Health Insurance for a thru hike

[saralynne1982]

Hi All!
Trying to budget for my thru hike in 2015 and looking at what I need to do for health insurance. What are the rest of you doing? To give some context I am currently a nonprofit administrator who will be taking a sabbatical and 32 yo. I am not sure what I am and am not eligible for with the new healthcare laws and where I should begin looking. Any ideas or assistance you can give?

Thanks!

[Dogwood]

I want to hear this. I'm totally bewildered with the same question as it applies to myself.

[2015 Lady Thru-Hiker]

Thanks for asking the question first saralynne. One of the things I've starting thinking about as well. How would Cobra fit into the this? Also wondering about "trip insurance". I know one of the docs I worked with had it for a hike he took in the Himalayans and it turned out to be a good thing. They ended up having to helicopter him out when he fell and dislocated his artificial hip.

[rocketsocks]

Hi All!
Trying to budget for my thru hike in 2015 and looking at what I need to do for health insurance. What are the rest of you doing? To give some context I am currently a nonprofit administrator who will be taking a sabbatical and 32 yo. I am not sure what I am and am not eligible for with the new healthcare laws and where I should begin looking. Any ideas or assistance you can give?

Thanks!

.....apparently neither are the founders, your not alone. I'd check with your health care provider though, as it seems these things are constantly changing. Fortunately I don't have to do this just yet (affordable health care act) and still have a policy in place, but that may change in the future, and I'll be asking the same question...good luck with it, do let us know what ya find out.

[rocketsocks]

.....apparently neither are the founders, your not alone. I'd check with your health care provider though, as it seems these things are constantly changing. Fortunately I don't have to do this just yet (affordable health care act) and still have a policy in place, but that may change in the future, and I'll be asking the same question...good luck with it, do let us know what ya find out.

I'm sorry I thought for some reason you had health care now...I see though you don't mention that, so I gotta assume you don't. In that case, good luck, you know as much as I about navigating the site then. Save your money though, I sounds as though it won't be cheap with the deductibles, and some changes go into effect next year I believe, then again the following year. I'm not a fan of this...sorry/not sorry but that's the way I feel about it.

[Just Bill]

Trip insurance- not for a hike.

Cobra- allows continued coverage in the event of a termination. You simply take over payments from your current employer so the existing policy can continue.

Affordable Care Act- Many benefits- buying non-group, personal insurance was very difficult previously. No pre-existing conditions issues any more, and you have access to the same plans offered to regular employer groups. Politics aside- from an average Joe, individual it's a very good deal. You can make arguments from the other side- but buying individual insurance is way easier and cheaper. HMO's were once the end of the world too- now they are standard practice.

Assuming you have decent health- you will pay out of pocket anyway with any standard deductible plans at a reasonable monthly premium. Roughly a 2500-5000 deductible. So unless you have a medical condition and plan to visit a physician often, it makes little sense to pay for a higher level of coverage as that could easily cost you $500 per month extra. So basically you are better off buying a "catastrophic" coverage plan. A high deductible, low monthly premium plan.

Assuming a regular hike- you'll pay out of pocket anyway for a doc visit or basic meds even with a mid level plan. An ER visit will still cost you $500 or so. So say you- contract Lyme, see a doc, need a script and fill it. You'll spend $250 to see the doc and $50 to fill the script. Maybe you break your toe and need an ER visit. $500 for the ER, $500 for Xrays. So you dropped $1300 in medical expenses.

You could easily pay $500 per month OVER a standard catastrophic coverage plan with a high deductible. Or- $1300 divided by six=$215 per month versus $500. So you could put $3000 in the bank ($500/mo x 6 months) and cover your out of pocket costs and save money instead of buying "full coverage". Add insult to injury- you haven't met your deductible anyway yet- so you will still pay the $1300 on top of your higher premium. You would actually pay $4300 on this hike over the cost of a cheap plan.

I am unsure what individual premiums are now, but around $250 per month sounds right. This covers you for major stuff only. I was paying $465 per month for basic $5000 deductible 80/20 coverage prior to taking my current job. This was for me, wife, and son. Prior to "Obamacare", I paid $567 and had no maternity coverage. (It was considered a pre-existing condition more or less under the old rules)

My current employer pays roughly $1200 per month, I pay an additional $160 (pretax) plus my employer set aside $4100 in an HSA account. This is for "Gold" level coverage, 100% coverage after $5000 deductible. I only pay $900 though as a result of the HSA (plus my monthly premium) However, as I was expecting a child- this was a sound investment/choice. I paid $900 plus $1920 (160x12) to receive 100% versus 80/20 coverage. A $10k labor and delivery bill would have cost 2k (20%) even if my deductible was met with 80/20 coverage. After this year, I will drop back to regular 80/20 coverage (silver) with a 5k deductible and no monthly payment. If everyone in my family sees the doc once at $250 each- it is still cheaper than the $1920 additional I pay now.

