OT: Health Insurance

[skip dog]

I'm asking b/c I just can not justify what I am paying for a product I basically do not use, and I fully believe that good insurance protects me and mine and allows me to sleep good at night......this is a product that is simply out of my knowledge base

I am Self employed and over 50, and wondering what other options I have out there to be considering.

When I look at what I have spent in coverage over the last 10 years, versus what I could have just paid cash for, we are talking a 99% savings by paying cash. The good lord has blessed me with good health and I hope I continue to have that blessing, but this expense has become vulgar

Thank you in advance for any insight anyone can provide

 

[DawgNsuds]

I'm asking b/c I just can not justify what I am paying for a product I basically do not use, and I fully believe that good insurance protects me and mine and allows me to sleep good at night......this is a product that is simply out of my knowledge base

I am Self employed and over 50, and wondering what other options I have out there to be considering.

When I look at what I have spent in coverage over the last 10 years, versus what I could have just paid cash for, we are talking a 99% savings by paying cash. The good lord has blessed me with good health and I hope I continue to have that blessing, but this expense has become vulgar

Thank you in advance for any insight anyone can provide

not able to answer your question, but this is an issue that needs to be rectified in our society. I will avoid any politics because both parities are equally complicit. Hoping you find someone on here that can assist

 

[OopsICroomedmypants]

The health industry is ruined. I'm in your same boat. Sounds like you had an ACA Marketplace plan. This crap pushed away private insurers by giving it away for "free". Once everyone was on the hook, the government started following the actual rules, then they raised the rates because it's not sustainable. You don't have a lot of options that I know of. However, make sure you have a life insurance policy that pays out some if you are temporarily disabled. These are usually fully underwritten and require bloodwork. You can also get a hospital indemnity plan that pays you back if you go into a hospital. There are cancer policies that will pay you a lump sum on diagnosis. There's just about anything you can imagine, except I can't find a good old fashioned plan that pays for me to go to the doctor that doesn't cost more than a mortgage.

 

[ababyatemydingo]

Start an HSA and put that money you were paying for your premium into it. Negotiate a cash payment with providers. It'll be way less than they were charging the insurance companies. And hope your health holds steady until 65 and you can get on Medicare. There are also doctors that now charge a monthly or yearly fee and they pretty much treat everything. Internal Medicine docs. Dr Hugh Muse in the Jackson area is one. My Urologist told me about him when I asked him if he knew of a good internal medicine doc.

 

[Podgy]

We do have a national healthcare program, Medicare, but you have to be a certain age to qualify. The government could change that and allow more Americans to qualify for Medicare but leaders don't seem to want that to happen. The prices we pay for some medical treatments are absurd. Because of the hyper-partisanship in America, look for Americans to blame the other team to explain why the system doesn't work well for many Americans. Negotiating a cash price with healthcare providers is a possibility as are high deductible policies. There are so many non-doctors, nurses etc making enormous sums off of the system we currently have.

 

[OopsICroomedmypants]

Start an HSA and put that money you were paying for your premium into it. Negotiate a cash payment with providers. It'll be way less than they were charging the insurance companies. And hope your health holds steady until 65 and you can get on Medicare. There are also doctors that now charge a monthly or yearly fee and they pretty much treat everything. Internal Medicine docs. Dr Hugh Muse in the Jackson area is one. My Urologist told me about him when I asked him if he knew of a good internal medicine doc.

I forgot to mention that. Good advice. There are more and more concierge doctors and an HSA is a good idea.

 

[dorndawg]

I don't have any good input other than to say I agree with others that it's a real mess & I feel for people dealing with it. There's a lot of decent, hard-working folks with a wide range of incomes who are in a bind - either essentially taking on debt to subsidize having some level of coverage, or forgoing coverage and needed care altogether. It sucks.

 

[ZombieKissinger]

You need to make sure you’re covered for catastrophic events/hospitalization. Providers generally have high chargemaster rates (like 225% of Medicare fee schedule) that you’d have to negotiate down, enter payment plan, etc. which can be hard based on certain incomes. You can piece stuff together as others are discussing here, but making sure you’re not on the hook for a $50k hospital bill is essential

edit: I also strongly recommend HSA as a savings vehicle. I max it every year and don’t reimburse any of it. I save all my receipts, amounts, provider, DOS. You have to keep $2k uninvested but you can invest the rest and reimburse it whenever you need to and/or have a giant fund for when you’re older and will need it

 

[patdog]

Man I priced some Obamacare policies a month or two ago & its pretty outrageous. I will need coverage for about 16 months after I retire before I start Medicare. Fortunately I’ve got an investment that should sell in January, generating 3 times as much cash as capital gain. So I’ll live off that for the most part & keep my taxable income low enough to qualify for the subsidies.

whatever you do at a minimum get a high deductible catastrophic policy. Cancer or a heart attack could bankrupt you. And stay away from those religious based “cost sharing” plans. They’re cheap but they’re not insurance. They’re mot regulated, have no financial strength requirements & can deny claims for questionable reasons (or just not be able to pay) & you have no recourse.

