If you work for the government or a large employer, you likely have the “option”
(often only option one, so is that really an option?) for comprehensive health care
“insurance”. Here I present an alternative for those who want more predictable costs
and higher quality care, tailored to your unique physical, mental, and emotional needs.
Today’s Obamacare compliant plans are neither comprehensive nor insurance in
the traditional sense. Insurance for everything else in life agrees to pay expenses
incurred for a loss in exchange for a monthly premium. Health insurance, on the other
hand, is a managed membership where the buyer is responsible for knowing what is
covered and what is not while the organization doles out care to maintain their
definition of acceptable profits. Managed care plans are one-size-fits-all buffet menus,
lumping healthy people together with those requiring massive amounts of care to
“ensure everyone gets the care they need”, according to the former President.
Unfortunately, economic law of supply and demand dictate that when demand is
unbounded against a fixed supply, costs must rise, as has been demonstrated again
since the Obamacare statute was implemented. The only way to control costs from
escalating further is to constrain supply, which means the availability of your unique
care may not be present.
To state explicitly what few conventional health insurance plans will admit. Your
health decisions will be determined by the plan, not by you. Depending on the area
where you live, you could have 0 to 20 primary car doctors, 0 to 5 hospitals, 0 to 5
pharmacies, and so on, to chose from. Even with so called “platinum” plans, your
choice of in-network pediatricians or physical therapists could be as few as one
provider. This is not the case when personally tailoring your health care.
Designing your own health plan with the available tools
Throughout life, your physical, mental, and emotional health will change.
Accidents happen and needs can change rapidly. What’s sold as “comprehensive
health insurance” is a myth that will not prevent “maximum out of pocket expenses”
from being exceeded in too many situations. Why not design your health plan
according to your current situation and adapt it to future situations, considering the
financial risks that are uniquely yours to measure?
Consider these opportunities to provide for yourself, mixing and matching as needed,
adapting over a changing life, balancing your spending against your appetite for future
– pay as you go, or self insuring. Consider saving the monthly premium typical of
a conventional health plan in a savings or investing account. An entry level
conventional plan for a family of 4 is typically $2,500/month. That amounts to $30k in
one year alone, saved for a major health event. At a paltry 5% rate of return, that $30k
would yield $1,500 to cover incidental wellness visits or the entire membership fee in a
DPC practice, leaving the $30k principle untouched.
– Health Savings Accounts (HSA). These are doubly tax-advantaged accounts
that are pre-tax funded and grow tax-free. Use funds for any medical expense just like
cash, or let the initial and subsequent contributions continue to grow.
– Sharing ministries, such as Medi-share, Samaritan Ministries, or Liberty
HealthShare, allow you to pool resources with like minded people to cover large
unforeseen medical expenses. While not technically insurance, these programs act
more like insurance than conventional health care plans. There are a variety of
contribution options ranging from a low $500/month contribution leading to a large ~
$20k max out of pocket expense to a high $900/month contribution leading to a low ~
$5k max out of pocket expense. Since they are not insurance providers, sharing
ministries are not legally obligated to reimburse specific expenses, but one could
objectively claim they have a better track record than the conventional health
providers. Let your personal medical needs and future risk tolerance guide you.
– Direct Primary Care (DPC). Consider a membership based care option if you
have a chronic condition or want the peace of mind that care for most common
ailments will be addressed by the DPC practice. For around $100/month, you have
assured access at no additional cost to the services offered by the DPC practice. It’s
important to understand the specific services offered by a particular practice and how
well that fits your health needs. Unforeseen major traumas are not likely to be handled
by the DPC practice; specialized treatments, complex lab work, or specialized imaging
are also not likely to be covered.
– Medical expense coverage as part of automobile insurance. Given that the
highest probability of being injured occurs while driving, you can purchase $100k of
medical expense coverage for yourself and your passengers for as little as $20/month.
These policies additions are pretty close to the definition of insurance – medical
expenses incurred as a result of injury in your automobile will be covered.
– Medicare…if you’re over 65 years old (younger if you are eligible for SSDI),
Medicare can provide coverage in certain health areas you deem important. Various
“parts” of Medicare cover hospital care, outpatient care, prescriptions, doctor visits,
etc. Your financial status determines how much each of these “parts” will cost you,
making the decision to participate in one or more parts complex in the extreme.
Taken together, designing your own health care plan and adapting it as your life
changes is the best way to provide for your health and longevity. Choose the care
providers you want that provide the care you require. I encourage you to do your own
research, explore available options, and speak to health providers outside the
conventional managed health system. You’ll likely find the care far superior and more
Article authored by Thomas Yengst, Heart2Heal