I've been looking at various options for healthcare post FIRE and posted it on my journal. I thought it made sense to post it here. Since it's not clear what will be there post ACA, this just looks at things available today. They are based on a 51 y.o. couple in Denver.
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Rather than just whining about the healthcare situation, I figured I'd actually do a little research and throwdown some numbers.
Option 1: ACA Plan (2018 numbers, I thought I had seen 2019, but maybe not)
Cigna Bronze: $961.14 per month for the two of us
Deductible: $6700 per person
Max cost: $7,350 per person
EPO only no coverage out of network
$50 PCP visits
50% coinsurance after deductible (which is kind of hilarious, you're only in the co-insurance phase from $6700 to $7,350)
I checked what this would be if we were 10 years older and it's $1450/month. Everything else is the same. If we're 5 years older, its ~$1100/month.
A Silver plan is available for $200 more/month, deductible is $4,000 per person and copay is 30% after deductible is hit. If we end up in the $5k-6k spending window this might be a slightly better option. I think we'd go bronze.
Option 2: "Short term" plans
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This is the new workaround to the ACA that I mentioned previously. You can now get 1 year "short term" plans and that is extending to 3 years next year. Except, it turns out, not in Colorado. Here, plans are limited to 6 months. You can "renew", but that is restarting on essentially a new plan, so if you get sick in the first 6 months you might get rejected in the 2nd due to "pre-existing conditions", or if treatment is ongoing you are probably screwed. This makes it somewhat of a non-starter for me.
Option 3: Ministry Health Sharing
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I looked at the details of Liberty (
https://www.libertyhealthshare.org/content/sharing-guidelines.pdf.)
The good:
$135 annual dues, $400/month "sharing cost", $24 monthly admin fee, $1750 deductible for a couple, $1 MM per incident (maybe, see below).
The bad:
- Need to sign paperwork that says you're religious
- You get checks from other members when you are getting paid. That means you can get a bunch of checks and you need to track it. It's not clear what happens if a member doesn't pay (other than they get kicked out, but it's not clear if you would still get paid).
- Trips to the ER are not covered if it's not an emergency. I read some reports of issues where someone thinks they're having a heart attack. Turns out it was a panic attack, so it wasn't an emergency and it's not covered. Same with ambulance coverage if it turns out it wasn't a life threatening situation.
- Injuries due to "hazardous" activity. An activity is hazardous if it is an activity which is characterized by a constant or recurring threat of danger or risk of bodily harm. Examples of hazardous hobbies include, but are not limited to, rock/cliff climbing, spelunking, skydiving, or bungee jumping. Note the "not limited to". This seems like another big hole where they decide whether to cover it after the issue. Skiing? Hiking in the mountains? Riding an ATV?
- Pre-existing conditions are not covered initially. Some coverage after 3 months, full coverage after 37 months...maybe. They can request a permanent waiver that basically says nothing related to the pre-existing condition or any side effects due to treatment are ever covered.
- The cost per month is actually variable. They can raise it at any time with 60 days notice.
- Similarly the payouts are variable. If they have a period of time where outgoing payments are too big, they basically ration the coverage.
So I think this is probably out. I'm just not that comfortable with the gaps and how it works.
Option 4: This is actually a new one I thought of yesterday. The local colleges offer (actually force you to buy) health insurance. It's super cheap, $2200 per person for great coverage. Basically no deductibles or copays. You have to be registered for at least 6 credit hours per semester, which costs $2800 for residents. It's not clear if you can buy coverage for a spouse. If you can, this might be a great stopgap for certain phases. I've thought about taking classes as something I might do in retirement anyway.
Option 5: Portugal Golden Visa.
Buy real estate for 500k+ Euros and you can get a 1 year residency visa, which is renewable. $5k to get the visa, $2k renewal. After 5 years you can get a permanent visa.
Being a resident will get you access to Portugal's NHS. You can also buy private insurance.
Greece and Spain have similar programs.
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