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Old 10-14-2016, 10:49 AM   #21
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Is moving to a lower health insurance cost area an option for you?
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Old 10-14-2016, 11:08 AM   #22
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I had led a rather healthy life until the middle of 2015 when I became sick and needed 12 days in the hospital to take care of not one but two significant problems. The unadjusted hospital bill was $63k and that didn't include all the doctor visits while I was in the hospital and shortly after. But simply having insurance, even a so-so ACA Silver plan limited my costs to the ~$6,400 max OOP amount.


I changed plans for 2016 so all I am on the hook for are the $50 copays for the doctor visits and zero for the drugs. I had another small ailment a few months ago which cost me only about $700 thanks to the greatly reduced negotiated charges. I don't worry about the small stuff like that, but I surely want protection for the "Big One" like what happened to me last year, or else my ER would be in danger. The ACA subsidy keeps my premiums down a little (not a lot; I am near the MAGI max).
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Old 10-14-2016, 11:19 AM   #23
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For 2017, I am not going to log in to healthcare.gov, select the lowest-cost bronze plan, and sign up. Instead, I'm going to carefully consider all of the options before purchasing an on-exchange or off-exchange plan, including various forms of partial and total self-insurance. This will be unpleasantly time-consuming, but as a skinflint I've been known to exhaustively investigate options for purchases much less costly than modern health insurance.
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Old 10-14-2016, 11:32 AM   #24
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The biggest reason that people declare bankruptcy is health costs. Insurance companies get discounts by volume bargaining. Unless you are so rich that you can self insure, I don't recommend dropping insurance.
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Old 10-14-2016, 12:28 PM   #25
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The biggest reason that people declare bankruptcy is health costs.
Exactly. No way would I consider going without it, especially after seeing the bills for my cardiac issues the last couple of years.
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Old 10-14-2016, 01:02 PM   #26
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I wouldn't risk not having insurance. This year we've had two relatively common issues, below are the billed amounts and what insurance did for us. (FYI - Our insurance is through my old company.) I can't imagine the bills without insurance for some of the really terrible things that happen to folks (cancer, bad car wrecks, etc..)


Kidney Stone Attack - 6 hrs in ER with pain meds and tests run + 1 followup doctor visit
$15,700 - billed
$ 9,650 - total negotiated price (61% of billed amount)
$ 2,250 - we paid out of our pocket

Gall Stone Attack and Gall Bladder Removal - Emergency Room visit with pain meds, misc tests + f/u visits to doctors and eventual surgery to remove
$54,390 - billed amount
$15,730 - total negotiated price (29% of billed amount)
$ 2,690 - we paid out of our pocket
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Old 10-14-2016, 01:46 PM   #27
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It really is a risk vs reward decision.... and with the costs you are talking about it MIGHT be worth it...

I will give an example... at the gym a younger lady (late 30s early 40s) was out... class instructor said she got pancreatitis and was in the hospital for 3 days... while talking to another lady she said that neither the lady who got sick or the lady talking to me had insurance... they could not afford it... (now, I did talk about tax credits etc. but the lady talking said she could not even afford $200 a month!!!)....

Now, the sick lady has a $26K bill... someone else said they had just finished paying of a bill for their son last year...


So, one lady has paid out big time for no insurance and one not at all...

Also, think about how much you are saving... $12K a year with no problems can add up quickly... if you have a major incident every 5 years that is $60K you have saved... plus, you still would have to pay out of pocket....


It might be an option to go outside and buy a very large deductible plan that does not cost near as much... sure, you take the risk but it probably would save you money in the long run....
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Old 10-14-2016, 04:04 PM   #28
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For 2017, I am not going to log in to healthcare.gov, select the lowest-cost bronze plan, and sign up. Instead, I'm going to carefully consider all of the options before purchasing an on-exchange or off-exchange plan, including various forms of partial and total self-insurance. This will be unpleasantly time-consuming, but as a skinflint I've been known to exhaustively investigate options for purchases much less costly than modern health insurance.
Assuming that as part of this you will be doing a legal analysis of your assets and income streams to identify which ones are fair game for creditors (ie hospitals) and which are not...

