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irwinsailor 20-03-2003 22:37

Health Insurance ?
 
Any ideas where and how to get afordable health insurance while being a fulltime live aboard cruiser?

GordMay 03-04-2003 20:11

I'm told - Blue Cross/Blue Shield - but we self-insured (ie: no insurance).

Kasidah 26-01-2007 09:54

Health insurance
 
Ok. This seems to be the most hard to find info of anything we have looked for to start our cruising lifestyle…Where to get affordable health insurance even if its just a very high deductible to just cover those major “illnesses”, that everyone hopes will never happen to them. Unless we plan on leaving the states for over 6 months out of the year and finding an off shore address, I just can not find it….unless I want to pay around 5 to 8 thousand dollars a year. Our thought is to self insure ourselves by have an account in place before we leave that would take care of some of the problems, how ever god forbid if one of those major illnesses struck….this would end our dream. Our thought is to put about 5 years of what we would pay for premiums aside and hope for the best.
My biggest questions for all of you out there that are self-insured is when something does happen where do you go and where are the affordable places without jeopardizing your health? Clinic? Hospital? For those who are in good condition health wise, do you find you end up needing a lot of medical treatment or advise each year? I know this would all depend on the person and your situation however I would like to just get some feed back from cruisers out there already in this situation.

Vasco 26-01-2007 10:12

I've used Worldnomad in the past but never had a claim so can't comment on that aspect.
World Nomads

David_Old_Jersey 26-01-2007 11:44

My plan would be to also "self insure"..........but as a back up if push comes to shove and I can't be fixed up locally (or get something longterm)then to fly home for treatment on the local equivalent of the NHS.

Kasidah 26-01-2007 12:27

Health insurance or self insure?
 
Thanks for the quick replies.... Alot of companies I have looked into won't cover you if you are cruising in your home country or you have to be out at least 6 month of the year. The idea of self insuring and just making sure that you are in a place or can get back to a place that will give you good care sounds like the way we will go unless we can find more affordable insurance that will pay claims when you summit them. We are divers and are members of DAN which should help if we need to get some where in an emergency. It would be great to hear from a lot more cruisers about this so that others just getting out there know they are doing about the same thing or have different choices when it comes to health insurance issues.

Vasco 26-01-2007 12:48

Arline,

Have you looked into how DAN actually works? I have heard some negative comments regarding actally getting repatriated.

Kasidah 26-01-2007 13:27

DAN
 
I was looking at DAN for a little extra insurance in case we have some type of a accident in the water (diving and what not). But I will go over that just before we go. I know we picked it up a long time ago when we would travel to dive and they covered you if you had to be transported for medical when diving(We dive a lot). I have not looked it over in a while but I will. Thanks. I put the part in about DAN just as an extra. The health insurance as a whole is really the part I am looking at. Any comments would be great.......
Quote:

Originally Posted by Vasco
Arline,

Have you looked into how DAN actually works? I have heard some negative comments regarding actally getting repatriated.


Brent Swain 26-01-2007 14:12

Health Insurance
 
Given the extremely high price of health insurance in the US you'd be better off to get health insurance for any other country and rely on getting there from wherever you are in the world, not the US.
I once bought health insurance from Travel Underwriters, Worldwide Mediclaim. When I made a claim they simply refused to pay, because I didn't have a credit card for them to put my expenses on( and force me to go to court to get reimbursement.) Other I've met have had bad experiences with this company.
Consumer reports say Voyager is one of the best.
People are flying overseas for medical attention a fraction the price of the same operation in the US, and often more reliable results .
I saw a report that said 40% of medical diagnosises in the US are wrong. When doctors went on strike in LA in the 70's the death rate declined noticably. Both Spain and Greece spend a fraction the amount per capita on health care yet have longer life expectancies.
I don't know why yanks in other countries with better medical systems feel the need to go to one of the worst countries in the world for medical atention.
Brent

Jentine 26-01-2007 14:31

Spoken like a man with a paper a$$hole.

David_Old_Jersey 26-01-2007 14:52

Quote:

Originally Posted by Jentine
Spoken like a man with a paper a$$hole.

Is that a medical diagnosis?? :smiling:

On a more serious note, Health Tourism is of course big business - if folk just judge on results and costs, yer may find you ARE already in the place you would choose if paying yourself.