 

[skip dog]

@DawgNsuds , agreed, not a dem/rep issue at all. just a issue that needs to be addressed to the benefit of all

@OopsICroomedmypants , yes, the healthcare industry has just about been ruined, and I simply can not morally & ethically buy into something that is subsidized by the government. It's not working

@ababyatemydingo , so the "insurance" I have, basically has no in network physicians in my area that I would see, so I essentially am always negotiating a cash payment and then submitting receipts to get some credit toward deductible. I have not really looked into "HSA" but will.

and just to add......have life insurance in place, and do have a healthy amount of savings for a bad event, but, still have enough sense to know health insurance in some form is needed

 

[L4Dawg]

I'm asking b/c I just can not justify what I am paying for a product I basically do not use, and I fully believe that good insurance protects me and mine and allows me to sleep good at night......this is a product that is simply out of my knowledge base

I am Self employed and over 50, and wondering what other options I have out there to be considering.

When I look at what I have spent in coverage over the last 10 years, versus what I could have just paid cash for, we are talking a 99% savings by paying cash. The good lord has blessed me with good health and I hope I continue to have that blessing, but this expense has become vulgar

Thank you in advance for any insight anyone can provide

I'm in my early 60s and I'm in the same boat. I never used it much at all, till this past year. Things can, and did, change out of the blue. It is a terrible risk to go without it.

 

[skip dog]

Man I priced some Obamacare policies a month or two ago & its pretty outrageous. I will need coverage for about 16 months after I retire before I start Medicare. Fortunately I’ve got an investment that should sell in January, generating 3 times as much cash as capital gain. So I’ll live off that for the most part & keep my taxable income low enough to qualify for the subsidies.

whatever you do at a minimum get a high deductible catastrophic policy. Cancer or a heart attack could bankrupt you. And stay away from those religious based “cost sharing” plans. They’re cheap but they’re not insurance. They’re mot regulated, have no financial strength requirements & can deny claims for questionable reasons (or just not be able to pay) & you have no recourse.

yes.....over the years I have priced obamacare / ace policies, and it just does not work, and I have done medical sharing, and again, I payed a monthly amount only to always end up negotiating cash payments to see the doctor I want to see!.

I've just reached a point in life where when I have spent 10-15 of my past years paying these "premiums" and receive nothing, and find it as a service I do not use, and the few times I do (covid, flu, poison ivy, general blood work to check health numbers), I'm still paying for it myself.

 

[DawgNsuds]

Man I priced some Obamacare policies a month or two ago & its pretty outrageous. I will need coverage for about 16 months after I retire before I start Medicare. Fortunately I’ve got an investment that should sell in January, generating 3 times as much cash as capital gain. So I’ll live off that for the most part & keep my taxable income low enough to qualify for the subsidies.

off topic, but hope it's a long term gain and you don't get taxed at short term rates, but I digress. Better yet if it was a transaction in some kind of retirement account

 

[Podgy]

You can also try to renegotiate a large bill with a hospital. Also, depending on the state you're in, you can let an especially large medical bill go to collections without any serious consequences. Make sure your medical debt can't be reported to credit bureaus. That's not the case in many states including MS. Then you can negotiate a lower price. That might seem unethical but then it's our healthcare industry. I want actual healthcare providers to be compensated but the way the system currently operates, lots of people who aren't actually interested in my health or well-being are cashing in. That's the nature of the system we live with. Except for co-pays, consumers don't even know what procedures and other services actually cost. That's just a bizarre system in a market-based economy.

 

[Hugh's Burner Phone]

I'm in my early 50's and have to have insurance. I looked at ACA plans just to see what they cost compared to my employer provided insurance and needed to change underwear. 8X the cost for less coverage. Fortunately, my employer has a program where, once you turn 55, if you have been with the company for 15 years, you can retire and stay on he company insurance for a set monthly premium. More expensive than what I'm paying now, but better than the ACA policies and much better coverage.

