When I quit my corporate job in 2018 to travel full time, people often asked me what I was doing for insurance. It’s a significant concern for people who want to leave their jobs to pursue their passions, as health insurance is often prohibitively expensive.
18 Months on COBRA: Costly but Comfortable
Being employed full-time by a generous company for many years, I didn’t think much about health insurance. I didn’t pay any monthly premiums; I only had to pay copays and deductibles. When I left my job in June 2018, I decided to use COBRA, a federal program that allows people to continue their same insurance plan for up to 18 months after leaving the company.
I had already paid a lot into my deductible for the year, so I planned to keep it through the end of the year. When 2019 began, I was busy planning my overseas trip and didn’t want to deal with insurance, so I continued using COBRA. To keep my United Healthcare insurance, I would have to pay $635 a month. I didn’t anticipate being out of the country for eight months, so I ended up using COBRA through the end of 2019, the full 18 months.
In December 2019, I received a letter stating that my COBRA coverage would end as of January 5, 2020. The last few months of the year were extremely hectic for me. I spent most of my time getting a house set up for Airbnb, and on December 20th, I had knee surgery on my right knee. When your COBRA ends, you have 60 days to enroll in a new plan. The yearly open enrollment period is only from November 1 to December 15, but I would be able to sign up outside of those dates because my COBRA coverage was ending.
The Insurance Maze Begins
My search began in December. The world of self-insurance is a deep, dark hole, and I pity anyone who has to experience it. I had planned to travel overseas for most of 2020 (having no clue that Covid was about to destroy those plans and bring me back to the US after only 10 days), so I didn’t want to pay for insurance that I wouldn’t use. In 2019, I paid $7,620 for insurance premiums. That doesn’t include what I paid in copays, lab tests, and deductibles. I didn’t use the insurance much (since I was out of the country for eight months), except for blood tests and my knee surgery. The insurance allowed me to go to one of the best surgeons in the country, so at least I got some value out of that.
My primary care physician in California didn’t take insurance, so I paid a monthly cash fee of $225/month, in addition to paying cash for medications and some tests. The two doctors in the office were great and don’t take insurance because they don’t want to treat patients based on what insurance companies dictate. I had great success with them, so I continued with their plan for a couple of years.
After lots of research and speaking to an insurance broker, I discovered my three options:
- Get a short-term plan with an insurance company
- Use a healthshare ministry
- Sign up for insurance in the Marketplace (Affordable Care Act/Obamacare)
The Denial That Shocked Me
I started with UnitedHealthcare because I had been with them for more than five years through my employer. I knew that all of my doctors would be covered, and I was familiar with them. After talking with an agent, I discovered:
- The plan would be for one year and renewed up to three years
- The cheapest plan that I could get would be $287 a month
- The cheapest plan would have a high deductible ($12,500)
- It would not cover vision or dental
I applied for the insurance because, after looking at my other options, this one seemed to make the most sense for catastrophic cases. The start date for my insurance was supposed to be January 7th, leaving me uninsured for two days. I went on with my life, blissfully unaware of the nightmare that I was about to enter. On January 8th, I hadn’t heard back about my application, so I called United Healthcare.
The woman on the phone told me, “Oh, I see here you were denied coverage.” Shocked, I said, “What are you talking about? How could I be denied, and why didn’t you guys tell me?” The woman went on to explain that they sent a letter, but it would take seven to ten days to be delivered. The reason for being denied insurance was that at some point in my medical history, a doctor filed an insurance claim for “Dysthymic”. I asked the woman to spell it because I had never heard of it before. I Googled it: “persistent depressive disorder occurring for at least two years.”
I explained to the woman that I had never heard that word before and had never been diagnosed with depression. I have never been prescribed an antidepressant. The woman was no help and said she could have someone call me back in seven to ten days, letting me know which doctor made the claim and when.
More than a week later, I received a phone call. The woman wouldn’t tell me which doctor made the claim, but as soon as she told me the date in December 2015, I knew what it was for. “That was when my now ex-husband and I went to marriage counseling. How could the therapist give that diagnosis? We saw her twice, and as a couple, because of his lies,” I explained. The woman on the phone said that a diagnosis was assigned for the first claim, and then I sought treatment in 2016-2018. Getting further frustrated, I responded, “Yes, I saw a therapist to help me process my divorce.” That was that. I could file an appeal, which would take 60 days.