Jump on the website though, get a quote for bottom of the barrel coverage and price it out.
Depending on your income, you may qualify for subsidies as well.
https://www.healthcare.gov/

In my personal experience both self employed and with employers- you are better off pocketing the premium difference and paying for the few issues that arise than trying to buy full or even mid level coverage if you don't expect issues. Even a true disaster- bad fall, broken leg & multiple injuries may not eat up your $5k deductible. You could easily pay $1,000 per month extra for the "best" coverage. I would rather put the 12k in the bank and cover the costs out of pocket than give it away if nothing does happen. Even an 80/20 plan "caps out" at say 20k out of pocket.

On the plus side, having insurance coverage means the insurer will get you the negotiated rate even if you are responsible for the bill.

Very long story short-
Put money in the bank and buy the cheapest coverage you can get if you are concerned, have a family, or are over 40.
If you are healthy, unlikely to suddenly develop a serious long term issue, and hiking- you may be best off simply putting your money in the bank and self insuring (paying out of pocket period with no backup)

As an aside- you can also speak to physicians or providers about the "cash" price. While you won't have this talk with the ER nurse, if you are stopping in a clinic for some antibiotics in a trail town, or even for an x-ray- it does exist. Paying cash means the cost will not go towards your deductible- but from a real life cash-flow standpoint- you will likely save money.

FWIW- I have been a plan administrator, self employed, and self insured person. I don't know all the ins and outs of the new plans by any means- I am more educated on the topic than your average bear- but take all this advice with a grain of salt and do your own homework. I found if you look at your coverage from a cashflow/annual cost rather than a monthly premium- cash in hand is typically the better choice for most. It is very confusing- even most plan administrators don't have answers.

You can also use an insurance broker now (much like car insurance) to assist you in your purchase, my auto, home, life, and health insurance were all sold to me via the same guy.

[rocketsocks]

JB I for one appreciate you breaking that down like that, very helpful indeed. I really do want all to have coverage, and the best part of the bill is the pre-existing condition clause...I just hope most can afford to pay, time will tell. I've already had one doctor drop out of the insurance game all together, and another say "if it comes to that I'll just go do something else" meaning quit practicing. Many boutique doctors have popped up in my area, and someone close to me, her Doctor wants $5,000 up front as a retainer...(she's been seeing him for years and years) and then $275.00 a visit...most won't be able to afford this. Again, I do appreciate your time to break that down.

[Just Bill]

That was easy- 35 Year old male-
Worst Plan-146/mo- 6k deductible- annual cost if nothing happens- $1752
Premium plan 438/mo- 1000 deductible/1500 max- annual cost if nothing happens- $5256

Worst plan- worst case- out of pocket max- $12,700+1752
Premium plan- worst case- out of pocket max- 1500+5256

scenario above- 1300 in expenses during a hike-
Worst Plan-1300 + 1752=3052 (annual)
Premium Plan- $1300 + 5256=6556

Diffence in annual premium- (5256-1752)=3504
Almost exactly what you need, in cash, to cover your costs for the worst plan in a typical scenario.
More importantly- if nothing happens- enough money to hike another trail or two.

If you have a catastrophic event-your 15k out of pocket costs with the worst plan will likely be the least of your problems.

Cue Colin Fletcher quote-

But if you judge safety to be the paramount consideration in life you should never, under any circumstances, go on long hikes alone. Don’t take short hikes alone, either – or, for that matter, go anywhere alone. And avoid at all costs such foolhardy activities as driving, falling in love, or inhaling air that is almost certainly riddled with deadly germs. Wear wool next to the skin. Insure every good and chattel you possess against every conceivable contingency the future might bring, even if the premiums half-cripple the present. Never cross an intersection against a red light, even when you can see all roads are clear for miles. And never, of course, explore the guts of an idea that seems as if it might threaten one of your more cherished beliefs. In your wisdom you will probably live to be a ripe old age. But you may discover, just before you die, that you have been dead for a long, long time.

