Self Coverage vs ACA Health Insurance

[pmac]

Open enrollment begins today, and the health insurance numbers are ridiculous.

$1,400/month premium for a bronze plan for a family of 3 (HSA eligible)

$7,000 individual deductible

$12,000 family deductible

So, you pay $16,000 in health insurance premiums for the year, then $7,000 on your individual deductible before the insurance company pays anything (that's $23,000)

If a 2nd person gets sick, you pay another $5,000 to meet the family deductible....(we're at $28,000 now!)


Is anyone doing self coverage out there? I feel like I could get a lot of great preventative care e.g. chiropractor, dentist, physical therapy, gym membership, massage therapist etc... with just the $16,000 I would have sent to the insurance company.

$23,000 is a lot of money to shell out before you get any type of help. And I'm not speaking to those who get the premium tax credit, that's a different scenario. I'm talking to the people who have too high of an AGI to qualify for that.

[bacchi]

It works out as long as you don't get seriously sick or get in a serious accident.

Covid treatment in an ICU alone would eat up that $23k very quickly.

[Paul der Krake]

Yes it's ridiculous.

No you shouldn't self-insure.

Your options are:
1) get someone else to pay for your coverage through a W-2 job
2) make less money to qualify for subsidies
3) make more money so that the cost is irrelevant
4) move abroad

[wenchsenior]

Not under any circumstances would I self-insure for health care. Even if it weren't for the pandemic, I've seen too many friends (in two cases perfectly healthy and with a healthy active lifestyle) in the past few years end up with unexpected health problems that would have cost them into multiple hundreds of thousands to millions of dollars for either critical ICU care or ongoing life-supporting care (need for monthly drugs to survive that cost 20-30K/dose) were they not insured.  No way, no how, not as long as I could scrape together the money.

[seattlecyclone]

If you have so much money that dropping six or seven figures on an ICU stay would be no big deal to you, you can forego health insurance. If you have so little money that declaring bankruptcy after an ICU stay wouldn't set your FIRE date back very much (and you're comfortable with the prospect of being refused further treatment the minute you're not in imminent danger of death anymore), you can forego health insurance. Anywhere in between, you really need to be covered.

[KarefulKactus15]

If you have so much money that dropping six or seven figures on an ICU stay would be no big deal to you, you can forego health insurance. If you have so little money that declaring bankruptcy after an ICU stay wouldn't set your FIRE date back very much (and you're comfortable with the prospect of being refused further treatment the minute you're not in imminent danger of death anymore), you can forego health insurance. Anywhere in between, you really need to be covered.

I came here to say exactly this:

1.) If you are so poor that filing bankruptcy makes no difference in your life.
2.) If you have so much money that 7 figure expenses make no difference in your life.


If you are in between then it just sucks. I dont like paying for the stupid shit either, but so much happens unexpectedly, even to young healthy men age 30 like myself.  Little simple stuff, like falling off a golf cart backwards and cracking your head on the ground or wrecking a bicycle. They are called accidents for a reason. If I could plan when to have an accident I could plan not to have it.

On the bright side - You have an income too high to qualify for subsidy. Im sure lots of folks in option 1 would trade with you.  For 2021 I'm setting my income at about 25k, Am I gaming the system a little? Yes...  But currently it cost too much to make more than I need from active income.

In closing - I hope something changes soon. I dont have a solution but I'm also tired of paying so much.

[WhiteTrashCash]

Sounds like your state doesn't have very good ACA coverage. You might want to move to another state.

[pmac]

If you have so much money that dropping six or seven figures on an ICU stay would be no big deal to you, you can forego health insurance. If you have so little money that declaring bankruptcy after an ICU stay wouldn't set your FIRE date back very much (and you're comfortable with the prospect of being refused further treatment the minute you're not in imminent danger of death anymore), you can forego health insurance. Anywhere in between, you really need to be covered.