-gauss
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Old 10-14-2016, 04:34 PM   #29
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We live in AZ and at this point, don't even know for sure if there will be one insurer in healthcare.gov. And if there is, I expect our premiums to double or triple. Could be paying $25k/year (for two of us) for a HDHP. We are healthy and don't see doctors much. I thought of self insuring, moving to another state, or going back to work as options. Of the three options, we expect that one of us will try to go back to work, just for group HI. It stinks, if that is what we have to do, but it's not just 2017 I'm concerned about. I have 5 more years to Medicare and my DW has 7.

I might have one more option and that is to try to lower our MAGI to under the cap to get the subsidy.
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Old 10-14-2016, 04:34 PM   #30
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We are both pretty healthy. It seems like there's a 98% chance that we'd be better off not getting insurance. The problem is that 2% chance that we get sick which could be a killer. Of course, we could re-enroll in 2018 if needed.

Would anyone roll the dice and not get health insurance under these circumstances?
Generally people buy insurance to eliminate worst case outcomes (even if unlikely) for which they can't take the hit. When the worst case outcome is not material, then it can make sense to skip insurance as it generally has negative expected return.

I'm comfortable going without comprehensive on my car because my net worth is such that I could buy a new car without any problem.

I'm not comfortable going without health insurance because a bad year (not even worst case) might result in several hundred k in medical bills. If my net worth was much higher (maybe $10-20M) then maybe health insurance would be inconsequential.

Also, how many years were you planning on going without insurance? A 2% risk for one year is not too bad a gamble (lets assume 2%/year is accurate). But if you repeat this several years in a row, you greatly increase the probability that you'll hit a bad outcome. E.g. for ten years you'll be at 20% probability of a bad outcome.
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Old 10-14-2016, 06:45 PM   #31
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There is no way we would take the risk to not have health insurance. DH and I are very active and healthy for our age. We do not take any medication and exercise weekly and eat healthy.

We have had a high deductible health plan for over 10 years and even when our deductible was 2,500 per person we never met the deductible. Even with our health history we would never take the gamble.

You are in good health until you are not.

A family member who exercised, did not smoke or drink and was not overweight had a heart attack called the widow maker at age 50. Heart disease does not run in the family. This heart attack came out of left field. He survived but his hospital bill was over $80,000 which did not include dr. visits or prescription drugs. When his co workers heard about it they were concerned because he was the last person they would expect to have a heart attack at such a young age.

Cancer also strikes many people at all ages regardless if they are healthy. Imagine being diagnosed with cancer and you are waiting 4-5 months for the next open enrollment before you proceed with the necessary surgery or chemo treatment.

We are also in a financial predicament for 2017 because Blue Cross is pulling out of major cities in Tennessee and premiums are predicted to increase 50%. We will be covered because our city was not part of the BCBS exodus but 2018 is another story. The ACA is slowly imploding. We are actually thinking about moving to another state that is more stable until we are Medicare eligible.
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Old 10-14-2016, 06:46 PM   #32
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We live in AZ and at this point, don't even know for sure if there will be one insurer in healthcare.gov. And if there is, I expect our premiums to double or triple. Could be paying $25k/year (for two of us) for a HDHP. We are healthy and don't see doctors much. I thought of self insuring, moving to another state, or going back to work as options. Of the three options, we expect that one of us will try to go back to work, just for group HI. It stinks, if that is what we have to do, but it's not just 2017 I'm concerned about. I have 5 more years to Medicare and my DW has 7.

I might have one more option and that is to try to lower our MAGI to under the cap to get the subsidy.
Update: I just received an email from our state insurance commissioner with rates for 2017. It looks like the rate increase we will be paying is 128% for a HDHP, more than double. We'll pay $1,555 per month from $682 this year. If I understand the subsidy calculations correctly, we will try to qualify for the subsidy. If not, it's back to work we go.
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Old 10-14-2016, 06:58 PM   #33
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Outrageous Packman!

I hope you can get your MAGI down so you will be eligible for subsidies.

