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mercoledì 22 gennaio 2014

How to save money on health care

Seeing that health care costs came in third (after housing and, ironically, (unhealthy) restaurant costs), I asked the Yakezie if they had any suggestions on how to reduce their health care costs. Dr Dean from the Millionaire Nurse Blog stepped up. Check out his blog for more on the intersection between health(care) and personal finance.

Personally, I found my current HDHP, which I pay $71 per month for, on ehealthinsurance.com (also see Frequently Asked Questions). I then max out my HSA and get $450 back in tax deductions. The total cost of my health insurance is thus $402 per year! DW has her health insurance separate from mine through her work like most people. Anyway, here’s the post …

Unlike the recent guest post by medicinesux, I have been the beneficiary of making a living at practicing medicine for 25 years. I have helped a lot of people along the way. Unlike many, I had no dreams of getting rich practicing medicine, I really did just want to help people, in a way that appealed to me. I chose to practice in a small town, close to relatives and don’t regret it.

Many of the negatives described by those writing and commenting on this blog about health care today are absolutely true. And, if someone told me I had an unlimited budget to “fix” the healthcare system in the US—I don’t think I could.

I think our problems are too endemic, and the politics are too complex. So we are destined to rock along, with band-aid like efforts for some time to come.

For that reason, today’s post is not about health care policies or politics, it is about saving money when it comes to your health.

Keeping more of your money in your pocket will allow you to reach your financial goals sooner. Whether that means quitting your job, and traveling, or just having more freedom to do what you want to do in your free time, while you continue your work doesn’t really matter.

So how can you save money on your health care?

Let’s divide this up into two categories.

Lifestyle/prevention

Acute care needs.

Lifestyle/Prevention

The best way to save money on health care is not to need any. Now you may say “I knew that and I didn’t have to go to school 12 years AFTER high school!” So if you knew it, why are you killing yourself everyday little by little (or in some cases: careening towards your death, like a blogger goes after a link?)

Are you resting 7-8 hours every night?

Are you eating a balanced diet, low in unhealthy fats, high in fiber, with liberal raw fruits and veggies?

Are you drinking alcohol excessively? More than one alcoholic beverage per day for females, two for men. (One drink is equal to one beer, one 5 oz glass of wine, or one mixed drink-measured) Also remember most restaurant drinks or at least a 1.5–2 shots, and wine glasses now sometimes hold 10–12 oz or more!

Are you exercising at least 30 minutes per day/5 days per week?

Are you minimizing your stress? We all have stress—it is what you do with it that counts. Pilates or Yoga, or brisk aerobic exercise are all great stress relievers. Journal keeping/reminding yourself what GOOD you did for others can also be effective.

Are you aware of special risk factors you have for illness (family history, or work related risk factors) and doing all you can to minimize your chance of following in your families’ footsteps? Or if work related-minimize risks as much as possible-such as proper ergonomics if you are at a keyboard 8 hours a day!

Are you keeping your weight in a healthy range—BMI less than 25?

Do you follow established preventive medicine guidelines? Colonoscopy at 50,…..

Are you smoking?

Are you engaging in risky behavior—illegal drugs, or multiple sex partners? (One study suggested that between 40 and 47% of deaths are at least partially attributable to preventable causes or aggravation of illness by behavior.)

Acute Care Needs

Now, when you do get sick or need medical care-how can you save money?

Don’t go to the doctor or clinic for every sniffle. Buy a medical book for laymen, and read it all the way through. Then keep it handy for reference. The reasons to go or not go to the doc are too complicated to cover here, but excellent references are available.

Don’t listen to your friends and relatives for health care advice. I don’t know how many people with a cold tell me—“I just came to get my mother/husband/….off my back.

Choose your online resources’ carefully. Many people have an agenda. You don’t always know if your great holistic website was written by someone whose child died of leukemia—but the parents blame a small-pox vaccine or a plastic toy they got from Grandma.

