A friend of the blog e-mailed me a question about short term plans and young invincibles:
At age 30, what conditions would, a) have a >~1% chance of occurring, b) will cost you >$25K OOP, and c) get covered under those shitty plans. Presumably a young, invinicible would want to know that.
As I read through, my former 30 yo self is saying, self, “why are you spending $150/mos?” The coverage is not worth a thing?
This is a damn good question. There are very few things that meet all criteria. Young adults who can pass underwriting are basically insuring against meteors.
I have one caveat, not all underwritten plans are inherently bad. Some are, some aren’t. Let’s assume that the rest of the answer is for someone on a non-scam underwritten plan that actually offers “decent” coverage where the pricing advantage is mostly based on excluding people highly likely to need services instead of excluding massive sections of services.
I can think of three immediate scenarios where a healthy late 20 something male could run up a $25,000 charge that would be covered under most underwritten plans.
In an odd way, I was a semi-professional athlete. I paid the mortgage on my house by refereeing and then I started to pay for day care for a child by refereeing as I ended my twenties and entered my thirties. I had my fair share of injuries: hip flexors, ankle sprains, and plantar fasciasitis were the injuries that slowed me down the most. I pushed myself hard but I pulled back when I had a soft tissue injury because I would rather lose a week or two of a season to rest and physical therapy than a season or two to surgery. Thankfully lots of things stretched and strained but nothing popped.
ACL’s popping was always a concern. I lucked out as an ACL replacement can easily cost between $20,000 to $50,000 without insurance. Things going pop in the knees is a risk for young invincibles. If it is done in an athletic compeition, some underwritten plans may exclude coverage but this is still a risk during snow shoveling.
Jamison Taillon, a starting pitcher for the Pittsburgh Pirates, missed a good chunk of last year because he had testicular cancer. He is 25. Testicular cancer is fairly common for younger men. It is not a disease of old age.
Finally, and to be morbid, people get shot. It is not hard for the first day of emergency treatment to run up $30,000 in charges. Any rehabilitation or complications can push total charges into the six figures quickly.
These were the first three scenarios that I would have told my 29 year old self if I had to convince him to get insurance even if it was underwritten insurance with some exclusions. I am still mainly insuring myself against unknown meteors hitting me in the head, and those were three meteors that crossed my orbit.
What did they do, rewrite a dental insurance policy and call it health insurance?
Speaking as a (former) road cyclist who amassed ~$40K in hospital bills following a significant, but not head-related, bike accident about a decade ago, I can attest to the need for insurance for the young and (at least) physically active.
As someone who had testicular cancer, I can say that not only is the surgery expensive (over $20k for 8 hours in the hospital), but the follow up CT scans, MRIs, bloodwork, and doctor visits become very expensive too.
Gin & Tonic
My son has spent some time also as a semi-professional athlete (i.e. he got paid a few bucks, but far, far from enough to live on.) One of his teammates blew out an ACL. Declared personal bankruptcy while still in his 20’s. That’s a hell of a beginning to adult life.
I was hit by a meteor when I was twenty-four (testicular cancer). Fortunately, I did a stint in the Marine Corps, so the VA took care of me. Good thing. The mid 1990s rate for four rounds of chemotherapy was around $50,000.
Maybe I am missing something, but to me, the obvious answer is significant injuries from a car accident. I know auto insurance comes with some coverage, but usually it is pretty limited.
I suspect injuries from a car accident are more common than testicular cancer for young men.
I broke my back in 73 on an ill fated trip to Florida and ended up in the public hospital in Atlanta. I was a seasonal worker at a university and, somehow, my health insurance was active. Spinal surgery, Harrington rods and 2 months in the hospital but it was mostly covered.
@b: @b: Was thinkingvthe exact same thing, car accident
40 years ago my (now) ex was diagnosed with keratoconus in his early 20s and was facing having to have both corneas replaced. Fortunately I had really good insurance through my work, because otherwise we were looking at $100,000 per eye, according to his ophthalmologist. He was able to head off surgery for a couple of years, so it wasn’t quite a meteor strike, but without a group plan that didn’t worry about pre-existing conditions he would have been royally screwed.
Duke of Clay
Hodgkins lymphoma: Hit my brother in his mid-twenties. Fortunately he was in the Marines and the Marine Corps and subsequently the VA covered the costs.
Several years ago I had a 23 year old student worker who had to have surgery for appendicitis. His bill was about $20,000 so he was glad the university made him buy insurance.
Duke of Clay
Another meteor: I had a patient some years ago who developed an infection from a trip to a nail salon which resulted in septic shock. The result was weeks in the ICU and hospital, followed by months of rehab. Her company offered the option of a extra week’s vacation in lieu of health insurance. As a young invincible, she had chosen the extra week of vacation.
At the “young invincible” stage, it’s accidents. Stray bullet courtesy of the NRA, hit-and-run car accident, falling off ladder during home repair, sports injury, etc. Of course, unplanned pregnancy also figures in.