[Just Bill]

JB I for one appreciate you breaking that down like that, very helpful indeed. I really do want all to have coverage, and the best part of the bill is the pre-existing condition clause...I just hope most can afford to pay, time will tell. I've already had one doctor drop out of the insurance game all together, and another say "if it comes to that I'll just go do something else" meaning quit practicing. Many boutique doctors have popped up in my area, and someone close to me, her Doctor wants $5,000 up front as a retainer...(she's been seeing him for years and years) and then $275.00 a visit...most won't be able to afford this. Again, I do appreciate your time to break that down.

Different problem.
Individually pretty good.
Employers and independent doc's- pretty up in the air.
Specialists- have always been tricky...

Going to be messy for awhile for sure. For hikers, or self-employed- It's pretty sweet.

[rocketsocks]

That was easy- 35 Year old male-
Worst Plan-146/mo- 6k deductible- annual cost if nothing happens- $1752
Premium plan 438/mo- 1000 deductible/1500 max- annual cost if nothing happens- $5256

Worst plan- worst case- out of pocket max- $12,700+1752
Premium plan- worst case- out of pocket max- 1500+5256

scenario above- 1300 in expenses during a hike-
Worst Plan-1300 + 1752=3052 (annual)
Premium Plan- $1300 + 5256=6556

Diffence in annual premium- (5256-1752)=3504
Almost exactly what you need, in cash, to cover your costs for the worst plan in a typical scenario.
More importantly- if nothing happens- enough money to hike another trail or two.

If you have a catastrophic event-your 15k out of pocket costs with the worst plan will likely be the least of your problems.

Cue Colin Fletcher quote-

But if you judge safety to be the paramount consideration in life you should never, under any circumstances, go on long hikes alone. Don’t take short hikes alone, either – or, for that matter, go anywhere alone. And avoid at all costs such foolhardy activities as driving, falling in love, or inhaling air that is almost certainly riddled with deadly germs. Wear wool next to the skin. Insure every good and chattel you possess against every conceivable contingency the future might bring, even if the premiums half-cripple the present. Never cross an intersection against a red light, even when you can see all roads are clear for miles. And never, of course, explore the guts of an idea that seems as if it might threaten one of your more cherished beliefs. In your wisdom you will probably live to be a ripe old age. But you may discover, just before you die, that you have been dead for a long, long time.

Brilliant!

[rocketsocks]

Brilliant!

Sorry that's the best I can do at 1:30 in the mornin' gettin' ready to shut this operation down.

[sympathetic joy]

Check out World Nomads:

http://www.worldnomads.com/


They are geared for international travel but domestic travel health insurance is possible. A 6 month policy is $335. They do have a rule for domestic travel that it only covers you if you're more than 100 miles from 'your' home.

http://www.worldnomads.com/travel-in...px?Country=USA

You should call or write them with any questions. I used them for a 1 month policy when I was traveling overseas. Luckily I didn't have to use the policy. Hiking is one of the covered activities for USA residents under their standard plan.

http://www.worldnomads.com/travel-in...insurance.aspx

[saralynne1982]

Thanks everyone-I will start doing some research and see what I find! I'll report anything good back to the group

[meat803]

Health insurance is a scam. Live healthy and save your money. If you live debt free, live within your means, and save money, you will have more than enough cash to cover any medical costs you incur. That is of course if you eat right and maintain a healthy lifestyle. As a member of this site you are probably healthier than 90% of Americans. I refuse to share a policy with those slobs. I agree with a lot JustBill said in his first post.

[Not Sunshine]

Disagree: live healthy and you won't need health insurance.

Believing that NOTHING could ever happen to you is completely ignorant. Accidents happen. Slip on ice - ankle fracture. Catch one wrong groove skiing - ACL tear. Trip over your dog's leash - wrist fracture. Believing that insurance is a "scam" and nothing medically could ever happen to you is absolutely irresponsible. (which - let me tell you from experience, ACL injuries are not planned events) If you're hurt without insurance, you'd better have $10,000 in a bank account to pay for your surgery/doctors bills if you expect you'll be repaired. Or expect to be told you'll have to wait months for charity care - if you get approved [you don't get charity care if you actually MAKE any money or OWN anything of value - because it's expected of adults in society today to take care of themselves].

I applaud those users on this site who TAKE RESPONSIBILITY FOR THEMSELVES (most of you do). I do not agree with those who believe society "owes" them a free ride and then turn around and complain they have to wait 4 months to see a specialist when they don't fork over a DIME [the entitled's]

I digress.

