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Health


The Affordable Care Act requires most American citizens to have health insurance or health care starting in 2014. Many of those required to have health insurance will owe additional tax if they are not enrolled in a plan. It’s no surprise that many citizens are not happy about being told by the government that they have to spend money. And whenever the government requires something of its citizens, it doesn’t sit well with many of those who don’t agree with what is being required.

When the government drafted young citizens into the armed forces during times of war, protests intensified with each action until the draft was eliminated, and some enterprising individuals did whatever they could to avoid military service, including fleeing to another country. National defense and national health may be good reasons to encourage citizens to take actions that would be for the benefit of society, but Americans’ individualistic nature prevents everyone from gladly jumping on board the train.

Take up thy stethoscope and walkThis time around, those who don’t want to accept the government’s requirements can avoid jail. The penalty for not buying a health care plan from a private company is to pay a fee. Compare this with other civilized companies that have a national health system, where everyone is covered for basic health care through a public, government-operated organization, and it’s just a service provided by the government and financially supported by citizens like infrastructure maintenance and national defense. The fee varies, and some households can avoid the fee entirely.

According to the Tax Policy Center, these groups are not subject to the health insurance requirement and can avoid the fee entirely:

  • Individuals with income below the income tax filing threshold. If you don’t have to file your tax return, you don’t have to pay a fee.
  • Individuals for whom the cost of getting health insurance (net of ACA subsidies) would exceed 8% of household income in 2014. That percentage would rise in subsequent years if premium growth exceeds income growth.
  • Individuals in states that did not accept the ACA’s Medicaid expansion who would have qualified for Medicaid under the expansion. These states did not accept the expansion: Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.
  • Members of Indian tribes.
  • Members of certain religious faiths.
  • Members of a health care sharing ministry.
  • Individuals not legally in the U.S. (undocumented aliens).
  • Incarcerated individuals.

For all other individuals, in general, the penalty for not having health insurance is 1 percent of household income after discussions with a maximum of $95 per adult and $47.50 per child. The penalty is capped at the average cost of a bronze level health plan for the same family, so in some cases — large families, most likely — it could be cheaper to buy health insurance than to pay the penalty.

Using the penalty calculator I ran some simulations. For a large family with a household income of $750,000 — this is a wealthy family — it’s probably cheaper to buy a bronze health insurance plan by 2016 as the fees increase. For a large family with a household income of $45,000, for whom the average price of a bronze plan would be $16,700 (or more than one-third of total income), the penalty of $285 for 2014 seems much more affordable. But the average health care plan price doesn’t take into account subsidies that are available for families that couldn’t otherwise afford private health care. Health care purchased from a private company through the national or state exchange can still amount to less than the fee if the situation calls for that much assistance.

My COBRA health insurance coverage ended in January, and I spent some time last year shopping for health insurance using the national exchange. Despite lots of initial difficulty, my application did go through, and I was able to sign up with health insurance from AmeriHealth. At the same time, however, I discovered that I was eligible for state continuation of COBRA through California’s program, Cal-COBRA.

Because I liked the plan I had under COBRA, I stayed with Cigna, stayed with my doctor, and paid a little more under Cal-COBRA rather than accepting the plan with AmeriHealth. The best AmeriHealth plan would have left me with fewer benefits than the plan with Cigna, but would have saved me money on monthly premiums. And because I can afford individual health insurance, the health exchange and the options presented aren’t really designed for me.

How do you feel about the Affordable Care Act penalty? Would you rather pay the penalty than be forced to buy health insurance? Do you see preventive healthcare as an important piece of a civilized society, or is health insurance primarily an individual issue?

If you want to calculate your health insurance penalty over the next few years, use this calculator.

Photo: Flickr

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Looking back over my career, which for me started in non-profit out of college in 1998 and 1999, included teaching middle school and high school, transitioned into the finance industry, and eventually culminated in working for myself full-time, I’ve had an opportunity to consider my approach to “sick days.”

In the early days, I took as many sick days as possible. The organizations or companies I worked for had policies that guaranteed no fewer than a certain number of sick days. I didn’t normally take sick days to conceal the lack of a desire to go to the office; for the most part, I was sick as frequently as I took advantage of these days, usually several each month. And for me, being sick involved something like the flu or flu-like symptoms.

Perhaps I was exposed to unhealthy people more often because I lived in an apartment with several roommates, shared an office with other people who would go to work while they were contagious, or spent weekends with hundreds of high school students. Perhaps it was a combination of all the above. On most these days I formulated the courage to call a judgmental boss to let him know I wouldn’t be making it in, I was actually sick.