I was infuriated. How could a doctor make that claim from a single session of marriage counseling? How is it legal for a doctor to make an insurance claim based on a diagnosis that I was never told about and that would later deny me future insurance? How could seeing a therapist once or twice a month to help process emotions of a life change like divorce be considered a treatment for a disease I was never told about? I wasn’t denied because of my recent knee surgery. I wasn’t denied because of my parathyroid tumors. I wasn’t denied because of Lyme disease. I wasn’t denied because of hypothyroidism. Depression is a symptom of all of these, by the way.
I Googled to find out what I could do. This wasn’t fair, and there had to be some sort of recourse. Then I stumbled on this 2003 article. The article warns that any kind of mental health diagnosis, such as depression, disqualifies you from insurance. For therapists to be reimbursed by insurance, they must include a specific code on the form that indicates insurance coverage. The article even told a story about a young guy who was prescribed an antidepressant for sleep apnea. The medication was to help him physically, not mentally. It didn’t matter. Any tests done, medication prescribed, or any diagnosis from a claim will disqualify you for insurance.
I never knew about this because I always had insurance through my employer, and people aren’t denied there, or even asked about their medical history. But when you’re an individual trying to get insurance, you’re denied. I was angry about what was happening to me, but I was also angry on behalf of our society as a whole. We have an epidemic of suicides going on in our country. With the high-profile suicides of Anthony Bourdain and Kate Spade, there was a lot of talk about de-stigmatizing mental illness. There were hashtags and articles written about the shame that people face, which prevents them from getting help. There are help lines and online counseling now available. It is all well-intentioned, but it is all bullshit.
What good is it to bring awareness and reduce the stigma that goes along with mental illness when you’re forever screwed if you actually seek treatment? I came across this article from 2018 that talks about families (usually well-educated and high earners) who pay cash for their child’s mental illness so they can avoid a paper trail through their insurance. This is insane!
The article talks about the person who sought a therapist for short-term depression to get over a breakup, or had PTSD after the September 11th attacks. Those short-term treatments will disqualify them from getting insurance, even if it was ten years ago. Seeking therapy means no insurance in the future, which means you can’t get future treatment for antibiotics, a broken leg, or cancer without going bankrupt – screw hashtags. Insurance and pharmaceutical companies are killing us.
In the same article from 2018, it discusses the problems associated with short-term health insurance, such as the one I applied for. The article mentions that Trump allowed insurance companies to offer these plans because the Affordable Care Act (ACA) Marketplace was far too expensive for many people. The competition is good, sure. However, if you examine the plans closely, they have ridiculous fine print, such as not covering a trip to the emergency room if you are admitted during the weekend. They won’t cover pre-existing conditions. If they do, the premiums are through the roof. They might not cover maternity care, mental health and drug treatment, or prescription drugs. These plans are not subject to the same federal rules that Marketplace plans must follow. They are cheaper because of it, but be careful about what you actually get with the plan.
The Faith-Based Health Share Route
Christian HealthShare Ministries are not insurance. They are an alternative to insurance. These are large groups of people who follow the Christian faith, and they pool their money to pay healthcare bills. Some of them have negotiated rates with healthcare facilities, lowering your cost. However, you usually have to pay as a cash customer and receive reimbursement later. You pay a monthly fee, but it’s not an insurance premium; it’s money that will go to pay other people’s bills. They’ll pay for your bills when you need them.
My sister, Amy, uses Christian Healthcare Ministries and has had a good experience with them. She has a catastrophic plan with them because she’s a doctor (chiropractor) and can actually do many things to help her family’s health on her own. She’s also a small business owner and couldn’t afford insurance for herself and her employees. These plans are not compliant with the ACA; however, Trump eliminated the annual penalty for not having insurance. By law, you are still required to have insurance, but there’s no penalty for not having it.
I looked into Medi-share because they have a large pool of people and some discounted rates. The cheapest plan I could get was $160 a month, but the annual household portion I’d have to pay before they covered my bills was $10,500. If I wanted the annual household share to be $1,750, my monthly payment would be $415. This was in January 2020.
