By the numbers: My spending for March 2019

March was a mixed month in my financial world. I ended March with a slightly higher net worth (up 0.6%) but my spending was the highest it’s been this year: $5989.10. Yet, that spending was mostly mindful. I wasn’t frittering away money on silly things.

If I wasn’t buying dumb stuff, then where did my money go? A few worthwhile places:

  • I spent $653.31 on the yard and garden. Specifically, Kim and I tore out a big cedar tree in the corner of the yard, then converted that space to a small orchard. I use the word “orchard” loosely here. We planted three fruit trees, four blueberries, four grape vines, and a bunch of strawberries. I hope to write about this more in the near future.
  • I spent $625.72 on health and fitness. In the middle of the month, I had quite a scare. Out of nowhere, I had chest pains, so I visited the local hospital ER. My co-pays and prescriptions are reflected in March’s spending — and there’s more to come. (We’re about to have a l-o-n-g article on the $6800 hospital bill I received in the mail yesterday. That’ll happen in April or May.) Meanwhile, Kim had knee surgery at the end of the month. I paid for some of her stuff out of my pocket.
  • I spent $579.36 on gifts in March, which is very very unusual.
  • I paid the $450 annual fee on my Chase Sapphire Reserve credit card. (Yes, I know this seems like a lot. But remember the card comes with a $300 travel credit, which means my effective annual fee is $150. I believe I receive $150 in value from the card’s other benefits.)

I don’t consider any of that spending frivolous although I recognize that some of it isn’t necessary. (Do we need an orchard? Do I need to give gifts?)

That said, I did have some weak spots in my spending. I bought several movies on iTunes. In fact, I spent $72.63 on iTunes in March. I need to be careful lest I return to my former profligate ways. No more looking in the iTunes store! I also spent $230.15 on alcohol during the month (most of which was beer).

How did I do with groceries? As you know, my food spending had grown out of control, which is one of the primary reasons I’m tracking my spending in detail this year. Last year, I spent over $1000 per month in food. This year, I’m spending less than $700 per month.

I was very proud of my food spending for most of March. I spent a total of $658.21 during the month: $468.27 on groceries and $184.24 on dining out. That’s my lowest monthly food total in two years (excepting months during which I’ve been on the road).

Going into the last week of March, I’d only spent $241.87 on groceries. That’s amazing! Things fell apart, however, when I stocked up on food for Kim’s convalescence. Meanwhile, we only had three restaurant meals during the month. For one of those, I paid for two guests. Not bad. Not bad.

Quarterly Spending

Now that we’ve made it through the first three months of 2019, I was curious how my quarterly spending compared to last year. Monthly spending can fluctuate quite a bit. You can get a better idea of your actual habits by looking at a bigger picture.

Here are some highlights:

  • I spent $116.56 at the iTunes store during the first quarter of 2019. That’s less than I spent on movies and TV shows during any single month last year, so that’s a win.
  • I spent $2076.54 on food for the quarter, which is lower than any quarter in 2018. I spent $1179.53 on groceries, $323.52 on HelloFresh, and $542.29 on dining out. That restaurant spending is another big win. The grocery spending was good — better than any quarter in 2018 — but I feel like I can do better.
  • I spent a lot on health and fitness during the first three months of the year: $1752.60. And the thing is, it’s not going to get much better.
  • This year, I decided to separate hot tub expenses into its own category. I spent $151.88 on hot tub stuff (chemicals, etc.) during the first three months of the year. And, no, that doesn’t include electricity.
  • Our zoo — three cats and a dog — cost us $447.54 during the first quarter of 2019.
  • You know where I could save big bucks? By drinking less. I spent $586.36 on alcohol during the first three months of the year (and that includes four weeks during which I didn’t drink a drop!). That’s $6.44 per day. Time for me to cut back on my craft beer obsession…

I spent a total of $15,364.85 during the first quarter of 2019, an average of $5121.62 per month. That’s not a great number, to be honest. It’s pretty much what I was spending last year. Still, I’m trying not to get too stressed about things…yet.

