Insulating against medical bankruptcy

[RedmondStash]

The recent fascinating thread about umbrella insurance made me realize that I don't actually know how much $$ I could be on the hook for after a catastrophic medical event.

Can anyone shed light on this? I've read enough stories about people who had good health insurance but still got socked with huge medical bills after a major medical event that I don't trust an out-of-pocket limit to insulate me against stash-destroying bills if something extremely expensive happens -- cancer, chronic disease, severe injury requiring long hospitalization and much rehab, covid, etc. I mean, there's a lot that health insurance doesn't cover, or doesn't cover fully.

Honestly, an expensive, unforeseen medical event is the only concern I have about my FIRE plan. Maybe I don't have to worry so much -- or maybe I do.

[RyanAtTanagra]

Posting to follow.  I've been posting in the other thread but this is really what I'm wondering about.

[Abe]

This is a very, unnecessarily complicated topic in the US.

The easiest way to break this down is that anything requiring long-term care by another person (rehab, nursing home, etc) will be very expensive as most insurance limits how much they will pay. This is because of the gray zone between “healthcare” and “existing while partly or wholly disabled”.

Most decent companies will pay for short-term issues like cancer medications, hospitalization, etc.  They will not pay for all the additional expenses of driving to/from clinics, time off work, etc. Neither will umbrella insurance (that is primarily for liability,  not for healthcare).  Long-term disability insurance would be the most likely to cover this scenario, if you are unable to work (but can be a nightmare to qualify for…yet another complicated issue). Unfortunately most of that gets sucked into basic living expenses rather than the new additional expenses people with disabilities face.

There is also long-term care insurance if you are not able to live at home (this can be quite expensive but much cheaper than paying for a decent assisted living room from your stash, were you to need it).


The way I have handled this is good health insurance, good specialty-specific disability, and living far below my income. The first is provided by my employer, but the second I pay out of pocket as group long-term disability policies suck.

[afox]

as far as i know the best protection against medical bankruptcy is health insurance with an out of pocket max that you can afford year after year. Please correct me if im wrong!

[SailingOnASmallSailboat]

as far as i know the best protection against medical bankruptcy is health insurance with an out of pocket max that you can afford year after year. Please correct me if im wrong!

Part of the problem is that the term "max OOP" is not what most logical people think it is. If a procedure or medicine or anything is not considered coverable by the insurance company, then any money you pay to that doesn't count toward the Max OOP.

Best protection against medical bankruptcy is not to need medical care.

[Turtle]

Accidents requiring air ambulance are notorious for insurance refusing to cover, or only covering a very small percentage.

VLCOL areas may be great for housing prices, but in any sort of major accident without a large hospital nearby, air ambulance is likely to be needed.

[Blue Skies]

I would love to see that there exists an answer to this issue.  I am not aware of one. 

Don't get sick or injured is a tough one to follow.  Especially don't get injured and taken somewhere out of network for services.  Ouch.

The OOP limit is a nice idea in theory, but in practice so much doesn't count... and then dental is a whole other issue.  My teeth will cost me a lot over the next couple of decades, and there isn't anything I can do to mitigate that.  The dental insurance we have covers 50% of imaginary, unrealistically low costs (not 50% of actual costs) up to a very low total each year, and I am on the hook for everything above that.

Healthcare is the biggest question mark in looking at my future plans as well.

[reeshau]

It's not a panacea, but this is one reason why I built up my HSA while I was working.  It not only would allow me to raise money for significant medical costs without taxes, but also without hitting my AGI, and therefore the secondary effect on tax credits, ACA subsidies, etc.

I didn't have a lot of years with an HSA; it's not six figures, but it is high five.

I certainly don't fear a medical bankruptcy.  But that's not to say that a multiple-six-figure bill wouldn't dent my retirement.

[RedmondStash]

It's not a panacea, but this is one reason why I built up my HSA while I was working.  It not only would allow me to raise money for significant medical costs without taxes, but also without hitting my AGI, and therefore the secondary effect on tax credits, ACA subsidies, etc.

This is an excellent point, one I hadn't considered. If your medical expenses go up, you have to free up money to pay, which can mean a bigger tax hit. That gives me an extra reason to keep pushing the IRA -> Roth conversions.

It sounds like there really is no protection against medical bankruptcy in the U.S. except not needing that level of medical care. Padding your stash is the only mitigating strategy I can think of, but it's hardly bulletproof.

Now I'm wondering about the process of declaring bankruptcy in the case of a catastrophic medical situation. Anyone know about that? Are any assets protected?

