Health insurance on the homestead

I'm wondering what all of the permise folks are doing for health insurance on the homestead.
In other words what are we as homesteaders doing to protect our hard work and investments from the possibility of medical bankruptcy?

Hi Rich,

Great question.  I am well covered at present. But this begs the question of what if I wasn’t.  I suspect I would work backwards and see if my state’s bankruptcy laws would adequately protect me.   Additionally, I would seek part time employment ....or full time ..... with some level of health coverage.   Take a good look at any policy you consider.   I taught health care management at the graduate level.   I find that many health policies are better at protecting the health provider than the patient.  

Also take a look at health care savings accounts and the various spin-offs.   Once again, read the policy carefully.

As a word of caution, I find paying cash to be the worst option in many cases.  Private pay patients often pay extremely high costs compared to people with insurance.  In line with this, now is the time to shop for providers.  You may be amazed at the price differences.  I have found hospitals located a few miles from one another with one with a price difference of 10x what the other charged for certain procedures.

The pay by cash approach can work in your favor though , depending on the provider, ........once, again,   shop around before the crisis hits.

To me, the best insurance for or on the homestead is good health.

Like John, I am well covered.

I didn't have any illnesses or see any medical practitioners in 2020, 2021 and so far 2022 except for a car visit to get a prescription refilled.

Eating the right way and getting plenty of exercise helps me with staying healthy.

Living a permaculture lifestyle also helps.

I have and always will be against bankruptcy. No one I know has ever taken that route.

I follow Dave Ramsey's financial advice regarding freedom by living without debt and keeping enough money in saving so that this will not happen.

To further break down OP's question(s), what to do about:
 - health insurance
 - medical bankruptcy

I'd cover the former with job-related health insurance, if you're a couple, and at least one of you works a traditional job. If this wasn't the case, and in reasonable good health, I'd go with catastrophe insurance, and pay as you go. If older, then at some point Social Security & medicaid/medicare would kick in, and that would provide a level of coverage.

I'd cover the latter by getting to mortgage-free, plus ensure that your "homestead exemption" is in place for your state, whatever it goes by. If this is your only home, and you do whatever it takes to get that qualification, it generally won't be taken in a bankruptcy ... just have to do the paperwork, per your state.

Mortgage-free means you'll have a roof over your head (vs a bridge), no matter what debts the costly medical emergency leaves you with.

There's no doubt that all forms of insurance have morphed from "we've got your back, no matter what" into "maybe, sort of, and only if we can't get out of it" coverage. You pay more, have to jump thru all kinds of hoops, and still might not get what you need when you need it.

We avoid all forms of insurance madness, and self-insure wherever possible ...

I have Medicare and don't have the property in my name, so it can't be taken. Likely in the future I will get Medicaid as well, working to structure things properly so this can happen.

I don't use credit so there are no negative impacts to me not paying unreasonable bills.

Stay away from the MD's, all they will do is hook you  on some medicine. Try a naturalpathic doctor, they will cure you and it won't cost you an arm and a leg. I follow Dr. Glidden ND on the internet, his web site is riseupintohealth.com .

If you don't have a workee job, the affordable care act "exchange" lets you buy coverage for a decent price.  If your income is on the lower end I hear the subsidies make it quite reasonable to insure yourself.

I'm seeing a lot of interesting and helpful comments and from several different points of view.

Here's my take: I'm not inclined to gamble especially with something as valuable and that has as much sweat equity in it as an established, solvent homestead. At 19 I took out a high-deductible, lower rate plan that I have kept in force most of the time up to the present.  Purchased the homestead at age 23.
As far as job-related healthcare that's definitely a great solution. However I think with homesteading a lot of people are trying to minimize or do away with the day job in favor of more Independence. I know that was our case. That leaves fending for one's self.

I agree with those who say living and eating right is pretty good assurance (Read insurance) of staying healthy. However even the best lifestyle or holistic health care can't prevent or treat many conditions,
Also accidental injury has a greater chance of happening to those who take responsibility for most or all homestead tasks. Felling trees, running tractors and heavy equipment and building construction come readily to mind. I'm certainly not suggesting doing otherwise on a homestead, in fact I've been doing it all for over 30 years. I'm just pointing out this type of direct involvement is a good reason for health insurance.
As far as transferring your assets (homestead) to another person however trustworthy, opens a person to eviction if the other person we're to be involved in a lawsuit and lose the property you are living on.
Most estate planners from what I've seen do not recommend pre-death transfer of assets especially the home.

Although the OP was directing the thread to Permies in general, the concerns I suspect are more relevant to the "US Permie" where health care is not already built into the tax structure (with the exception of Medicare/Medicaid) of where one lives.....thus, I can't help but wonder what those outside of the US will think as they read this conversation.

