When is health insurance not worth the cost you pay for it? Especially if you are single or have no children.
I’ve asked this question a lot over the years. I’ve had company insurance plans, I’ve had individual plans, I’ve had Obamacare from the marketplace and I’ve had no insurance.
What I have found is for the masses it depends on your individual situation, including general health, relationship status, family size, employment type, risk for health or accidents and more. But in the end, for a single, self-employed female with generally good health it was an easy decision to say no to the health insurance conglomerates.
If you have an employer offered plan or if you go to the open market for a provider, the plans are general and usually not very customizable. You likely have to pick a plan that may or may not have your primary doctor or other specialists as “in-network” providers. Then there is the navigating of the premiums versus deductibles, co-pays and co-insurance. Throw in the in-network, out-of-network categories on medical providers and tier categories on prescriptions. How are you suppose to keep up with all of this? And it changes constantly at the insurance companies discretion.
The major flaws I experience with health insurance plans is they change every year. So as soon as you figure out how one works, it changes. Then you get established with a doctor or specialist and they no longer accept that insurance, so now you have to pick to either keep the doctor you like and pay or go to someone new and start the process all over.
This seems counter productive to the goal of healthcare and healthy living, but health insurance companies haven’t done anything to change this constant changing cycle. My final decision came down to ultimate control. I prefer to be the one in control of what care I have access to, by whom and at what cost.
So, I chose to simplify and focus on my healthcare. Yes, CARE, instead of the insurance. Now this may not be the best choice for everyone, but if you take the time to do the math on the premiums, deductibles, copays, co-insurance and compare to what you could get instead with that same amount of money you may be surprised. Also, compare the level of care you have access to as well.
Here are a few advantages and disadvantages to choosing to go without the status quo health insurance.
Benefits of Self Pay Healthcare
- Full control of healthcare provider selection
- I pick who I like
- My providers know me
- Building relationships with your doctors helps them better treat, recommend and prevent health issues
- No referral needed
- No paying a copay to a doctor’s office you barely know to get them to send you to a specialist you already know you need. An easy example is going to see a dermatologist for a mole removal. Why do you need a primary to tell you it’s ok to go see someone?
- As an independent payer you simply pick the specialist you like and want and go
- Upfront Cost Transparency
- I get to ask how much an office visit will cost
- Everything is negotiable!
- I’m not getting a statement saying it costs $500, but someone got me a deal for it to only cost me $250 and of that $250 I owe a $50 copay and 80/20 co-insurance….what???? No! Cost = Cost and no guessing.
- No payments to a company that only gives you grief
- Everything I pay goes directly to the provider
Pitfalls of Self Pay Healthcare (there are Pitfalls)
- Cash Needed – Keeping an Emergency Medical Fund (just smart to do no matter what)
- Emergency Situations – unknown cost – no cap
- Major Medical Situations – unknown cost – no cap
Ways to Mitigate Pitfalls of Self Pay Healthcare
- Budget Planning for your Healthcare
- Ear mark funds for medical wellness each year, including: yearly physicals, paps, dental exams, eye exams
- Emergency Fund – have a fund that you pay into yourself each month – set it up to make money for you (low risk market or money market)
- Add medical coverage to your Auto Insurance
- Most policies have this option and it pays no matter who’s fault an accident may be.
- Purchase Accident Insurance (major medical no longer exist)
- slip on a wet floor or trip over a dog bone – twist an ankle and need an x-ray – this pays you for the accident and you pay the provider (you still have your negotiating power and power to chose your care)
- Purchase Cancer or other Major Medical Insurance packages
I’m sure there are other circumstances where you may have a chronic illness or a constantly sick group of kiddos that may make this option not appealing, but to those out there that are single, self-employed or just want to have the control of who they see without loss of benefits, then self pay may be the option to explore.
Please comment or ask questions. I have so much more to share on this subject. We are just getting started.