Not the answer I wanted, but maybe the answer I needed :)

This makes complete sense to me, and I would hate to have an ICU bill like that the one year I forego insurance...

Just sucks paying so much money for insurance when it used to be so cheap!

[peeps_be_peeping]

One year ago I was a healthy 41 year old woman. I had average BP of 110/70, heart rate 55-60, ate plant based diet, exercised several times per week, etc. The last time I had any major medical issue was in 1995. Then I was diagnosed with a giant abdominal tumor (benign but will require major surgery), spent 4 nights in hospital with bacterial pneumonia at the beginning of the pandemic, and was diagnosed with and am still receiving treatment for stage 1B breast cancer (two types of chemotherapy, one surgery, many tests, and dozens of office visits). I reached my in network OOP maximum of $8500 in March of 2020. I estimate by the end of 2020 I will have consumed close to $200K of medical care. My monthly premiums are $1000 (COBRA from a prior job). Preventive care only gets you so far. Good health is no guarantee against contracting a life threatening disease.

[friedmmj]

Open enrollment begins today, and the health insurance numbers are ridiculous.

$1,400/month premium for a bronze plan for a family of 3 (HSA eligible)

$7,000 individual deductible

$12,000 family deductible

So, you pay $16,000 in health insurance premiums for the year, then $7,000 on your individual deductible before the insurance company pays anything (that's $23,000)

If a 2nd person gets sick, you pay another $5,000 to meet the family deductible....(we're at $28,000 now!)


Is anyone doing self coverage out there? I feel like I could get a lot of great preventative care e.g. chiropractor, dentist, physical therapy, gym membership, massage therapist etc... with just the $16,000 I would have sent to the insurance company.

$23,000 is a lot of money to shell out before you get any type of help. And I'm not speaking to those who get the premium tax credit, that's a different scenario. I'm talking to the people who have too high of an AGI to qualify for that.

What is your employment situation?  How much income?  What state do you live?  Some folks have most/all of their net worth in 401K accounts which are shielded from bankruptcy.  If that describes you (unlikely) you might want to roll the dice with a decent emergency fund and a comfortable stache in 401k(s).

[FiveSigmas]

If you have so much money that dropping six or seven figures on an ICU stay would be no big deal to you, you can forego health insurance. If you have so little money that declaring bankruptcy after an ICU stay wouldn't set your FIRE date back very much (and you're comfortable with the prospect of being refused further treatment the minute you're not in imminent danger of death anymore), you can forego health insurance. Anywhere in between, you really need to be covered.

Not the answer I wanted, but maybe the answer I needed :)

This makes complete sense to me, and I would hate to have an ICU bill like that the one year I forego insurance...

Just sucks paying so much money for insurance when it used to be so cheap!

I hear ya. If it’s any consolation, you’re at least getting the insurer’s negotiated rate, so you can pretend like you’re getting something even before you hit the deductible.

[seattlecyclone]

You also get a tax deduction on your HSA contributions (and premiums, if self-employed). That's worth something as well.

[FiveSigmas]

Oh, BTW: you may not be limited to just the ACA marketplace offerings. Try checking directly on the insurance provider’s website. They often will have non-ACA (but still high-quality) options. They likely won’t be radically cheaper (and you for certain won’t get the ACA subsidy), but they may offer a better fit. For instance, not all of my carrier’s HSA-compatible plans are in the marketplace.

[pmac]

Oh, BTW: you may not be limited to just the ACA marketplace offerings. Try checking directly on the insurance provider’s website. They often will have non-ACA (but still high-quality) options. They likely won’t be radically cheaper (and you for certain won’t get the ACA subsidy), but they may offer a better fit. For instance, not all of my carrier’s HSA-compatible plans are in the marketplace.

Thanks, I will call about that.

[GoCubsGo]

I'm curious as to if that number is typical of what a upper middle class family would pay (say $100K per year income)?  That number you quoted was shocking to me (and a little disheartening).  I haven't begun looking into ACA for my early retirement but if those numbers are representative of someone who plans on FIRE'ing with a healthy budget, that could basically add years onto a FIRE number.