When I tore my ACL, my knee was so unstable, I could not bear ANY weight on it. I was totally handicapped. I had surgery and 6 months of physical therapy - today I am pain free and just completed my first triathalon pain free and am planning a section hike of the smokies. I am an absolute SUCCESS story and it only cost me $3,000.

I don't take any daily medications - I eat healthy and exercise regularly. I opted for a cheaper-up-front High Deductible plan and was eligible for a tax-deferred Health Savings Account - money put in my "HSA" is not only tax deductible but never expires or gets taken away from me - it EVEN earns interest.

The money I saved on lower monthly premiums (high deductibles have lower monthly premiums) I put into that HSA so that if I GOT injured or sick, I would have money put aside JUST FOR HEALTHCARE bills - which was totally TAX DEDUCTIBLE - to cover my higher deductible cost.

Plus, if I did have prescriptions, I get a discount on those costs through my insurance company...as well as doctors visits as long as I stay in-network. My recent visit to a specialist (new patient, endocrine) was $98. No $50 or $100 copay. $98 was the total cost of the visit.

In my opinion: the high deductible plan is the way to go if you (1) don't take medications daily and (2) don't run to the ER/private doctor for every stubbed toe and runny nose. [and I don't mean to offend anyone who takes daily medications and whose provider needs to see them every 3-6 months for refills].

If I were thru-hiking, I would hope for NO visits to the ER/urgent care...and save money on that high monthly premium. I would INVEST that saved money in an HSA just in case I were to get hurt. Because if you DO get hurt while attempting a thru-hike, you'd better have enough in savings to cover the deductible - you're hurt: you probably won't be able to find a job in your hurt state.

In reality - if you find ways to get GOOD nutrition into any section/thru hike - you'll be healthier walking all day in the woods than you would be sitting in front of a computer all day. I'm hoping I can attempt when I'm retired. Hopefully I'll be in my early 60s.

[perrymk]

JustBill - Thanks for a great breakdown, the kind of thing I need to see to break down costs. You saved me some time.
sympathetic joy - thanks for the insurance source. I was wondering if such services existed. I figured they had to, but one never knows,

For my two cents, veterans can apply for VA healthcare. The last I read on the VA website is that it meets the ACA (Obamacare) requirements. Eligibility rules changed a few years ago. Now it pretty much reads either you have a service related dsiability or are destitute. Either one means full, free medical care even for non-service related issues. Despite recent news reports, most VA facilites provide reasonable care and the ones in my area typically get high marks.

As for myself, when I got out of the service I just assumed the VA was for service related issues and as I left healthy, I had no need so didn't apply. Part of me thinks I did the right thing regardless (I wouldn't want to take an appointment from someone more deserving, that is, with a service related issue), but part of me would rather not have to fork over the cash when the time comes. Fortunately, while I do not qualifiy according to most definitions as a wealthy man, I am employed with medical insurance and doing reasonably well both financially and healthwise.

To any recently discharged veterans, now is the best time to apply. You don't have to use it but it is a nice backup plan. Don't wait until you find a job that provides healthcare and are then ineligible.

[Alligator]

Health insurance is a scam. Live healthy and save your money. If you live debt free, live within your means, and save money, you will have more than enough cash to cover any medical costs you incur. That is of course if you eat right and maintain a healthy lifestyle. As a member of this site you are probably healthier than 90% of Americans. I refuse to share a policy with those slobs. I agree with a lot JustBill said in his first post.

I eat healthy and exercise regularly and have done so for a most of my life. I also have a $250,000 heart. That was just to fix it, does not include a couple hospitalizations to resynch it. Plus back and rotator cuff surgery. My wife's medication runs about $10,000 a year. She exercises less but still eats well. We were both covered before diagnoses. To think you will not need it by eating right and exercising is not accurate. Nor should you think you will be able to amass the needed $ prior to an illness. You may be struck young or even during your prime earning years.

I do not know the ins and outs of the current health care laws but I would recommend having some plan that would cover catastrophic illnesses.

[meat803]

I eat healthy and exercise regularly and have done so for a most of my life. I also have a $250,000 heart. That was just to fix it, does not include a couple hospitalizations to resynch it. Plus back and rotator cuff surgery. My wife's medication runs about $10,000 a year. She exercises less but still eats well. We were both covered before diagnoses. To think you will not need it by eating right and exercising is not accurate. Nor should you think you will be able to amass the needed $ prior to an illness. You may be struck young or even during your prime earning years.

