self insured- specifically health insurance

[Pigeon]

What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..

I think that would be the old system: "Can't pay your medical bills? Ok, you're dead."  Only everyone saved money by not buying bracelets.

There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.

To someone from the UK, they are horrifying examples.  Our system is a long way from perfect, but it has better and fairer outcomes than that.

Well, to be fair, there does have to be some system for organ transplants. Until we can print enough of them for everyone, someone is going to not get the organ they need from the very finite supply available.

I'm not sure I'd term this system as fair though.

[Metric Mouse]

What if we had a euthanasia bracelet if the cost gets above X?
We as a society really need to come to terms with dying..

I think that would be the old system: "Can't pay your medical bills? Ok, you're dead."  Only everyone saved money by not buying bracelets.

There are two examples of that in this thread already: no life-saving organ transplants if you are not insured for the anti-rejection meds, and no operation for a treatable cancer if you are not insured for the operation.

To someone from the UK, they are horrifying examples.  Our system is a long way from perfect, but it has better and fairer outcomes than that.

Well, to be fair, there does have to be some system for organ transplants. Until we can print enough of them for everyone, someone is going to not get the organ they need from the very finite supply available.

I'm not sure I'd term this system as fair though.

I would argue it is (generally) fair to not give a valuable organ to someone who is unlikely to take care of it, if that organ could go to someone who is likely to take care of it.

Being unable to take care of a donated organ because one cannot get health insurance due to low income could be said to be unfair.

[markbike528CBX]

OP here,

does the possible changes to ACA change anyones thinking?

[jim555]

Who knows what will happen in the next few years. 

If you do self-insure maybe look at medical tourism since a lot of countries have much lower drug and hospital costs.

You could always move (creating an open enrollment period) and buy insurance after the fact if you ever ever get sick.

As long as you never get an IRS refund you can avoid the penalty indefinitely.

[CBnCO]

One of the major benefits of insurance is negotiated costs.   The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company.  If you have a 20 percent co-pay, your out of pocket is $400.  Without insurance, you will be billed for $10,000.  You might get that down somewhat if you have no money, but not to the insurance company's price.  Have money?  You will pay $10,000.

I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.

[wenchsenior]

One of the major benefits of insurance is negotiated costs.   The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company.  If you have a 20 percent co-pay, your out of pocket is $400.  Without insurance, you will be billed for $10,000.  You might get that down somewhat if you have no money, but not to the insurance company's price.  Have money?  You will pay $10,000.

I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.

The problem I see is that a free market health care system doesn't work like a 'regular' free market. For medical care that is routine, or elective, I suspect cutting the middle man WOULD bring prices down. But why would it for emergency care, or care for a potentially life threatening problem? In that case, the patient is 'captive'. They can't negotiate freely because they can't 'walk away' or choose not to purchase care.

[Altons Bobs]

OP here,

does the possible changes to ACA change anyones thinking?

What are the possible changes?

[wenchsenior]

OP here,

does the possible changes to ACA change anyones thinking?

What are the possible changes?

It's almost certain to be repealed early in 2017. The question is what it will be replaced with, or if it will be replaced with anything.

[LiveLean]

Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.

[jim555]

OP here,

does the possible changes to ACA change anyones thinking?

What are the possible changes?

If the ACA is repealed then yearly / lifetime caps would most likely return.  This would also effect employer based policies.  So if you get leukemia and need a stem cell transplant, which could cost 800K to 1MM be prepared to die as your insurance cuts off before your treatment is finished.

The ACA closes the Medicare Part D 'donut hole' from 2013 - 2020, so the hole gets reopened as well.

[MrsPete]

I'm with the majority in saying, Horrible idea. 

My husband spent a single night in the hospital, and it was something like $9,000.  I had outpatient surgery, and it cost as much as I earn in a whole year.  These costs are huge and unpredictable, and -- unlike so many of our other costs -- cannot be managed through frugal living. 

As for negotiating (either with the doctor, the hospital, or the insurance company), that's pretty much impossible.  "The system" is so big, so complicated and contains so many "moving pieces" that most of us simply don't have the knowledge to negotiate effectively.  Personally, I think the insurance companies want us to be "out of our element" here.