Jon D 26-01-2007 16:15

We have a high deducable individual policy with Humana that is affordable. You have to be in pretty good health to get however and they will exclude prior conditions. It's a standard PPO, what that means is we self insure the everyday stuff but major events are covered. This comes in handy as I recently had a unexpected surgery. I know BC/BS also offers similar policies. We are currently cruising US waters between 1/2 and 2/3 time depending on the year. We have been able to find doctors in plan in all the coastal states.

Brent Swain 26-01-2007 18:15

The medical bills in many countries are less than the cost of insurance in the US. I once had to visit a doctor in Mexico. Charge $10 CDN.
Brent

irwinsailor 26-01-2007 19:28

My plan is to pay as I go out side of the US. I understand that medical costs are about 10% of the cost of the US. Now I need to get out there.

seafox 27-01-2007 02:04

Eat an apple a day.

ssullivan 27-01-2007 05:52

I agree with Brent. Jentine... you're a good guy. Not sure what is meant by the paper ahole statement. I'm not familiar with the expression. Maybe it wasn't as derogatory as it sounds?

Anyway, the cost of healthcare outside the US is signficiantly less expensive and prescriptions in many cases aren't even "prescription!" Just head to the pharmacy and buy them. Forget the prescription.

It's also important to note that the US isn't even close to number 1 in longevity, or quality of healthcare services. We are, however #1 in cost of healthcare. So, this is one case where anything you do will be better than standard USA insurance or medical treatment. Take a look at this article. There are a couple of quotes and a link:
"
https://msnbcmedia3.msn.com/i/msnbc/C...rceReuters.gif
Updated: 8:13 p.m. ET Sept 20, 2006

WASHINGTON - The United States spends far more on health care than any other country but gets only mediocre care in return for its investment, according to a report released Wednesday.
The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found.
“Overall, you will see ... that the United States scores poorly — an overall score of 66 (out of 100),” Cathy Schoen, senior vice president for research and evaluation at non-profit health-care research foundation, told a news conference."


...

"There is one area where the United States comes in first, compared to other countries. “We are by far and away the leader on costs,” Schoen said. Americans spend 16 percent of gross domestic product on health care — double the median for all industrialized countries.But the United States scores 15th out of 19 developed nations on deaths from causes that are easily prevented if timely medical care is provided, such as heart attacks. France scores the best, with 75 deaths per 100,000, while the United States weighs in with 115 per 100,000. Only Ireland, Britain and Portugal score worse.


U.S. infant mortality is far higher than in any of the other 23 countries measured, with a rate of 7 deaths per 1,000 births. The next worst is New Zealand, with 5.6 per 1,000, while Iceland scores the best with 2.2 per 1,000."

U.S. gets bad grade on health care scorecard - Health Care - MSNBC.com


So, don't be afraid to get medical coverage and/or treatment outside the US. You can save money and get better care in many cases. The notion that the US is the best country in terms of medical treatment is incorrect and possibly some outdated leftover. It's not what it used to be. Prescription drugs in *every* other country are far superior. Not as much regulation and a small fraction of the cost.




As to health plans, I think I've posted this on the board before, but I have used these people while working on megayachts outside the USA. Never had a claim, but the policty was from Lloyd's of London. From what I understand, they are a fairly reputable outfit. :)


International travel medical and health insurance, featuring trip cancellation travel insurance online.



They covered me outside the USA and for short visits back into the USA. There were limits on how long I could be covered while in the USA. It was a couple months a year, I think.

GordMay 27-01-2007 06:34

The term “paper asshole” is a derogatory epithet, suggesting a person who talks a lot, but doesn't say anything, talks nonsense, or is “full of it”.

Jim (Jentine) might be advised to revise or delete his disparaging comment, which does nothing to advance his own reputation.

hellosailor 27-01-2007 17:27

Arline-
"I just can not find it….unless I want to pay around 5 to 8 thousand dollars a year." That's actually about the norm for any "decent" medical insurance policy for ONE person in the US, it would be cheap for a family (typically 11-14,000).

Typically anything cheaper is literally cheap insurance, i.e. you'll find that if you can extort a copy of a policy from them before buying in, that there's a lifetime limit of $100,000 on the policy, or a per-incident limit of $50,000, or you're getting just a "major medical" policy (which can be good if that's your choice) which covers hospitalization--but only the hospital costs, which do not include the bills from surgeons and anesthetists, etc.

There's no magic way to get cheaper insurance in the US, only policies that provide less and you have to shop carefully for what you anticipate. (i.e. $100,000 lifetime limit may sound good--but you can exceed that in one kidney failure, one car accident, etc.) Usually the only discounts that mean anything are if you can qualify with a group, a trace association, a fraternal, the AARP, etc.

