Likelihood of large medical expense

[camfused]

Hi. DW is thinking of retiring around the end of the year or so. We are on her health plan right now. Plan A is to go with ACA, and plan B to go with a faith-based plan (maybe Liberty). For Liberty, DW is worried about the $1M max coverage per indecent. This is all for 3.5 years, until 65 and Medicare.

My question is how likely do you think this would happen? Sure, I know if you are really sick you could run up a pretty good size bill, but would it be over $1M? We are both in pretty good shape at the moment.

Thanks

 

[REWahoo]

I don't think how likely is the issue, I think what's important is the fact that it is possible. Unless you absolutely can't afford the ACA premiums, why take the chance?

 

[MRG]

I've known a few people who would have blown through a million easy. I wouldn't consider any non-insurance options. That's a 1 up, 10 down kind of choice.

 

[EastWest Gal]

Hi. DW is thinking of retiring around the end of the year or so. We are on her health plan right now. Plan A is to go with ACA, and plan B to go with a faith-based plan (maybe Liberty). For Liberty, DW is worried about the $1M max coverage per indecent. This is all for 3.5 years, until 65 and Medicare.



My question is how likely do you think this would happen? Sure, I know if you are really sick you could run up a pretty good size bill, but would it be over $1M? We are both in pretty good shape at the moment.



Thanks

And if you get COVID-19 and end up in an ICU for a couple of months? Go with ACA related plans, IMO. If your income is less than the 4x poverty limit, it is not expensive with the subsidy.

 

[camfused]

Yeah we totally plan on ACA. She is just concerned about ACA going away (I am not) and refuses to retire unless I can get her over that. Having a plan B is one of my attempts to do that, but this $1M issue has to be thought through.

 

[Sarah S]

Before ACA work plans had a max lifetime benefit. At least every one I ever had did. I think it was 1 million. Maybe a little more at the end. Were things to revert to pre ACA rules I bet they would come back. I was never told about the max but I always read the entire plan document and it was always there.

 

[njhowie]

Hi. DW is thinking of retiring around the end of the year or so. We are on her health plan right now. Plan A is to go with ACA, and plan B to go with a faith-based plan (maybe Liberty). For Liberty, DW is worried about the $1M max coverage per indecent. This is all for 3.5 years, until 65 and Medicare.

My question is how likely do you think this would happen? Sure, I know if you are really sick you could run up a pretty good size bill, but would it be over $1M? We are both in pretty good shape at the moment.

Thanks

Stay away from faith-based. There are no guarantees they will pay.

They are not "health insurance". Go review the financials for the plan - they are all required to file and make publicly available. Most all are extremely thinly financed and operate close to insolvency.

Most folks really do not understand these plans or what they are paying for - they primarily only focus on the monthly premiums, and that's a big mistake.

 

[ivinsfan]

Yeah we totally plan on ACA. She is just concerned about ACA going away (I am not) and refuses to retire unless I can get her over that. Having a plan B is one of my attempts to do that, but this $1M issue has to be thought through.

Does she really want to retire, this all sounds like the what ifs, as in no matter what answers you give her she will say "What if".....

The chance of ACA disappearing in the next 4 years is somewhere between slim and none. Now if you were talking 20 years that another story but 4 that's a no brainer.

To actually answer your question about the million dollars, it's a million dollars of at least a 30-40 off of rack medical rate so it would go farther then you might think. I don't endorse this plan, I do know some people who use it.

 

[pacergal]

One MVA that could involve multiple surgeries, ICU, rehab could be well over a million; and not unusual.
Some folks are happy with faith based coverage, I had a family member who had it and was not as satisfied with it after the fact, as most things were denied.
I would prefer regular insurance.

 

[camfused]

Yeah, she is on the fence (but this is quite a normal place to be for her). Its my job, frequently, to help her down from the fence. She is apprehensive about health care insurance, what to do with her time, etc. I am not forcing her, but helping her analyze one hill at a time.