I wonder if we'll ever have true healthcare reform to put these questions to rest.

[Adventine]

This has been on my mind as well. Apart from having an HSA, my husband and I also have the option of returning to my home country, where medical care is much cheaper, and it's much more affordable to have private nurses and home health aides. I'm also lucky to have a couple of doctors in my family from whom I've received free or discounted treatment in the past. I also trust my doctor relatives to refer me to specialists who won't charge as much.

[RedmondStash]

FWIW, I found this article useful:

https://www.creditkarma.com/advice/i/medical-debt-in-bankruptcies

I hadn't thought about it, but medical institutions that send you huge bills are aware that some people won't be able to pay them. They're probably used to negotiating. So that's something.

[LifeHappens]

The "No Surprises Act" went into effect Jan 1, 2022 and addresses some concerns. There is a high level overview here: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills.

An excerpt:

As of January 1, 2022, consumers have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. Through new rules aimed to protect consumers, excessive out-of-pocket costs are restricted, and emergency services must continue to be covered without any prior authorization, and regardless of whether or not a provider or facility is in-network.

Previously, if consumers had health coverage and got care from an out-of-network provider, their health plan usually wouldn't cover the entire out-of-network cost. This left many with higher costs than if they’d been seen by an in-network provider. This is especially common in an emergency situation, where consumers might not be able to choose the provider. Even if a consumer goes to an in-network hospital, they might get care from out-of-network providers at that facility.

In many cases, the out-of-network provider could bill consumers for the difference between the charges the provider billed, and the amount paid by the consumer’s health plan. This is known as balance billing. An unexpected balance bill is called a surprise bill.

[afox]

as far as i know the best protection against medical bankruptcy is health insurance with an out of pocket max that you can afford year after year. Please correct me if im wrong!

Part of the problem is that the term "max OOP" is not what most logical people think it is. If a procedure or medicine or anything is not considered coverable by the insurance company, then any money you pay to that doesn't count toward the Max OOP.

Best protection against medical bankruptcy is not to need medical care.

I must say in 40 years of using health insurance I have not run into an issue where a medical service I needed was not covered by the insurance company. I think that is mainly because Ive always just used "conventional" medicine.

I have had many cases where the insurer denies a valid claim for covered conventional medicine, I have always appealed and won. That seems like just a part of doing buisness for the insurance companies and as the insured consumer I expect to have to appeal to the insurance company. Looking thru my plans brochure it seems like stated non covered stuff is cosmetic, traditional medicine...

[SwordGuy]

The only real defense in the US is for enough people to vote progressives into office so we get a National Healthcare Service based on one of the many successful ones around the world.

[afox]

The only real defense in the US is for enough people to vote progressives into office so we get a National Healthcare Service based on one of the many successful ones around the world.

Probably a main reason national single payer has'nt happened is that a large percentage of people in the U.S. have good health insurance either thru their employer or medicare medicaid, 91% of americans have health insurance.

Looks like obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

I believe insurers can also no longer put lifetime max's benefits in their plans.

I think the only reasonable way to prevent medical bankruptcy is to budget for paying your premiums and out of pocket max's until you qualify for medicare and consider non-covered services as not an option, a death sentence, etc. Sad Fact: Note that single payer national healthcare systems worldwide have long lists of non-covered services, some may just be expensive conventional medicine, essentially those conditions may be death sentences for the afflicted but not covering them saves many more lives due to the cost savings.  Theres just no getting around the fact that healthcare is a large expense and it certainly puts the kibosh on an early retirement for many, myself included.

[JupiterGreen]

I must say in 40 years of using health insurance I have not run into an issue where a medical service I needed was not covered by the insurance company. I think that is mainly because Ive always just used "conventional" medicine.

I have had many cases where the insurer denies a valid claim for covered conventional medicine, I have always appealed and won. That seems like just a part of doing buisness for the insurance companies and as the insured consumer I expect to have to appeal to the insurance company. Looking thru my plans brochure it seems like stated non covered stuff is cosmetic, traditional medicine...

Are you in the US? If so, this is astounding to me. My parter and I have been denied coverage for a bevy of things and we have (what is considered) good coverage through our employer. It is also near impossible to find out if something will be covered in advanced so I (and I know many others) have simply avoided getting an issue/possible issue checked out. For example, my doctor referred me to radiology for an x-ray, but they couldn't tell me if my insurance would cover it. I called my insurance they also couldn't tell me if it would be covered. After sitting in the radiology waiting room for at least an hour and a half and being passed around on the end of my insurance I finally got a tentative answer. I may have ended up paying for it out of pocket, I really don't remember. All I know is it was not worth the frustration. The experience/system is set up so we either just pay for it and don't ask questions or don't get care. It's infuriating. Thankfully, we are fairly healthy individuals.