I never once had an employer ask for a doctor’s note, but I’m sure a few times in my first job with the non-profit I received a call from the office to check up on me. I was not calling out sick to go to a concert, I was not partying. If I called out sick, I was either sick or recovering. Every once in a while I would use a sick day for a personal recovery day; but when you work long hours seven days a week because the organization is under-staffed and over-reaching, I think that’s acceptable. Occasionally.

But as I got older, my approach to sick days — and possibly my general health — changed. When my schedule was no longer super-packed, I didn’t get sick as often. I moved out of the communal apartment and found a place with just one roommate — and a few years later, lived on my own. I was no longer exposed to hundreds of children each week. My need to take advantage of the maximum number of sick days allowed by company policy decreased, even though I managed to fill the rest of my at-home schedule with working for myself.

Also, the company I worked for began offering an opportunity for employees to work from home. Although this wasn’t the intent of the flexible arrangement was, I could occasionally work from home if I felt under the weather, and the more relaxed environment might have saved me from developing a more serious affliction each time.

Officially, the financial company I worked for did not want employees to come to the office if they were sick because of the fear of an ailment spreading through the office. Of course, this not a genuine concern of a corporate entity; the company policy was such to avoid the possibility of reduced efficiency among the employees. While staying at home in the event of sickness was the official approach, at the team level it was a different story. Employees were expected to come to the office as much as possible despite the threat of transmitting sickness to others.

Quitting the corporate day job and working for myself full time probably had the biggest effect on my health. By writing this, I hope I’m not tempting fate, but I haven’t really been sick since quitting my job. Perhaps I’ve felt sick enough once or twice a year to prevent me from getting everything done in a particular day, but that certainly isn’t the same frequency of immobilization as I was experiencing towards the beginning of my working life.

It’s also true that my environment is more isolated today than it’s been any other time in my career. I have no office to go to. I do not work with high school or middle school children. I see people only when I choose, and so perhaps I’m not exposed to many of the same infections I would be had I remained in other jobs. I don’t have a stressful schedule. I don’t have stressful deadlines unless I create them for myself. I have control over the way I live and work, which was less true earlier in my life.

And, in some ways, if I have to take a sick day, it affects my own bottom line. That was not the case in the past, though if my superiors and co-workers thought I was taking advantage of company policy — and I’m sure they did — it would affect my reputation at the office.

If you work in an office, when do you call out sick? Have you used employer-provided sick days to take care of chores or to take care of your children, or do you just call out when you’re actually unable to make it to the office? Do you try to go in when you’re sick to continue work?

If you don’t work in an office, do you find that you’re not getting sick as often? Are there other factors that contribute to your health, like being around children or other adults frequently? Are you motivated to be sick less often if you’re working for yourself?

Photo: Flickr/kodomut

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As a kid, I might have had attention deficit disorder (ADD). I was never diagnosed as far as I know, but I had many of the symptoms of the “inattentive” type of ADD, and some of those symptoms continued into adulthood. An actual diagnosis of ADD as an adult would require exhibiting at least six recognized symptoms since childhood and for those symptoms to often interfere with one’s functioning in life, work, and relationships. I don’t think I’d qualify as having ADD, but the symptoms I do have do affect my life and my finances.

There has been some criticism of the ADD diagnosis. There’s been some concern that, at least for a period of time, the condition had been overdiagnosed. The symptoms of ADD and ADHD (ADD with hyperactivity) can come from other causes than the disorder. An inability to focus, for example, could be a symptom of ADD or could just stem from a lack of experience focusing on tasks. In adults, procrastination could be a manifestation of ADD or it could be a conscious choice to avoid responsibility until the last moment possible.

Doctors believe, however, that ADD/ADHD is underdiagnosed. Three to five percent of the United States population might have adult ADD/ADHD, but only 15 percent of those who could be diagnosed are aware that they have a disorder.

Self-diagnosis of adult ADD or ADHD is not possible, at least not without a medical degree. Besides just an observation of the required number of symptoms and an analysis of the effect those symptoms have on one’s life, there are several tests that are required to rule out other causes of behavior. You should check with a doctor if you suspect you might have ADD to receive tools that can help control the symptoms.

With a diagnosis or not, the symptoms of ADD can be harmful to one’s financial life. ADD/ADHD and its symptoms can prevent financial independence or slow down the approach towards wealth or stability:

Adults with ADD/ADHD often experience career difficulties and feel a strong sense of underachievement. You may have trouble keeping a job, following corporate rules, meeting deadlines, and sticking to a 9-to-5 routine. Managing finances may also be a problem: you may struggle with unpaid bills, lost paperwork, late fees, or debt due to impulsive spending. Melinda Smith, M.A. and Robert Segal, M.A.