My wife and I may be outside of the norm....not sure.  I was raised in a medical family and the idea of access to mainstream medical care was drilled into to me from an early age.  Over time, I got to see and ponder more of the pluses and minuses of that system, both from a patient and practioner viewpoint.  My wife already avoided the health care system like the plague and I've followed suit over the years, even as I'm inclined for some things to interface with the system on a needs basis.  Early retirement  resulted in leaving an above average health care plan from my employer. My wife is on Medicare, but hasn't seen a doctor in over 15 - 20 years. During the years that followed, I played around with contracted income and watched how I could qualify for Medical Assistance (Medicare....decent coverage with no premiums), but then as some years had more income, needed to transition to the Affordable Care Act-associated plans (one of the 'exchanges' noted in a previous post).  I find the latter quite horrific and can't imagine how those with families afford these plans along with other household expenses.   The plan chosen is a 'medium' coverage plan, balancing cost of premiums with coverage and the ~$6000 USD deductible.  Being in the middle of this plan now will have me considering to not re-enroll at the end of the year and instead tracking the maximum allowable household income that would permit me to qualify once again for Medical Assistance.  I won't delve into matters more cider-pressy, but it's a deeply imperfect system.

In response to John Weiland's post.
As John stated the Affordable Care Act exchange has  several plans. I believe John is talking about the tax credit program, which covers incomes from 200 to 400 percent of the federal poverty guideline.
Those plans usually have reasonable premiums but as John noted rather high deductibles per person.
Many state exchanges also have a state plan. In Minnesota we have Minnesota care. This is a very reasonably priced plan but only covers people whose incomes are between 138 and 200 percent of the federal poverty guideline, a very narrow slice of the population. Anyone with an income below 138 will only be able to qualify for Medicaid often called Medical assistance as John called the program , which has no monthly premium. However a word of CAUTION HERE: In most States if you're over 55 years old and receive Medical assistance or Medicaid the state will try to take all-expenses-paid,  back when you pass away, through their Medicaid estate recovery program!  In these states Medicaid is merely a long-term loan for monthly insurance premiums. IT'S FREE NOW BUT YOUR HEIRS WILL PAY THE BILL. We had problems with this in Minnesota.

Rich Rayburn wrote:.... the state will try to take all-expenses-paid,  back when you pass away, through their Medicaid estate recovery program!  In these states Medicaid is merely a long-term loan for monthly insurance premiums. IT'S FREE NOW BUT YOUR HEIRS WILL PAY THE BILL. We had problems with this in Minnesota.

Hmmmm!.....all of this news to me and as I reside in Minnesota as well, a thankful shout out to you Rich for this information.  I will look into this soon as I think it rather unconscionable to chase estates, especially below a certain income level, for "taxation of the departed".  Right now I'm signed up with 'Health Partners' and as you noted, I pay a proportion of the premiums and tax credits account for the remainder.  Still not happy about the ~$4000.00 I'll be out in premiums over the year and if I were to incur $6000.00 of medical expenses this year, that would not be billable to insurance since that is the deductible if I'm calculating correctly.  So unless I'm missing something, were I to need medical care to the tune of the deductible, then I'm out almost $10,000.00 total for the year with the insurance provider collecting handsomely and providing next to nothing.  I was able to get them to 're-negotiate' downward with the hospital what the final bill(s) would be, but that is their contribution to date.  It is understood that these numbers are a far cry from the hundreds of thousands of dollars in bills many people have faced or are dealing with now, ..... just a strange dysfunctional system in my mind and as Rich note, worth some investigating in each homestead's locale.

The Medicaid estate recovery plan is done in California as well. I'm not sure about Oregon but that is one of the reasons that the property is in my daughters name. Typically you can't own much of anything to qualify for full Medicaid nor can you have given away property/assets within the last five years which is why I don't currently qualify.

The deductible thing is insane. I had Kaiser for most of my life so I had no idea how bad other health insurance is but alas no Kaiser here. I go to a small clinic and decline any major testing.

In response to John weiland and Minnesota's Medicaid recovery. Currently Minnesota recovery is only for nursing home care, not the insurance premiums, however they keep all the records of expenses indefinitely and can change the law anytime! If you really want to get into this give me a call 218 565 1122.
Regarding Stacy's comments, California also currently only recovers for nursing home care, the same for Oregon. The problem is all laws are theoretically temporary. And when State budgets get tight.... Well you all can fill in the blanks!

I am probably not what is normal, but I was able to farm full-time because I worked at Ground Zero for nine months back in 2001-2002 and got cancer.  I got full medical coverage during my years of full-time farming, but now that my cancer is mostly behind me (3 types of cancer), I have gone back to work and picked up employer-employee coverage just because it was so cheap. I use that now along with my government health insurance. I just did not feel right having taxpayers pick up the full cost of my heath care. Now, they only pay my co-pays, and I am more comfortable with that.

As a side note, this was possible because when 911 happened in 2001, there was a government act that funded the TSA and a bunch of other stuff, but included within it, was health costs for 911 workers as they knew we would get sick.

We did.

IMO health insurance is dealt with in the same way and people deal with poker.
You play or you dont play.In Australia we have a pretty good public health system which runs for the benefit of the population not the Doctors and medical industry.
Doctors are paid well, but people do not die in car parks.
Observation of the system in the USA show a frightening system and I do not understand why the public accept it at all.