I went to the ER in Germany once, it was amazing. What I wouldn't give to have their healthcare system (single payer?).     

[Blue Skies]

The only real defense in the US is for enough people to vote progressives into office so we get a National Healthcare Service based on one of the many successful ones around the world.

Probably a main reason national single payer has'nt happened is that a large percentage of people in the U.S. have good health insurance either thru their employer or medicare medicaid, 91% of americans have health insurance.

Based on no data at all, my opinion is that single payer hasn't happened in the US because the majority of people have not yet been unhealthy enough to see what healthcare costs even with insurance through their jobs.

People are continually surprised by how much it can cost to be sick even with insurance.  If more people were aware of the possible OOP costs, they may be more interested in government sponsored healthcare.  Or maybe they will just continue to believe they will never get sick, it will never happen to them, so who cares?

[afox]

I must say in 40 years of using health insurance I have not run into an issue where a medical service I needed was not covered by the insurance company. I think that is mainly because Ive always just used "conventional" medicine.

I have had many cases where the insurer denies a valid claim for covered conventional medicine, I have always appealed and won. That seems like just a part of doing buisness for the insurance companies and as the insured consumer I expect to have to appeal to the insurance company. Looking thru my plans brochure it seems like stated non covered stuff is cosmetic, traditional medicine...

Are you in the US? If so, this is astounding to me. My parter and I have been denied coverage for a bevy of things and we have (what is considered) good coverage through our employer. It is also near impossible to find out if something will be covered in advanced so I (and I know many others) have simply avoided getting an issue/possible issue checked out. For example, my doctor referred me to radiology for an x-ray, but they couldn't tell me if my insurance would cover it. I called my insurance they also couldn't tell me if it would be covered. After sitting in the radiology waiting room for at least an hour and a half and being passed around on the end of my insurance I finally got a tentative answer. I may have ended up paying for it out of pocket, I really don't remember. All I know is it was not worth the frustration. The experience/system is set up so we either just pay for it and don't ask questions or don't get care. It's infuriating. Thankfully, we are fairly healthy individuals.

I went to the ER in Germany once, it was amazing. What I wouldn't give to have their healthcare system (single payer?).   

Yes, in the U.S.

I think you/we are conflating non-covered medical services and denials of claims. Non-covered services are stated in the plan brochure.

Denials as I said are common and are an insurance company tactic to save money. Every insurance company has a process for submitting appeals to denials, everyone in the U.S. needs to understand the process and appeal when necessary. Listen to the podcast "an arm and a leg", learn about the process, learn as much as you can about the process, read your plans brochure, spend A LOT of time on the phone with your insurance company. When I call them I like to put them on hold while I research things, I treat their time like they treat my health. We're stuck with insurance based healthcare in the U.S. so gotta play the game.

[afox]

The only real defense in the US is for enough people to vote progressives into office so we get a National Healthcare Service based on one of the many successful ones around the world.

Probably a main reason national single payer has'nt happened is that a large percentage of people in the U.S. have good health insurance either thru their employer or medicare medicaid, 91% of americans have health insurance.

Based on no data at all, my opinion is that single payer hasn't happened in the US because the majority of people have not yet been unhealthy enough to see what healthcare costs even with insurance through their jobs.

People are continually surprised by how much it can cost to be sick even with insurance.  If more people were aware of the possible OOP costs, they may be more interested in government sponsored healthcare.  Or maybe they will just continue to believe they will never get sick, it will never happen to them, so who cares?

Dont be like "Most People"!!! What "most people do or think is irrelevant" Understand what services covered and which are not, know how to find out if a provider is in network or not, ask a lot of questions. Often times the front desk/office staff at providers dont know enough about the insurance process. Budget to pay your premiums and out of pocket max every year even if it means retiring years later or make a plan to live on little enough to qualify for medicaid. The state of healthcare in the U.S. is what it is.

[JupiterGreen]

The only real defense in the US is for enough people to vote progressives into office so we get a National Healthcare Service based on one of the many successful ones around the world.

Probably a main reason national single payer has'nt happened is that a large percentage of people in the U.S. have good health insurance either thru their employer or medicare medicaid, 91% of americans have health insurance.

Based on no data at all, my opinion is that single payer hasn't happened in the US because the majority of people have not yet been unhealthy enough to see what healthcare costs even with insurance through their jobs.

