I have to make my Marketplace decision about next year’s insurance. I paid thousands for health insurance last year and didn’t use it except for dental and vision. On the other hand, I’ve been blogging for the top non-.gov website on the subject and therefore doing lots of research.

So my choices are these:

  • an HMO type, at about the same price I’ve been paying, with a predictable co-pay for doctor visits and prescriptions
  • a catastrophic coverage type with an $11,000 deductible, which pays nothing until the deductible is met.

Essentially, I can pay thousands for something which I will probably not use — but I might, since I could visit a doctor for $40 — or pay fewer thousands for something which I will almost certainly not use.

Half of all the healthcare expenditures in the U.S. are for about 5% of the people. Those people are typically old people with chronic diseases. I may be old, but I am in rude health and never need medical care. All Americans have about a 20% chance of needing hospital or emergency room care. But since that number aligns with the 5% needing predictable care, my chances of needing a hospital stay are actually very slim.

Now, if I have the bad luck to rend up in the hospital, I couldn’t afford $11,000 for the deductible anyway. I’d be unlikely to need that much care, actually, and if I did I would just have to pay it off gradually for the rest of my life. So the high deductible catastrophic coverage will be $1,000 or so from which I absolutely won’t benefit.

The other option will cost me closer to $3,000. That’s what I paid this year, and I’ve had a couple of dental visits, the most expensive of which came during some sort of waiting period and was not covered, and an eye doctor visit which cost me $600 counting the glasses. No doctor visits. So I might well spend more with that option and still not benefit.

That is, the most likely outcome either way is that I will pay a lot and get nothing much. From that point of view, I’d be better off paying the smaller amount for nothing much.

Imagine that I pay the $100 or so each month and set aside the $150 so I save. I could use those funds for medical care, and probably still spend less than with the HMO option —  but also run the risk of needing care and not having the funds set aside yet.

However, if I choose the HMO option, I might get preventive care, catch something early, and maintain my excellent health until I’m eligible for Medicaid or Medicare or whatever it is, which will actually happen in a mere five years. From that point of view, I’d be choosing between paying a lot for nothing, or rather more for something.

Studies have shown that people who get preventive care feel healthier, even if they are not healthier in fact.

Since I have to pay for it anyway, it might make best sense to pay more, and then make sure to use it.