Cheaper to hire an ex-Soviet surgeon and give him free room and board on the boat, and the right to take in business while you're in port, yes.

David_Old_Jersey 28-01-2007 03:22

Quote:

unless I want to pay around 5 to 8 thousand dollars a year


Is that really the going rate??

ssullivan 28-01-2007 03:35

Quote:

Originally Posted by David_Old_Jersey

Is that really the going rate??

That's accurate. See why medial is so high on our country's refit list? :)

Jon D 28-01-2007 07:29

Going to say this again there are better policies.. we pay under $4,500 per year for two of us. Yes it has a high deductible by choice [it's where the added cost for no deductible vs normal annual costs wash]. It has a lifetime max of 5 million so that's reasonable. the other benefits are in line with group stuff etc. The individual plans do exist, you have to work at it to find them. I would search a little harder. And yes you do have to be in reasonable health to get a policy that's the bad news.

The US is different when it comes to medical care - yes we spend more money but we also have better access to lots of things like MRI, CAT scan as routine while the rest of the world does not. You can argue whether they are needed or not..You can also manage your own care to minimize costs within reason.

ssullivan 28-01-2007 08:12

Quote:

Originally Posted by Jon D
The US is different when it comes to medical care - yes we spend more money but we also have better access to lots of things like MRI, CAT scan as routine while the rest of the world does not. You can argue whether they are needed or not..You can also manage your own care to minimize costs within reason.

Acutally, we don't have better care Jon. Several European countries offer better access to health care. Did you read the articles in the links?

alanperry 28-01-2007 08:22

I have had medical care in places as odd as Sierra Leone and Laos, Thailand, Switzerland and Egypt and I can say that the health care in Asia is generally better than that in other parts of the developing world. Of course this is a country by country issue too.

Several years ago my son had a mortorcycle accident in Thailand while we were riding around the northern provinces. His arm was badly injured. After a 3 hour ambulance ride to Chaing Mai (major northern City) about 2 hours in surgery, 12 days of returning to the hospital everyday to have it checked and rebandaged and finally the stitches taken out, it cost me about $280 USD. The hospital and doctors were world class (as good as any here in the states) and the level of care and concern for us was just heart warming.

After about 30 years of traveling the world I agree with those that advise getting the insurance from Britain, France or some other EU country and use the local doctors (with discretion and advise from expats living there).

Just a note; many of my friends who work for Swissair all go to Bombay to get dental work done. Apparently there are many fine dentists trained in the US and Europe with practices designed for Westerners. This type of thing is true in many places around the globe.

However for the much more serious things such as cancer, organ failure, stroke etc you probably want to be at home with loved ones anyway.

Jon D 28-01-2007 09:34

Quote:

Originally Posted by ssullivan
Acutally, we don't have better care Jon. Several European countries offer better access to health care. Did you read the articles in the links?

Sean

Depends on how much money you have or insurance.

The articles don't tell the whole story [what else is new]. And statistics don't tell all either. After all numbers never lie but liars figure. I know that you can make the numbers tell you what you want - I've done it and seen it done lots of times - numbers were never wrong just put together a certain way.

You are correct that certain countries offer universal access [better?] however in most of those countries there also also private clinics for those who can afford better treatment or more immediate treatment. The issue is not that simple - US is not as bad as made out to be - clearly not perfect either.

I am not a big fan of socialize anything as you can see. It means higher taxes and less service in general.

I do believe in open access though -and that raises an issue as to how to get fairly priced medical services for all - I do not have the answer for that. Part of the problem is liability, part of the problem is over testing, part of the problem is greed... aah that's why I dropped out for a while.. and went cruising :)

hellosailor 28-01-2007 10:21

Jon, what provider and what policy do you have that gives a family of two, who are not employees or group members, whatever you consider "good" insurance under $5k per year?

Broad words like "good" can't be used in discussing insurance, there are simply too many options and variables. Odds are at that price you're not in the norm. Routine coverage or meds or something isn't there, or you are being classed differently for any of the other usual reasons.

I don't doubt you've found something you're happy with--I just know that at least in my corner of the US, what you have could only be a major medical policy, or a subsidized state plan, or another "limited" plan of some type. That's from reading policies and quotes--not articles about them.

And from a friend who's a doctor, who provides me with much comic relief as he tells tales of what his patients come in with. One, with "full chiropractic coverage" according to their policy. Except, the coverage specifically excluded all "spinal manipulation" which of course essentially means zero chiropractic coverage, contrary to the plan declaration.

