Coming late to this party, and having dealt with a deadline for Cobra
conversion by gritting our teeth, grimacing and signing up, we have
another avenue to explore.

A full-time cruiser, just arrived in our boatyard where we're not quite
left yet, but at least, in the water, published writer in Latts/Atts,
Lat38 and others, sez he doesn't do health insurance, even in his
relatively high risk years before cruising.

Several reasons, all amounting to "wherever you are, they have to take
care of you" plus whatever the cost adjustments/free you can negotiate
on top of the international differences in the medical care costs as
compared to the US.

He cited several large medical expenses he'd incurred in the past
several years, and the total expense was way smaller than he'd have
paid in premiums.

I believe I recall reading in this forum of some who had gone bare and
even cancer wound up being substantially less than the premiums in a
relatively short period.

What prompts this discussion, since we'd originally planned on going
bare, was my stress test producing 3 stents and a lifetime of Lipitor,
as well as a totally benign breast biopsy for Lydia this past year,
just before we left our coverage under her employer. Thus, we modified
our belief in what was appropriate about our insurance situation.

So, after dithering, and looking into all we could find about
international (we anticipate, even if we base in St. Thomas, being out
of the US and territories for more than 6 months a year) insurance, all
of which would have required a minimum 2 year moratorium (and maybe
forever) on our pre-existing conditions, we bit the bullet and signed
on to Cobra.

However, that represents about 1/3 of the income we anticipated living
on (an additional, unexpected, cost), so it was a real struggle.
Worse, even if we wanted to keep it, our maximum time available on that
is only 18 months. I'll not be eligible for medicare for a couple of
years post-Cobra, in any event, so even if we run out the string, we're
faced with doing something for a couple of years, regardless.

Back to the original - who's done it bare, and what's been the
experience with medical necessity (it's of no value to hear of all the
folks who have self-paid for normal doctor/prescription costs; the
issue is about major care) over time?

Thanks.

L8R

Skip and Lydia

"Skip Gundlach" wrote in
ps.com:

who's done it bare

I have!.....er, ah.....but I don't think that's gonna make me any
healthier...(c;

No, I don't wanna "sail naked", either. They laugh quite enough as it
is....

Hiya, and thanks for the commentary.
Dave wrote:
On 21 Oct 2006 13:20:23 -0700, "Skip Gundlach"
said:

However, that represents about 1/3 of the income we anticipated living
on

Have you considered a high deductible policy plus saving for routine care?
What is today called health "insurance" is too often simply prepayment of
expenses you know you'll incur, with a sizeable profit to the "insurance"
company for handling the money. True insurance should cover the catastrophic
loss but not the routine costs.

You message brings to mind Blanche's famous line in Streetcar: "I've always
depended on the kindness of strangers."

We have, too - but that's another entire thread! - and go out of our
way to be "strangers" as well.

We're now looking into "medical savings accounts" as a tax-sheltered
(not that we have a shelter problem - but every bit helps!) solution,
next, but...

We've found - at least in the admittedly hurried and limited looking
we've done - that the premium savings doesn't nearly match the
deductible outlay, particularly as you get into the higher
deductibles. If you NEVER have a covered event, a high deductible will
save you the difference in premiums. However, I've been in the
hospital or under the knife entirely too frequently of late, after more
than 50 years of never seeing a doctor other than to qualify for life
insurance.

For the last few months that we'll have it, our automotive has had, for
the last many years, a zero-deductible comprehensive policy, and a
relatively high collision policy coverage. That's because, in the case
of the comprehensive, it doesn't allow me to control the circumstances.
Thus a tree limb falling on my car, a rock hitting the windshield,
some nut keying the side (all of which have happened to me, and the
windshield, several times) weren't something I could avoid. I can
control how I drive, or if I'm careless or stupid enough to cause
damage, own up to my responsibility and cough it up. I calculated the
premium difference in Comp, for the various deductibles, on how long it
would take me to recover the cost of a windshield (very cheap in car
repair terms) by a reduction in premiums. I couldn't make it
comfortable - even the least expensive would have taken me something
like 7 years - so went with full coverage. Before I sell it (just
before we leave), I'll have the latest windshield replacement...

Back to health care, though, pre-existing conditions are rightly
excluded in new policies, other than a group which, of course, will
evaluate the members before quoting. In our case, had we not had
coverage, in this past year, we'd have had to come up with (assuming we
were able to negotiate the same amounts paid by BCBS, not a given at
all) over 40K- but if forced to pay the billed amounts, over 200K.
(The year before that was similar, because one of my surgeries had an
infection that put me in the hospital for a week, and the follow-on
meds were over 30K while I stuck them up my arm in the PICC
unassisted.) That also assumes that we'd have gone in for the testing
which prompted my angioplasty and stents, and her biopsy which, alone,
would have represented several thousand out of pocket.