[CBnCO]

One of the major benefits of insurance is negotiated costs.   The emergency room visit with a nominal cost of $10,000 will be negotiated down to $2,000 by the insurance company.  If you have a 20 percent co-pay, your out of pocket is $400.  Without insurance, you will be billed for $10,000.  You might get that down somewhat if you have no money, but not to the insurance company's price.  Have money?  You will pay $10,000.

I always thought this was interesting assumed that the list prices..in this case your $10,000 example where not really market based; but, inflated to allow the insurance companies to negotiate them down. If the market would be allowed to work, I would think the actual "cash" price would be the same $2,000. In essence, the entire system as regulated by the government and supported by the insurance lobby is set up to funnel everybody into insurance. It's really warped that there would be no benefit to cutting out the third party and paying cash direct to the caregiver.

The problem I see is that a free market health care system doesn't work like a 'regular' free market. For medical care that is routine, or elective, I suspect cutting the middle man WOULD bring prices down. But why would it for emergency care, or care for a potentially life threatening problem? In that case, the patient is 'captive'. They can't negotiate freely because they can't 'walk away' or choose not to purchase care.

My grandfather once told me that the first health insurance that was available was called "Hospital" insurance and akin to what we would call catastrophic or emergency insurance. I think going back to this might be a good idea. My initial post was to point out that the prices of almost all healthcare in the U.S. are not real prices based on cost and competition; but, instead manipulated by corporations and the government. You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash. Further, I think self insuring for basic primary care needs would certainly motivate people to take a little more responsibility for preventative care. The interesting thing to me is that I rarely hear any mainstream politician talk about structural ideas like this one; but, instead small tweaks to protect their donors.

[Fomerly known as something]

I'm in the camp of "horrible choice".  Even if you have 1-2 million per family member, that could literally be wiped out after an encounter with a drunk driver or a stint with cancer -- and you can't avoid those awful things. 

On the other hand, paying out of pocket when you catch strep throat or your kids need vaccinations -- while maintaining a high-deductible catastrophic illness policy -- makes sense financially.

4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip.  One is possibly now quadriplegic.  Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation. 

[wenchsenior]

I'm in the camp of "horrible choice".  Even if you have 1-2 million per family member, that could literally be wiped out after an encounter with a drunk driver or a stint with cancer -- and you can't avoid those awful things. 

On the other hand, paying out of pocket when you catch strep throat or your kids need vaccinations -- while maintaining a high-deductible catastrophic illness policy -- makes sense financially.

4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip.  One is possibly now quadriplegic.  Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.

Yup. A close friend of ours had a backache a couple years ago. It got worse and worse, despite steroid shots and rest. After a week, one leg and his bladder became paralyzed and he was rushed to the emergency room for surgery on his spine...a rare incident had occurred where a minor bacterial infection had migrated to the bone of his spine, eaten it away,  and collapsed it on his spinal chord. More than two years later, including ongoing rehab, etc. and he still is mostly wheel chair bound, with a catheter. He can walk slowly with a walker on even ground, but mostly uses his wheel chair for work because walking is too risky.  Between the medical bills, the medications, the rehab, having to redo parts of their house for wheelchair access, and buying a new van for disabled drivers? The official bills ran about 1 million just for the first year (mostly covered by insurance) and a couple hundred thousand the second year, and I expect his lifetime bills will run middle double digits for life. Without insurance, that family (relatively high earners with some family money on top of that) would have been crippled by that first year's bills alone.

[Altons Bobs]

I know a guy who knew this old man who was 82 then.  He retired long time before then with $10mil in assets and didn't think he needed health insurance, so he thought it would be perfectly fine to self-insure.  His wife got cancer, he paid for rounds of treatment out of his pocket, and at the end, she died, and he was left with nothing. He had to go work at Walmart as a greeter because at 82, no one else wanted to hire him, and he didn't have money to live if he didn't work again.

[Enigma]

When someone is sick you will use every dime you have to make them better...   even if they never get better.

[MrsPete]

You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash.

Yeah, you can plan medical tourism for some things, but you can't count on that working for you.  For example, if you have chest pains or are injured in a car accident, you can't get yourself a quick flight to Mexico. 

4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip.  One is possibly now quadriplegic.  Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.

That's terrifying, and not a single one of us can say, "That'll never be me." 