The whole point of this exercise is for me to figure out where I’m spending my money and why. Once I have a clear picture, I can make some course corrections.

April is the Cruelest Month

Unfortunately, April is going to have some crazy, crazy spending numbers. My accountant called yesterday to give me my tax bill. I owe $20,000. (I’m not joking.) The hospital called too. They wanted to let me know that I owe them $6800 for the ER visit in the middle of March. To cap things off, payment is due on the vacation that Kim and I booked a year ago. We’ll be headed to Greece and Italy in August — but we’re paying for it today.

Fortunately, I knew that some of these expenses were looming, so I have cash set aside to pay for taxes and our trip. (The ER visit was a surprise, obviously, and I don’t have money set aside for that.) That doesn’t change the fact that April’s expenses are going to be insane, though. It just means I’m somewhat prepared for the insanity.

The upside to having a $6800 hospital bill so early in the year? It gives me a chance to make maximum use of my health insurance! My max “out of pocket” is $7900 annually. Since it looks like I’m going to hit that, it makes sense to address all medical issues that are bugging me in 2019.

At the end of 2018, I had a net worth of $1,334,227.20. At the end of March, my net worth was $1,397,545.18. That’s a leap of more than $63,000 (or 4.75%). That’s great! In reality, this simply reflects a hot stock market. My investment accounts are up $77,933.04 this year (11.45%).

A hot stock market can cover a multitude of sins…

Source: getrichslowly.org

My True Travel Insurance Story – A Broken Leg & Surgery in the Dominican Republic

Today, I have a great article written by my sister-in-law and editor, Ariel Gardner. She is sharing her travel insurance review story, and goes in-depth on the travel insurance process. I asked her to write about this because I feel like it’s not really discussed, yet there is a lot to learn! You may have seen her here before talking about taking her side hustle full-time, living in a small house, real life frugality, and more.

Earlier this year, I was enjoying myself on a relaxing Caribbean cruise with one of my best friends.

I had breakfast delivered to my room every morning, drank fancy cocktails in the evening, and barely thought about the travel insurance policy I bought just in case.

On the fourth day of our cruise, we docked in Santo Domingo, Dominican Republic and disembarked to explore the city. Our group ended up at Fortaleza Ozama, a Spanish fort built in 1502.

We walked up four or five flights of stairs to get a view from the top, and on the first step back down, I fell and broke my leg.

It wasn’t a major fall.

But I twisted my leg in just the right way to end up with a spiral fracture that broke several bones in my ankle, my tibia, and fibula. 

There was so much chaos as we figured out how to handle everything, from whether or not to have surgery in the Dominican Republic and how to fly my husband down.

On top of everything, this was at the beginning of March 2020, just as the U.S. and many other countries were shutting their borders down because of COVID-19.

The impressive Fortaleza Ozama. 

My travel insurance policy went from an afterthought to a necessity as I racked up more than $10,000 of out-of-pocket medical costs and unexpected travel expenses in just a couple of days.

Eight months after this whole ordeal began, I’ve finally got closure. My travel insurance claims are paid, and I had my last visit with the surgeon who fixed my leg with a metal rod and seven screws.

I learned so much about the travel insurance process over these past few months, and I was excited when Michelle asked me to share my experience. 

My biggest takeaway from it all? I will always buy travel insurance when traveling out of the country, and I’m about to explain why.

Related content:

  • How To Travel On A Budget And Still Have The Time Of Your Life
  • How To Take A 10 Day Trip To Hawaii For $22.40
  • Want To Be A Full-Time Traveler? 13 Ways To Make It Happen

My True Travel Insurance Review Story & Why You Should Consider Travel Insurance

 

The cost and details of my travel insurance plan

You can expect travel insurance to cost 5%-10% of your total trip cost. The cost largely depends on what kind of coverage you want, where you’re traveling, length and cost of trip, and your age. 