That kind of nonsense in plans is sadly normal these days, and with policies that run 1/2" thick, all near impossible to read much less compare in advance.

Kasidah 28-01-2007 11:09

Insurance
 
Thanks for the returns... I would also love to know this "good" insurance that is under $4500 for a family because I can not find it. I have been searching for many years and always come up with about double that with a high deductible if not more. We had a policy for about 6 years with Mutual of Omaha it was a major med only with a $5000 deductible it cost $6000 last year. This we never used because we never had any major issues (knock on wood). We got a cancellation notice last month; they were not going to carry this anymore. So considering that we are going cruising in about two years we have decided to go through my husbands business and pick up insurance through a group. Wow it is expensive even this way but it is great coverage. We have decided to buy insurance for just my husband and I under this policy, which cost $8712 per year, family was $11328. We have two girls in college, one will graduate in May, and so we picked insurance up for them through the colleges, which was only about $800 per year. Sorry to get into this so deep but my point is there just is no way to get a good coverage without spending around $10,000 for the family. We plan on getting checked over this year and having any issues dealt with so if we can’t find a reasonable insurance with high deductible when we leave to go cruising we will feel a little better about self insuring while out there.
I wanted to thank everyone that gave names of insurance companies to check out for cruising, I have been making a list and plan on researching them. I will let everyone know what I came up with before we set out.

Jon D 28-01-2007 15:09

Quote:

Originally Posted by hellosailor
Jon, what provider and what policy do you have that gives a family of two, who are not employees or group members, whatever you consider "good" insurance under $5k per year?

My policy is through Humana - it is individual health no group, for two adults only. It does not have dental, vision, it does have prescription coverage. I am not going to put my policy up here for discussion but I have had very very good coverage before we dropped out to go cruising and this is not that good. But it is more than adequate. Similar coverage is available through Blue Cross/Blue Shield, Cigna that I know of. Again if you have major medical history that will be an issue and if you expect a $500 deductible it won't happen for those costs. And it takes time and is a PITA to go through the process. It took us a good 6 months from when we started to when it was approved.

sneuman 03-04-2007 04:55

Quote:

Originally Posted by alanperry
I have had medical care in places as odd as Sierra Leone and Laos, Thailand, Switzerland and Egypt and I can say that the health care in Asia is generally better than that in other parts of the developing world. Of course this is a country by country issue too.

In fact, dollar for dollar (or baht for baht, as the case may be), I'd say medical care in Thailand is the best value in the world. In Bangkok, several hospitals offer excellent, efficient care and low-cost prescription drugs for a fraction what you'd pay in the states.

Admittedly, this is largely because of two factors a) cheap labor and b) minimal costs incurred from liability insurance.

Reality Check 27-06-2007 09:19

US Health insurance cost is driven by several factors. One of the major ones being liability... to reduce liability many CYA test are performed to protect the medical establishment from the massively excessive law suites that flood our courts.

Another is the non support / no subsidy of medical services by the Federal or State governments AND ironically the need to have everyone who has insurance or ability to pay for services.. Pay for the services of those who use the facilities but never pay.... This alone almost doubles each individual expense. In the US almost every area has a public hospital that MUST provide services with out regard as to a patients ability to pay and this is often abused by citizens and non citizens.

At this time in the US, the massive flood of illegal aliens across our southern boarder has bankrupted many public hospitals and public health organizations.

To make up for these unpaid services, those with insurance or the ability to make payments have to not only cover their own cost but a portion of all the un paid cost. For a capitalist (a good thing) based country... we do fall into many of the Socialist arena but expect individuals and not the governments to actually face the cost.

It is ridiculous but not much is being done to correct it although caps on liability awards are frequently discusses and Federal subsidies to areas where illegal aliens have depleted the local resources are discussed but generally never acted on.

For full time cruisers, it is probably a good thing to get non US coverage or to set up a personal Health Account which is allowable by the IRS as a form of self or semi self coverage with tax benefits. This is far more difficult for those of us that are at the 50/50 or less mark as to in or out of US Cruising and work.

Apple a day seems to be a good choice, probably need to dip it in Rum just to be sure.

Brent Swain 27-06-2007 13:06

I usually buy only enough medical innsurance to get past the US. I avoid "Travel Underwriters Worldwide Mediclaim "as they refuse to pay
Brent

gettinthere 11-11-2007 07:20

plenty of choices
 
Surf this site...
Health Insurance, Medical Insurance, Individual Health Insurance Quotes

They provide lots of options from lots of different insurers. I and my wife are over 50 & can get insurance well under $5000 per year, total.