To give a less dramatic example, a guy I know just in passing -- friend of a friend type -- was bitten by a Brown Recluse spider (at least I think it was a Brown Recluse).  I had no idea a spider could affect a person this way.  He was in a coma for weeks, and the skin around the bite literally died, and he had a giant wound with which to deal.  I have no idea what his treatment cost, but I'm sure it was big bucks -- enough to put a big dent in even a lifetime saver's accounts.  And, again, none of us can say, "That'll never be me."

[Metric Mouse]

You can get similar car for many primary conditions in Mexico or other countries for 1/4 or 1/5th of the price paying cash.

Yeah, you can plan medical tourism for some things, but you can't count on that working for you.  For example, if you have chest pains or are injured in a car accident, you can't get yourself a quick flight to Mexico. 

4 coworkers from an office in a different city from me were hit by a drunk driver on a business trip.  One is possibly now quadriplegic.  Yes he will be on workers comp for a lot of his bills but his care for life is likely to be $5 million per the reeve foundation.

That's terrifying, and not a single one of us can say, "That'll never be me." 

To give a less dramatic example, a guy I know just in passing -- friend of a friend type -- was bitten by a Brown Recluse spider (at least I think it was a Brown Recluse).  I had no idea a spider could affect a person this way.  He was in a coma for weeks, and the skin around the bite literally died, and he had a giant wound with which to deal.  I have no idea what his treatment cost, but I'm sure it was big bucks -- enough to put a big dent in even a lifetime saver's accounts.  And, again, none of us can say, "That'll never be me."

Right? It would be far superior for everyone if the USA moved towards universal provided healthcare.

[markbike528CBX]

I see MMM has FINALLY caught up with me ( OP ) on this topic.  :-)

http://www.mrmoneymustache.com/2017/11/05/when-your-shitty-health-insurance-doubles-in-price/

[Gin1984]

Except that he determined going without would be a bad idea....

[letsdoit]

hearing everyone,
it seems far easier to keep working (in USA) in order to stay  on the predicatable health insur

is there a search engine that FIRE or self-employed people use to buy their own insurance ?

[Erica]

Two Ideas-

1. If you attend church, you might want to look into Christian Healthcare Sharing Ministry
VERY inexpensive rates for a good amount of coverage.
5K deductible or get 5K worth of discounts on your bills which is generally really easy.
So I consider this no deductible insurance.

$45 per person per month for up to 125K of coverage per incident.- https://www.chministries.org/programs.aspx
$25 per person per mo- for coverage beyond that 125K- adding 100K coverage for each year until it caps out at one million dollars.-
Brothers keeper
https://www.chministries.org/catastrophicbills.aspxer
-------
$70 each

We've been members for 5 yrs so have 125K per incident + 500K = $625K coverage for one year
In 4 more years, coverage will be over 1 million and stay that way
Again, just $70 a month per person.
They are first or last payer, you're choice.

2. Check into  Ambulance Helicopter insurance in the form of a yearly  membership.
Our family membership is $65 a year/$5.41 month
The average life-flight helicopter flight is almost 100K right now.
This covers two life- flights per year, per person, for as many people as are in your family

[markbike528CBX]

OP here- -- 

I've FIREd, now have COBRA until my wife's open enrollment period at work, where we might end up under her plan.
While COBRA is spendy, it was a way to get FIREd without depending on my wife's plan, so she could
1) Retire Early
2) change jobs without mental hindrance.
AND  COBRA isn't that bad, as my former company is self-insured, which brings costs down some.


As to the exchanges, differs by state

https://www.healthcare.gov/marketplace-in-your-state/

For non-US and the acronym-phobics
COBRA
A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.

[Wilson Hall]

Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.

Can someone please explain this scenario to me?

A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?

[jim555]

Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.

Can someone please explain this scenario to me?

A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?

I can't speak to your state, but in NY they have SUM coverage, which is supplemental uninsured/underinsured coverage.  My liability say was 300/300, that defaults to a SUM of 300/300, so if the guy who hits me only has 25/50 my own insurance covers me to 300/300.  I tried to lower this and they require I sign a waiver to do it, some new law came in recently.

