Insurance scare question

Hello everyone

Well I just happened to purchase insurance and I never imagined how exceptionally expensive it is to have DT1, my question to all is what kind of insurance would you reccomend, I mean with the doctor visits and medications basically it almost leaves me with 000’s in my pocket, I would greatly appreciate any info, resources, anything that would help. Thanks in advance and God bless.

Kary, there are two parts to insurance the out of pocket cost and the premium. As a purchaser of insurance you must balance the parts. At one level, there is the cost of plan, always high. But the higher the premium the usually the less out of pocket. Ont he other the out of pocket cost can be extraordinarily high, thus you take more premium.

There is to blanket right choice. One has to decide their level of risk I am older (57) and I have love risk tolerance. So I would take a higher premium to assure much of costs will be covered. An example my medical bills this are about $1400,000 so I want to lay as much of that into insurance as I can thus my premium would be much higher than most.

A younger person with no medical issues woudl normally opt for a lower premium. My son for example has very medical costs, thus he has higher risk tolerance.

So that brings me to you. My suggestion is to look at your both your ability pay the premium but also your ability to pay the large cost of a medical issue. Not knowing your situation at all I suggest you compare two premiums. One for the policy with a 10,000 maximum out of pocket and the otehr for a $5,000 out of pocket. The first will be more expensive but you have the $10,000 risk. The second less but you still have a $5,000 out of pocket.

I cannot answer this question for you. Only you can do that. I also suggest you look at the various subsidies available for your income range. The Affordable Care Act (ACA) gives subsidies to many people who purchase health insurance and who have lover incomes.

Depending on your income you might also look at your State medicare pool. This is for lower income people and while it is not ideal it can cover many of costs, at a very low level of cost. All states are different, but if your income is less than $30,000 for a single person I suggest you look into medicare. In my state a single person would need an income of less than $18,500 in order to qualify for medicaid. But all states are different.

I hope this helps. Insurance is very expensive and it is incredibly important. i wish you the very best.


I think the program Rick is referencing is Medicaid, not Medicare. It's absolutely worth looking into. One other expense to look at is deductible. It is part of the total out-of-pocket expense but can be a very big block for people who don't have much savings on hand. You need to weigh all these options. Best of luck to you.

Ooops I am sorry it is Medicaid not Medicare. UUUGH giving advice and I named the wrong program. I apologize for the mistake.

Thank youfor the advice
@ rick the blogabetic and
@ michelle
Thats another thing I wanted to mention I am 27 yo and to my understanding mesicaid and medicare are for adults 65+ or am I wrong?, either way it is good to know what resources people have.

Every state is different...that's for sure!

In California what I know is you MUST go through Covered California's website if you qualify for ANY subsidies and you want them, but you MUST pay the insurance carrier directly (I set mine up for auto draft, but I check each month the make sure they've collected or else I think you can be dropped until the next enrollment period, ugh)!

Also, in California your choices and premiums and deductibles are different depending on which county you live in (if you move or plan to move, it's wise to ask about coverage & premiums in the next county beforehand).

I use my (utterly swamped) home owners health insurance agent, but you can use any insurance agent (they're all about the same...swamped to the gills! I rarely get them on the phone and usually only get emails (including my own home owners agent, unreal IMHO) I DROVE to his office a couple of times to get verbal answers, it's that bad and CC = Covered California's website is considered one of, if not the best, in the country (CC and ACA is just another layer of bureaucracy and all the agents dislike this and gripe, especially because they barely make a dime due to the lower commission they now get) it's tiring (for both sides and the Dr's, too).

I was advised and learned if you do NOT qualify for subsidies, it's best to avoid your states exchange (if you're lucky enough to live in a state with an exchange) otherwise I've heard it's the Federal route and that's reputed to be a BIG hassle.

I'm self employed, and there is a sweet spot for maximum subsidies (and btw I paid FULL price for MY insurance for YEARS, I didn't go to ER's and such for medical care and then hop on in to CC for ACA coverage). And I spent 100's of hours learning ACA & CC ropes for plans and subsidies (it's based on your MAGI = modified adjusted gross income, the amount you make after taxes) and I know exactly when to STOP earing one dollar over that, otherwise you land on Medi-Cal. I also applied for and was granted funds to cover 1000's of $'s for deductibles my CC ACA insurance didn't cover (most hospitals have funding for that, thankfully).

Back to the other side of this hassle-mare... Gee, Medi-Ca sounds sooo nice, unless you own a home or expect to come into an inheritance or expect a windfall. AS far as I know, currently in California there's a little tiny fine print part that is called something like "States Recovery" this means the gubbermint can TAKE full subsidy back from you if you sell your house or inherit or have a windfall. NOT gonna happen to me! I'll STOP earning income by choice if my MAGI comes even close to the "sweet spot" and just so you know this is still a free country, it is perfectly legal for me to STOP working if I want to and when I want to.

Don't get me wrong, ACA has helped me, but buyer beware!

Also, I haven't taken the time to learn if "states recovery" is or will be in effect, yet. I'm overwhelmed with a serious back injury in addition to being a newbie T2. I'm simply erring on the cautious side, until I sell my home and then maybe I'll allow myself to land on Medi-Cal (even though I think the care will not be as good as having REAL insurance, especially in my area bc we only have ONE Doctor and you're rarely gonna see the Doc...instead you get a fancy nurse practitioner).

IMHO If you can get decent coverage through your employer, I think that's often best (but again, check if it's decent coverage/insurance). I also have a new found deep appreciation and respect for my previous employer's HR Dept. insurance team! I miss that "team", a lot. I'm mentally and physically exhausted from navigating all of this alone. I learned this all in a hurry, from a hospital bed, on a tiny cell phone, and read endless blogs, online articles, comment sections, spoke to many health insurance agents, medical billing departments, other people in the same boat, tax preparers, and on and on, oh my...lots and lots of reading until my eyes were bleeding!

I may have missed some important points and I could write a book about it all so tall that it'd reach outer space, but I've forgotten more than I know about this CC ACA stuff. It also constantly changes, I always check my inbox from CC. I also make sure my income is steady so I don't fall in then out of REAL insurance and Medi-Cal, for the most part your income must be the same every month by 10% +/-. otherwise you'll spend hours on end calling CC to (beg them politely or they cop a rude nasty attitude and rule against you, trust me I know person I know well experienced that nightmare, uh!) and they rarely answer the phone, they do NOT have a "we'll call you back" feature (California DMV does! haha, can register a car easier than call CC to save your life, hopefully, some year, CC will pay for that feature)! arg! I recall one day (recently) when I did get through, waited for over an hour and they simply hung up! Shame on them.

You can adjust the amount of subsidy on CC and that should be closely monitored IMO.

In 2014 I was hospitalized three times, and I chose to see as many specialists as I could cram in in 2014. I may sell my house in 2015, so I'll either adjust my subsidies down in 2015 or take full amount and let the gubbermint collect the full amount of subsidy I don't qualify for if I sell my house for a capitol gain. But I know this, I WON'T be seeing many specialists in 2015 (if at all possible) just in case I sell my house for much of a gain.

It's sad, but I feel in 2014 it paid to NOT work as much as I would've liked to but why bother if the gubbermint is just going to take the amount over that "sweet spot" of MAGI. Hrmph!

This isn't a vent or a rant, it's an important warning and reminder of "Buyer Beware" post.

Here's to a better year in 2015 and maybe I can become a federal employee and pay a measly $100 a month for health insurance, lol! No Thanks! I'm hopeful I can recover enough to earn far more than the "sweet spot" and simply buy insurance off the rack and avoid CC altogether.

Good luck, to us all!