Mister Money Mustache Health Insurance Strategy

… I’m surprised he’s an advocate of those “health sharing ministry” scams. An early retiree should be able to manage his income and get a better deal on the Obamacare Exchange.

https://www.bogleheads.org/forum/viewtopic.php?t=404648

intercst

1 Like

In the past, his blog has made over seven figures annually - and I’m sure you noticed your own shoutout in that thread. :slight_smile:

https://www.bogleheads.org/forum/viewtopic.php?p=7314180#p7314180

If you’re running a million dollar, high-margin business, the tax deduction on employer provided health insurance would likely be even greater than an Obamacare tax subsidy. That makes it even stranger to screw around with a health sharing ministry scam to save a few bucks. Since most of the other stuff MMM does is logical and well-founded, the health insurance issue struck me as “out of left field.”

intercst

2 Likes

Per this post Two Years Without Health Insurance (and What I’m Doing Now) (mrmoneymustache.com) his complaint was Two years ago, I was unsatisfied with my options for health insurance. The premiums were rising even as the quality dropped in the form of an ever-increasing deductible. Getting a lower premium that still results in a higher deductible isn’t going to ameliorate his complaint about the ever increasing deductible.

That said, I agree that the increasing deductibles are annoying. On May 1, I had some symptoms that resulted in some tests and an outpatient procedure. 2 1/2 months later, I have met my deductible of $8400 and am only $81 short of meeting my slightly higher ‘max out of pocket’ amount of $9100** So, just because you think you’re healthy and you think you’re doing all that you can to remain so, your body may still have other plans for you. (I will note that in prior years, I have never come near to meeting my deductible, much less my max out of pocket.) I think MMM is taking a significant risk by opting into a healthcare sharing plan, even if the one he is currently in is less religious than most. However, if his blog is making 7 figures (or even mid 6 figures), he is one of the people who could likely afford it if his body is one of the ones that presents him with a poor diagnosis. I do worry that his followers will take the same track, but do not have a 6 or 7 figure income to fall back on.

**‘Max out of pocket’ seems to be somewhat of a misnomer, since I am still being charged ‘co-pays’ that don’t count toward the deductible or the max out of pocket. But I do take some solace that the co-pays for the follow up ultrasound are probably going to cost a lot less than the $1.8k that the original diagnostic ultrasound cost.

AJ

8 Likes

This must be something new. I had some elective surgery done when I was on Obamacare 5 or 6 years ago and once I hit my annual max out-of-pocket limit, all the billing stopped. So now co-pays don’t count towards the limit??? Private insurers are always going to find a way to gouge you. At least it gets a lot better once you turn age 65, if you choose traditional Medicare.

intercst

3 Likes

I have more than a bit of experience (every year) in dealing with this through ongoing problems with the Mrs.

Anecdotally, our misses have been that Anesthesiology services often are out of network, even if the whole of the procedure is in network.

Increasingly, we are seeing additional expense in the medicine part of our coverage where there truly is no out of pocket maximum (but at 20% rate once other criteria are met).

We also see that some recommended services are just not covered. They simply are excluded. These are sometimes basic tests which are a tier 2 or tier 3+ diagnostic aid. Insurance covers all Tier 1 (with very few exceptions), but coverage falls off for tier 2 and (dramatically!) tier 3.

edit to add: Our coverages have been through major employers. Not the marketplace.

2 Likes

This is the sort of thing that should be legislated out of existence.
A service (healthcare) being provided by whatever insurance should be required to cover the entire service. Actuaries can work out the appropriate rates to charge for insurance that does that.

IMHO, insurance that does not do so is fraudulent representation of coverage.

5 Likes

Insurance requires the payor to specify the coverage envelope through their covered services and procedures.

The Service provider has to sign an agreement with the payor to the advertised rates.

These specialty service providers (like the Anesthesia service) often simply do not agree to the terms. As a result, the surgical or therapy team and facility can either deny coverage for all based on one individual (or company), or they can provide everything else EXCEPT that service in network.

The out of network feature is becoming more prevalent as providers of value recognize that they can simply not participate.

This is not all on the insurance company, but, unfortunately, it is VERY difficult to figure this out beforehand. The surprise is almost always after the services have been rendered.

1 Like

Doesn’t the No Surprises Act cover this?

1 Like

Well, I’ll just say that we are in the middle of extensive examples where this is actually happening to us. We are fighting mad and are having to comply with every aspect of the process to ensure appeals, responses, and procedural steps are taken to fight, fight, fight.

To date, the discrepancies are running well beyond a deductible, out of pocket max and any reasonable higher sum.

… all because of changes made after the fact.

That this burden is placed upon an otherwise sickly person is all the more tragic.

3 Likes
2 Likes

Not really. If there’s an out-of-network Anesthesiologist in the hospital on day you appear for surgery, they could inform you up front that it’s out-of-network and will be billed at a higher cost. "What do you want to do? Go ahead with the surgery, or reschedule and hope the in-network guy is here at that time? "

I’d jump off the table before I let them bill me “out-of-network”.

It’s “No surprise bills”, but if they inform you up-front, they can still price gouge you.

intercst

1 Like

All of these stories and similar are just… enraging to me. Like intercst pointing out the multiple M$ and bonuses annually the CEOs & execs of the major insurers get paid, for keeping US congressmen in their pockets and sharing the vig… Medicare “advantage”… dear God.

For all the so-called “evils” of - gasp! - socialized medicine such as the UK NHS, EU systems, Canada where they’re all governmental division EEs and there is sometimes care rationing / waits… basic numbers say I would rather pay an extra 5-10% in taxes every year and be done with it than this ridiculously expensive and complicated administrative gamed nightmare that our healthcare system is. DD in graduate school paid $600 / year NHS fee in UK. Fell off her bicycle, destroyed the end of her elbow and needed surgery to rebuild it and reattach her tricep. $0 expense, done in a week; US review when she got back here was “that’s the best surgery for that injury we’ve ever seen.”

No “insurers”, no lawyers, no bills, no auditors involved. Same surgery here would have billed tens of thousands, “contract price” thousands, paid deductibles would have been less thousands - on top of hundreds of $ a month in insurance premiums!

11 Likes