@RepubAnon: Pregnancy (planned and unplanned) is often excluded from these types of policies
My first though in reading this post was testicular cancer -and there it is. And in just a few comments both prufock and central planning had/survived. My older brother had no insurance in 1986 when at 27 he was diagnosed just as he began roadying for GnR. Had it not been for medi-cal, he’d never have survived. The chemo regimen was grueling and the cost of it was astronomical.
So how prevalent is TC?
But her emails!!!
Aren’t young people generally more likely to be “struck by meteors” than older people do to more risk taking behavior?
Appendicitis was my first thought, too. There’s no way to know when the damn thing is going to go bad. When I had really crappy insurance from Crown Books, Aetna tried to tell me I wasn’t fully covered for an appendicitis scare that landed me in the hospital overnight.
@b: Um, yeah: I would think automobile injury would be way >~1%
Welp, we’re a 2 meteor family.
-1994, my wife came down with leukemia at 30. The small group plan at her job maxed out its total benefits in 4 days of DX. Lesson learned: The meteor costs more than you think possible, and even what sounds like coverage worth paying for results in bankruptcy.
2011, I developed eye cancer. We had me & the kid on a family plan, underwritten, as I was a healthy 30yo when we first bought the policy. We paid premiums for 9 years, for a total of $36,400, before I used a service beyond vaccines and annual ladyparts exam (which we figured out later I used 4 of because we were busy young parents, she had a breast lump which we paid cash to work up so that year we had no money, and the standard of care for my situation changed during that decade). They paid $4300 for local DX then disavowed all costs because no one in their network had malpractice coverage to work on my disease. Lesson learned: Health insurance companies don’t pay for things they should pay for unless you bring a lawyer to the table too.
Literally, I said to the review panel: Your ads show people my age falling off a snowboard. Think of this as an unlikely event that I could not have avoided and didn’t know existed when I was shopping for my coverage. It sounds like this is a consumer protection claim, not an appeal for out of network coverage.
I had my first inguinal hernia operation before I was thirty, and a second soon after. They now do it laparoscopically (didn’t back then) and it runs $4,000-$11,000 according to these folks. So not quite meteor scale, but still a hit. These are common: “Inguinal hernias account for 75% of abdominal wall hernias, with a lifetime risk of 27% in men and 3% in women.” (According to a recent BMJ paper).
I wore my uncle’s hand me down truss (aka the family truss) for the 6 weeks or so before I could schedule my first surgery. It helped — a lot, actually — but going through life w special underwear designed to hold your innards in is not a satisfactory substitute for health insurance.
What Have The Romans Ever Done for Us?
I went uncovered at various times throughout my 20s and early 30s. No meteors struck but I knew someone who had acute appendicitis in the NYC area…she’d just moved there for a good job but hadn’t started yet and hence her employer provided health care hadn’t kicked in. The total bill came to $90K but I think she was successful in negotiating it down significantly.
I generally tried to maintain the protection against meteors $150 a month policy but I always suspected that if the meteor struck the insurance company would wiggle out of paying for the damage the meteor did, and I probably wouldn’t even get the money I paid in premiums back much less defrayment of costs. Frankly, I kind of felt like a sucker paying for it because I was essentially forking over money for nothing. Mostly I did it so that if some smug and superior asshole couldn’t say “you should’ve had health insurance” if a meteor had struck and I’d been left financially destitute.
People have mentioned Hodgkin’s, testicular cancer, and appendicitis. To the list of diseases that are seen commonly or even more commonly in the young, add multiple sclerosis (normally diagnosed in late teens through early 30s), influenza complications, pneumonia, ovarian and testicular torsion, ovarian cysts, endometriosis, various types of diabetes, asthma, complications from congenital heart disease, myasthenia gravis, rheumatic diseases like RA and lupus. None of those diseases are very common, but I bet that most of us know some youngish person who was diagnosed with one or another.
I even know someone who has ongoing chronic issues from a shark bite.
My boss’s son dove into a breaking wave 1.5 years ago and is now a quadriplegic; his total medical bills are now around $2.3 million. He was 18 when it happened. His rehab care at Craig Hospital (well known for spinal and brain injury care) put him in contact with so many other young males who did the same thing in the ocean, a lake, a swimming pool, a river. One even broke his neck diving off a boat in deep water but hit a sea turtle that was swimming under the boat at the same time he dove. Broken necks and disability resulting from that seems to be highly concentrated in young males.
My “oh shit” and under 30 story involves being marginally employed during the crap economy of the early 1990’s here. I was buying those 6 month “bridge” policies and managed to go to Planned Parenthood when the check was not yet cashed to continue on the same plan. I came up with a stage 4 cervical dysplasia, the last step before cervical cancer. Since it was PP, they do the liquid nitrogen treatment to nuke the surface of the cervix and the follow-up care for a fee I could afford, but if it had been cervical cancer I would have been in deep, deep trouble. PP saves lives.
ETA: cervical cancers and others of the oral and genital area are often linked to HPV viral infections, and those infections are incredibly common now. The rates of cancers caused by HPV infections is clearly on the rise.