People are continually surprised by how much it can cost to be sick even with insurance.  If more people were aware of the possible OOP costs, they may be more interested in government sponsored healthcare.  Or maybe they will just continue to believe they will never get sick, it will never happen to them, so who cares?

I don't want to get into politics, but this is a political topic. I do think a lot of people in the US know this. When polled, the results seem to indicate the majority of Americans do want better healthcare, but our country is so gerrymandered (I live in a notable gerrymandered district) that our national and (sometimes local) politics often don't reflect the will of the majority. The ACA should have been repealed but as everyone knows Sen. McCain did not like that the issue to repeal was not following normal order (regardless of his motivations, I'm glad he saved it). So unfortunately the entire issue of healthcare does come down to politics.

With that said, I get your point that many people don't understand the extent to which that medical bills can financial ruin someone. Perhaps the pandemic will put this front and center again. 

[SailingOnASmallSailboat]

I must say in 40 years of using health insurance I have not run into an issue where a medical service I needed was not covered by the insurance company. I think that is mainly because Ive always just used "conventional" medicine.

I have had many cases where the insurer denies a valid claim for covered conventional medicine, I have always appealed and won. That seems like just a part of doing buisness for the insurance companies and as the insured consumer I expect to have to appeal to the insurance company. Looking thru my plans brochure it seems like stated non covered stuff is cosmetic, traditional medicine...

Are you in the US? If so, this is astounding to me. My parter and I have been denied coverage for a bevy of things and we have (what is considered) good coverage through our employer. It is also near impossible to find out if something will be covered in advanced so I (and I know many others) have simply avoided getting an issue/possible issue checked out. For example, my doctor referred me to radiology for an x-ray, but they couldn't tell me if my insurance would cover it. I called my insurance they also couldn't tell me if it would be covered. After sitting in the radiology waiting room for at least an hour and a half and being passed around on the end of my insurance I finally got a tentative answer. I may have ended up paying for it out of pocket, I really don't remember. All I know is it was not worth the frustration. The experience/system is set up so we either just pay for it and don't ask questions or don't get care. It's infuriating. Thankfully, we are fairly healthy individuals.

I went to the ER in Germany once, it was amazing. What I wouldn't give to have their healthcare system (single payer?).   

FYI they have to tell you if something is covered and how much it costs, by law. It can take invoking those very words to actually get the information from the insurance company. I was asking about an MRI and there was much hemming and hawing. I said. "I understand that by law you need to give me that information" and POOF in about 30 seconds I had the answer. Doctors offices often do not have that information, because it's been negotiated by the insurance company.

Insurance companies suck.

[DaMa]

This is my soapbox issue.  Afox has already said a lot of this...

TLDR:  Educate yourself.  Know your coverage.

Most medical bankruptcies are caused when people get sick and then lose their jobs.  They then also lose their health insurance that was tied to their jobs.  Another cause is people who have high deductible and OOP maximums and no ability to pay them.  Imagine you make $15 an hour and have a $4000 deductible.  Those bills will just pile up, year after year. 

However, we are FIRE folk, so neither of those issues apply to us.  Our health insurance will not be tied to our jobs (retired), and we have saved for this (deductibles,etc.).  For us the risk is in needing what’s not covered.  So you need to know what’s not covered. 

Out-of-network is the biggest risk.  (1.) What hospital is an ambulance going to take you to in an emergency?  Is it in your network?  If that hospital is not, you need a different health plan.  (2.) If you get cancer, where are you going for treatment?  If those providers are not in your network, who is?  If you aren’t happy with that, you need a different health plan.  (3.) Are there any other doctors or hospitals you want access to if you get sick?

Next up is prescription drugs.  All the insurance companies have their own rules about drugs - how many, how often, what requires pre-approval, what requires step therapy, what copay tier, etc..  You need to know how to access this information.  If you take an expensive drug, and it’s not on your health plan formulary in a preferred tier, you need a different health plan.

Some things are just not covered.  If you have dental, it’s only going to pay $1-2k per year maximum.  Vision plans don’t pay out much more than you pay them.  Hearing aids are rarely covered and cost thousands. 

Does this mean you can’t retire?  No.  You could work, get sick, lose your job, and be in the same place.

The health insurance plan matters.  I worked for several in my career.  I live in a state with several that are  good.  Avoid for-profit plans.  I would NEVER enroll in a United Healthcare plan. 

Grievances and appeals work.  And if they don’t, be the squeaky wheel.   Send letters to the CEO of the company.  File complaints with your state insurance office.  Send letters to your Congressperson.  I have seen firsthand how well these work.