I decided to purchase a travel insurance plan through Generali Global Assistance because they had high ratings and offered the kind of plan I wanted. 

For $142.68 my trip would be covered under Generali’s Preferred Plan, which offered the following coverage limits:

  • Trip cancellation: 100% of trip cost
  • Trip interruption: 150% of trip cost
  • Travel delay: $1,000 per person
  • Baggage loss: $1,500 per person
  • Sporting equipment: $1,500 per person
  • Sporting equipment delay: $300 per person
  • Missed connection: $750 per person
  • Medical & dental: $150,000 per person
  • Emergency assistance & transportation: $500,000 per person
  • Accidental death & dismemberment (air flight accident): $75,000 per person/$150,000 per plan
  • Accidental death & dismemberment (travel accident): $25,000 per person/$50,000 per plan

There were a few aspects of this plan that I was really concerned about, including trip cancellation and interruption. I was leaving for a cruise as the COVID-19 pandemic was hitting the U.S., and there was a real possibility something might happen to my travel plans.

Cruising at the start of a global pandemic wasn’t an awesome idea, but luckily no one on our ship showed signs or tested positive for COVID-19 after getting back to the states.

My plan offered “cancel for any reason” coverage for trip cancellation and interruption. This is the most comprehensive kind of coverage – you’re reimbursed for a portion of your costs no matter what your reasons are – but it’s a little more expensive. 

Medical coverage wasn’t a huge priority to me because I assumed the chances of getting hurt were pretty slim. This is laughable now.

Despite feeling like medical coverage wasn’t necessary, the reason I got travel insurance (with higher medical coverage) was because of a story an acquaintance told me a few years earlier.

This woman had gone on a 10-day cruise in the Mediterranean, and her esophagus spontaneously ruptured a few days into the cruise. This is an incredibly serious condition that will result in death if it’s not immediately treated.

When the cruise ship doctor realized what was happening, they ordered a helicopter to medivac her to the closest hospital. I can’t remember which country she ended up in, but between surgery, complications, and recovery, she ended up in the hospital for two months.

She paid $450 for a premium travel insurance plan, and it covered all of the $1,000,000+ expenses she incurred. From health care, medivac, trip interruption costs, and flights back and forth for her husband.

With that story stuck in my head, my worst-case-scenario mindset kicked in and told me to buy travel insurance for my cruise.

 

What my travel insurance actually covered

I’ve broken my ankle before and the treatment is pretty straightforward and easy. Slap a boot on your leg and be on your way. This break was worse, and being in a foreign country complicated things.

First of all, I sustained an open fracture. That means my tibia bone broke through my skin, which puts you at risk of infection. Had it been a closed break, maybe I could have gotten back on the cruise ship, had the onboard doctor set my leg, and cruise back on painkillers until I got home.

Open fractures need to be treated with surgery as soon as possible so the wound can be cleaned out. Surgery meant that I would not be getting back on the cruise ship. 

There was a lot of debate about where to take me – the Dominican Republic has a very different health system. It was decided that the best care would come from a private clinic. 

The clinic required a deposit of 80,000 Dominican Pesos (DOP) before I could be treated. The exchange rate varies day-to-day, but this equals $1,369 at the time of writing.

I was put on an IV drip for antibiotics, given IV painkillers, was x-rayed, had an electrocardiogram, and was prepped for surgery. The surgery to clean out the wound was quick, but it still required anesthesia. 

The surgeon said I also needed an ORIF (open reduction internal fixation) to fix my leg. This is where they fix your break with a rod and screws. It’s not a complicated surgery, but after talking with some people back home, and with a doctor friend who was traveling in our group, we decided it was best to wait until I was back in the U.S. for the ORIF surgery. 

After the surgery to clean out the wound, the surgeon ordered me to stay in the clinic for two days before it was safe for me to fly home. I spent that visit on more IV antibiotics and painkillers. After the deposit was applied to the total, my stay was another 357,000 DOP or $6,110.