Rather than fighting the tendencies described above resulting from ADD or its symptoms, one approach would be to use these effects to one’s advantage. Here are a few suggestions that take ADD traits and turn them into advantages. Wouldn’t you know it, as I was writing this article, I got distracted by reading the testimonials on the Ted Mosby Is Not a Jerk website. I’m easily distracted.

Leave the corporate world behind in favor of working for yourself. This isn’t exactly a simple proposal. In fact, for someone struggling with ADD symptoms, succeeding as an entrepreneur can be that much more difficult. And in some cases, the decision to start your own business if made because of a desire to get away from corporate mentality can be a big mistake.

You never work for yourself, even if you own a business; you have to answer to customers, clients, stakeholders, employees; in fact, owning your own business greatly complicates the structure of responsibility. In some cases, though, the increased responsibility of owning a business can have the same effect as procrastination: when the stakes are higher, those who procrastinate might operate at their most efficient and effective levels.

Build systems to keep you organized.

When I was in the corporate world, companies offered educational programs designed to help employees learn the skills that assist with organization and time management. Corporations are willing to spend money on this type of education for one simple reason: organized employees work more efficiently, and efficient work saves the company money. Corporate culture is not designed to invest in the personal development beyond what is good for the company’s bottom line. Unfortunately, ADD or its symptoms make it difficult for those employees to make permanent improvements based on the skills taught in these educational programs.

Have you experienced this? After hearing some great suggestions for keeping some part of your workday organized, you put the system into action. After a week, maybe two, you get bored of the system and revert to old habits. What you need is a meta-system. A meta-system is a system, but it’s a system that helps you manage the systems you put into use. It may not be enough to organize your email inbox using incoming folders, archive folders, color-coded priority ranking, and a policy of clearing your inbox every day. This is a good system, but if you have the tendency of letting chaos creep into your email behavior, you need another system that raises the stakes to keep your system in check.

An example of a meta-system that keeps this inbox system in check might involve measuring your success once a week and rewarding yourself for your level of effectiveness.

Paying bills is one of the most important financial responsibilities one can have because the disastrous consequences of not doing so. One system often suggested for maintaining bill payments is to make them automated. You can set up recurring payments from a checking account sent automatically from your bank to the company that bills you on the same date each month. Sometimes you can set up an automated electronic transfer.

Automated bill payment is a classic example of what someone who struggles with paying attention to details can do to alleviate the potential consequences of unpaid bills. The system of automation requires oversight. If a company keeps increasing the amount charged and knows that you are automatically paying bills without review, it makes it easy to be overcharged for services. That could damage your financial condition over the long term.

Fight boredom by adding randomness into your day.

Boredom might come from ADD or ADHD. It could be a result of a lack of a challenging environment. Boredom might also be the result of settling into a behavioral pattern.

One thing that has worked for me while I was bored in my corporate environment was to take time out of the day to do some things that gave me energy. Sometimes I would go to the roof of the parking deck and jog a mile in a loop. Exercise is great if you experience the restlessness symptom of adult ADHD, because channeling that restlessness into a physical exercise satisfies the need for activity while also being beneficial to your health.

In order to fight boredom and tediousness, sometimes I would put my work away for a few minutes and work on a personal project. The boss might not have been happy about my using some time for personal endeavors, but taking a break to work on something fulfilling helped me perform my job-related assignments better.

Even visiting co-workers at different times during the day, being careful not to interrupt anyone who wouldn’t appreciate a quick social visit, help keep the boredom away.

Use focus and passion to your advantage.

ADD/ADHD can manifest as difficulty with mutli-tasking or task switching. First of all, attempting to multi-task can be damaging. According to a recent study, the more you try to multi-task “the less you’re able to learn, concentrate, or be nice to people… The less you’re able to filter out irrelevant information.” Other studies show that humans can’t multi-task at all; what we think of multi-tasking is actually task switching.

The difficulty with task switching among those with ADD can sometimes take the form of an exceptional ability to focus intently on one thing. While it’s true that some with ADD/ADHD have difficulty maintaining focus, the opposite, hyperfocus, may manifest itself in other activities — usually not the activities others want you to attend to, but personal activities that inspire some kind of passion.

You can’t always design your life and work around what you’re passionate about, but some of the creativity and restlessness that can come from ADD can help you discover life paths that incorporate those passions.

Be aware of the ADD/ADHD income deficit.