 

[BioChemDawg]

I’d caution against using data from your 30-40s to make decisions about your 50s/60s regarding your utilization of insurance. Like others have said, you gotta be covered for the financially catastrophic health events.

 

[GloryDawg]

You really don't have a problem. Sounds like you can afford insurance but don't want to pay it because you don't use it. If I was in your place, I would get a really high-deductible health plan, set up an HSA, purchases an Accident plan and a cancer plan. A radicle idea would be just for go any plan. Have enough money set aside if you get a serious illness. Then when open enrollment comes around buy a plan.

 

[NWADawg]

Start an HSA and put that money you were paying for your premium into it. Negotiate a cash payment with providers. It'll be way less than they were charging the insurance companies. And hope your health holds steady until 65 and you can get on Medicare. There are also doctors that now charge a monthly or yearly fee and they pretty much treat everything. Internal Medicine docs. Dr Hugh Muse in the Jackson area is one. My Urologist told me about him when I asked him if he knew of a good internal medicine doc.

The issue is that there are cash prices and insurance prices.
A relative of mine chooses not to have insurance. Husband is a lawyer and does very well.
Their daughter broker her arm. Go to emergency room , get cast. ... The hospital asked her if she has insurance- answer no. Are you employed- answer no. Result was a bill of $400. An insurance claim would have been more like $10k with $1000 out of pocket.
Why?

 

[BoDawg.sixpack]

This is another reason why, while you're young and healthy, it's important to build a passive income portfolio separate from your retirement account that is paying you monthly and quarterly.

 

[johnson86-1]

The issue is that there are cash prices and insurance prices.
A relative of mine chooses not to have insurance. Husband is a lawyer and does very well.
Their daughter broker her arm. Go to emergency room , get cast. ... The hospital asked her if she has insurance- answer no. Are you employed- answer no. Result was a bill of $400. An insurance claim would have been more like $10k with $1000 out of pocket.
Why?

It's a heavily regulated industry subject to baumol's cost disease (in part because of all the regulation and liability risk, but largely just because of the nature of the beast). It's going to have some 17ed up characteristics. The only way to avoid it is to allow something like a free market, which politically we are not willing to do. The other option is Medicaid for all, which people mostly won't like but would be fine after a painful adjustment period. I think uou'd see a lot of cash options pop up where people just paid cash, with middle class people paying cash for non surgical healthcare and more affluent people paying fore and/or insuring for more and more treatment the further up the income ladder you go.

 

[patdog]

off topic, but hope it's a long term gain and you don't get taxed at short term rates, but I digress. Better yet if it was a transaction in some kind of retirement account

Long term gain. Should be taxed at a 0% tax rate with me keeping my taxable income down next year.

 

[DoggieDaddy13]

The issue is that there are cash prices and insurance prices.
A relative of mine chooses not to have insurance. Husband is a lawyer and does very well.
Their daughter broker her arm. Go to emergency room , get cast. ... The hospital asked her if she has insurance- answer no. Are you employed- answer no. Result was a bill of $400. An insurance claim would have been more like $10k with $1000 out of pocket.
Why?

You answered your question -- the high cost is directly related to the for profit insurance system we've set up. Not only are they for profit, but they assume no real risk.

 

[Walkthedawg]

I'm asking b/c I just can not justify what I am paying for a product I basically do not use, and I fully believe that good insurance protects me and mine and allows me to sleep good at night......this is a product that is simply out of my knowledge base

I am Self employed and over 50, and wondering what other options I have out there to be considering.

When I look at what I have spent in coverage over the last 10 years, versus what I could have just paid cash for, we are talking a 99% savings by paying cash. The good lord has blessed me with good health and I hope I continue to have that blessing, but this expense has become vulgar

Thank you in advance for any insight anyone can provide

I'm not a Health insurance guy... but I have heard talk of people considering looking for a catastrophic health plan and put back money for minor things. Catastrophic plans have very high deductibles, but lower monthly payments. Then just know you will be paying out of pocket for a bit before it kicks in, but you will be covered for a major emergency.

 

[FormerBully]

whatever you do at a minimum get a high deductible catastrophic policy. Cancer or a heart attack could bankrupt you. And stay away from those religious based “cost sharing” plans. They’re cheap but they’re not insurance. They’re mot regulated, have no financial strength requirements & can deny claims for questionable reasons (or just not be able to pay) & you have no recourse.