We are currently paying 1300/monthly and with the 2017 increase it would not surprise me if our premium will be close to 2000/monthly. No subsides at this point but next year we will move money around to reduce the MAGI. Maybe take money out of savings accounts if necessary.
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Old 10-14-2016, 07:05 PM   #34
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Update: I just received an email from our state insurance commissioner with rates for 2017. It looks like the rate increase we will be paying is 128% for a HDHP, more than double. We'll pay $1,555 per month from $682 this year. If I understand the subsidy calculations correctly, we will try to qualify for the subsidy. If not, it's back to work we go.
That is outrageous...... I would move before I would go back to w*rk!

Will the new premium be more than 8.13% of your income? If so, what is the pricing of catastrophic coverage for people your age in your state?
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Old 10-14-2016, 08:39 PM   #35
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Update: I just received an email from our state insurance commissioner with rates for 2017. It looks like the rate increase we will be paying is 128% for a HDHP, more than double. We'll pay $1,555 per month from $682 this year. If I understand the subsidy calculations correctly, we will try to qualify for the subsidy. If not, it's back to work we go.
DW and I are on our OMY still. The ACA bronze HSA plan premium that I looked at 2 years ago, has now increased more than 30%. We are in Los Angeles. Within my zip code, there are 38 plans to choose from (actually more than 2 years ago), except all have increased pricing.

My retirement income would be mainly Roth conversion. In order for me to get subsidy now, I will have to cut back on large amount of Roth conversion. That means that I definitely will pay more taxes after RMD begins. I will need to work on the math of getting subsidy, as opposed to paying taxes.
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Old 10-14-2016, 08:52 PM   #36
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I agree with a previous poster that if you plan to risk having no health insurance, research your state medical bankruptcy laws and have as much of your assets in protected areas as possible. I know a couple who decided to retire in their late 50's and forego health insurance. She had an emergency appendectomy at age 60 that resulted in blood clots and a bad stroke. They declared bankruptcy but lost some savings because it was distributed between several IRAs and investment accounts. Sold their motor home and extra vehicles to family members. He is a lawyer so is able to navigate the system better than most of us.

I don't know if their lack of health insurance impacted the quality of her healthcare but they could not afford the expensive rehab that she needed to regain some independence. She then went on Medicaid so they could afford a temporary nursing home but Medicaid paid very little for rehab.
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Old 10-14-2016, 09:36 PM   #37
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Nope! You also gain access to the discounted "in-network" provider rates via the insurer--especially if you use the large dominant player in your area.

Without insurance there are no limits on what the providers can charge you.

I look at the premiums as half "insurance" and half "group purchasing".

-gauss
+ 1. I recently ended up in the emergency room , got some tests , discharged in about 10 hours , not admitted to the hospital. The billing were close to $14,000. The insurance co ( BC, PPO ) paid about $2800 , I paid about $400.

No way to pre negotiate a cash price after the fact. I would have been stuck with the " List Price bill if un-insured.

Sure , you can shop for medical services on a non urgent basis, and get a price close to the so called " Negotiated rates".
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Old 10-14-2016, 09:51 PM   #38
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Would anyone roll the dice and not get health insurance under these circumstances?

No. No no no no no.

I was in a bike crash several years ago, and the bill for my treatment and rehab amounted to over $250K. I had insurance at the time and I only paid about $8K out of pocket.

If I had to go without health insurance, I'd stay home wrapped in bubble wrap.
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Old 10-14-2016, 11:24 PM   #39
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Wouldn't even think about it. Woke up this spring with a special kind of pain. The kind no male could ever ignore. Few hours in the ER was 20k after the insurance companies discount.

All that money for a few tests and bottle of pills, and a diagnosis of "don't know".
Hope it's better, I really hate stepping on it as well
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Old 10-15-2016, 02:17 AM   #40
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Never. I could get cancer or some other serious illness that would cost beyond any reasonable means of cost to treat.

And, it isn't just that. Having insurance can protect you against balance billing if you go to an in network hospital and you get the benefit of discounts. A couple of years ago, my daughter had to go to the ER due to abdominal pain (we started with urgent care who sent us to the ER). It turned out to be the flu. Anyway, the amount that would have been charged was something like $18000! Now, this was an in network hospital and after discounts it was only a few thousand dollars. But, if there had been no insurance the bill would have been huge.
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