But, now, we've got ongoing medication which is an OOP of 300 a month,
not covered in any policy we found (Cobra reduces it to 100). Granted
that this will drop in any other than the US. And, should I actually
*have* a "heart event" (no symptoms, ever, before and after - the
testing I forced was male-relative/geneology driven; good thing, too,
cuz I was a heart attack waiting to happen), the OOP are likely to be
pretty high, or me dead, or both.

Not taking the meds would bring me back to the previously high-risk
status eventually, I expect. So, one of the evaluations we did was
going bare but making sure we bought the meds. However, in a cat
policy, we'd have to buy them anyway. Those costs would bring even the
cheapest cat policy close to our Cobra - and we'd not be covered to the
pre-existing conditions.

As the *only* reason we'd have insurance is those PEC, we bit the
bullet, for now. We expected to go bare - and may, in the term between
the Cobra and Medicare coverage. However, I don't know how M treats
international stuff - is it just covered in the US? Can't imagine it
would be, but I just don't know, having not even looked at that since I
can't affect it, and it's so cheap that unless it doesn't cover
anything outside, I'd buy it anyway.

Back to the particular response, it would be a good topic to spin off
(don't hijack this thread) to discuss cat policies' experience, as it's
another option I'm sure many have considered and/or done. I'm still
leaning toward going bare, but haven't enough experience with these
stents to know what I think about the advisability of that course.
Even if we keep the Cobra, it will expire in ~16 months, so we'll have
to face that question then if we've not first resolved it.

So, back to the question: Who's done it bare (or maybe with a
ridiculously cheap, ridiculously high deductible, policy equating to
bare until 25K OOP or something similar), and what have been the
experiences?

Thanks.

L8R

Skip and Lydia

Medical bills are often cheaper if You don't have insurance. They usually
jack up the bill if You have insurance because they know the insurance
companies will negotiate a reduced amount. I say screw the capitalists and
go it bare cause chances are the insurance company will try to wiggle out of
paying for a claim no matter how high your premiums are. To me insurance is
a big ripoff brought about by greedy capitalists and there high priced over
paid lawyers. so stick them with the bill by going bare
"Skip Gundlach" wrote in message
oups.com...
Hiya, and thanks for the commentary.
Dave wrote:
On 21 Oct 2006 13:20:23 -0700, "Skip Gundlach"
said:

However, that represents about 1/3 of the income we anticipated living
on

Have you considered a high deductible policy plus saving for routine
care?
What is today called health "insurance" is too often simply prepayment of
expenses you know you'll incur, with a sizeable profit to the "insurance"
company for handling the money. True insurance should cover the
catastrophic
loss but not the routine costs.

You message brings to mind Blanche's famous line in Streetcar: "I've
always
depended on the kindness of strangers."

We have, too - but that's another entire thread! - and go out of our
way to be "strangers" as well.

We're now looking into "medical savings accounts" as a tax-sheltered
(not that we have a shelter problem - but every bit helps!) solution,
next, but...

We've found - at least in the admittedly hurried and limited looking
we've done - that the premium savings doesn't nearly match the
deductible outlay, particularly as you get into the higher
deductibles. If you NEVER have a covered event, a high deductible will
save you the difference in premiums. However, I've been in the
hospital or under the knife entirely too frequently of late, after more
than 50 years of never seeing a doctor other than to qualify for life
insurance.

For the last few months that we'll have it, our automotive has had, for
the last many years, a zero-deductible comprehensive policy, and a
relatively high collision policy coverage. That's because, in the case
of the comprehensive, it doesn't allow me to control the circumstances.
Thus a tree limb falling on my car, a rock hitting the windshield,
some nut keying the side (all of which have happened to me, and the
windshield, several times) weren't something I could avoid. I can
control how I drive, or if I'm careless or stupid enough to cause
damage, own up to my responsibility and cough it up. I calculated the
premium difference in Comp, for the various deductibles, on how long it
would take me to recover the cost of a windshield (very cheap in car
repair terms) by a reduction in premiums. I couldn't make it
comfortable - even the least expensive would have taken me something
like 7 years - so went with full coverage. Before I sell it (just
before we leave), I'll have the latest windshield replacement...

Back to health care, though, pre-existing conditions are rightly
excluded in new policies, other than a group which, of course, will
evaluate the members before quoting. In our case, had we not had
coverage, in this past year, we'd have had to come up with (assuming we
were able to negotiate the same amounts paid by BCBS, not a given at
all) over 40K- but if forced to pay the billed amounts, over 200K.
(The year before that was similar, because one of my surgeries had an
infection that put me in the hospital for a week, and the follow-on
meds were over 30K while I stuck them up my arm in the PICC
unassisted.) That also assumes that we'd have gone in for the testing
which prompted my angioplasty and stents, and her biopsy which, alone,
would have represented several thousand out of pocket.