Lastly, Medicare does not solve these problems.  It has deductibles and coinsurance and does not even have an out-of-pocket maximum.  It doesn't cover dental, vision, or hearing.  You still pay 5% of all drug costs, even in catastrophic phase.

[DaMa]

In case you want some real numbers...

My expenses include $1000 per month for healthcare.  I also had an extra $100k for a healthcare buffer.  (25x expenses + 100k).  That $1000 per month is based on my expected cost of an ACA plan without subsidies (premium+OOP max).  It should also cover what Medicare doesn't, even if I have high drug costs.

There are a lot of strategies available to reduce these expenses, and I use them.  The money leftover each year goes into my travel budget for the following yea

[Fire2025]

On the dental side.  I know a couple who used Geo-arbitrage for very expensive work they needed done. 

They went Yuma AZ, crossed into Mexico, and saved thousands of dollars.  They heard about it from friends who are RVers.  They said the whole experience was excellent.

When the time comes, that's what I'll be doing for expensive dental work.

[DaMa]

On the dental side.  I know a couple who used Geo-arbitrage for very expensive work they needed done. 

They went Yuma AZ, crossed into Mexico, and saved thousands of dollars.  They heard about it from friends who are RVers.  They said the whole experience was excellent.

When the time comes, that's what I'll be doing for expensive dental work.

Same here!  My mouth is full of 40 year old fillings, so I expect them to start failing anytime.  A friend's brother had dental work done in Mexico in 2019 and was very happy with it.  It wasn't in Los Algodones, though.  He has a cousin who lives in another part of Mexico, and he stayed with them for several weeks.

I read about somebody going to Thailand (I think) for a knee replacement.  The costs of the trip plus the medical bill was less than his OOP costs on a high deductible plan.

[RedmondStash]

The health insurance plan matters.  I worked for several in my career.  I live in a state with several that are  good.  Avoid for-profit plans.  I would NEVER enroll in a United Healthcare plan. 

@DaMa , there are not-for-profit health plans? First I've heard about this. How can you find them?

[SailingOnASmallSailboat]

Most health insurance companies you've heard of are technically not-for-profits.

[DaMa]

The health insurance plan matters.  I worked for several in my career.  I live in a state with several that are  good.  Avoid for-profit plans.  I would NEVER enroll in a United Healthcare plan. 

@DaMa , there are not-for-profit health plans? First I've heard about this. How can you find them?

I think if they have a stock they are for profit.  Not-for-profit plans are usually accountable to their members and/or have an extra layer of state oversight.  They still make money, but in general their "profits" go back into the business and are used to lower future prices.  They still suck, just not quite as bad as the for-profits.

[Ron Scott]

I believe about half the bankruptcies in the US are related to medical expenses.

It seems like many people give up without trying to negotiate with the carriers and get caught up with the debt collection agencies. But the numbers are too high for that to be the only reason.

Solution = bigger stash

These are black swan-like situations…it’s highly likely you’ll need the money, but if you do you better have some financial flexibility.

I would say such flexibility is part of basic FI.

[Scandium]

I believe about half the bankruptcies in the US are related to medical expenses.

It seems like many people give up without trying to negotiate with the carriers and get caught up with the debt collection agencies. But the numbers are too high for that to be the only reason.

Solution = bigger stash

These are black swan-like situations…it’s highly likely you’ll need the money, but if you do you better have some financial flexibility.

I would say such flexibility is part of basic FI.

Not to downplay how awful the US medical system is (worst in the world?), but that study just included any bankruptcy where they had any form of medical debt, in addition to any other as being "caused by medical debt". Kind of disingenuous IMO. It's bad enough, we don't need to lie with statistics to prove a point

[JupiterGreen]

FYI they have to tell you if something is covered and how much it costs, by law. It can take invoking those very words to actually get the information from the insurance company. I was asking about an MRI and there was much hemming and hawing. I said. "I understand that by law you need to give me that information" and POOF in about 30 seconds I had the answer. Doctors offices often do not have that information, because it's been negotiated by the insurance company.

Insurance companies suck.

Thank you, I didn't know that. Also thank you Afox, I think the whole thing is purposefully confusing but thank you for your suggestions to be the squeaky wheel. Even though it's frustrating, it's not going to prevent me from retiring early.

[Ron Scott]

I believe about half the bankruptcies in the US are related to medical expenses.
 

that study just included any bankruptcy where they had any form of medical debt, in addition to any other as being "caused by medical debt". Kind of disingenuous IMO.