I had a chat with my auto/home insurance agent. He has had ongoing serious health issues. His self insurance cost dropped by 2/3 recently. He claims that the number of individuals seeking individual insurance has risen dramaticly and that is causing the rates to fall.

I also personally think the insurance companies are reading the writing on the wall. They see the push for a national health care system that would put them out of business so they've stopped gouging. We will generally accept private insurance if it's reasonably priced. So they are getting closer to 'reasonable' to keep the alternative at bay. A strange sort of competition.

If we can get rid of the John Edwards of the world, aka ambulance chasers, we can knock the costs down quite a bit more. A US doctor can easily spend several hundred thousand dollars on malpractice insurance per year.

hellosailor 11-11-2007 12:57

" He claims that the number of individuals seeking individual insurance has risen dramaticly and that is causing the rates to fall."
I see that as the sadly normal Western mistake of seeing coincedence and mistaking it for causality.
I would guess that as more people seek individual insurance, more people are getting into the business of marketing and selling more "individual" insurance plans. Many of which are poor quality products, which may now be cheap and common--but that's about all.
As opposed to rates dropping because more people were in the "group" called "individuals" as opposed to any other group (i.e. union members).

I hear too many tales from doctors (firsthand) about insurance company practices, and I've read published interviews to the same extent. The insurance companies are in the business (oh right, COMPANIES are BUSINESSES!) of making money, and most or all of them in the medical insurance business have formal policies which consist of plainly illegla actions in order to delay or deny payments to "providers" aka doctors, among other ways of making sure the "insured party" gets denied coverage that they are legally entitled to.

The only question is how long it will take before the RICO statutes are used to prosecute several of these companies, because they are in flagrant violation.

I'm sure some of them provide an honest deal--it's just that no one seems to be able to figure out a short list of honest and reasonable medical insurers.

gettinthere 12-11-2007 04:40

Quote:

Originally Posted by hellosailor (Post 110732)
" He claims that the number of individuals seeking individual insurance has risen dramaticly and that is causing the rates to fall."
I see that as the sadly normal Western mistake of seeing coincedence and mistaking it for causality.
I would guess that as more people seek individual insurance, more people are getting into the business of marketing and selling more "individual" insurance plans. Many of which are poor quality products, which may now be cheap and common--but that's about all.
As opposed to rates dropping because more people were in the "group" called "individuals" as opposed to any other group (i.e. union members).

The only question is how long it will take before the RICO statutes are used to prosecute several of these companies, because they are in flagrant violation.

HS
I quote an insurance agent; a guy with knowledge of the business and personal experience and you then GUESS at what you think is happening.

This agent does not sell health insurance; only life, car & home. He has a serious, ongoing health issue; and his policy cost dropped significantly. He gets good comprehensive coverage, in fact he told me his coverages expanded and the deductables went down as he got the lower rates. Those are facts, not guesses.

GordMay 12-11-2007 05:30

Quote:

Originally Posted by gettinthere
”I quote an insurance agent; a guy with knowledge of the business and personal experience and you then GUESS at what you think is happening.
This agent does not sell health insurance ...
... he told me his coverages expanded and the deductibles went down as he got the lower rates. Those are facts ...

Having been a technical salesman, then a sales manager, I would hardly classify salesmen as the highest authority on the products and/or services they sell.
I assume even less competence about “allied” services, that they don’t actually sell.

Your agent friend offers interesting anecdotal process information, to which you interpret cause & effect.
I suspect it’s your interpretation that HS questions, offering his own alternate speculation.

All of these unsupported opinions might be characterized as “guesses”.

Process describes how something happens; whereas Cause and Effect analyzes why something happens.

rebel heart 12-11-2007 08:43

We're planning on leaving on a big trip in four years (one year into the five year plan). I opted for an HSA plan at my work. I take $5K a year out of my paycheck, tax free. It goes into an account that I can control the asset class, and every year I can put another $5K into it.

If you have high medical bills, or are planning on it (child birth, knee surgery, etc), it's not the plan for you. But if you don't use much insurance, it's a great plan.

When we leave for our trip, we'll have about $10K - $15K in the HSA account, which we can use for healthcare with no tax implications. That cash, coupled with a high deductible emergency plan, should work out nicely.