I have been telling her that her ACA concerns are not necessary, and that it (or equivalent) is quite likely to be around. But, she does not trust my opinion. I think after the elections this fall, she might start considering my opinions.

Thanks all for the input.

 

[RetiredAt55.5]

Hi. DW is thinking of retiring around the end of the year or so. We are on her health plan right now. Plan A is to go with ACA, and plan B to go with a faith-based plan (maybe Liberty). For Liberty, DW is worried about the $1M max coverage per indecent. This is all for 3.5 years, until 65 and Medicare.

My question is how likely do you think this would happen? Sure, I know if you are really sick you could run up a pretty good size bill, but would it be over $1M? We are both in pretty good shape at the moment.

Thanks

Well, you never know. My 63 year old brother has been in the hospital for 6 weeks and counting, at least half in the ICU. He had to have brain surgery for a tumor, after he had a stroke at home. 3 weeks of radiation and chemo, multiple CAT scans, etc. He might never regain much movement in his left leg and arm, so he's going to need lots of therapy that'll go on for months. He can't be released for home in his present condition, so after the hospital he'll have to go to a live in therapy center.

Before this, he had never been in a hospital. This is a worse case scenario, but it happens and it sucks. I can't imagine what the total bill will be, but it wouldn't surprise me to be well over $1M.

He does have good retiree insurance.

 

[nhcycling]

Stay away from faith-based. There are no guarantees they will pay.

They are not "health insurance". Go review the financials for the plan - they are all required to file and make publicly available. Most all are extremely thinly financed and operate close to insolvency.

Most folks really do not understand these plans or what they are paying for - they primarily only focus on the monthly premiums, and that's a big mistake.

+1

 

[Aerides]

More than 20 years ago I developed gall stones, went for a routine gall bladder removal - an outpatient surgery, a few grand in costs. A single "slip" by the surgeon left me in hospital for 7 weeks with numerous other procedures, surgeries, etc, and a bill close to a half mill. In today's dollars it would likely exceed 1M.

One of the greatest "un-sung" benefits of the ACA law is the removal of limits on lifetime caps. I would never gamble with coverage limits to save a few bucks.

 

[ExFlyBoy5]

I would always urge caution when it comes to medical expenses. My wife, who is barely in her 40s recently had spinal surgery as well as proton therapy. It was for a recurrent tumor that "only recurs in less than 5% of cases" and this was the THIRD surgery. She spent 6 days in ICU after the surgery. At last tally, the total billed amount was edging very close to $500,000 and there are still claims coming in. The proton treatment alone was billed at almost $200,000 (and insurance paid $120,000).

So, I would tread very carefully in taking a health/insurance gamble.

 

[aja8888]

I would always urge caution when it comes to medical expenses. My wife, who is barely in her 40s recently had spinal surgery as well as proton therapy. It was for a recurrent tumor that "only recurs in less than 5% of cases" and this was the THIRD surgery. She spent 6 days in ICU after the surgery. At last tally, the total billed amount was edging very close to $500,000 and there are still claims coming in. The proton treatment alone was billed at almost $200,000 (and insurance paid $120,000).

So, I would tread very carefully in taking a health/insurance gamble.

Exactly! You should see the bill from my BIL's heart transplant....and the ongoing visits to the "replacement team" doctors, anti-rejection and other drugs, yearly invasive testing, etc....millions $$.

 

[ExFlyBoy5]

Exactly! You should see the bill from my BIL's heart transplant....and the ongoing visits to the "replacement team" doctors, anti-rejection and other drugs, yearly invasive testing, etc....millions $$.

Yep, I can only imagine. Also, I am *very* apprehensive about the faith-based plans. Since this isn't insurance, I can only guess there is so much that they can deny and there isn't much recourse for the consumer.

Proton therapy is a good example. In my state, it was difficult to have insurance cover it for some people due to doubts on it's effectiveness. Eventually, the law was changed to REQUIRE insurance companies to cover this the same as traditional radiation.

