It’s open enrollment season at Siren Security, and when my Manager handed me my renewal packet I flipped through the pages to find the benefits selection page. My first four years at Siren Security my medical premium remained unchanged, but they’ve been increasing every year for the last couple years. Not just a little but a lot. I located the benefits selection page, find the medical insurance portion, run my finger from left to right and land on the medical premium, it’s been increased, AGAIN. This time, it’s up another 15%(interesting how my raises are nowhere near this number). I think about inflation and compared to my yearly raises (1%-3%), it’s hard not to feel squeezed.
At the mandatory workshop the Benefits Coordinator explains the changes in this year’s benefits. He explains how much value we’re getting—which is true, despite the increase I am happy about the range of coverage especially being able to see a specialist without a referral. However (and while not an apples to apples comparison) from the time when I first enrolled in the medical plan eight years ago to now the premium has increased by 146.54%. At the end of the presentation, my coworker Rich raised his hand to ask a question. Rich is a straight-shooter, does not mince his words, and he asked the question which I assumed most of us had on our mind:
Why is the health insurance increasing every year?
I am sure intuitively we all had an idea but we wanted to hear it from the source. The Coordinator explained when he first started in the industry (back in the late 1980s), there were 15+ big medical insurance companies to pick from which helped keep rates competitive. Today, the big players are down to four: UnitedHealthcare, Aetna, Cigna and Anthem. The smaller pool plus a range of other factors continue to drive up the costs. Even though our share of the premium is increasing our employer is still shouldering the majority of the burden. I wonder, If this is the cost under an employer sponsored plan what would I pay in the open market should I find myself jobless? A layoff can happen, I could be fired, or what if I decided to leave, what then?
If medical cost are expensive with insurance, what would I do if I find myself without?
COBRA – I could try and remain on my employer-sponsored plan and pay 100%+ of the cost. While I could shoulder the cost in the short term, this is unsustainable, I would run out of savings and have to find an alternative after 18 months.
ObamaCare/Medicaid – While the cost with Obamacare/Medicaid may vary (I believe you can qualify for full subsidy with $0 income). Compared to my current insurance coverage, this will be limited and much more restrictive and good to have in the event of a catastrophe.
Health Share – While an alternative to traditional insurance, health share ministries have specific rules for membership and they can drop coverage for pre-existing conditions. Since they are technically not insurance there is no protection for unpaid claims or denial of coverage. Liberty Health Share is one such organization, their most affordable plan for an individual over 30 years old is $249/month ($2,988/year).
Medical Tourism – The book How To Retire Early, has opened me up to the possibility of medical tourism. While the United States health system is one of the best in the world, it is not the only one. Right across the border from Yuma, Arizona, in Algondones, Mexico is a haven of dental offices, at a fraction of the price. When I got my crown and implant I paid close to $4,000 (with dental insurance), the same procedure would have cost $1,400 in Algodones.
There are sites such as MedicalTourism.com and PatientsBeyondBorders.com were you can compare the cost of procedures across countries worldwide. Stateside a knee replacement costs $35,000, while in Thailand it would cost $14,000, see other comparisons here.
Move Abroad – Countries like Taiwan offer universal coverage (novel idea, right?). Depending on the future of US healthcare, I keep this option in the back of my mind. I am always amazed when I read stories of US citizens walking into a foreign hospital with no insurance, see a doctor in a timely manner and paying a fraction of what they would have in the US, such as the one detailed by Jason (Mr. Free At 33), here. In certain countries you can become an English teacher and enroll in national healthcare. There is also the option to obtain expat insurance, I ran a quote using IMG Global and the cost is SIGNIFICANTLY less than what it would cost in the US.
No Insurance – Chris Rock has a bit where he says insurance is when “I give a company some money in case something happens, now if something don’t happen, shouldn’t I get my money back?” I have been blessed with great health, eat mostly clean and work out regularly. I get my yearly physical and two dental cleanings a year, and luckily have no major chronic issue. Although the thought of no insurance does scare me, my medical history makes this slightly less intimidating. While certainly risky as no one knows the future, this would certainly be a last case scenario.
What are your feelings regarding the United States medical insurance fiasco?