*** I work for an insurance company, by the way.

gettinthere 12-11-2007 10:34

Quote:

Originally Posted by rebel heart (Post 110909)
*** I work for an insurance company, by the way.

Well then, thanks for the confession. We'll consider your info to be biased & prejudiced. And you should be prosecuted under the RICO act as a criminal. We know all insurance companies & their employees are evil. Thank you

rebel heart 12-11-2007 17:38

Quote:

Originally Posted by gettinthere (Post 110924)
Well then, thanks for the confession. We'll consider your info to be biased & prejudiced. And you should be prosecuted under the RICO act as a criminal. We know all insurance companies & their employees are evil. Thank you

:rolleyes:

An HSA is a great option for people who would like to save up some money for future healthcare costs. I would really advise it for anyone that doesn't normally have a really high health care bill. If you spent less than $1K a year for the last few years, and don't see an increase coming up any time soon, check with your emplower about it.

Also, after age 65, you can use your HSA balance for *anything*, no penalty. It's also a great way to slice another $5K off of your taxible income every year.

maxingout 12-11-2007 19:27

There is no cheap health insurance in the United States that I have found. On the other hand, my son obtained offshore health insurance for about seven hundred dollars when we were cruising around the world. But, he was not allowed to use health care facilities inside the USA.

Therapy 12-11-2007 19:58

Quote:

Originally Posted by rebel heart (Post 111013)
:rolleyes:

An HSA is a great option for people who would like to save up some money for future healthcare costs. I would really advise it for anyone that doesn't normally have a really high health care bill. If you spent less than $1K a year for the last few years, and don't see an increase coming up any time soon, check with your emplower about it.

Also, after age 65, you can use your HSA balance for *anything*, no penalty. It's also a great way to slice another $5K off of your taxible income every year.


Can I put 5k a year away and let it carry over year to year? Building up what I don't spend.
What about the wife? Can I add 5k for her too = 10k?

rebel heart 12-11-2007 20:31

Quote:

Originally Posted by Therapy (Post 111032)
Can I put 5k a year away and let it carry over year to year? Building up what I don't spend.
What about the wife? Can I add 5k for her too = 10k?

Yes and no.

You can add up $5K per year ($5,450, exactly) if you're married and carrying a dependent, but essentially you now have a $5K deductible, so you can get hit pretty hard in that regard. Like I said, if you think you'll be paying a lot of medical bills, I wouldn't advise it. Health savings account - Wikipedia, the free encyclopedia

Here's some scenarios:

A) You get hit by a car, and have $4,000 worth of contributions so far. The total bill is $40,000, so you'll burn that entire $4,000, plus you'll owe an additional $1,000, and your insurance company will pick up the $35,000.

B) You save $5,000 in a year, and have $1,500 worth of expenses. You'll end the year with a balance of $3,500, which will carry over for the next year. It is *not* a use-it-or-lose-it thing, like an FSA is. The only thing HSAs have in common with FSAs is the last two letters of the acronym; totally different plans for totally different uses.

So you can carry over the balance, but if you're married, only one of you can do it. There's a lot of options in where you keep your money however; the medical insurance company (in my case, PacificCare) is totally different than the fund holder (Fidelity, in my case). I can call up Fidelity and put my money in one (or several) of their funds.

It's really great, if you can answer yes to a few of these questions:

A) Do you not, or are you not planning on having, high medical bills?
B) Would reducing your taxible income by $5,450 be a good thing?
C) Would you like to save up cash for a high deductible account later on?

Another thing to consider is that when you first start on your HSA, you will end up with a $5K deductible, but you'll be adding into it slowly paycheck to paycheck. If you then get hit by the car your first week into the plan, you'll be liable for the entire deductible amount right then.

HSAs are a bit complicated, but so are jet airplanes; just because it's complicated doesn't mean it's a bad thing. I realized I did the right thing with my HSA when I saw my account going higher and higher, and figured out that all the money-smart people in my company, including my CFO and CEO, are on the HSA.

One other caveat. Some plans, like mine, don't hit your deductible for "routine checkups", pre-natal, and some other options. For some other things, they split it with you 80/20 (the 80 being their share). But for catostrophic stuff, or surgery, your deductible is first to go.

In the real world, with myself and my fiancee (my "domestic partner", on my plan), we've saved up $4,600 this year, so far, and she's been to the doctor a few times for things that hit the deductible hard. So I figure we'll have $4K at the end of the year, growing interest, and usable for the big trip.

When we're getting ready to have kids, we'll switch back the HMO.


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