I think their point is that half of bankruptcies include medical expenses. Certainly, people going into bankruptcy are likely to have several financial problems.

Whatever. I don’t think it is too much to ask people who would declare “financial independence“ (big words!) to pad their stash for a possible medical hit.

[Paul der Krake]

Yeah the normies stats about medical bankruptcy are largely irrelevant. People with no buffer get it bad when they need a buffer.

I don't think think one time large expenses like medical is what you should worry about. Oh no, a shark bit off my leg and I had to be rushed to the nearest level I trauma center in a helicopter and it costs 50k after negotiating it down to a real price and it's not covered. Well that sucks, but the 50k is kind of a rounding error in the grand scheme of things of a FIRE portfolio. And I'd happily pay 10 times that amount to have my leg back, probably.

Much more dangerous is the recurring, long term expenses that require paid labor for years and years. Think slow moving degenerative diseases, etc. That's the real portfolio killer.

[Reynold]

Not to downplay how awful the US medical system is (worst in the world?), but that study just included any bankruptcy where they had any form of medical debt, in addition to any other as being "caused by medical debt". Kind of disingenuous IMO. It's bad enough, we don't need to lie with statistics to prove a point

My understanding is that the medical care in the U.S. is generally the best in the world, which is why rich people from other places often travel here for operations and treatments, but it is also the most expensive and arguably the most complex in the world.  The upside to "most expensive" is that most funding for new drugs, procedures, medical equipment comes from the high prices we pay, but that's not a lot of comfort if you don't happen to need anything exotic.  I do suspect that if a health insurance plan was set up with the restriction that you don't get anything developed after, say, 1970, it would be more like 1970 prices. 

I do believe certain things that have some coverage here, but it is expensive, have no coverage in some single payer countries.  For example, the National Health System in the U.K. seems to have a limit of about 30k British pounds per 6 months for medical care.  Treatments that cost more than that generally don't get covered.  Some health care outcomes, like cancer, seem to be worse there.    Long waits for certain procedures are common.  I knew someone British who routinely brought relatives to the U.S. for treatment, and saved an aunt's life because she got cancer screening and treatment much faster.  On the other hand, patients in the U.K. don't have to fight with insurance companies for coverage, or overpay for things.  There are definitely tradeoffs. 

In terms of how to insulate against medical bankruptcy, in which I include things like possible need for long term care, aids, etc. when elderly, our plan is to just budget a lot of money for that just in case.  Yes, that means if we both retain good health we won't need it, but we want to avoid being one of the many people in my father-in-laws dialysis center who were on Medicaid because the cost of dialysis AFTER Medicare had still bankrupted them. 

[bill1827]

For example, the National Health System in the U.K. seems to have a limit of about 30k British pounds per 6 months for medical care.  Treatments that cost more than that generally don't get covered.  Some health care outcomes, like cancer, seem to be worse there.    Long waits for certain procedures are common.

There is no defined limit on the value of treatment in the NHS, the treatment you get is decided by the medical professionals in their clinical judgement. However, the National Institute for Health and Care Excellence (NICE) attempts to assess th eeffectiveness and value for money of medical treatments; if they say a treatment is not effective or poor value for money you are unlikely to be able to get that treatment from the NHS.

For example a drug with a nominal cost for a single dose of £1.8 million has been administered by the NHS https://www.england.nhs.uk/2021/06/nhs-treats-first-patient-with-the-worlds-most-expensive-drug/

Yes, the NHS has always had waiting lists for non urgent treatment, but pre 2020 you would generally get treated fairly quickly for anything serious. At the moment there are serious waiting list issues, largely due to Covid, but also due to reduced funding for the past 10 or more years. This is deliberate government policy. The NHS has been in the process of stealth privatisation for quite a while, but the process is accelerating. Private companies, mainly US owned have been acquiring access to the more lucrative portions of the NHS and the current government is facilitating even more of this.

[Scandium]

Not to downplay how awful the US medical system is (worst in the world?), but that study just included any bankruptcy where they had any form of medical debt, in addition to any other as being "caused by medical debt". Kind of disingenuous IMO. It's bad enough, we don't need to lie with statistics to prove a point

My understanding is that the medical care in the U.S. is generally the best in the world, which is why rich people from other places often travel here for operations and treatments, but it is also the most expensive and arguably the most complex in the world.  The upside to "most expensive" is that most funding for new drugs, procedures, medical equipment comes from the high prices we pay, but that's not a lot of comfort if you don't happen to need anything exotic.  I do suspect that if a health insurance plan was set up with the restriction that you don't get anything developed after, say, 1970, it would be more like 1970 prices. 