Is the only reason people are so keen on saving ACA (not FIRE people, just regular working folks) is because of pre-existing conditions?  Because $23K for a bronze plan for a family of 3 sounds like ACA is broken.  I'm not into politics so I'm looking at it more through the lense of FIRE'ing with a bigger spend.  Maybe not the place to ask but it seems ACA talk devolves into politics too often for my taste.

[bacchi]

I'm curious as to if that number is typical of what a upper middle class family would pay (say $100K per year income)?  That number you quoted was shocking to me (and a little disheartening).  I haven't begun looking into ACA for my early retirement but if those numbers are representative of someone who plans on FIRE'ing with a healthy budget, that could basically add years onto a FIRE number.

Is the only reason people are so keen on saving ACA (not FIRE people, just regular working folks) is because of pre-existing conditions?  Because $23K for a bronze plan for a family of 3 sounds like ACA is broken.  I'm not into politics so I'm looking at it more through the lense of FIRE'ing with a bigger spend.  Maybe not the place to ask but it seems ACA talk devolves into politics too often for my taste.

You really need to look. It depends on where you live, your age, your family size, and your income.

We pay $1000/month for MFJ. Given that I was paying around $250/person pre-ACA, and health care inflation runs about 5.3%/year, it's about what I'd expect (and of course we're 10 years older since the ACA started).

To put it another way: Health care insurance is expensive because health care is expensive.

[Paul der Krake]

I'm curious as to if that number is typical of what a upper middle class family would pay (say $100K per year income)?  That number you quoted was shocking to me (and a little disheartening).  I haven't begun looking into ACA for my early retirement but if those numbers are representative of someone who plans on FIRE'ing with a healthy budget, that could basically add years onto a FIRE number.

It's only shocking because people forget the 20k or so a year paid by employers to cover a family.

An upper class family isn't paid "100k", they're paid "120k, with 20k going to someone else".

That doesn't make the pricing right, but until radical political change comes, it is what it is, and everyone should account for it when deciding whether to work for themselves.

[jim555]

In NY there is no age rating, which is good if you are near 65, but bad if you are 25.  The benchmark Silver plan runs about $588 a month per person, any age.

[nirodha]

There's also the health share option.

[GoCubsGo]

Yeah, I guess I've taken our cadillac corporate insurance for granted.  I was ballparking $15k total out of pocket in retirement for a family of 4 (assuming my kids stay on my insurance into their early 20's). I'm guessing that number is low with no subsidies.  I won't have a mortgage which may allow me to squeak in a little bit of subsidy given I won't need to draw income for that.

I'll have to run Illinois plans and see how bad the damage is.  The stock market gains pushed our FIRE timeline way up but my wife has always been concerned with healthcare.  This might push it back again some. People are so polarized on this topic, I guess I was avoiding looking into it (basically the last thing to do before I pull the plug)

[Mr. Green]

24 hours in any hospital will cost you more than $28,000 without insurance. Self insuring is a terrible idea. It sucks, but that is the current state of US healthcare.

[slappy]

Open enrollment begins today, and the health insurance numbers are ridiculous.

$1,400/month premium for a bronze plan for a family of 3 (HSA eligible)

$7,000 individual deductible

$12,000 family deductible

So, you pay $16,000 in health insurance premiums for the year, then $7,000 on your individual deductible before the insurance company pays anything (that's $23,000)

If a 2nd person gets sick, you pay another $5,000 to meet the family deductible....(we're at $28,000 now!)


Is anyone doing self coverage out there? I feel like I could get a lot of great preventative care e.g. chiropractor, dentist, physical therapy, gym membership, massage therapist etc... with just the $16,000 I would have sent to the insurance company.

$23,000 is a lot of money to shell out before you get any type of help. And I'm not speaking to those who get the premium tax credit, that's a different scenario. I'm talking to the people who have too high of an AGI to qualify for that.

