---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

Health insurance is a massively complex issue, but fundamentally depends on what sort of insurance policies your employer subsidizes. .... Bear in mind that 94% of employers with shares on the stock exchange "self insure", meaning they determine the premiums, and pay out for treatment, and only use a health insurance company to manage the scheme. ..... I will guarantee that this is news to a large majority of people in the US covered through their employer's health insurance as they think they are being insured by whoever is managing the scheme!

For someone coming from the UK with health care provided by the NHS, what I am about to say may be shocking, and probably counter-intuitive: you will likely be better off choosing insurance with a relatively low premium and a high deductible (UK speak: "excess") - look for a "high deductible" plan, and then paying for your basic healthcare yourself. You can do this using a "health savings account" (HSA) which works a bit like a private pension - you can fund it using pretax income, and your employer will probably chip-in some money too, then draw funds at any time for legitimate healthcare expenses.

Preventive treatments, such as vaccinations, and screenings, including an annual physical are free, paid for by your insurance(that is required under US law), but the cost of occasional trips to the doctor and prescriptions such as antibiotics and other commonly prescribed drugs, will cost you less over all if YOU pay for them rather than if you pay a higher premium for insurance with a low deductible, which may still be $500-$1,000.

What pushed us over to HD insurance was realizing that we used so little medical services that we weren't even exceeding the LOW deductible! What we realized was that we were paying high premiums and receiving no benefit from them!

If you don't use the funds in your HSA they roll up year on year. The aggregate balances in the HSA's that my wife and I have are very substantial, and as we continue to fund them each year to the maximum allowed by the IRS, they will likely provide a very useful cushion for medical expenses in our retirement.

---

---

For cost effective and tax efficient health insurance more and more people are realizing that "high deductible" (HD) insurance combined with a "Health Savings Account" (HSA) is the best choice. The HSA works like a private pension - you put "before tax" money into it, and then you can use it for medical expenses and if you don't use it then you have it for future years. The thing is, with HD insurance you pay the first, typically, about $2,500-$3,000 per person of medical expenses, so if all three of your family members ALL got injured (broken bones), or need other expensive treatment IN THE SAME YEAR, then you could end up using all your $6,800 maximum contribution to your HSA.

But if you are generally low-moderate users of medical services, then after the first year you will have your brought forward HSA balance, and it can roll up remarkably quickly - after seven years my HSA balance is a long way into five figures, so given that in the worst case scenario when my wife, my daughter, and me ALL get seriously sick or injured the insurance picks up everything after about $8,500, I am unlikely to ever have to worry about medical expenses. :)

FWIW a colleague of mine switched to HD/HSA and swears it was the best decision for him and his family despite one of his four children breaking an arm in the first six months on HD insurance. Another colleague with three children thinks the same despite having three children, two of whom are boys who play sports and get their share of bumps and bruises.

---

---

---

---

---

---

---