[Wilson Hall]

Whenever posts like these come up, there's the inevitable car accident scenarios raised. Remember, car accidents have far more to do with your AUTO insurance than your health insurance. Assume the idiot who hits you -- drunk, distracted, whatever -- has no assets and minimal or no insurance. (This happened to me.) How you're treated, what medical options you have, and the financial hit you take will depend largely on your AUTO insurance, specifically how much uninsured motorist (UM) insurance you have. People who nickel and dime over their collision usually ignore how much UM they have -- if they have it all. Thankfully I wasn't one of those people. Max out your UM and also max out UM on your umbrella liability policy you should have.

Can someone please explain this scenario to me?

A member of my family got into a car accident this week. The other driver was at fault; therefore, I presume his insurance is supposed to cover not only property damage but bodily injury to my relative, who is now undergoing medical tests. The at-fault driver only has whatever the state minimums are insurance-wise, but my relative's is pretty decent, including UM. Does this mean once the other driver's insurance limits are maxed out, my relative's medical bills/ pain and suffering would be covered by her own auto insurance policy? Or would her health insurance cover the difference?

I can't speak to your state, but in NY they have SUM coverage, which is supplemental uninsured/underinsured coverage.  My liability say was 300/300, that defaults to a SUM of 300/300, so if the guy who hits me only has 25/50 my own insurance covers me to 300/300.  I tried to lower this and they require I sign a waiver to do it, some new law came in recently.

Thank you-- this explanation helps. I had started doing some Internet research on this topic, because my injured relative does not seem to understand that her own auto insurance will have any bearing on the outcome. She thinks that because the other driver has some insurance, her bills will be covered only to those limits. I thought that part of the reason one buys higher limits of auto insurance, specifically bodily injury and UM, is to protect your physical well-being against the random person who hits you. Right now, she's not buying it, but then again, she might have a concussion.

[Erica]

This isn't true for every circumstance.
You must pre-plan depending upon where you live.
Tell the doctors you will pay in cash.
The hospital we used was affiliated with Sutter.

After getting hit by a car riding my bicycle about 5 yrs ago, I ended up taken to hospital unable to form coherent sentences.
They ran very expensive tests.
Doctor bill, I've forgotten the amount....but he was willing to cut it by 35% when I offered cash.
Telling him that is all I pay with
At his office, I noticed it needed painted.
My husband is a painting contractor so we painted for the entire amount.
He was VERY happy.
So were we! We worked together, 40 hrs that week, to complete the job
My indemnity policy only covered 10K of the hospital bill
2k of the Doctors bill.
The Hospital took $350 month payments cutting their fee by 50%. It was paid off within 1 yr with a few extra payments

Everything is negotiable.
What skills do you have?? offer them up!
Otherwise ensure you offer CASH to individual doctors
Unless you are involved in Kaiser, or some large HMO w(hich I do not recommend for this reason) then you could be screwed.

Our $65 family membership to Calstar, life-flight helicopter, covered my transport.
Where-as the indemnity plan covered just 2K of the 25k or so trip

Right after this incident, we joined Christian HealthCare Sharing Ministry for just $65 a piece per month. About 600K yr coverage.
5K deductible is satisfied when you get 5K in discounts.
Cost has not increased much at all, yet every year until it hits 1 million, they add on 100K of coverage.

[afox]

The problem is that what americans call health "insurance" isn't really health insurance at all, its actually health care.  All human beings need HEALTH CARE.  The idea of health insurance is problematic and inaccurate, its as if there is a chance that the human being would not need to make a claim.  All human beings need health care not health insurance.  An analogy would be like buying car insurance that covered oil changes and new tires, as you can imagine that type of car insurance would be expensive and wasteful and it would be hard to shop for your oil changes and tires.

This idea is not mine and is discussed in more detail by my favorite podcaster:
https://moneyfortherestofus.com/213-health-insurance-mess-2/

 

[Dancin'Dog]

Christian HealthCare Sharing Ministry sounds interesting.
But I don't attend church & drink an occasional beer, so that might might not work for me.

I've read about some world travelers that get their international insurance from Germany that is supposed to be good and it is affordable.  I think they only need to visit Germany every year, or maybe it's every 2 years, to renew the policy. 

