My health coverage is going up 5% again. That means I will pay $12,750.00 starting Jan 1st for my family plan before insurance will start paying 80% of a medical bill. What other alternatives are out there? I could put all that money into my own medical rainy day fund or maybe there is a catastrophic insurance option that would cover hospital bills above a certain amount and leave doctors’ offices up to me? Any ideas?
Is your current health insurance from the Government Health Insurance Marketplace (Affordable Care Act insurance)? Is the $12,750 just the premiums? Is it a high-deductible plan?
You certainly don’t want to go without any coverage as a major issue could be hundreds of thousands of dollars out of pocket and make the $12,750 look like peanuts.
1 Like
$3,600 deductible, $765 in premiums/month. It’s a plan available through my company. The other plan does not quality for an HSA but costs about the same. They take the deductable down but add the exact same amount to the monthly premiums.
“You certainly don’t want to go without any coverage as a major issue could be hundreds of thousands of dollars out of pocket and make the $12,750 look like peanuts.”
Yeah, I get that. Hence my original question. Is there anything out there that works like homeowners insurance that covers you for catastrophic things, but allows you to pay for your own epairs as they pop up but are there for catastrophic problems? Health coverage seems to be my only option, but I want an actual Insurance plan, not Full Coverage.
There are catastrophic plans available through the Government Exchange (I just Googled it), but they won’t necessarily be available in your state. I just looked up what I could get on the exchange in Washington State and I don’t see any catastrophic-only plans here. So, if I wanted a catastrophic only plan, it doesn’t look like I can get one. So, it seems my only two options for any health insurance is through my employer or through the exchange, which is more expensive.
I would poke around for Affordable Care Act plans in your state. Beyond that, your only option may be to get the highest deductible plan through your employer. Or maybe find a health insurance broker in your area to see what options are available. I’m not an expert, only to the extent that I have to pick a plan every year like most other people and have poked around on the exchange to see what options I have if I retire before Medicare kicks in. Good luck.
Like most govt programs, there’s just a new set of winners and losers. In order to satisfy the small set of losers previously, they made the majority of us losers.
3 Likes
They used to be available, but haven’t been for years. It ought to be an option…no coverage until some large out of pocket is met, then a large % covered.
What would make that different than a high deductible plan?
Basically a super high deductible with, hopefully, lower premiums.
But I suspect the OP will be out of luck.
I dont recall the specifics, but it did not cover any expenses that were less than a very high dollar amount, which would be things like being hospitalized, having surgery, etc. But the out of pocket for those were similar to what they’d be on a normal policy.
What about umbrella insurance? It’s mostly used by businesses to cover for catastrophic expenses. But, I believe it can also be used by individuals.
Best wishes
As a self-employeed individual, I have a ACA (Affordable Care Act) plan which costs over $400/month for single coverage with a high deductible. I looked at private plans through Blue Cross, which are less expensive, however, there are protections built into the ACA plans that aren’t offered by the private plans through Blue Cross. I don’t trust insurance companies, thus don’t trust private plans. You can see the private plans at the Blue Cross website.
My quick history: I retired early in 2016 at 57 without insurance. I got a heath care sharing plan (Google it) for $300 a month for my wife & I. It was okay but I never fully trusted it to pay if we had a serious medical condition. ACA bronze plan premiums were too high (>$1000/mo) at the time because our income was over $62k. When the Biden & the Dems got in they passed a new covid spending bill that raised the ACA income levels and we now have a high deductible ($14k) plan which is basically a catastrophic plan for about $60/mo. I would suggest you apply for an ACA high deductible plan and see what kind of premium you can get.
2 Likes
Quick update: I couldn’t find anything that would work with our situation, so I decided to drop coverage for my family. I am covered for “free” at work, but my wife and kids are on their own. I am now taking the money that would be going to a health coverage plan and putting it in a separate bank account to use solely on medical expenses. I am also maxing out my HSA. I can cover a lot of doctor visits for $16K+/year. if I spend less than that a year, I will add it to next year’s $16K+. I know people will think this is incredibly stupid, but honestly, even if there is a catastrophic event in our family, a hospital will not demand $1B immediately. Instead, they will work out a payment plan. One hiccup so far: my wife was diagnosed with arthritis. Our family doctor tried to refer her to a specialist, but there wasn’t one in our area who would take self-pay patients. I guess that means more money in our pockets. 