HSA’s and high deductible health plans—Others have written on these pages about HSA’s tied to high deductible health plans, and other money saving health insurance options—so I won’t cover that here.

Negotiate with your medical provider. I know that may sound cheesy, and I can’t promise that some docs with an unhealthy, grand ego won’t throw you out of his/her practice- but I think it is worth asking.

Most practices now have to take huge discounts from the larger insurance providers such as United Healthcare or BCBS. They are now used to discounting fees-especially if you offer cash up front. The medical practice can save on collection worries, as well as assisting with their cash flow.

Negotiate with the hospital. When you get your bill, go visit a manager in the collection department, and ask—“I will pay half (or even less) the charged amount in cash today—will that wipe out this bill?”—many will take it and run.

Pre-visit/procedure negotiation. If you have no insurance—then definitely negotiate before any procedure with the doc and the facility—remind them that you will pay cash up front!

If broke-tell them you are broke-early. And always ask about indigent plans/financial support-but these days-those funds, if a facility has any available, are used up early in their fiscal year.

Ask the “If this was your momma?” question. If you do get seen by a medical practitioner, ask them if you were their mother would you get this same Rx filled or have (xyz) procedure done? That can help determine if the med or procedure was recommended just for CYA purposes as a liability hedge. (Do this in a respectful manner and you will usually get a respectful response.)

In summary, the health care system in our country is broken. The costs are only going to go up. I would strongly recommend “self-insuring” by having a Health Savings Account (if they don’t get outlawed by congress!) or a large liquid savings fund.

Know when to go to the doc and what it will cost. There are no stupid questions when it comes to your money-so write them down, and ask them in advance of receiving the care. (When you are ill, your mind doesn’t work very well-make lists in advance-both health questions and money questions.)

Do everything you can do, to live a healthy lifestyle, keep your weight and stress down, and your lifetime medical costs will be minimized -and your enjoyment of life will be maximized. Whether your retirement is early and extreme or late and run of the mill-your body will thank you for paying attention.

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How to save money on health care

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Personal Finance, guest post, health, health-care, how to, insurance, personal finance

mercoledì 15 gennaio 2014

Guest post: Fulfillment

via Early Retirement Extreme:

This is a guest post from Peter Lawrence author of The Happy Minimalist. He was born and raised in Singapore and lives in Santa Clara, California. He has been able to retire well before the normal retirement age not because he won a lottery, inherited wealth, or joined a start-up. Peter attributes his early retirement to his minimalist lifestyle.

Sometimes, some people can keep eating and yet continue to feel hungry. Gorging oneself with empty calories is no substitute for the essential nutrients that the body needs. Eating a variety of different colors of fruits and vegetables together with nuts, grains and legumes can provide the necessary nutrients that the body needs such that one can actually cut down on the calories without experiencing hunger. Calorie restriction is a proven way to slow the aging process and maintain peak vitality. The goal should then be to consume nutrition dense food rather than calorie rich foods. Unfortunately, many people choose the latter. And when they continue to feel hungry, they continue to stuff themselves with the same junk, processed or packaged foods. But no amount of foods rich in energy but poor in nutrition will fulfill the body’s craving. Likewise, no amount of material stuff can fulfill our highest needs.

In 1943, Abraham Maslow put forth his theory of human motivation commonly known as Maslow’s hierarchy of needs. At the bottom of the pyramid are the physiological needs. At the apex is the need for self-actualization. In the developed world, despite having easily fulfilled our lower level needs, many don’t seem fulfilled. The reason is they are trying to satisfy their highest need with lower level stuff. The pursuit to keep up and beat the Joneses is deemed as the ultimate success. As such, they continue to play in the lower levels of the pyramid instead of recognizing that they have enough and transcending. As long as you are stuck in the mode that you have to have a bigger house, a faster car etc; you are never going to be fully satisfied .Just as your body’s needs cannot be satisfied with empty calories, your soul’s cravings cannot be satisfied by material stuff either. As Abraham Maslow said, “A musician must make music, an artist must paint, a poet must write if he is to be ultimately at peace with himself.”