[Adam Zapple]

This may come across as snarky, but it is not meant to be.  I wonder how many of us would be just the same as we are today without "healthcare" as most of us probably see it.  If we treated healthcare as something to be used in emergencies only, my guess is that if we all self-insured from the day we became adults, a vast majority (but not all) of us would come out ahead. 

I also wonder if I'm the only person who thinks we should have more choice on whether or not it is ok for us to die.  Perhaps its the fact that I have lived through fairly long periods of illness that skews my opinion on this.

Like maybe someday, when I'm 65 years old or something, or I have a chronic illness that makes life terrible, I'll say to myself "I've had enough life for one person, I'd like to let nature take its course from now on."  But this is almost impossible to carry out in real life.  Even advanced directives don't matter if you are hit by a truck and nobody is around to tell the paramedics and doctors not to fix you.  Wearing a "do not resuscitate" bracelet is useless without the actual paperwork available spelling out what level of care you will accept. 

I guess I just feel that there's something wrong with the fact that somebody will fix you and charge you or your family $1 million without you having a say in the matter.  I work in the healthcare field and see a lot of people being treated to preserve a life that they probably don't want to be living anymore.  Since these people can't speak for themselves, care is continued.  This is mostly because they were not aware that they had the option to die before they got sick.  They also failed to plan for end-of-life care.  Doctors, nursing homes etc will provide them care around the clock for days, weeks, months or years...all the time the meter is running and bills pile up that someone will have to pay.  Even if they plan ahead and tell everyone they don't want care of any kind if they get sick, this probably won't happen because their family can face penalties for failing to provide them proper care.

We are expected to get care if we are sick but it should be a personal choice.  I should be able to self-insure and say "I don't have insurance because I am willing to accept that I will die someday" and be left alone.

[afox]

Huh.  This is America, you dont have to go to the doctor.  You dont have to have health insurance, you can pay a small penalty and not have insurance.  You CAN have an advance directive/DNR/etc.  Yes, the ambulance and ER may have to treat you before they have a chance to review your advance directive orders but noone is forcing you to treat your cancer or long term injuries.  You cant really expect the EMTs to be able to interpret the legality of your your DNR/directives.  If you are conscious you certainly can wilfully deny any medical care. 

Guess, Im not sure what you're complaining about?

[genesismachine]

The most common ways to break the bank are chronic conditions (immediately leave the US for any other country to get care in cash), and if you get into a car accident (solved by uninsured motorist coverage which is usually something tiny like $1/mo extra).

That still leaves you open to catastrophic events where you don't have time to leave the country, but this should be far less likely than the above two categories. Personally it's not worth the risk for me.

Or you could just move to another country and get covered under their national healthcare. I bet that move would cost way less than $1M. If you have a long way before reaching 65, this may be your best option if you insist on being self-insured (which it sounds like it's not really by choice but because insurance + deductible is too expensive). If you are in the North, and not far from the Canadian border, perhaps it would be close enough that you could still drive down and visit family/friends and have it not impact your life too dramatically. Same goes if you're in the South and living in Mexico.

And the number on the bill that the insurance company 'negotiates' is an invented number. I had family members who self-insured and they never paid anything close to those made up numbers when they had cash. They did this for 30 years until the ACA (not wise IMO, but they did it). They went through surgeries and all sorts of medical procedures and have tons of experience. I also recently had a brief lapse in coverage where I paid $595 for an MRI that insurance would have been billed $1200 for.

Cash prices are very very likely to be way below the insurance 'negotiated' price if that's any consolation.

[jim555]

Or you could just move to another country and get covered under their national healthcare. I bet that move would cost way less than $1M. If you have a long way before reaching 65, this may be your best option if you insist on being self-insured (which it sounds like it's not really by choice but because insurance + deductible is too expensive). If you are in the North, and not far from the Canadian border, perhaps it would be close enough that you could still drive down and visit family/friends and have it not impact your life too dramatically. Same goes if you're in the South and living in Mexico.

It is not that easy to move to another country.  Visas MIGHT be given if your job is needed in the country of interest, but then out goes the retirement plan.

[letsdoit]

it's not exactly 1980.  in general, rich countries dont want americans unless they have  certain skills

[genesismachine]

Depends on the country, but many countries have provisions if you're rich and want to move there. This can take 2 forms in general, one is that you have a certain dollar amount net worth/investment income and can prove you won't be a burden on society; the other is that you either invest in or open a business that agrees to employ X people for Y years. Many countries have forms of both.