A study has determined that those with adult ADD/ADHD earn significantly less income than those without. Here are some of the pertinent economic results from the study, with figures from 2005:

  • Adults with ADHD are less likely to be employed full-time.
  • High school graduates with ADHD earn $10,791 less annually than their non-ADHD counterparts.
  • College graduates with ADHD earn $4,334 less annually than college graduates without ADHD.
  • Because of the tendency for adults with ADD/ADHD to be more likely to abuse drugs and alcohol, the cost of the disorder $180 billion a year, plus $77 billion due to lower annual income.

The economic disadvantage for adults with ADD/ADHD or its symptoms is significant, so it’s important to find ways to counter that disadvantage. Working harder or more isn’t always an option. Sometimes life prevents you from getting a second job. But you can look to overcome difficulty with negotiations to make sure you’re getting the most out of your day job income. You can consider how quantum jumps can boost your wealth. You can use some of the above tips to counter ADD tendencies, reducing the deleterious economic effects of those symptoms.

How do you deal with your adult ADD/ADHD symptoms? Have you interacted with children with ADD/ADHD or its symptoms? What behaviors have you seen among those with ADD/ADHD that helped them succeed?

Photo: Flickr/adreson

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Although I’ve mostly figured out how to get my financial life in order, other aspects of my life still need work. For example, I’ve visited a physician only a few times over the past ten years. I should be seeing a doctor about once a year if I were to listen to the typical medical advice. With my medical insurance provider changing four times in the last two years, it’s been even more difficult for me to nail down some consistency in medical coverage. But that’s just an excuse.

As an independent contractor, it’s up to me to find and pay for medical insurance — and this isn’t cheap in the state of New Jersey. An increasing number of people in my situation — as well as those who do have employer-provided insurance — are turning towards concierge medicine.

The type of care provided by doctors who follow the concierge model is more like the medical care of the past: doctors have fewer patients and build personal relationships, make house calls, and in many cases, earn a better living than they would when dealing with insurance companies.

For a monthly retainer fee, a patient can have access to their family physician at any time.

There are great benefits to this model, but it can’t replace insurance completely, particularly not for people who aren’t rich. Concierge medicine has been a service consumed by the wealthy, but as it has been growing in popularity, the idea is increasingly gaining traction among those who are not as flushed with cash. The concierge model is not a replacement for insurance. It’s fine when all you need to deal with is a physician, but specialists can cause problems.

Treatment not handled by a physician can be expensive. This is how people without insurance can find themselves in debt that they can’t overcome. One operation can cost hundreds of thousands of dollars without insurance, and concierge medicine does nothing to solve that problem. It cannot be a full replacement for insurance — or it can be, until a patient needs anything more than basic medical care.

The career situation for physicians is difficult, and moving from insurance to a concierge practice is one way for their industry to survive and thrive. Many of the best medical students turn towards a specialty because the compensation is so much better, as a result of the way insurance companies reimburse doctors for services. Compensation is not just the simple issue of supply and demand, but that has something to do with it as well.

Society still needs primary care physicians even though they don’t make as much money as specialists for the most part. To justify the ever-increasing cost of medical school, doctors need to seek higher compensation. A concierge model can increase the annual income of a practice. For the patient, however, the typical concierge medicine approach is incomplete. Insurance is still necessary — though perhaps an insurance plan that includes only catastrophic coverage — because once you need a specialist, without insurance, you’ll need to pay for your care out of your pocket.

Would you be willing to pay a monthly retainer fee for more direct access to your physician? How would you then cover yourself for any procedure or treatment your physician might not be able to handle? Is concierge medicine still only a reasonable health care option for the wealthy? With the Affordable Care Act, designed to encourage insurance for all citizens, is concierge medicine a viable option?

Photo: Flickr

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How to Work Out Without Over Working Your Budget

by Guest Author

This is a guest article by Jennifer Calonia, Junior Editor at GoBankingRates. In the article, the author offers suggestions for staying fit without breaking the bank. It’s that time again: Beach season is fast approaching and franchise gym promotions are in full swing to lock you and your checking account into a pricey workout regimen. ... Continue reading this article…

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The Cost of Raising a Child With Autism

by Luke Landes

A few years ago, I shared a statistic showing that it costs almost $200,000 to raise a child, from birth to age eighteen. If that weren’t enough of a financial burden, consider that one out of 88 children are now diagnosed with autism, according to the Centers for Disease Control and Prevention (source, pdf). Regardless ... Continue reading this article…