My wife worked for two different doctors before we had kids, and part of her job involved handling insurance. She has told me repeatedly that these Christian health-sharing plans are some of the biggest scams out there. She saw far too many people skip necessary medical care or end up in serious debt because their plans couldn't cover their bills. One story that stuck with me was about a ministry that had enough money to pay the founders' bills but somehow didn't have enough left to help a member who broke his leg.

 

[FormerBully]

You can also try to renegotiate a large bill with a hospital. Also, depending on the state you're in, you can let an especially large medical bill go to collections without any serious consequences. Make sure your medical debt can't be reported to credit bureaus. That's not the case in many states including MS. Then you can negotiate a lower price. That might seem unethical but then it's our healthcare industry. I want actual healthcare providers to be compensated but the way the system currently operates, lots of people who aren't actually interested in my health or well-being are cashing in. That's the nature of the system we live with. Except for co-pays, consumers don't even know what procedures and other services actually cost. That's just a bizarre system in a market-based economy.

True story. I once let a $300 medical bill sit in collections because I felt like I was being ripped off. I had a nearly identical visit a few months earlier, and it only cost me $80. When I questioned the difference, they told me I must have been charged incorrectly the first time. After about six months in collections, they called me again. I told them, “I don't have $300, but I can pay you $80 today.” They accepted it and cleared the entire bill. Funny how a $300 bill suddenly became an $80 bill when that was all I was willing to pay.

 

[8dog]

My wife worked for two different doctors before we had kids, and part of her job involved handling insurance. She has told me repeatedly that these Christian health-sharing plans are some of the biggest scams out there. She saw far too many people skip necessary medical care or end up in serious debt because their plans couldn't cover their bills. One story that stuck with me was about a ministry that had enough money to pay the founders' bills but somehow didn't have enough left to help a member who broke his leg.

Anytime anyone anywhere links business with Christianity it’s a scam.

 

[johnson86-1]

You answered your question -- the high cost is directly related to the for profit insurance system we've set up. Not only are they for profit, but they assume no real risk.

It's not exactly direct. That makes it sound like the insurance profit is driving high costs. We have strangled supply for decades and that is probably the biggest factor in prices. We have made it worse by spending a lot of resources on insurance companies and billing trying to pretend that insurance companies can hold prices down when there is basically a government sanctioned cartel on the other side. Then we've kept a heavy burden of regulation that mostly prevents alternative approaches that might save money.

Our three biggest (and in some sense only significant) problems are healthcare, housing, and education, and none of them have one single cause. They are all multicausal and can be simplified into a story of some actual challenges compounded by voters wanting things that sound nice but are ultimately stupid and destructive and politicians being more than happy to give it to them. But it's still multiple real problems/tradeoffs and multiple stupid ideas by politicians and voters.

 

[FormerBully]

Anytime anyone anywhere links business with Christianity it’s a scam.

Look at Tebow the last two weeks.

 

[The Peeper]

There's this guy that I've "heard of", named guy #1. I heard he became a "consultant" for another guy that he's friends with (guy #2) that owns his own company with group health insurance. Guy #1 (the "consultant") pays his health premium directly to guy #2 (company owner) every month that owns the company. Periodically there's a meeting of the minds where "minutes" are taken and everyone present is noted and a little of what was discussed is noted. Guy #1 is pretty happy with the arrangement and plans to continue almost 14 more months until he can retire and get Medicare, I heard. Skip dog, maybe you could find you a guy like guy number 2?

 

[8dog]

Look at Tebow the last two weeks.

Yep. Once Pablo gets you in his crosshairs it’s bad news

 

[dorndawg]

Anytime anyone anywhere links business with Christianity it’s a scam.

I wouldn't say anytime anywhere, but if that's what somebody leads with in a business interaction I'm putting my billfold in my front pocket around them.

 

[johnson86-1]

Anytime anyone anywhere links business with Christianity it’s a scam.

Well, those are non-profits and that probably has as much or more to do with it being labeled a christian organization. There is a reason non-profits don't provide all our goods and services even though in theory it sounds nice. It's just hard to effectively police those organizations, whether it's classified as an actual charity or it's a member owned organization.

 

[FormerBully]

One of the biggest problems with healthcare costs today is administrative spending. A study found that 34.2% of U.S. healthcare spending went toward administration, compared to just 17% in Canada. Think about it. When you visit a hospital, you'll likely receive three or four separate bills. That means multiple billing departments, insurance claims, and employees processing everything. All of that costs money. Now compare that to any other industry. Imagine going to dinner tonight and getting a bill from the restaurant, another from the food supplier, and another from the cleaning crew. Would you ever go back? Of course not! Yet somehow, we've accepted this as normal in healthcare. No wonder it's so expensive.

