Same here, I just need to figure out what I realistically want to do. Health care is the primary requirement; enough money to get by and not hit my retirement accounts is a relatively close second.
I agree, health care is primary. I see a lot of people on the FIRE forums who are young and haven’t really looked into what insurance can cost in the years leading up to Medicare eligibility age. It’s the best argument for working until close up 60.
Personally, I’ve focused on finding a place I enjoy being, rather than optimizing for income and planning to retire ASAP.
Nowadays insurance costs upto 5000$/month with high deductibles and plenty of bureaucracy and paperwork.
I have decided to not get any insurance and negociate directly with healthcare provider (They almost all give you huge discount if you pay cash so they don't have to deal with the insurance backdoor deals). If you FIRE anyways, you should really consider medical tourism and do major procedure abroad.
Everyone is afraid of a catastrophic 1M$ one time event. I get that.
But if you end up paying 50k$/year in insurance cost for 30 years that you could have invested and compounded instead, do you really need insurance? For that one-off event that you could have saved for instead?
I guess my view is that I'm also ok to have a 0.1% to go bankrupt over this. We all got brainwashed into getting insurance at absolutely any costs. It is clear to me that it is not worth it at the current price.
In my case, I need to get a head MRI every 6-12 months for the rest of my life, and regular oncology visits forever. I'm still going to investigate the feasibility of going without insurance; the possible ER visit is what really has me worried.
Those are pretty high, I'd want to know more about circumstances and I would be skeptical without knowing more. It can certainly be expensive, but the overall average for unsubsidized ACA plans is about 6000/year.
My wife has a small business and she does not pay anywhere even approaching 40K for a pretty much bog standard policy for a ~50 year old woman. She does not go through the ACA marketplace, she gets a group policy through the company she uses for payroll.
> but the overall average for unsubsidized ACA plans is about 6000/year.
That gives you a bronze plan with a really high deductible and out of pocket. Basically you will be paying the inflated insurance prices and mostly not reach the deductible.
> she gets a group policy through the company she uses for payroll.
That's why she pays less though. they are poolling people together through that company. (healthy and unhealthy)
The concern isn't really about the cost of one-off procedures (which ARE ridiculous and potentially financially bankrupting in the USA), but the low burn of everyday office visits and specialists. $50 office visit here, $250 specialist visit there, $1000 in blood tests there... Without any chronic health problems, my family's out of pocket $5-10K a year or so with insurance. Without insurance (or on a crappier plan), it'd be even worse.
It really depends. I went without insurance for a couple years. I was able to bring every single price with the provider directly. As soon as I told them I wanted to pay cash in advance they had discount and other incentives.
In the end I paid less than even the inflated copay I would have had to pay with insurance. (And I had a lot of procedure and visit that year).
There is a good chance your 5-10k$ of copay would become 2-3k$ without insurance (Copay are absolutely inflated based on catalog prices that insurance negociate in the background).
Personally, I’ve focused on finding a place I enjoy being, rather than optimizing for income and planning to retire ASAP.