(We will keep looking.) I was surprised to hear that doctors prefer to battle it out with an insurance company rather than collect payment before exiting the clinic. Once we get older, I can always put my family back on my employer’s plan during open enrollment, but for now, I will keep rolling the dice.
1 Like
My wife had like $1,500,000 in cancer bills in 2022. $600,00 in 2023. No amount of self insuring and saving could have prepared us for that. She was healthy and active until she wasn’t. A catastrophic automobile crash can do the same.
My martial arts teacher’s wife passed in her 40s from pancreatic cancer. Left five small kids. No warnings. Sick, struggled for a year, dead. But she was supposed to be dead in 90 days. At least she had time to say goodbye.
Going without insurance is a terrible idea.
2 Likes
I definitely get it. Our first child birth cost over $50K for a normal, healthy, vaginal birth with no epidural (hospitals make up fake numbers on bills that they don’t expect any insurance company or person to ever pay. It cost $8K when all was said and done.) If something catastrophic happens we will just figure out how to deal with it. Like I said, we can negotiate a deal with the hospitals if it comes to that.
“I’ll bet your insurance company paid less than half that amount.”
Most likely they pay much less than half. I went to the heart clinic last year. They took an EKG and charged me a little over $1000. Insurance slashed it to $74.00, which is the amount I paid and the amount the clinic accepted as payment in full. Insurance didn’t pay a dime, they just took the clinic’s procedural codes and the applied their negotiated rate for each code. (My insurance company is even known as a generous insurance company that every doctor in my area happily takes.) I figured I could look up the reasonable cost for the codes in my area and negotiate the bill down that way.
I can 100% answer that question. My wife and Sensei’s wife were both at MD Anderson Cancer Center Houston. MD Anderson won’t serve you until they get insurance pre-authorization. We have seen people get turned away in the line in clinic because they had some insurance problem. They don’t do the incur the bill / haggle over it later thing.
They do have a program for cash customers where I would imagine the cash customers pay some kind of preferred rate, maybe the same as insurance companies or Medicare after all of the network discounts and all, but 50% off of $2,000,000 is still $1,000,000.
They don’t take ACA plans either. I think these elite, top-shelf places where you get the best chance at living do this… MD Anderson, Cedars Sinai, Memorial Sloan Kettering, etc.
The consensus of people we know with her particular disease is that MDA / MSK etc are head-shoulders above the rest in a field where a tight linkage between the clinic and R&D is required for the best outcome. There has been lots of research showing who you see first if you have Multiple Myeloma dictates how you do.
Her oncologist has decades of clinical and research experience in MM. A regular doctor might see a few MM cases in a career. How can the decisions and outcomes possibly be the same? We read in the press about “coming breakthroughs in MM treatment” then we realize, oh, her doctor has already been doing exactly that all along. MDA gets lots of referrals from doctors who are out of their league and know they are outgunned by the disease. But waiting 6 months, a year with this disease growing unchecked can be a death sentence. It’s better to start with the best team.
But sure… you can get treated for blood cancers at the County hospital “for free” under the indigent care programs. Until you get refractory relapsed disease and have to go to MDA anyway, or decide to accept the end-stage disease without a fight.
I guess make sure you choose not to get highly complex diseases or injuries, they’re you’re OK without insurance?
I’m not sure my insurance would pay for me to go to MD Anderson. If not, then I’m back to the uninsured problem if that’s what I need.
The other choices here in town are Houston Methodist, Memorial Hermann, and HCA (“the killing hospital”). I have no idea what their policies are. Maybe the same, maybe different from MDA. Who knows.
Your scenario is exactly why I started this thread in the first place. Why is there so few, if any, catastrophic options? I know there are diseases that are a nightmare to treat and cost a fortune. I would love to purchase a policy that just covered that kind of thing and let me fend for myself with the year-in-year out medical, dental, and vision expenses. But there wasn’t any catastrophic policies like that in my area. My option is to pay tens of thousands annually on insurance premiums, high deductibles, medicare taxes, co-pays and prescriptions every year of my working life. They get to pick what they will cover and who you will see. Also don’t get sick near the end of the year otherwise your deductible and max out of pocket will re-set and you’ll have to keep paying the following year. And if you don’t get a plan, someday you might get a rare and horribly expensive disease that will ruin you financially (sometimes it still does, even with health coverage). It’s just such a stupid and corrupt system in my opinion.
2 Likes