I don't know much about the ACA. Is this after the subsidy?

[jim555]

This will give you an idea of ACA plans and subsidies:

Health Insurance Marketplace Calculator
https://www.kff.org/interactive/subsidy-calculator/

[slappy]

This will give you an idea of ACA plans and subsidies:

Health Insurance Marketplace Calculator
https://www.kff.org/interactive/subsidy-calculator/

Interesting. Here are my results, with putting my income at 250% of FPL four a family of 4.

Estimated financial help:$953 per month ($11,433 per year)as a premium tax credit. This covers 68% of the monthly costs. Your cost for a silver plan:$447 per month ($5,369 per year)in premiums (which equals 8.26% of your household income).The most you have to pay for a silver plan:8.26% of income for the second-lowest cost silver plan. Without financial help, your silver plan would cost:$1,400 per month ($16,802 per year)

[GoCubsGo]

That's just the premium.  It looks like total out of pocket can be $17,100 for a silver plan, even at 250% of FPL. 

Still not as bad as $23k but there must be some state specific issue going on with the OP.  Because even at $400k yearly income the cost of a unsubsidized silver plan is only $13,029 per year with the same max Out of Pocket being $17,100

[jim555]

If you are between 100% and 250% FPL and have a Silver plan (Silver only) then the Max OOP gets reduced by cost sharing reductions.

[GoCubsGo]

Thanks for that website jim555.  I've heard the term "ACA cliff" and it looks like I will have to really figure the income part out.  For example; I have rental houses that throw taxable income.  I might have to consider selling one before I FIRE so that I can use the proceeds  to live off of.  The loss of rental income will be offset by the monthly subsidies I would receive by lowering my FPL percentage.

Managing MAGI has to be a bit of a pain for newly FIRE'd people living in HCOL areas on a yearly basis. Especially considering premiums can change significantly from year to year.  Sucks.   

I wonder if the average CPA is knowledgeable enough to advise the average self employed person or early retiree?  People on this forum are, for the most part, financially savvy and can do the math to make the best decision.  I wonder about how non- financially literate people deal with all this.  Crazy

[jim555]

It pays to master the quirks of the ACA, especially as you approach 65 and the age rating pops the premiums.  Keeping in the subsidy zone limits the damage to a set percentage of income.

[Trifle]

Managing MAGI has to be a bit of a pain for newly FIRE'd people living in HCOL areas on a yearly basis. Especially considering premiums can change significantly from year to year.  Sucks.   

Yes to all your comments ^.  I FIREd last year, and have spent so much time trying to understand and optimize MAGI and ACA.  It's crazy.   

[Queen Frugal]

Every year is a juggle to walk myself right up to the ACA cliff but not fall off.  I have been lucky enough to be healthy and not need a lot of care, maxing out my HSA every year, but 2021 is going to be a high health cost year. My plan for 2021 is 200% of FPL to maximize my cost share savings. It brings my max out of pocket costs down to $1500 and my premium down to $242 per month.

However, the low income kicks my daughter out of the ACA and into a CHIP plan. That makes me a little nervous. Anyone have experience to share with the CHIP program?

[BuildingFrugalHabits]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

[FiveSigmas]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

MAGI is Modified Adjusted Gross Income. It does not include the standard deduction (not that the doubly-modified modifier makes this very clear).

[PDXTabs]

I know people that self-insure in Latin America. Not in the USA.

[BigEasyStache]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

MAGI is Modified Adjusted Gross Income. It does not include the standard deduction (not that the doubly-modified modifier makes this very clear).

MAGI does include the standard deduction.  In fact, it is very common for the MAGI to be the same as the AGI.