I do not know the ins and outs of the current health care laws but I would recommend having some plan that would cover catastrophic illnesses.

Do the insurance companies run a charity or did they have to charge far more than your expenses to cover your costs, their operating costs, and 13 billion in profits? Sometimes yes as an individual you can come out the winner. Much like the Lottery. But as a whole, you are more likely to pay much more into a system then you will ever get out. As a overall healthy individual you are most likely going to be fitting the bill for someone that does not take care of themselves. Head up to walmart and look around. These are the slugs you are "sharing" coverage with.

If you want insurance then by all means go for it. But on a logical level, the system takes in more in premiums than it ever pays out by design. This is a fact that you cannot argue. When I accepted this fact, I decided to no longer participate as I know I can invest/save my money in a manner that will provide for my own needs. Most people live paycheck to paycheck and cannot handle this responsibility.

Someone once told me that in ancient China you only paid your doctor if you were healthy. When you got sick, he had to treat you for free. It was in his interest for you to not be sick. Today the exact opposite is true. I have found they prefer to treat your condition with expensive drugs and procedures, rather that find the root and cure it. They have a vested interest to support that business model. Get heart disease and the doctor may briefly mention exercise and diet. But more importantly he will prescribe some drug that will supposedly fix what ails you. The drug may help, but side effects and altering your body chemistry can cause numerous other problems that they will have to address. And the cycle continues.

One more thing I would like to add is that cash paying customers get huge discounts on medical bills vs those that pay with insurance. I recently took my son in for immunizations and they quoted me 360$ at the end. I informed them I was paying cash and then they said oh, then it is 180.

[Just Bill]

That was easy- 35 Year old male-
Worst Plan-146/mo- 6k deductible- annual cost if nothing happens- $1752

Worst plan- worst case- out of pocket max- $12,700+1752

Diffence in annual premium- (5256-1752)=3504

Regardless of politics, the business of health care, or the speculation. The whole point of insurance is that you do not KNOW what life will bring. You can gamble in either direction.
I'm more one to hedge my bets, and regarding money- cash is king.

The numbers above are what matter to most, relatively healthy, young and even middle aged folks.

Take this example longer term-
Bottom of the barrel plan costs you $1752 annually.
You save $3504 per year making this choice.
Whether you take tax advantage with a self funded HSA or have enough discipline to set your own aside...

Your bottom of the barrel plan has a max annual out of pocket of 12,700 plus premiums.
$12700/3504= 3.62. As in, after 3.62 years- or the fourth year- you have saved enough in premium difference to fund the 12,700 dollars needed in a catastrophic health event.

If you self funded- you would be putting in 1752 a year since you bought no plan.
Assume a catastrophic event occurs costing $25,000. It would take 14.26 years of absolutely nothing happening for you to self fund this incident.
If you saw a Doc once a year, at $150 per visit- it would now take you (25k/(1752-150) 15.6 years to save enough. Roughly from age 25 to age 40.

Some level of coverage makes sense to avoid financial ruin in the event of something serious.
Bottom of the barrel- return on savings means you effectively have the best coverage available within 4 years time. And continue to save on cheaper premiums.
The best coverage available means you will likely loose money and fund the pool.
No coverage is unrealistic, and akin to gambling with your money IMO. Perhaps under age 30-35 you could make the argument, after that- you are playing a loosing hand.

[Just Bill]

One more thing I would like to add is that cash paying customers get huge discounts on medical bills vs those that pay with insurance. I recently took my son in for immunizations and they quoted me 360$ at the end. I informed them I was paying cash and then they said oh, then it is 180.

In actuality- you did not receive a cash price. You received the negotiated rate.
Not picking on you- just passing on info.

A doc bill the insurance $360, $500, $1000- whatever really. In actuality they know the insurance company pays $180. Period.
This silly game they play costs us all money. Simply billing the published/negotiated rate would save us all headaches and money.

Offering to pay cash, typically gets you the negotiated rate.
Because of liability insurance, and actual CASH, as in off the books, transaction is increasingly rare. That would have been $75-$150.
However, if you come back and sue/complain/etc. Since the provider took cash and did not put the transaction on the books they would not be covered by their liability insurance.

True cash prices are more likely to be found at a small clinic when passing through, where the Doc actually owns the office and is willing to make the judgement call. Something simple like you come in with an infected blister and need a script for anti-biotic.