Between just having surgery and the fact that my broken leg wasn’t fully fixed, I couldn’t just fly home by myself. The surgeon in the Dominican Republic said I needed a travel companion to help me fly home, so my husband booked a flight and came out the day after my surgery. His flight was $400.

The surgeon ordered two things to fly home safely: an ambulance to transfer me to the hospital and first-class flights home to give me enough room for my bandaged leg. Side note: this was the first time I’ve ever flown first class, and I’d love to do it again when I can appreciate it. At least my husband got to enjoy the complimentary Bloody Marys.

Those tickets weren’t cheap. Not only was it first class, it was a last minute, one-way flight at the start of a global pandemic. We paid $1,275 for each ticket.

The ambulance ride to the airport was 7,600 DOP or $130. We paid the drivers in cash plus a tip. They were amazing, by the way. Neither of them spoke English and we don’t speak Spanish, so we spent the 30 minute drive communicating via Google Translate.

Because I was wheelchair-bound at this point, we would need more time in the airport, and our ambulance ride was going slower than expected. The driver knew we were pressed for time and drove over the grassy median into oncoming traffic to get us to the airport in time. Probably not the safest move, but it worked.

They were so sweet and even wanted to take a picture with us because, as they said, “You’ll want to remember this day!” 

Omg, the compression sock and three-day old outfit is a look. What you can’t see is that I was also traveling with a catheter in because I was completely immobilized. Definitely won’t forget that day!

Between my husband’s flight to the Dominican Republic, our first-class tickets home, and the ambulance ride, that was an additional $3,080.

Here’s what travel insurance covered from those costs:

  • $1,369 deposit for the clinic
  • $6,110 for surgery and hospital stay
  • $2,550 for two flights home to the U.S.

=$10,029 total costs reimbursed

Travel insurance didn’t cover my husband’s $400 flight to the Dominican Republic – they said it wasn’t part of emergency assistance and transportation. Their reasoning was that someone already in the Dominican Republic could have flown home with me.

We also claimed $200 for the flight I would have taken home from Florida after the cruise, and this was denied too because I paid for it with credit card points. Some travel insurance offers reimbursements for points, but Generali’s plan didn’t. We tried to claim it knowing they might deny it.

The other cost travel insurance denied was the $130 ambulance ride from the clinic to the airport. The problem was that the receipt wasn’t dated. 

That’s $730 that I wasn’t reimbursed for.

One thing I haven’t mentioned is the cost of the cruise and getting reimbursed for the part of the trip I wasn’t able to take. Long story short, my friend was part of the cruise’s entertainment and the organizers covered my ticket because I was going as her guest. 

The cruise organizers have their own insurance to deal with that claim. Had I paid for the cruise, then I would have submitted that loss to my travel insurance company. Make sense?

All in all, my $142.68 travel insurance policy saved me more than $10,000 in out-of-pocket costs.

 

Will my health insurance cover medical costs when I travel?

It’s unlikely that your domestic health insurance plan will cover medical care outside of the U.S. If your plan does cover anything, it will only be for very, very emergent situations. 

For example, my broken leg was a serious enough injury that I needed emergency surgery in a foreign country. I had to leave my friends and my belongings on the cruise ship and stay in a hospital for two days.

My health insurance company (Anthem Blue Cross Blue Shield) did not consider this an emergency situation – it was only deemed urgent. 

This is how my insurance company describes emergency care: if the injury is severe enough that it places “the Member’s physical and or mental health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.”

I recommend calling your health insurance company and asking about their policy on international travel, but realize that it probably won’t offer the kind of coverage you’re looking for.

 

What about the travel protections offered by my credit card?

Not all credit cards come with travel protections, but some of the more popular travel cards (like the Chase Sapphire cards and American Express Platinum card) do offer it. Important point: you will have to book your trip using that card to qualify for coverage.

The other thing about the coverage that comes with your credit card is that it’s fairly limited when you compare it to third-party travel insurance. 