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Personal Finance, early retirement, guest post, maslow, minimalism, peter lawrence, philosophy

lunedì 13 gennaio 2014

Guest post: Why I’m pursuing ERE: greed vs. passion

via Early Retirement Extreme:

This is a guest post from Zev. Many of you may know him from the forums and some of you may recognize the name from the copyright page in the book. He contacted me out of the blue earlier this year offering to correct the book manuscript for me. Knowing that my English is not perfect, I took him up on the offer and we spent about three or four months passing the manuscript back and forth getting rid of 99.9+% of my errors—I’ve never seen so much red ink on any of my papers. During that period he chose to become financially independent himself. You can see the steps he’s already taken in his journal.

I had the privilege of being one of the first readers of the ERE book, and, having balked at actually pursuing ERE earlier this year after discovering and poring over the blog–”I live in New York City; I don’t want to be an urban hermit; I fail to see the miser’s contribution to society”–the book gave me a broader outlook, ultimately leading me to decide to become financially independent–nothing resembling “retirement” really enters into it–within five years; my ERE/FI date is 7/15/2015, and so far I’m running about a year ahead of schedule.

The primary reason for my decision, to put it in extreme terms, is to resolve the tension in my life between greed and passion.

Like many in the labor market, I have mostly based my decisions about what sort of work to do on what will provide the maximum return on my time. This has led me to be self-employed in the same transcription business for my entire adult life (I’m 32). I’ve become steadily more productive, savvy, and reputable in my business, and my income has risen accordingly. I am one of those “rational economic actors” that economists like to presume in their theorizing; I have “followed the money.” So far as I can see, this puts me right in the middle of the pack of the American workforce, albeit with a lot more control of the fruits of my labor: I sell my labor to the highest bidder, with the usual considerations of legality, ethical standards and safety–if there’s a black market for transcription, I haven’t heard of it.

Also like many people, working full-time has crowded out the activities I feel most passionate about, which, as is typical, are far less remunerative–reading, writing, playing music, making films. For someone with a middle-of-the-road constitution, at best–I sleep nine hours a night–”work-life” balance realistically translates to giving my best hours to my business and doing mostly passive activities and errands during the rest of my waking hours. This pits my social life, passionate interests and day-to-day upkeep (not to speak of downtime) against each other for the scraps of my schedule.

Truth be told, I’ve had a number of false starts in pursuing other careers–music/songwriting in my mid-20s, filmmaking a couple of years ago–and while the poor compensation didn’t scare me off, the opportunity cost of not maximizing my income, and the prospect of not ever having meaningful savings, did. Ironically, I never socked away so much as a dollar until setting my ERE/FI goal a few months ago. This lack of savings also puts me right in the middle of the American heap–”I must be rightfully compensated, so I can spend spend spend, because I deserve it.” This “because” has actually been more mysterious to me than that–”Why? To what end?” do I earn what I earn, do I maximize what I earn? I paid lip service to my neglected passions–”My income allows me to buy the gadgets with which to compose music and make films; my flexible work schedule gives me time to pursue them”–but as Jacob writes in the ERE book, the gadgets largely became tokens of my interests rather than tools to execute on them, and I would haul them from this closet to the next. My free time I have overestimated, both in quantity of hours and quality of focus.

So, while I guard against seeing ERE/FI as a panacea, I do see it as a potentially transformative opportunity to be freed from “maximizing profit” as my raison d’être, as well as a compelling answer to why I currently pursue it. I have the nagging feeling that this pursuit of maximization is more neurotic and deeply, culturally embedded than can be cured by a modest dividend-paying portfolio, but I feel an equal urgency to give myself the gift of the best 40-50 hours each week, freed from all anxiety about making a living INDEFINITELY, and see what creative output comes out of that.

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Personal Finance, early retirement, guest post, strategy, work, zev