[/quote]

To find your MAGI, take your AGI and add back:

Any deductions you took for IRA contributions and taxable Social Security payments18
Excluded foreign income5
Interest from EE savings bonds used to pay for higher education expenses19
Losses from a partnership20
Passive income or loss
Rental losses21
The exclusion for adoption expenses22
 Many of these deductions are not commonly used, so your MAGI and AGI could be similar or even identical.9
[/quote]

[KarefulKactus15]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

I'm not too low to qualify but I do live in a state where that is possible because medicaid wasn't expanded.

I can't speak to the legal side of this, but everything I read says people just over estimate their income and there's not a section of the aca that addresses this because it was assumed all states would expand medicaid to cover the too low gap. 

[jim555]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

I'm not too low to qualify but I do live in a state where that is possible because medicaid wasn't expanded.

I can't speak to the legal side of this, but everything I read says people just over estimate their income and there's not a section of the aca that addresses this because it was assumed all states would expand medicaid to cover the too low gap.

The law when it was created said if a state wants to have the Feds match their Medicaid they had to expand Medicaid.  The Supreme Court ruled this was "coercive" and gave states the option to expand or not.  The match for elderly Medicaid is 50% and for the expansion it is 90% paid by the Feds.  So in non-expansion states you have a gap between 0% and 100% FPL where you can't get subsidies or Medicaid.

[BicycleB]

I was thinking it would be difficult have an income high enough to qualify for the ACA if you are living off investments.  Depending on your cost basis, a couple living on 50k a year might show capital gains of 25k if their investment doubled prior to selling.  Then the standard deduction is $24,800 giving a MAGI of just $200.  Is anyone in a situation where their income is too low to qualify?

MAGI is Modified Adjusted Gross Income. It does not include the standard deduction (not that the doubly-modified modifier makes this very clear).

MAGI does include the standard deduction.  In fact, it is very common for the MAGI to be the same as the AGI.

As shown by the link below, the standard deduction does not enter into the calculation of MAGI for ACA.

https://laborcenter.berkeley.edu/modified-adjusted-gross-income-under-the-affordable-care-act/

My experience matches the link. I myself have been using ACA for over five years. Most of my income is from investments (rent, transfers from traditional IRA to Roth, tidbits from brokerage financial investments). Throughout, my income has been so low that if it were reduced by the standard deduction before ACA eligibility is determined, my income would be too low to qualify for ACA (I live in a non-Medicaid-expansion state). In addition to qualifying, I also get nearly 100% premium subsidy if I complete all paperwork correctly. So far, have received continuous health coverage.

Meanwhile, when taxes are calculated, the standard deduction applies. Typically this reduces my income from around $14,000 to around $1,300 (which produces income tax liability of around $130). It can still be tricky to have sufficient income year after year, so plan carefully. But @BuildingFrugalHabits, it's not quite as bad as you were thinking.

[pmac]

I'm curious as to if that number is typical of what a upper middle class family would pay (say $100K per year income)?  That number you quoted was shocking to me (and a little disheartening).  I haven't begun looking into ACA for my early retirement but if those numbers are representative of someone who plans on FIRE'ing with a healthy budget, that could basically add years onto a FIRE number.

It's only shocking because people forget the 20k or so a year paid by employers to cover a family.

An upper class family isn't paid "100k", they're paid "120k, with 20k going to someone else".

That doesn't make the pricing right, but until radical political change comes, it is what it is, and everyone should account for it when deciding whether to work for themselves.
[/quote]

It's shocking for my situation because I'm self-employed and write those checks. Fortunately our state now has 2 insurance providers instead of just 1, so premiums went down about $200/month.

[dresden]

It's shocking for my situation because I'm self-employed and write those checks. Fortunately our state now has 2 insurance providers instead of just 1, so premiums went down about $200/month.

So you have several things going for you - you should be able to deduct your healthcare premiums since you are self-employed.  You can also deduct an HSA and the great thing about it is is that you get a tax deduction when money goes in and when money goes out for healthcare - you pay no tax.  You can also use the HSA money for dental expenses and we just use an AETNA vital savings card and pay for dental expenses out of our HSA.

