Broke Urban Lawyer Pays Cash for Medical Care

I've written previously about how I don't have health insurance because it's not a good financial option for me. I do, however, get regular medical care, and my care doesn't suffer due to my lack of insurance. In some ways it's better because I don't have to wait for approval from an insurance company before getting stuff done. If my doctor and I agree on it, it happens without bureaucrats interfering.

I have some mild chronic health conditions that I manage, but other than that, I'm generally in good health. If you're someone with more expensive medical needs, your calculation might come out differently.

Here's how I handle it:

1. Primary care - I found a local doctor about 5 years ago when I first moved to my city, and I've been seeing her ever since. She bills by the hour, which works for me. (As a lawyer, I understand and respect billable hours.) A typical office visit costs about $200, and I see her 3 times per year for checkups and to manage my conditions.

2. Chiropractic care - I'm prone to my bones slipping out of joint, so I see a chiropractor regularly. There's a national chain called The Joint that has low-cost chiropractor visits. They don't take insurance. I'm on an annual plan that costs me about $500 per year and I get 4 visits per month. They also sell packages of visits for people who don't need to go as often, and a one-off visit is around $30. I can go to any clinic owned by The Joint anywhere in the country, which comes in handy because I travel so much for work. I tend to go to the same clinic most times, though, because it's near my house and I like the doctor. Since I see him nearly weekly, he's often my first point of contact for any "hey, do I need to be concerned about this weird thing?" questions.

3. Minor illness or injury - In my area, both Walgreens and CVS have clinics in their stores. The clinics are staffed by a nurse practitioner, and they can handle most minor issues. This is where I go for things like ear infections, vaccinations, etc. I prefer Walgreens over CVS because I've had issues with misdiagnosis and shady billing practices at CVS. Walgreens is excellent, though. A visit usually costs about $80, and then if I need a prescription, it's another $10-15 or so. When I cut my hand on a rusty tire and had to get a tetanus shot, that was about $30 and I didn't have to pay the office visit price.

4. Prescription drugs - Walmart and Target both have a large number of $4 generics. Walgreens also has several reasonably priced generics, though the prices aren't quite as good. I still generally do Walgreens because typically the only time I need a prescription is if I'm ill and need an antibiotic, so it's just easier to do it there because I'm already there for the urgent care visit. For people who have more regular prescriptions, I've heard good things about GoodRx, which shows the prices of different medications at local pharmacies so you can see if you're getting the best price.

5. Over the counter drugs and supplements - For over the counter medications, I buy drugstore brand generics. A bottle of generic ibuprofen is about 1/3 the cost of a bottle of Advil or Motrin, and it contains the exact same stuff. For specialized supplements, I often check Amazon for the best prices. I have a credit card that gives me 5% cash back on all purchases on Amazon, and if it's something I use regularly, I can get another 5% discount for setting up a recurring subscription, which has the added benefit that I never have to remember to re-order.

6. Blood tests - Lab work can be expensive. I have to get my blood drawn 3 times per year. If I go into the lab and request the tests myself, it's about $700. But if I order them online in advance through a third party company, it's a fraction of the cost. The same tests will run me about $300. Depending on the prices at the time, there are a few companies I use. I always google for coupon codes when I'm ready to order, and I can often save at least an extra 10%. The way it works is that you go to the website, select whether you want to go to Quest or Labcorp, and then order the tests. Then you pay the company you order from (not the lab) and print out the lab order. Take it to the lab, show the order, and get the blood drawn. I prefer Labcorp because they're faster and because Quest was involved in the shady billing practices I discussed above with CVS, so I personally don't want to give them my business. Also, the Labcorp tests tend to be a few dollars cheaper. I usually use Walk-in Lab, but sometimes I'll do DirectLabs if they're running a special.

7. Imaging and minor surgical procedures - If I need imaging or a procedure, MD Save is my go-to place. It's a site where patients pre-pay for their procedures and get heavy discounts. I'll be getting a CT scan in the near future, and it's going to cost less than $250. I also looked at the prices of other surgical procedures I could anticipate needing at some point, and an appendectomy is about $7500. (I chose appendectomy as the comparison because when I told my parents I wasn't going to buy health insurance, my dad said, "What if you get appendicitis and have to have your appendix taken out?" Now I have the answer to that question. It's still cheaper than insurance.) There's another similar site called MediBid, though they focus a bit more on medical tourism. If I need an expensive procedure, I might look into it more, but on last check, they required a fee to join.

8. Dental care - My dentist has a cash-pay patient plan where I pay $250 per year up front and get two cleanings/exams, a set of x-rays, and a few other little things per year, and then a 10% discount on any other procedures that are necessary. I have really good dental health, so I generally don't need anything beyond just the regular preventative care. For major dental procedures, I would go to Mexico, where dental care is a fraction of the price. There's a city called Los Algodones, just across the border from Yuma, AZ, that caters to American and Canadian medical tourists, especially for dental work. Because of where I'm located, I could make it a day trip.

9. Eye care - I don't really spend much on eye care because my contact lens prescription hasn't changed since I was 17 years old, and I still have a 2 year supply of unopened contacts that haven't expired yet. Back when I had an FSA at my old job, I had to spend it all down before I quit, so I bought up all the contacts I could. I only wear a contact in my right eye, so they go twice as far for the same price. For people with more complex needs, VSP offers individual plans for about $15 per month. VSP is really good insurance, and it's what I've had every time I've had a job with benefits.

10. Unexpected expenses - Sometimes, even with the most careful planning, an unexpected medical expense will pop up. I have CareCredit for that. It's a medical credit card that offers interest-free financing on medical procedures as long as the bill is paid off during the promotional period. The promotional period varies from 6-24 months depending on the cost. I had to have a benign tumor removed a few years ago, and I was able to make payments on it. I paid it off during the interest-free period. Also, many hospitals will work out payment plans.

Cost/benefit analysis: The cheapest health insurance plan available to me is about $450 per month with a $6500 deductible. Adding up the cost of my regular out of pocket care (not counting dental and vision because those aren't covered under regular health insurance), I spend about $2200 per year, assuming two urgent care visits per year. This means that to make health insurance worth it for me, I would need to have medical expenses of an extra $9700 per year (the cost of monthly premiums plus the deductible, minus my current out of pocket expenses). I only have one appendix, and even that would cost less than the difference! Due to some tests and procedures I may need this year, I'm looking at perhaps an extra $2000 over and above my normal stuff, which is still a bargain to pay out of pocket.