Episode 104: I’m a Doctor and Spent a Year Without Health Insurance

The Story

In late Summer of 2019 my wife and I had to make a difficult choice - to buy traditional health insurance or go without. We are both physicians so it is sort of expected that we have traditional health insurance for us and our family. In fact, it is quite funny to see the shock on someone's face when I tell them that we don't have health insurance while working in the operating room.

My wife is a pediatrician and I am an anesthesiologist. The circumstances that led to this decision were strange but like most people, our insurance coverage is tied to our employment. Well, we had always gotten our health insurance through my wife's pediatrics practice. The partners provided insurance as a benefit to themselves by paying most of the premium out of their practice. It was a benefit that you either took advantage of or  bypassed but she was basically 'paying' either way out of the group's overhead.

Well, life changed dramatically for us in August of 2018 when our middle son, Andy, was killed in a car crash. Although I went back to work, it became impossible for my wife to see children in the clinic while dealing with the grief of losing her child. Since she hadn't worked in quite a while, her office was no longer able to cover her with insurance leaving us with two options: take my group's insurance or go without.

Initially, we purchased insurance through my physician practice. The expense was full, however, as we have structured our group so you get whatever benefit you want but you pay for it ahead of time as a business expense. So, although you can write off some of it by paying pre-tax, it is still a sizable cost which is why it always made sense before to choose my wife's insurance.

After two months we were approaching open enrollment in November of 2019 and I was looking at the expense of the insurance. Earlier that month I had done an episode on health sharing and I happened to have lunch with another physician who told me about his health sharing ministry. His pleasure at the coverage, structure, and expense of the plan convinced me to research it. I knew our loss of insurance for my wife's employment would be temporary once she started working again but it presented us the opportunity to 'try no insurance' for a year.

To be fair, we have a comfortable income and unless something went catastrophically wrong with the sharing, we could financially survive. Additionally, if things got too difficult we would always have the option of buying insurance through my private practice group.

THe Plan

Our plan was built on two parts. One, to put the family on the same doctor who was operating a direct primary care. This is essentially an affordable membership based doctor who allows you 24/7 access with many other valued benefits. Ours provides medications at wholesale prices and finds significant discounts for laboratory and imaging if needed.

Second, we selected a health sharing ministry to provide the coverage should we find ourselves with a large medical expense. Health sharing ministries aren't exactly insurance. You basically sign up and agree to pay someone somewhere a set payment to help them cover their medical expenses. Then if you ever need payment for procedures or doctor visits or treatments others send you checks in the mail to cover your costs. These sharing ministries won't cover any pre-existing conditions and make you pay the first $250 or so for any new diagnosis.

I have included a chart (link below) detailing our expenses for the year with medications, sharing amount, labs, imaging, and doctor visits outside of our DPC doctor. I tried to be as faithful to actual costs as I could estimate since I knew some of the cost of medications purchased through insurance and some of the copays with a traditional HMO/HSA family with $3000/$6000 deductible.

The Punchline

There were a number of questions I had going into this year long experiment. I was pleasantly surprised that the answer to them was positive. We saved probably around $3000 in a calendar year despite having to pay extra for a doctor. The health plan option after the tax benefit was about $200 more per month. However, with the savings we received through the DPC doctor on medications easily drove up our savings. We quite possibly saved even more money with our procedures in November of 2019 because we paid cash and didn't pay the inflated 'discounted' insurance deductible cost.

Additionally, we became much better shoppers of medications, laboratory work, and medical resources. Admittedly, we didn't use a lot but we thought about price so much more than ever before and saw even more in depth how broken, crazy, random, and dumb the medical billing system is. The part I was most worried about was how comfortable would I feel in my 'coverage' should something bad happen. I can say, whether it was because Samaritan Ministries was unique or not, was that I never felt worried. We dealt with a claim right out of the box and saw that it would be handled quickly (once I figured out how to do it) so it made sense and seemed like a prudent choice.

Ironically, we will enter onto my wife's insurance again now that she has restarted working simply because it is so much less expensive. However, we will keep our DPC doctor because the service was a million times better and we get some savings from medications.