As a Canadian, I am absolutely blown away whenever I hear about health care in the US.  I'm a 52-year-old man and I can honestly say I have very little idea how my healthcare works.  Whenever I or a member of my family is sick or injured we go to the doctor.  Simple as that.  I know my taxes pay for it but I have never, ever had to think about medical care.  It seems wrong to me that the wealthiest people get better health care than the poor and the stories of medical bankruptcy are absolutely astounding.  Putting insurance corporations in charge of medical decisions for the individual seems to me to be a horrible idea.   When have they ever chosen the individual over profit?

John and Stew,
People in the US seem to be mostly apathetic towards healthcare costs. I don't understand it either. Statistics show that about half of all Americans have to provide their own health insurance, the other approximate half with employer based health insurance "on average" pay $20,000 a year just in premiums for a family plan!  The privatization of healthcare in the US is getting worse, the government sponsored programs such as Medicaid and the retirement insurance Medicare, are rapidly being handed over to private corporations for management(even Medicare has co-pays and deductibles that can be quite expensive). This privatization makes it highly unlikely for any universal Health Care program in the near future. Americans have also been told over and over that a Universal Health Care system will result in less care and poorer outcomes.
Under the current system the more independent homesteader must find the means to carry at least a catastrophic illness insurance policy to ward off the potential of medical bankruptcy.  As hard as it is to throw thousands of dollars a year down the insurance rabbit hole the alternative is often losing your dream to illness or injury.

John, I don't think that you have to prove that universal healthcare will lead to poor results, if people keep hearing the story over and over they eventually accepted it as truth. For example an acquaintance of ours just finished nursing school to become an RN. We had a discussion about Universal Health Care and this person stated that during school it was common"knowledge"that a universal Health Care system would destroy any incentive for the doctors to better themselves as they would all be receiving the same sub par wages. I assume this is not true but there was no changing this person's mind. We are often also told here that in Canada people must wait an indeterminate amount of time to get any medical care, which is also I'm sure not true but it scares people into accepting the status quo.

Rich Rayburn wrote:I'm wondering what all of the permise folks are doing for health insurance on the homestead.
In other words what are we as homesteaders doing to protect our hard work and investments from the possibility of medical bankruptcy?

I haven’t had health insurance since leaving my parents home at 17. I haven’t seen the inside of the hospital in 32 years except for three occasions that required multiple stitches. Paid cash. Same with dental, I pay cash on the occasions that I absolutely need to go. Is this ideal? No.. but I’m probably going to die someday from something, so I guess in the big picture, it hardly matters.

Ted Abbey wrote:  I haven’t seen the inside of the hospital in 32 years except for three occasions that required multiple stitches. Paid cash. Same with dental, I pay cash on the occasions that I absolutely need to go. Is this ideal? No.. but I’m probably going to die someday from something, so I guess in the big picture, it hardly matters.

Ted, I have only been in a hospital to give birth to two kids.

Before Mar 2020, I have not paid for an office visit to a doctor in maybe five or six years and when I did it was only to get a prescription refilled. And since then I have only paid for that one visit in Mar 2020.

When talking about health insurance, I thought everyone in the US was required to carry health insurance so every time I see this thread I am puzzled.

Anne Miller wrote:

Ted Abbey wrote:  I haven’t seen the inside of the hospital in 32 years except for three occasions that required multiple stitches. Paid cash. Same with dental, I pay cash on the occasions that I absolutely need to go. Is this ideal? No.. but I’m probably going to die someday from something, so I guess in the big picture, it hardly matters.

Ted, I have only been in a hospital to give birth to two kids.

Before Mar 2020, I have not paid for an office visit to a doctor in maybe five or six years and when I did it was only to get a prescription refilled. And since then I have only paid for that one visit in Mar 2020.

When talking about health insurance, I thought everyone in the US was required to carry health insurance so every time I see this thread I am puzzled.

We have a million nonsense laws in the US.. Everyone is probably “guilty” of breaking one or more. I just do the right thing, no matter what.. and try to ignore the charade of state.

Anne,
You do not have to have health insurance in the United States, hence the reason for this post.
As of 2022,  9% of the United States was uninsured and 43% of working age adults in the United States were underinsured.
Being uninsured may work for those who have nothing to lose and are extremely lucky, for those of us that might have families that depend on us for income and paying for the homestead, going without insurance is highly risky and even though some individuals may prefer to expire rather than seek healthcare, if a family member such as a child, becomes ill it's really not a question of whether to seek medical attention or not. In the current healthcare system even a small injury could easily bankrupt a homestead!!

I was not aware of that so I asked google:

investapedia said, "Health insurance coverage is no longer mandatory at the federal level, as of Jan. 1, 2019. Some states still require you to have health insurance coverage to avoid a tax penalty.

So the tax penalty is so small that folks will risk going without coverage?

When I had a job, I did not get to choose who I got my health coverage from as my employer chose for me.

After leaving that job I purchased a policy that ended up being $300 a month.

Now I get to decide who my health carrier is.  This is so much better for me.

I now pay $49.00 above what is taken out of my social security.

Basically that $49.00 is for prescription coverage.

I am very happy with health coverage in the US.