When we're talking in the $1M+ net worth range, I think in general either option would be viable. The problem would come if you had no money and just wanted to move there one day - then you would have to get in via the skilled worker provisions.

The details vary by country, but I'm not aware of any first world countries (let alone third world countries) that don't have some form of these provisions. Certainly you would have lots of options to choose from.

[letsdoit]

once you get to being rich, that is true. 
i currently dont want to lend latvia 300k in order to get a schengen visa, but i could see why someone would

[Altons Bobs]

Canada will only take you if you have the skills they need or have a job that can get you a visa, or if you are willing to spend at least $2mil (not $1mil) and start a business and hire Canadians and improve their economy. If you have $100mil and you don't have any of the above, they still won't take you.

[brooklynmoney]

For this reason I am very intrigued by the golden visa programs at many EU countries like Portugal and Greece. Portugal’s requires 500K EU real estate investment from what I understand.

[letsdoit]

i'm not saying this is the greatest blog in the world, but he goes through the details of all of these issues
http://nomadcapitalist.com/second-passport/

[markbike528CBX]

OP here again.  Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.

I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.

Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots.  I didn't think of asking for the GoodRx price.   

Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan.  However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).

Reason fora possible change of heart/plan?  We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.

[tipster350]

Yup, self insuring works...until it doesn't! It's madness at any age, but when I read that you are in your 50s, I see that you are playing a game of Russian Roulette financially that has way more spaces filled with bullets than not. To say nothing of the burden on society you will become.

[OtherJen]

OP here again.  Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.

I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.

Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots.  I didn't think of asking for the GoodRx price.   

Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan.  However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).

Reason fora possible change of heart/plan?  We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.

Oh dear. Yes, mid-50s is when a lot of significant health problems start cropping up. It’s the age range when an acquaintance found out that he had metastatic prostate cancer (with a housewife and 3 teenagers at home), when my grandfather and a couple of uncles had heart attacks, when my uncle’s rheumatoid arthritis destroyed his lungs to the point that his options were double lung transplant or die (he chose the transplant and remains alive more than a decade later), and when my grandmother died of ovarian cancer.

In the US, it doesn’t seem prudent to consider self-health insurance unless your net worth is at least 8 figures. I agree that there’s not much reason to self-insure for dental coverage unless you’re expecting major dental surgery and want the discount. Routine dental care isn’t prohibitively expensive, and we wouldn’t bother with dental coverage if husband’s employer didn’t cover it.

[brooklynmoney]

OP here again.  Update:
Well, despite the overwhelming majority opinion that heath self-insurance is a bad idea, I decided to go that we would go this calendar year 2020 as self-insured.

I have not had any problems getting service at my dentist (normal visit, some X-rays) or my regular doctor.
Even got about 10% "discount" for paying at time of service.

Lessons learned. get your shingles shots under insurance, it was $250 for the first of two shots.  I didn't think of asking for the GoodRx price.   

Now that we have a better handle on our income (~24K SEPP, the rest taxable gains), we _might_ try for an ACA plan.  However, an un-subsidized plan is about 14K/year for two of us (age mid 50's).

Reason fora possible change of heart/plan?  We've had 2 people who are(were) parents of friends die of Covid-19 and a friend die of breast cancer after one remission.

Oh dear. Yes, mid-50s is when a lot of significant health problems start cropping up. It’s the age range when an acquaintance found out that he had metastatic prostate cancer (with a housewife and 3 teenagers at home), when my grandfather and a couple of uncles had heart attacks, when my uncle’s rheumatoid arthritis destroyed his lungs to the point that his options were double lung transplant or die (he chose the transplant and remains alive more than a decade later), and when my grandmother died of ovarian cancer.

In the US, it doesn’t seem prudent to consider self-health insurance unless your net worth is at least 8 figures. I agree that there’s not much reason to self-insure for dental coverage unless you’re expecting major dental surgery and want the discount. Routine dental care isn’t prohibitively expensive, and we wouldn’t bother with dental coverage if husband’s employer didn’t cover it.

My close friend is in the 8 figure range and does not work. He pays for private health insurance.