With these sharing ministries, you must abide by Christian principles. I looked into a few different companies, but they all had the same basic requirements:
- Have a testimony of your Christian faith
- You have to follow alcohol consumption from a biblical point of view
- You cannot do any illegal drugs
- You cannot have sex outside of marriage (they also will not cover pregnancy, birth control, or STD’s for unmarried couples)
- You have to attend a church weekly
I did not care for these rules. What is drinking alcohol according to a biblical point of view? Some churches believe a glass of wine is ok. Jesus always drank wine. Others believe it’s fine unless you’re drunk. Personally, I don’t mind drinking, and I don’t think it’s a problem to drink. There’s something about religion forcing people to abide by the rules that they deem correct that bothers me. I’ve attended church my entire life, participated in summer and winter camps, went on a high school mission trip to Mexico, joined life groups, and even led groups. But I’ve never been a member of a church. I just always had a hard time officially stating I believe every single thing they do and that I’ll live exactly how they tell me to. For me, it’s about my personal relationship with God, and I trust him to speak to me. Churches have their place, and I am grateful for the connections I’ve built there. I just don’t necessarily agree with all of their rules.
I decided to sign up anyway because I would be out of the country most of the year and just needed catastrophic coverage. I paid $50 for the application fee, and towards the end, was notified that I would need to pay an extra $99 per month for being overweight according to their height and weight charts.
This is absurd. Those charts don’t account for muscle or bone structure. When my weight was within the chart, people told me I looked too skinny. I don’t have any of the weight-related issues like diabetes, high blood pressure, or high cholesterol. Shouldn’t that matter more? My doctors always tell me I’m very healthy, all things considered. I am active, and my surgeon told me that my knee recovery was exceptional, considering how well I was recovering. None of that matters. Simply being overweight, according to them, will result in a 50% increase in my monthly dues. And that’s for a share plan that isn’t even insurance. Paying $260 a month for a non-insurance plan with essentially a deductible of $10,500 didn’t seem like a good choice.
The Catch: Networks, Credits, and Coverage Gaps
After experiencing the two options above, I decided to explore the Marketplace. With the help of a broker, she walked me through my options with all three. The Marketplace doesn’t ask for a medical history because it cannot deny someone with a preexisting condition. When the Affordable Care Act was first implemented, it was not very affordable. This is why I avoided signing up until I had to. I remember my ex-brother-in-law looked into signing up when it first came out. To get the same coverage his family of four got through his employer, it would cost them $950 a month. I’m not sure if it’s because Trump allowed insurance companies to offer short-term plans for the previous two years, but it seemed it was more affordable by 2020. Of course, I chose the cheapest plans with weaker coverage, and it’s just for one person. If I had selected another plan, it would have been more than $500 a month, which is still cheaper than what I was paying through COBRA.
I filled out an application, and the catastrophic plan was $303 per month, while the bronze plan was $305 per month. My deductible and maximum out-of-pocket would be $6,500 per year. Once I entered my estimated annual income (which was very low, as it was from a new small rental property), I became eligible for a monthly credit of $297. The insurance would basically be free. I decided to allocate only $200 a month for the credit, in case I made more money than I expected. I didn’t want to end up paying the tax credit back when I filed my taxes. This made my premium $105 per month. The frustrating thing about the tax credit is that if I made less than $12,500 a year, I got zero credit and would have to pay full price. If I earned between $12,500 and $52,000 per year, I’d receive a credit that would vary depending on my actual income.
The soonest the plan could start was February 1, leaving me with no coverage for almost a month, and paying $100 per physical therapy appointment for my knee recovery. I would also need to purchase travel insurance to cover expenses while I was out of the country.
The only downside to the plan is that it does not provide national coverage. My doctors in Los Angeles would not be covered. Even in the local Lake Saint Louis area, I could only go to certain doctors. Out-of-network doctors are not covered at all. The plan was offered through WellsFirst, and since it was new, there were no customer reviews available. It also didn’t cover dental or vision. I could have included dental for an additional $13 a month, but I chose not to.
What Needs to Change in Our System
I always knew that our healthcare system was screwed up, but this was a nightmare. I recall a news story from the early 2000s about the issue, and their proposal was to eliminate health insurance altogether or only have it for catastrophic reasons. The reason behind the idea was that people with insurance don’t check their itemized bills because insurance is paying. When they do, they often find they were billed for ridiculous things, like the box of overpriced Kleenex that was available in their room. If people were paying out of pocket for these things, they’d care and fight against being charged like this. In addition, procedures like CT scans are often billed for $8,000 because hospitals know that the insurance company will only pay a percentage of the cost, typically around $1,500. If there weren’t insurance, hospitals would just charge what they should actually charge.
This idea is already in effect for things not covered by insurance, such as cosmetic surgery. The news story highlighted how the offices of plastic surgeons were much nicer, and the doctors responded to emails, etc. The reason it was such a better experience than going to a regular doctor appointment is because people were spending their own money. They cared about the service and the reviews. They could easily go to a better surgeon. The competition leads to better pricing and high-quality service. In that world, you’d go to the doctor and see a menu with prices. Maybe a checkup is $50. Not paying a high insurance premium, you have the $50 for the visit. When I was in Australia, I went to a doctor and paid the cash price, which was $70. My medication was $65. The cash price wasn’t bad at all.