 

[DoggieDaddy13]

Yep. Once Pablo gets you in his crosshairs it’s bad news

I admire Team Tebow for pulling back from Life Surge and calling the allegations "extremely serious."

You only know what you know and I can imagine the bill of goods he was sold to be out in front. Apparently they were using other big name athletes as well.

 

[Seinfeld]

Not trying to get into your personal life, but are you married? There’s a surprising number of jobs out there that may be on the lower end of the pay scale, but that are also low stress and that come with reasonable family healthcare benefits

I see a lot of couples go that route where one of the two has the job that pays the bills and the other has the job that provides them with health coverage

 

[FormerBully]

I admire Team Tebow for pulling back from Life Surge and calling the allegations "extremely serious."

You only know what you know and I can imagine the bill of goods he was sold to be out in front. Apparently they were using other big name athletes as well.

I disagree. I find it hard to believe Tebow had no idea what was going on. He was reportedly making $50,000 to $100,000 per appearance, and there are videos of him encouraging people to sign up for these classes. His name and reputation helped sell this stuff. On top of that, his team was reportedly warned about Life Surge back in 2025, yet he didn't publicly distance himself until Pablo Torre's reporting brought more attention to it. I'm not saying he knowingly participated in a scam, but when you're making that kind of money promoting something, you have a responsibility to know what you're selling.

 

[patdog]

I admire Team Tebow for pulling back from Life Surge and calling the allegations "extremely serious."

You only know what you know and I can imagine the bill of goods he was sold to be out in front. Apparently they were using other big name athletes as well.

He had a responsibility to do some due diligence before he started endorsing these crooks.

 

[DoggieDaddy13]

For profit health insurers like UnitedHealth Group, Elevance Health, and CVS Health (which owns Aetna) are all publicly traded on stock exchanges.

How do you maximize profits for investors? Buy low, sell high.

Treatment does not follows scientific/medical guidelines. It follows the logic of commerce in a poorly regulated, imperfect market. Health insurers spend more on lobbying than the nation's defense contractors.

That is the model we operate in. Now with new and improved automated tools to limit, delay, and deny coverage. These insurers generate tens of BILLIONS of dollars in annual profits and direct massive amounts of capital toward stock buybacks and executive compensation. It's GREAT work if you can get it.

About a half dozen corporate giants dominate regional and national healthcare markets. That reduces choice. They get to push down payments for physicians based on location and increase the cost to maximize profits.

As someone who manages a rather small business, it still pissesmerighttheheloff that I am responsible for providing healthcare to my employees and paying for a large portion of it.

And who benefits from that? My employees?

Where does the money actually end up?

Think about it.

 

[DoggieDaddy13]

I disagree. I find it hard to believe Tebow had no idea what was going on. He was reportedly making $50,000 to $100,000 per appearance, and there are videos of him encouraging people to sign up for these classes. His name and reputation helped sell this stuff. On top of that, his team was reportedly warned about Life Surge back in 2025, yet he didn't publicly distance himself until Pablo Torre's reporting brought more attention to it. I'm not saying he knowingly participated in a scam, but when you're making that kind of money promoting something, you have a responsibility to know what you're selling.

Let's show a little grace guys.

Come on... it's Tim Tebow.

If Jesus were to come back to earth as QB, I think we all know he'd look like.

***

Hopefully, he'll do the right thing going forward.

 

[skip dog]

There's this guy that I've "heard of", named guy #1. I heard he became a "consultant" for another guy that he's friends with (guy #2) that owns his own company with group health insurance. Guy #1 (the "consultant") pays his health premium directly to guy #2 (company owner) every month that owns the company. Periodically there's a meeting of the minds where "minutes" are taken and everyone present is noted and a little of what was discussed is noted. Guy #1 is pretty happy with the arrangement and plans to continue almost 14 more months until he can retire and get Medicare, I heard. Skip dog, maybe you could find you a guy like guy number 2?

I actually started thinking about who my friends are with big companies and group plans that I can approach like this exact scenario!

thing that gets me, a self employed single payer like myself is going to be very efficient in how they use insurance....meaning, responsible use.

The stories I hear of people on large group plans and how much they use their health insurance for frivolous things