that just feels like gambling that I will need it.