I haven't reviewed the law closely (or related case law since the law was passed) but I don't think the faith based programs are subject to this requirement. And never mind that my DW's surgery was done almost 1,000 miles away from home since no one here in town would touch her with a 10 foot pole. Not sure how tough it would be to get a faith based program to allow coverage that far from home...do they even have a network? Way too many variables for me.

 

[ivinsfan]

Yep, I can only imagine. Also, I am *very* apprehensive about the faith-based plans. Since this isn't insurance, I can only guess there is so much that they can deny and there isn't much recourse for the consumer.

Proton therapy is a good example. In my state, it was difficult to have insurance cover it for some people due to doubts on it's effectiveness. Eventually, the law was changed to REQUIRE insurance companies to cover this the same as traditional radiation.

I haven't reviewed the law closely (or related case law since the law was passed) but I don't think the faith based programs are subject to this requirement. And never mind that my DW's surgery was done almost 1,000 miles away from home since no one here in town would touch her with a 10 foot pole. Not sure how tough it would be to get a faith based program to allow coverage that far from home...do they even have a network? Way too many variables for me.

It would not work for anyway due to pre existing conditions riders ...

 

[Dtail]

Go with the ACA plan. Any major cancers/heart issues which could take her over 1m would end up not being covered by these faith based plans.

 

[Scratchy]

OP, why would you consider a faith based plan? What do you see as the advantages? You state that your wife is concerned the ACA plans may go away, but that does not seem to be a reason to choose the faith based plan now.

 

[ivinsfan]

OP, why would you consider a faith based plan? What do you see as the advantages? You state that your wife is concerned the ACA plans may go away, but that does not seem to be a reason to choose the faith based plan now.

That's why the OP said it might be his Plan B...

 

[Peter]

My late wife's cancer treatment came to over $1MM. And that was in 1997.

 

[harllee]

Before ACA DH had a very hard time finding any kind of health insurance due to a preexisting condition. He had to go on the state high risk plan, it was the only one that would take him. It had a lifetime cap of $1 million and we were constantly afraid that he would hit the cap someday, DH lost sleep over it. We felt like insurance with a 1 million cap was not real insurance. We were so glad when the ACA came along and DH was able to get real insurance. I would never take a policy with a $1 million cap if there were any alternative.

 

[camfused]

Ok, y'all have some good arguments against faith based plans. So, what should a plan B be, if for some reason ACA goes away? I think I might be able to get on with ACM (Association of Computing Machinery, an industry association that has health care plans), if needed (but probably expensive).

I always try to have a plan B.

Edit: Never mind, i'll just follow the other ACA thread on that thought.

Edit edit: Wait, that thread was closed.

 

[ivinsfan]

Ok, y'all have some good arguments against faith based plans. So, what should a plan B be, if for some reason ACA goes away? I think I might be able to get on with ACM (Association of Computing Machinery, an industry association that has health care plans), if needed (but probably expensive).

I always try to have a plan B.

Edit: Never mind, i'll just follow the other ACA thread on that thought.

Edit edit: Wait, that thread was closed.

Well you need to be able to think on your feet and stay informed. If ACA goes away you won't be the only person looking for insurance. if you have some money and stay informed that's half the battle.

A professional association such as you mentioned could be option. Or going back to work ...

Despite the trashing here of faith based plans if the choice is no ACA (or nothing) or a faith based plan, it seems easy. Only in the event there is no ACA...

 

[MRG]

More than 20 years ago I developed gall stones, went for a routine gall bladder removal - an outpatient surgery, a few grand in costs. A single "slip" by the surgeon left me in hospital for 7 weeks with numerous other procedures, surgeries, etc, and a bill close to a half mill. In today's dollars it would likely exceed 1M.

One of the greatest "un-sung" benefits of the ACA law is the removal of limits on lifetime caps. I would never gamble with coverage limits to save a few bucks.

Wow. Glad you are ok, now.

A former co-worker/mentor had a similar experience and spent 6 months in the hospital. After fifteen years he passed from the opioid addiction he picked up in the hospital.