Since watching that news program, I have become a fan of eliminating insurance companies. Maybe keep them around for catastrophic reasons, but the care would be much better if they weren’t involved. This would also help limit the spending of pharmaceutical and insurance companies, which collectively spend billions of dollars a year influencing our laws through lobbying.
Going through this whirlwind forced me to see just how messed up our healthcare system is. During all of this, a friend of a friend reached out to me to ask about my experiences with insurance and the options available, as her dad had recently lost his job, leaving them without insurance. She was on her dad’s plan too because she was under 26. She was lost and didn’t know what they’d do. I am grateful for the Marketplace and the ACA. Without it, I wasn’t able to get insurance at all.
Year by Year: The Coverage Shuffle
For 2020, I used the plan through the Marketplace. It was okay, but I didn’t like having to choose doctors from their approved list. The deductible was also high, so nothing was reimbursed that year. Preventive care visits were covered.
For 2021, I used the broker to help me find a better solution. I was able to obtain short-term medical insurance through National General. It was a 6-month plan, but it renewed automatically, so I would be covered for a year. They didn’t cover pre-existing conditions, but I didn’t have anything pre-existing, and they covered my Thyroid medication. I didn’t need to use them for much, so it was fine.
For 2022, I renewed with National General. However, I discovered they stopped covering my thyroid medication because it was now considered a pre-existing condition. I called the company and couldn’t believe it when they said that was how it worked. The first year that you’re diagnosed with something, it will be covered. The next year, it’s considered pre-existing, and they won’t cover it. Imagine if you got diagnosed with something at the end of the year?!
For 2023, I decided to switch to a Health Share Ministry, One Share. I had to pay around $240/month and had a $5,000 deductible. They don’t cover medications or specialists because it’s a lower-tier plan. I mostly had it for catastrophic health issues because I was seeing a doctor in Missouri who doesn’t take insurance and charges a reasonable monthly fee, and acts as my primary care and urgent care doctor. However, I also had to pay for blood work and any medications.
For 2024 and 2025, I have continued with the health share plan. Now that it’s been two years, I don’t have to worry about them not covering pre-existing conditions. In February, I needed left knee surgery because I had two tears in my meniscus and couldn’t walk without a limp (it was so bad that an agent at the Los Angeles Airport got me a wheelchair). I had to obtain authorization for the surgery with the health share plan in advance. Then, I had to pay upfront as a cash patient, obtain detailed receipts from each doctor and facility, and wait a few months for reimbursement. I had to pay $5,000 before they’d pay out anything over that. The entire process of submitting invoices for the MRI, surgery, physical therapy, and other services was a significant hassle.
What will I do in 2026? I’m not sure. I might keep the health share plan (it’s now $280/month), but I might upgrade to a better plan.
Golden Handcuffs and the Fear of Losing Coverage
This entire experience made me incredibly aware of the primary reason people are afraid to quit their jobs – health insurance. I recently met a man in his early 60s who wants to quit his day job to focus on flipping homes, and he said he’s waiting until he qualifies for Medicare. The first year I traveled full-time after quitting my job, people always asked me what I was doing for health insurance. People often had dreams of doing something they were passionate about, but the risks involved seemed too high – one of those risks was losing health insurance through a company. For the first 18 months, I used COBRA. While it was expensive, it was good insurance, and I didn’t have to worry about anything. Once that ended, I gained firsthand experience in understanding the real problems that come along with not having insurance through an employer.
I also discovered one reason many people struggling with their mental health don’t seek treatment. Even if your insurance includes therapy like mine did, you may have consequences down the road for using the services. Yes, we need the social stigma to go away (and for companies to give mental health days like they do with physical health sick days), but we also need insurance companies to stop punishing people for seeking help.
This is one of the primary reasons people stay in their jobs. All of these motivational speakers talk about following your dreams, but they don’t realize people are held captive by the golden handcuffs. The salary and health insurance benefits often keep people in jobs that are detrimental to their health and in roles that aren’t their true calling. I get it. Quitting your job to pursue your dreams, such as starting your own business or traveling, can have severe consequences. Your health shouldn’t be one of them.
Have you ever struggled with health insurance after leaving a job? I’d love to hear your story in the comments.
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