Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
As someone who has gamed the system (slightly), permit me a few observations:
- it's difficult, and if you're not good with arithmetic and probabilities, you're likely assuming a lot more risk than you think
- if you're very healthy (basically just getting periodic checkups), there's not much you can do to beat the system (no services to bunch together like bundling all your deductible expenses into one tax year when filing tax returns)
- even if you're making more extensive use of services, you need to have a good sense of the probability distribution of your service needs (how likely you are to need what services and in what amounts) and/or in need of services that are expensive and deferrable.
Back surgery is something that might fit that last description. Or minor stuff that, say, a dermatologist might deal with (though not something serious like melanoma).
Mostly, it's a matter of picking the right type of policy to best fit your expected use, which arguably isn't gaming the system but just using it efficiently.
There are really only a few parameters or levers to play with when buying a policy:
- worst case cap (premiums plus out of pocket max) - look at this primarily if it is likely you'll have inpatient surgery or some other major procedures
- how much you need to pay before coverage kicks in for most services (deductible); ignore out of pocket cap - if you're healthy, you may want to focus on plans with higher deductibles (and lower premiums); if you just need to see your PCP a few times, some plans will throw those in, maybe generic drugs too, without requiring a deductible.
If you expect to need even less, an HSA-qualified plan can make more sense. These are not allowed to cover anything except preventive care before the deductible kicks in, but the extra tax savings should more than cover an extra visit or two to the doctor.
- "traditional" plans where most services charge co-pays without needing to meet the deductible. They tend to be more expensive than high deductible plans, but can be much cheaper out of pocket (and total cost) unless you need any service that requires you to pay the deductible. Then you lose. So these are better for people with some minor issues but nothing that would require hospitalization.
Note that different plans will differ in what they provide for copays only. For example, some will cover physical therapy for just a copay, many will not. Some will let you go to specialists for only a copay, many will require you to meet the deductible first.
Now, look at those bullet items. That's just a description of how to shop for insurance. How many people are going to be able to take it to the next level and get into real gaming, and also have enough control over the services they need to be able to pull it off?
Comments
- it's difficult, and if you're not good with arithmetic and probabilities, you're likely assuming a lot more risk than you think
- if you're very healthy (basically just getting periodic checkups), there's not much you can do to beat the system (no services to bunch together like bundling all your deductible expenses into one tax year when filing tax returns)
- even if you're making more extensive use of services, you need to have a good sense of the probability distribution of your service needs (how likely you are to need what services and in what amounts) and/or in need of services that are expensive and deferrable.
Back surgery is something that might fit that last description. Or minor stuff that, say, a dermatologist might deal with (though not something serious like melanoma).
Mostly, it's a matter of picking the right type of policy to best fit your expected use, which arguably isn't gaming the system but just using it efficiently.
There are really only a few parameters or levers to play with when buying a policy:
- worst case cap (premiums plus out of pocket max) - look at this primarily if it is likely you'll have inpatient surgery or some other major procedures
- how much you need to pay before coverage kicks in for most services (deductible); ignore out of pocket cap - if you're healthy, you may want to focus on plans with higher deductibles (and lower premiums); if you just need to see your PCP a few times, some plans will throw those in, maybe generic drugs too, without requiring a deductible.
If you expect to need even less, an HSA-qualified plan can make more sense. These are not allowed to cover anything except preventive care before the deductible kicks in, but the extra tax savings should more than cover an extra visit or two to the doctor.
- "traditional" plans where most services charge co-pays without needing to meet the deductible. They tend to be more expensive than high deductible plans, but can be much cheaper out of pocket (and total cost) unless you need any service that requires you to pay the deductible. Then you lose. So these are better for people with some minor issues but nothing that would require hospitalization.
Note that different plans will differ in what they provide for copays only. For example, some will cover physical therapy for just a copay, many will not. Some will let you go to specialists for only a copay, many will require you to meet the deductible first.
Now, look at those bullet items. That's just a description of how to shop for insurance. How many people are going to be able to take it to the next level and get into real gaming, and also have enough control over the services they need to be able to pull it off?