Individual Mandate Repeal (NOT)

Like many of you I was very interested in the promise made by the President to repeal the individual mandate set in place by the Obamacare and Affordable Care Act, which essential forced me to either pay for a crappy health insurance plan or pay a penalty to the government.

This frustrated me as I don’t like health insurance controlling my heath care or denying me care, despite the high fees I was forced to pay them.

That aside after waiting anxiously for the final votes and news reports and googling to be sure the individual mandate was really repealed back in December when so I had the option to not renew for January the crappy over priced health insurance from the Marketplace, I’m now finding out and seeing reports that despite the victory sung by the President and the new reports the repeal is not effective for 2018. WTF!!

I’m sure I’m not the only one who chose not to renew the Marketplace health insurance in January after hearing the new of the repeal. I’m also sure I’m not the only one that was relieved since the same crappy insurance increased its premium by 30%. This would have made my month premium $500 per month for a plan that had minimal coverage (bronze) and a $6500 deductible that had to be met before anything was paid out.

Do that math, $500 x 12 months = $6000 plus another $6500 deductible, so $12,500 before they cover anything. Why is this something I’m going to be fined by the government for saying no this makes no sense for me financially??

Even though I thought I was free of the 2.5% penalty, this penalty still makes more sense financially for me to just pay. Since I’m self employed and a freelancer/consultant, my business expenses effect my adjusted gross income fairly substantially.

Just an example, say I do make an adjusted gross income of $70,000 the penalty of 2.5% of that is $1,750.00. Add on top of this the $50 a month I pay for my primary care membership (doctor I can call 7 days a week who calls back and sees me for free), $50 per month for the accident insurance and $55 per month for cancer insurance. And in total I’m covered for $1860 per year to my providers and $1750 to the government, so $3610 total. This saves me an out of pocket immediately compared to the Marketplace health insurance by $2400 (rounded).

If I do need to pay for some sort of healthcare, well the Marketplace insurance wasn’t paying until after I was out of pocket another $6500 and only if that provider was “in-network”, which no one was with my plan from 2017. That means I’d have to be out of pocket $6500 plus the $2400, so a total of $8900 above my costs and the penalty in order for buying the health insurance to make any sense financially for me.

How does forcing this on Americans make us better off? How does this improve our healthcare system? I’m not following the logic. But maybe that’s because I do the math and I prefer to be the one making the decision on who and what HealthCARE I receive.

Tell me your experiences. I welcome a discussion here.

And yes, I’m single with no dependents. I know this is a different animal if you are dealing with children in the family and their health coverage.

If you want to calculate your penalty go here: https://taxpayeradvocate.irs.gov/estimator/isrp/estimator.htm

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Health Insurance Worth it or NOT?

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.

Alternatives to Health Insurance

What if you can’t afford health insurance? What if you just don’t want to be restricted by health insurance? What are your options to be sure your protected in both health and financially?

I had heard about major medical insurance, that old option no longer offered that covered catastrophic illnesses or accidents. This made sense to me, as I take care of myself and would rather pay for only major coverage rather than pay for a hangnail or cold to be treated by an insurance.

I’ve always compared health insurance to auto insurance. I didn’t understand why health insurance covered the day to day small things which drive the cost up, when it would be much more affordable if the insurance was used for catastrophic events only just like an auto policy. Auto insurance doesn’t pay for my regular oil changes and tire rotations or car washes, but it does protect me if I get in an accident or someone steals my car.

So, I began to look into my options for coverage that would protect me from accidents or catastrophic illness and then options for my day to day health. Here’s a break down of what I found to be most helpful and comforting for coverage and financial protection:

  • Opt to maintain a healthy living style
    • Gym Membership – $10 per month
    • Healthy Food – cost ranges
    • Cooking at home – less expensive than eating out!
    • Yoga membership – Free App or $12 per class with instructor = Stress Relief
    • Using holistic treatments in lieu of prescription drugs when reasonable
  • Good RX – simple free app
    • discounts on perscriptions
    • transparency on cost based on where you get your prescription filled
  • Primary Care Physician Membership (concierge doctor) – $50 per month
    • Local physicians that offer memberships for a small group of paitents
    • You have 1 doctor
    • They get to know you
    • They take the time to know all about you
    • Includes a yearly physical with blood work and some even include female yearly exam
    • Same day appointments, call backs and/or Perscriptions
    • Typically these memberships have pharmacy arrangements for discounts
  • Accident Insurance – ~$50 per month
    • pays out cash directly to me
    • accidents including slip and fall, car accident, tripping over a dog bone and twisting an ankle, etc.
    • amount paid based on treatment, diagnostics needed and such
  • Cancer Insurance – ~ $50 per month
    • pays out cash directly to me
    • amount paid based on type of cancer diagnosis, treatments, and other variations
  • Medical Payment option within Auto Insurance
    • added coverage within auto policy for insured persons medical expenses from car accident (whether or not your at fault doesn’t matter)
    • can go up to $10,000 in coverage

 

Please share any other findings you as my readers may have found. I am always in search of new alternatives and options. This is an evolving industry and this blog is to bring together options for all.