If you are significantly over the limit for subsidies the cost is a drop in the bucket.  If you are near the cut-off point you might want to look at options to reduce income with retirement accounts and HSA to get that benefit which is up to 400% of Poverty line which is over 80k for a family.

Currently ACA subsidies account for 5% of federal healthcare subsidies for folks under 65 while employer plans account for 35%.  I hope self-employed and gig workers get more help with healthcare, but that is not likely if Trump wins again as his priority is repealing ACA rather than replacing it.  For someone with pre-existing conditions those premiums are probably in excess of 50k if those protections go away.

Insurance in general is expensive and almost to the point of ridiculous.  I pay high rates for home insurance because I live in Florida (hurricanes).  I pay high rates for auto insurance with no at-fault or shared-fault accidents or tickets due to having 20-year old son.  I don't feel I can risk going without an umbrella policy and then there is healthcare.  Insurance is my #1 expense in early retirement.

[GoCubsGo]

@pmac 

I guess my question based on the website jim555 posted above is that it says the total out of pocket expense on a silver plan is $17,100 even at 1,500% of FPL.  Is that not the case for you?

[dresden]

@pmac 

I guess my question based on the website jim555 posted above is that it says the total out of pocket expense on a silver plan is $17,100 even at 1,500% of FPL.  Is that not the case for you?

I would go to this site: https://www.healthcare.gov/

and then click "Get Coverage" and then "Search Now" to preview plans - you can put your income and family info in.  You will see prices, subsidies, deductibles, co-pays etc.

At 100-150% of FPL you are looking at silver plans with no deductible and $1 - $5 co-pays to visits to doctors.  So basically no significant out of pocket expenses.  The problem is the lowest cost plans have terrible doctor options and NEVER go with a plan that includes dental - they have practices that make money from upselling unnecessary services.  To get a silver plan with a good selection of doctors you are looking at about $5k per year AFTER significant subsidies or you can get a bronze plan for $0 and put that money into an HSA.  The silver options available for under $100/month with subsidies don't have very good options for doctors, e.g., I would have to travel 50 miles to get a colonoscopy even though there are plenty of doctors local.  None of the local doctors in the lower cost plans are accepting new patients.

In our area the 3 providers are OSCAR, Ambetter and Blue Cross.  I had Ambetter last year which was the cheapest silver plan and it's fine - you get the medical care you need, but you will be very limited with doctors.  Blue Cross has all the doctors I had with my employer plan previously, but it is much more expensive (over 2k per month for silver and 1600 for bronze).  So with BCBS someone with 150% FPL pays 0 for bronze plan and nearly 400/mo for silver after subsidy.    So if healthy I think it's still better to go bronze and put 400/mo in HSA.  The bronze plan pays for physical and basic preventive services 100% including colonoscopy.  You pay virtually nothing with silver plans @ 150 FPL so if you need alot of care silver definitely makes sense.

If you check that site you can see the deductibles and copays of silver plans go up as you change your income.  you can also put in doctors to see if they participate in the plan.

[jim555]

@pmac 

I guess my question based on the website jim555 posted above is that it says the total out of pocket expense on a silver plan is $17,100 even at 1,500% of FPL.  Is that not the case for you?

I didn't say that.  At 150% FPL you should have substantially lower OOP costs.

[GoCubsGo]

@jim555, I didn't say you said that.  I typed in $400,000 family income for a family of 4 using "average US rates" to the website https://www.kff.org/interactive/subsidy-calculator/

And it said the following:

"Estimated financial help:$0 per month ($0 per year)
as a premium tax credit. This covers 0% of the monthly costs."

Your cost for a silver plan:$1,243 per month ($14,922 per year)
in premiums (which equals 3.73% of your household income)."

"The health reform law sets limits on the amount you have to pay out-of-pocket each year. Your out-of-pocket limit for a silver plan can be no more than $17,100 in 2021."