But, now, we've got ongoing medication which is an OOP of 300 a month,
not covered in any policy we found (Cobra reduces it to 100). Granted
that this will drop in any other than the US. And, should I actually
*have* a "heart event" (no symptoms, ever, before and after - the
testing I forced was male-relative/geneology driven; good thing, too,
cuz I was a heart attack waiting to happen), the OOP are likely to be
pretty high, or me dead, or both.

Not taking the meds would bring me back to the previously high-risk
status eventually, I expect. So, one of the evaluations we did was
going bare but making sure we bought the meds. However, in a cat
policy, we'd have to buy them anyway. Those costs would bring even the
cheapest cat policy close to our Cobra - and we'd not be covered to the
pre-existing conditions.

As the *only* reason we'd have insurance is those PEC, we bit the
bullet, for now. We expected to go bare - and may, in the term between
the Cobra and Medicare coverage. However, I don't know how M treats
international stuff - is it just covered in the US? Can't imagine it
would be, but I just don't know, having not even looked at that since I
can't affect it, and it's so cheap that unless it doesn't cover
anything outside, I'd buy it anyway.

Back to the particular response, it would be a good topic to spin off
(don't hijack this thread) to discuss cat policies' experience, as it's
another option I'm sure many have considered and/or done. I'm still
leaning toward going bare, but haven't enough experience with these
stents to know what I think about the advisability of that course.
Even if we keep the Cobra, it will expire in ~16 months, so we'll have
to face that question then if we've not first resolved it.

So, back to the question: Who's done it bare (or maybe with a
ridiculously cheap, ridiculously high deductible, policy equating to
bare until 25K OOP or something similar), and what have been the
experiences?

Thanks.

L8R

Skip and Lydia

Chi Chi wrote:
Medical bills are often cheaper if You don't have insurance.

Can you substantiate this assertion with
data or is your conviction based solely
on a priori analysis?

Take a look at this, for example.

They usually
http://www.cbsnews.com/stories/2006/...n1362808.shtml
Hospitals: Is the Price Right?, A Look
At Hospital Pricing For The Uninsured -
CBS News



jack up the bill if You have insurance because they know the insurance
companies will negotiate a reduced amount. I say screw the capitalists and
go it bare cause chances are the insurance company will try to wiggle out of
paying for a claim no matter how high your premiums are. To me insurance is
a big ripoff brought about by greedy capitalists and there high priced over
paid lawyers. so stick them with the bill by going b

it's been my own experience that I'm using. In reading the link you provided
I noticed it said what insurance companies end up paying, that's because
they negotiate and usually will only pay what is reasonable and customary so
in the end You end up being charged the difference from what the bill is and
what the insurance company actually pays.
"chuck" wrote in message
...
Chi Chi wrote:
Medical bills are often cheaper if You don't have insurance.

Can you substantiate this assertion with data or is your conviction based
solely on a priori analysis?

Take a look at this, for example.

They usually
http://www.cbsnews.com/stories/2006/...n1362808.shtml
Hospitals: Is the Price Right?, A Look At Hospital Pricing For The
Uninsured - CBS News



jack up the bill if You have insurance because they know the insurance
companies will negotiate a reduced amount. I say screw the capitalists
and go it bare cause chances are the insurance company will try to wiggle
out of paying for a claim no matter how high your premiums are. To me
insurance is a big ripoff brought about by greedy capitalists and there
high priced over paid lawyers. so stick them with the bill by going b

Hi Skip,

FWIW, based on our experience during our just completed 2 year trip
around the Pacific, and numerous cockpit conversations, I'd say that
over half of the cruisers out there are going without medical insurance
of any kind. That doesn't mean that it is the smart thing to do, just
that it's what people (ourselves included) seem to be doing.

In our case, other than some dental work done in Mexico (far cheaper
than in the US) and purchasing my blood pressure meds (all over the
counter stuff just about everywhere we went, but I need prescriptions
now that I'm back in the US), we got away with it. Everyone has to make
their own decision, but when I look at the cost of the insurance, the
costs that could have been involved if something serious had come up and
the likelihood of it happening, I think that we made the right choice
for us.

One thing that has to be considered is that in these near-third world
countries, the level of care that can be had in the States isn't
available, but what is available is much less expensive.

In the end, as with all things, ya rolls the dice and you takes yer chances.

Nice to chat with you again -Dan

"If you get sick they gotta pay for it" A reply from a true idiot.

You really need some form of health insurance that'll cover you in the event
of a serious injury or illness. The "They gotta pay for it" in most cases
though is true, providing you enjoy health care at it's very minimum.
Well, we all have to die sometime. The "They gotta pay for it" gentleman
will just go a little sooner and in a bit more pain than the rest of us.