I do believe certain things that have some coverage here, but it is expensive, have no coverage in some single payer countries.  For example, the National Health System in the U.K. seems to have a limit of about 30k British pounds per 6 months for medical care.  Treatments that cost more than that generally don't get covered.  Some health care outcomes, like cancer, seem to be worse there.    Long waits for certain procedures are common.  I knew someone British who routinely brought relatives to the U.S. for treatment, and saved an aunt's life because she got cancer screening and treatment much faster.  On the other hand, patients in the U.K. don't have to fight with insurance companies for coverage, or overpay for things.  There are definitely tradeoffs. 

In terms of how to insulate against medical bankruptcy, in which I include things like possible need for long term care, aids, etc. when elderly, our plan is to just budget a lot of money for that just in case.  Yes, that means if we both retain good health we won't need it, but we want to avoid being one of the many people in my father-in-laws dialysis center who were on Medicaid because the cost of dialysis AFTER Medicare had still bankrupted them.

They may be true for individual treatments (I don't know), but looking at the macro view the US spend the most per person on healthcare, and have some of the worst health outcomes in the OECD. Looking at infant mortality, death in childbirth, chronic illness, life expectancy, and almost all other health metrics. Almost all other single payer countries spend less, and the population is get better care (as in fewer health issues, diseases etc), and are healthier.

Any system that spends the most and has the worst outcome I think qualifies as "worst". Even if one specific like cancer treatment is "better", that matters little on the grand scale if everything else is worse.
(and most other countries spend half per capita on healthcare of what the US does, so maybe if they doubled their spending they could do better than the US anyway..?)

[dblaace]

I added a Critical Illness/Cancer Coverage plan a couple of years ago through work. I am continuing it since retiring. It has fixed payouts for diagnosis and care. It has paid out once already.

[jim555]

The best coverage is Medicaid, $200 max out of pocket a year.  ACA policies limit max OOP to a set limit for the plan.  Medicare has no limit and many buy a Medigap policy to limit OOP.

No health insurance covers skilled nursing for more than a short time.  Medicare covers 100 days for something you can recover from. 

No one is going bankrupt with health insurance in the US unless you have almost zero savings.  Most of the bankruptcy stories are pre-ACA, when companies could drop you from a plan for pre-existing conditions.  But that is no longer the case.  Of course if you have no insurance then you could easily go bankrupt.

[MMMarbleheader]

One think I have found helpful is to go to a PCP who is affiliated/works for your local major hospital. I had a PCP is MA who was part of Partners healthcare who owns Mass General/Bringham Womens hospital as well as other satellite hospitals. They seem to take the most plans.

1) They can search into their database to get you care quick if you need it.
2) If they are in network, most everything they refer you to will be as well.

Cons are they they are more expensive to go to is you are in a HDHP.

[afox]

Cons are they they are more expensive to go to is you are in a HDHP.

HDHPs also have negotiated rates for in network providers. Since the negotiated rates are almost always lower than the no insurance rates this is a major features of a HDHP.

[afox]

I added a Critical Illness/Cancer Coverage plan a couple of years ago through work. I am continuing it since retiring. It has fixed payouts for diagnosis and care. It has paid out once already.

Does your health insurance really not cover "critical illness" or "cancer"?

Seems like having more than one health insurance plan would just make it harder to reach those out of out of pocket maxes and deductibles.

Obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

[RedmondStash]

Obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

Only for "covered services." Which means you're still on the hook for anything not covered by insurance, and for out-of-network providers.

[afox]

Obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

Only for "covered services." Which means you're still on the hook for anything not covered by insurance, and for out-of-network providers.

Do you have an example of something not covered by insurance? Obamacare established standards for coverage, are there major holes we should be aware of?

The only excuse for seeing an out of network provider is if it's an emergency and you can't choose the provider. Otherwise as frugal consumers it's critical to only see on network providers. In an emergency does anyone know if the new surprise billing rules will help?

[dblaace]

I added a Critical Illness/Cancer Coverage plan a couple of years ago through work. I am continuing it since retiring. It has fixed payouts for diagnosis and care. It has paid out once already.

Does your health insurance really not cover "critical illness" or "cancer"?

Seems like having more than one health insurance plan would just make it harder to reach those out of out of pocket maxes and deductibles.

Obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

This is in addition to health insurance and are direct payments to help cover deductibles and other expenses incurred. Think Aflak.