That's the main thing that threw me off was the out of pocket max being set by law at $17,100.  Maybe the site is incorrect?

[jim555]

That's the main thing that threw me off was the out of pocket max being set by law at $17,100.  Maybe the site is incorrect?

The max OOP is set by law, but can be lower with a Silver plan in the right FPL range.

[Paul der Krake]

@GoCubsGo I think you're getting hung up on the terminology.

"Out of pocket max" means something very specific in insurance lingo: it's the maximum amount paid for copays/coinsurance/deductible for in-network claims, but it does not include premiums. The maximum out-of-pocket maximum is set by law.

OP, however, is using "out-of-pocket" as an informal phrase because, well, premiums are money out of his pocket. He's looking at the total cost.

Hope this clears things up.

[GoCubsGo]

Thanks Paul! That was exactly where I was getting hung up and that makes sense.

[norajean]

Tens of millions of Americans self insure.  It is risky as you could need medical care and not be able to afford it, in which case you might suffer unduly or even die. There is always Mexico I guess.  Then again, you might save a fortune on insurance. It's a gamble!

[ltt]

Open enrollment begins today, and the health insurance numbers are ridiculous.

$1,400/month premium for a bronze plan for a family of 3 (HSA eligible)

$7,000 individual deductible

$12,000 family deductible

So, you pay $16,000 in health insurance premiums for the year, then $7,000 on your individual deductible before the insurance company pays anything (that's $23,000)

If a 2nd person gets sick, you pay another $5,000 to meet the family deductible....(we're at $28,000 now!)


Is anyone doing self coverage out there? I feel like I could get a lot of great preventative care e.g. chiropractor, dentist, physical therapy, gym membership, massage therapist etc... with just the $16,000 I would have sent to the insurance company.

$23,000 is a lot of money to shell out before you get any type of help. And I'm not speaking to those who get the premium tax credit, that's a different scenario. I'm talking to the people who have too high of an AGI to qualify for that.

Yes, it is a lot of money to shell out, but do it anyway.  Insurance isn't really about preventative care; it's about what could go wrong.

Realizing that deductibles and out-of-pocket maximums are high under the ACA, am deciding that we just need to bite the bullet and be prepared.

This year, I have ended up in the emergency room twice and had unexpected surgery each time.  The first was a minimal procedure with overnight stay that, without insurance, would have cost a little over $20,000.  The second surgery, unrelated to the first, had costs of around $40,000 and will, more than likely, have some further physical therapy costs.

All it takes is one accident and you will be glad you paid for insurance.

[Segare]

I have been hesitant to chime in.
I have not had health insurance since 2006.
I am 56.
There are many reason why I don't have it.
I think the concept is ridiculous, middle man entity called the insurance company is placed between those who need coverage and those who provide it. Someone has to pay for all their paychecks, benefits, operating cost and profit.  The cost of medical care is too high and part of that is due to this middle man entity.
I think what you focus on you get, it seems to me too many people who were convinced they needed insurance ended up needing it shortly after they got.
Anyway, doubt I will change anyone's mind, but I am going to just live healthy, do what I can and live life.

[KarefulKactus15]

I have been hesitant to chime in.
I have not had health insurance since 2006.
I am 56.
There are many reason why I don't have it.
I think the concept is ridiculous, middle man entity called the insurance company is placed between those who need coverage and those who provide it. Someone has to pay for all their paychecks, benefits, operating cost and profit.  The cost of medical care is too high and part of that is due to this middle man entity.
I think what you focus on you get, it seems to me too many people who were convinced they needed insurance ended up needing it shortly after they got.
Anyway, doubt I will change anyone's mind, but I am going to just live healthy, do what I can and live life.

I disagree with the fundamental argument. (Perhaps due to ignorance).  Its my understanding that due to insurance "float" money being invested, insurance companies are able to offer insurance below apparent cost.  Im not sure if this is relevant to healthcare.   

But I'm sure having the middleman operating for profit isn't the cheapest model possible.