Then again there is always the option of just not going. Stay someplace,
get a job and get insurance. You can still enjoy life. Its hard to sail
when your extremely sick or dieing.

Good luck.

Cap'n Ric

Hi Skip,

Skip Gundlach wrote:


Back to health care, though, pre-existing conditions are rightly
excluded in new policies, other than a group which, of course, will
evaluate the members before quoting.

Pre-existing conditions are not excluded in COBRA coverage. Also part
of the COBRA legislation is a requirement for all insurers who sell
health insurance, in any market of interest, must also offer a
"Portability" plan. These plans offer variable deductibles and
coverages, like most plans, but are not allowed to exclude any
pre-existing conditions. They are more expensive - naturally - but if
you can't make through underwriting (quite likely in your case - I can't
either, and have no heart issues) this is your one sure-fire option.
You can only get these plans after COBRA coverage is exhausted, and you
have a limited time in which to purchase (63 days IIRC).

In our case, had we not had
coverage, in this past year, we'd have had to come up with (assuming we
were able to negotiate the same amounts paid by BCBS, not a given at
all) over 40K- but if forced to pay the billed amounts, over 200K.

We have portability coverage through BCBS, in Arizona, and it's $17K for
both of use (we're both 50) with a $5K deductible each, and a max out of
pocket of $9K each. It's also a PPO plan, with prescription coverage, so
preventive medical is quite reasonable - even if the premiums aren't :-)

Back to the particular response, it would be a good topic to spin off
(don't hijack this thread) to discuss cat policies' experience, as it's
another option I'm sure many have considered and/or done. I'm still
leaning toward going bare, but haven't enough experience with these
stents to know what I think about the advisability of that course.
Even if we keep the Cobra, it will expire in ~16 months, so we'll have
to face that question then if we've not first resolved it.

So, back to the question: Who's done it bare (or maybe with a
ridiculously cheap, ridiculously high deductible, policy equating to
bare until 25K OOP or something similar), and what have been the
experiences?

I don't believe you'll find *anything* ridiculously cheap, irrespective
of the deductible amount. Certainly not in my experience. *Many* people
will "sell" you a health policy, and collect premiums from you, only to
deny you coverage once the policy goes into underwriting. BTDT ('course
the premiums are refunded - months later). I'd suggest you find a
policy you think meets your needs and risk level (while still on COBRA)
then apply for it. You may find, as I did, that anyone with any medical
history to speak of is uninsurable these days. As for the portability
plans, insurance companies won't even tell you they exist unless you
specifically ask for one - they don't want to sell policies to people
who may need them :-)

As for going bare; why would anyone else's experience matter?
Seriously, it's an individual gamble, based on individual risks, and
everyone's is different. Could you foot another $200K or $300K bill if
you had too? If so, then maybe that's a feasible way to go. Good luck
'n happy cruisin!

Keith Hughes

On Tue, 24 Oct 2006 15:11:29 GMT, "Chi Chi"
wrote:

it's been my own experience that I'm using. In reading the link you provided
I noticed it said what insurance companies end up paying, that's because
they negotiate and usually will only pay what is reasonable and customary so
in the end You end up being charged the difference from what the bill is and
what the insurance company actually pays.

I think you might be confused. The providers have their "list prices"
and in order to be in a network they will agree to discounts to those
prices to make sure they have large groups in their client base. If
you are not covered by one of the groups offered the discounts, you
are billed "list". Now some cannot pay it and often do not pay it at
the peril of their credit status, however, the providers do not offer
them lower prices, and certainly not lower than the discounted prices
offered to the groups.

My experience is one who managed a large, self insured operation
covered by the network discounts negotiated with the providers by a
TPA. If one or our covered employee's went "out of network", they
were billed at "list" by that provider and were responsible for the
difference. Exceptions being the abscence of an in network provider
for that service.

The suggestion of a high deductible/low premium policy and an HSA, is
I think, a better alternative to going bare. Even if you cannot fund
the HSA significantly, you do have catastrophic protection.

But then, I've never cruised extensively, so maybe bare works.

Frank



"chuck" wrote in message
...
Chi Chi wrote:
Medical bills are often cheaper if You don't have insurance.

Can you substantiate this assertion with data or is your conviction based
solely on a priori analysis?

Take a look at this, for example.

They usually
http://www.cbsnews.com/stories/2006/...n1362808.shtml
Hospitals: Is the Price Right?, A Look At Hospital Pricing For The
Uninsured - CBS News



jack up the bill if You have insurance because they know the insurance
companies will negotiate a reduced amount. I say screw the capitalists
and go it bare cause chances are the insurance company will try to wiggle
out of paying for a claim no matter how high your premiums are. To me
insurance is a big ripoff brought about by greedy capitalists and there
high priced over paid lawyers. so stick them with the bill by going b