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Church Health Insurance: Effective in the Amish Community

by Luke Landes
Horse and buggy

The Amish community is exempt from the health insurance mandate that is now federal law. Members of this community rely on each other for taking care of their health, rather than relying on insurance companies. It’s an interesting approach to healthcare, and it is effective for communities where people rarely leave or enter. I visited ... Continue reading this article…

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Boost Your Human Capital: Stay Healthy

by Luke Landes
Jogging Girls

It’s easy to focus on the personal policies that help improve your net worth immediately. Saving money, investing thoughtfully, and earning income affect your bottom line immediately. This view can be shortsighted occasionally. Focusing effort on your personal human capital can have a greater affect on your net worth over the course of the rest ... Continue reading this article…

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My New Gym Membership: Good Idea or Foolish Move?

by Luke Landes

After years of failed self-improvement in a number of aspects of life that most people tend to consider important, like organization, time management, and self-motivation, I’ve come to accept some of my flaws while taking advantage of my strengths. I haven’t completely given up on the strive to improve facets about myself that could lead ... Continue reading this article…

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Look At Your Medical Bills Before Paying

by Luke Landes

My dentist’s office is changing billing procedure. I should note that my dentist is not part of an insurance network. It may be a cliché, but I have heard people who say that any dentist who aligns his office with insurance carriers is one you want to avoid. That doesn’t mean that I have to ... Continue reading this article…

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Concierge Medicine: Differentiated Healthcare for the Rich

by Luke Landes

Earning or having more money might not universally increase happiness or health. Wealthy people can be sad or sick just like those who are less financially fortunate. More money does provide more access to “stuff,” though, and people often like that “stuff.” Businesses that cater to the rich with services for which they might be ... Continue reading this article…

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Potential Doctors Attracted to Primary Care Physician Jobs

by Luke Landes
Ambulance

The Health Insurance Reform Bill was signed into law a year ago. It’s already having an effect on the state of the medical profession. Thanks to some incentives, general practitioners or family doctors, typically the best choices when one is selecting a primary care physician, are becoming attractive jobs. It’s easy to see why, for ... Continue reading this article…

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Financial Motivation to Get in Shape

by Luke Landes

I started the year out right. I didn’t join a gym for my exercise, but I signed up for a “class” using RunKeeper, a mobile application that tracks my progress as I run, walk, or get any physical exercise, and posts my results publicly. It ties into my philosophy well, using the same tricks I ... Continue reading this article…

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Braces and Orthodontics: Costs and Benefits

by Luke Landes
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Through most of my four years of high school, I had braces on my teeth. The braces helped to correct an overbite, and I wore them longer than most kids my age most likely because I wasn’t consistently wearing the head gear during the night as prescribed. It’s hard for me to weigh the cost ... Continue reading this article…

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Why You Should Care About Your Wallet and Your Waistline

by Philip Taylor
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This is a guest article by Philip Taylor, the owner of the blog PT Money. Philip created PT Money to share his own experiences with successfully managing his money. It’s no secret that our money and our health are connected. More people want to excel with these two things for their lives more than any ... Continue reading this article…

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Running in the Snow

by Luke Landes

One of my goals for 2011, like most people who make New Year’s resolutions, is to lose weight. Earlier this week, I started a training program that will lead me to be able to finish a 5K. To track my progress and to assist with training, I’m using an application for my phone, RunKeeper. RunKeeper ... Continue reading this article…

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Life After Salary: COBRA vs. Individual Health Insurance

by Luke Landes
Cobra

One month ago, I notified my boss at the corporation where I worked that I would be leaving. I was headed for the new frontier. Leaving my salary and benefits behind, I looked to the horizon and contemplated what I needed to do in order to keep my life secure. My biggest concerns besides maintaining ... Continue reading this article…

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Make More Money By Sleeping More

by Luke Landes

Although I’ve always been a proponent of the value of getting a full night’s sleep for health, this is something that I haven’t been able to do for myself for many years. The people I know who are most committed to their careers and those for whom anything other than success is unacceptable have had ... Continue reading this article…

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Reducing the Cost of Dentist Care

by Luke Landes

How often do you visit the dentist for preventive care? Since graduating college, I’ve been getting regular check-ups and cleanings twice each year. I’ve seen the results of neglect, and I have no desire to lose my teeth any time soon. I’ve also seen results of bad dental work, so it’s imperative not only to ... Continue reading this article…

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The New Health Insurance Law and Your Money

by Smithee

Aside from some procedural maneuvering in the Senate, the health insurance reform bill that Congress has been working on for the last year, now falling under the Reconciliation Act of 2010 (H.R. 4872) and the Senate health bill, will soon be signed into law. How is the new law going to affect your personal finances? ... Continue reading this article…

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