[afox]

I added a Critical Illness/Cancer Coverage plan a couple of years ago through work. I am continuing it since retiring. It has fixed payouts for diagnosis and care. It has paid out once already.

Does your health insurance really not cover "critical illness" or "cancer"?

Seems like having more than one health insurance plan would just make it harder to reach those out of out of pocket maxes and deductibles.

Obamacare put a limit on out of pocket max's ($17,400 for a family for 2022):
https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

This is in addition to health insurance and are direct payments to help cover deductibles and other expenses incurred. Think Aflak.

There is no way in hell thats a good deal unless you're certain you're going to get cancer, you'd be much better off using the amount of the premiums to invest in something and keeping the benefit amount in savings in case its needed.

[kite]

Have lots of kids, preferably daughters.
Statistics prove your kids take better care of you if there is more than two and if they are female.  Alternatively, get a younger, fitter, female partner.  “Nurse with a purse” is the popular term. 

This is tongue in cheek.  You likely need several million for the worst case scenario. 

Until she got dementia, my mother lived on only her SS income spending less than $20,000 each year. Home health aides cost $60,000 a year and that’s for only one shift per day, pushing her annual spend to $80,000. The costs of the aides will triple, effectively putting her at $200,000/year when she needs round the clock care at home.  In-facility care is even more expensive in our area.  And she’s really healthy. She’ll probably live 10 years beyond her diagnosis.  Any disability can blow a 4% safe withdrawal rate to bits.  The only reason she hasn’t yet needed round the clock aides or a nursing home is her wonderful daughters.  You need money or daughters, preferably both.

When you leave the country, get travel insurance that will bring you home if something happens overseas.  Medical transport is crazy expensive.  And stay off of recreational drugs. If drug habits don’t bankrupt the family, rehab can.  Claims that Obamacare capped OOP expenses have plenty of exceptions.  Addiction treatment is one of those things.   Some can be covered, but there isn’t an endless pool of insurance money available.  It costs more than an Ivy League school to get off the junk for some people.  My friends who had their son in rehab 6x did go bankrupt.

[Adventine]

Have lots of kids, preferably daughters.
Statistics prove your kids take better care of you if there is more than two and if they are female.  Alternatively, get a younger, fitter, female partner.  “Nurse with a purse” is the popular term. 

This is tongue in cheek.  You likely need several million for the worst case scenario. 

Until she got dementia, my mother lived on only her SS income spending less than $20,000 each year. Home health aides cost $60,000 a year and that’s for only one shift per day, pushing her annual spend to $80,000. The costs of the aides will triple, effectively putting her at $200,000/year when she needs round the clock care at home.  In-facility care is even more expensive in our area.  And she’s really healthy. She’ll probably live 10 years beyond her diagnosis.  Any disability can blow a 4% safe withdrawal rate to bits.  The only reason she hasn’t yet needed round the clock aides or a nursing home is her wonderful daughters.  You need money or daughters, preferably both.

Not funny. Not even as a tongue in cheek comment.

[afox]

Claims that Obamacare capped OOP expenses have plenty of exceptions.  Addiction treatment is one of those things.   Some can be covered, but there isn’t an endless pool of insurance money available.  It costs more than an Ivy League school to get off the junk for some people.  My friends who had their son in rehab 6x did go bankrupt.

Not true about addiction treatment, its the fifth bullet here:
https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

I honestly would like to know what the major holes are in covered services. Im not interested in non covered services from healthcare sharing plans, other plans that get around the ACA rules in some way.

[jim555]

People are mixing long term care and health insurance, the two are NOT the same.  LTC is a whole other can of worms.

[afox]

Have lots of kids, preferably daughters.
Statistics prove your kids take better care of you if there is more than two and if they are female.  Alternatively, get a younger, fitter, female partner.  “Nurse with a purse” is the popular term. 

This is tongue in cheek.  You likely need several million for the worst case scenario. 

Until she got dementia, my mother lived on only her SS income spending less than $20,000 each year. Home health aides cost $60,000 a year and that’s for only one shift per day, pushing her annual spend to $80,000. The costs of the aides will triple, effectively putting her at $200,000/year when she needs round the clock care at home.  In-facility care is even more expensive in our area.  And she’s really healthy. She’ll probably live 10 years beyond her diagnosis.  Any disability can blow a 4% safe withdrawal rate to bits.  The only reason she hasn’t yet needed round the clock aides or a nursing home is her wonderful daughters.  You need money or daughters, preferably both.

Not funny. Not even as a tongue in cheek comment.

I didnt think it was meant to be funny, sounds more like a "sad but true" thing.