Limited outpatient (Part B) service plans

There is a trend I am noticing where people get a policy that pays for inpatient hospital services only. Basically, what is considered Medicare Part A services. Which to layperson seems like would be protecting you from the big hits. Lets look at some Medicare Part B services, or what is considered outpatient services

Cardiac Cath – between $50,000 and $120,000 depending on the number of stents placed

Hysterectomy laparoscopic - $31,000 to $50,000

Gallbladder removal $5,000 to $12,000

Lithotripsy (Sonic waves kidney stones) $4000 to $9000

Detached retina repair - $5000 to $10,000

Appendix removal $10,000 to $35,000

You are self-insuring for these if you have a plan that does not pay Part B or outpatient services.

And these are just the procedures themselves. The tests and possible ER visit leading up to getting the procedure is also Part B or outpatient and won’t be covered by a plan that does not cover Part B or outpatient services.

These is not an ACA/Healthcare.gov market option. These are being offered by employers from what I can tell. I have had the opportunity to go and talk to one of these patients myself about there visit not being covered. And recently we had 2 more of the same plan prefix coming across in emails in the last couple of months. Because of HIPAA and the fact I cant find the policy information online to reference, I cant tell you the plan or plan prefix.

A majority of what happens in the hospitals are day or overnight procedures, which are outpatient or observation stays. Heck, a healthy candidate for even an inpatient coronary artery bypass graph (CABG) can be out the door in 4 to 5 days.

If you are not planning on returning to work, can you afford a $15,000 to $120,000 hit to your nest egg. You do get a tax write off, but if you are not paying that much in taxes, do you really gain anything with that tax credit. You could possibly use an existing HSA account. And if you have and HSA account, financial assistance (Charity) might not happen until you deplete that account to pay for your Cath and 5 stents.

Insurance is risk mitigation and should be treated as such when you are deciding what it is insuring and why. Its to protect your money from a catastrophic loss. Health insurance is complex, but you have a whole bunch of body parts and you need most of them to have a good life. The complexity of you is part of the reason for the complexity of health insurance. Add in the uniqueness of your financial plan, that’s a lot of variables to consider.