The most common kind of coverage through your credit card is for baggage delays, trip delays, trip interruption, emergency trip cancellation, accidental death and dismemberment, and auto rental collision damage cover.

But you probably won’t get the kind of coverage you need if you, say, break your leg in the Dominican Republic.

I have three credit cards that are considered travel cards, and none of them would have covered what my travel insurance did.

The Points Guy has a really good article that explains more: When to Buy Travel Insurance vs. When to Rely on Credit Card Protections.

 

What about flight insurance?

Most airlines offer a limited form of travel insurance, and limited is key.

I’m sure you’ve seen the pop up when you enter your payment information for your flights. Something like, “Do you want to spend $25 on coverage to protect your flight from cancellation or delays?” 

Seems like a good deal, and I’ve bought it before when I didn’t understand what it covers. The coverage airlines offer does not include medical care, lost luggage, and it’s not “cancel for any reason” coverage. 

 

When should you buy travel insurance?

You now know that you can’t rely on your health insurance in a foreign country, your credit card doesn’t offer comprehensive coverage, and flight insurance is meh

That’s why I highly recommend travel insurance if you’re traveling out of the United States. Experts will offer the same advice for these reasons:

1.You’re concerned about medical expenses

Travel medical insurance is similar to your domestic health insurance, and it’s honestly the main reason experts recommend travel insurance. Without it, a medical emergency in a foreign country could devastate your finances. Most policies have limitations for pre-existing conditions, but you can shop around and find coverage for pre-existing conditions.

2. You want coverage for your baggage and personal belongings

It’s not uncommon to travel with some pretty expensive stuff. It adds up quickly when you think about the combined value of your laptop, tablet, cell phone, camera, jewelry, etc. 

Travel insurance may cover these things if they’re lost or damaged. I say “may” because most policies expect that you’re not being reckless with your belongings. For example, you’re not leaving your laptop unattended in the hotel lobby. 

You should ask about high-value things like your wedding rings because there will be some limitations to the coverage. Better yet, leave your expensive jewelry at home.

Some policies have additional coverage for things like golf clubs, ski equipment, and hunting or fishing gear. They might even offer coverage if you miss days for skiing or golfing, or even pay for rental gear if yours is lost or delayed in transit.

3. You’re an adventurous traveler

There are risks with all kinds of travel – my husband cut off the tip of his finger during a relaxing beach vacation in the Bahamas, and he was only chopping green onions. But there are some kinds of vacations where you’ll encounter more risks.

Hiking through the jungle, ziplining, parasailing, surfing, caving, etc., those are all things that can increase your chances of getting hurt. World Nomads is one of a few travel insurance companies that covers extreme sports.

4. You want to be able to cancel your trip for any reason

Things come up. Maybe you didn’t apply for your passport soon enough, your pet gets sick, you have a financial emergency, you’re traveling during a global pandemic, etc. If you want the option to cancel your trip for any reason, travel insurance can help. 

I’ve said this already, but not all policies are considered “cancel for any reason” or CFAR. Most CFAR policies don’t cover 100% of your prepaid and nonrefundable travel expenses – it’s more like 50% to 75%. 

These policies are more expensive and cover less than people expect, so do your research. Most companies offer CFAR as an add-on, but they’re expensive and cover less than people expect. 

5. You might need to come home early

A friend of mine had to leave his honeymoon early because his new father-in-law landed in the hospital with a life threatening illness. It’s a good thing they came home because the father-in-law passed away a few days after they got back. Travel insurance reimbursed him for the rest of his honeymoon and their last-minute plane tickets.

All in all, travel insurance is peace of mind. You can’t control what happens, but you can reduce a lot of the financial stress associated with emergency scenarios.

 

Traveling with travel insurance

Before you leave for your trip, make sure you have your travel insurance policy printed and stored somewhere you can easily access. It should stay on you when you’re away from your hotel, cruise ship, etc.

Because I didn’t have my policy on me, someone had to go back to the cruise ship, find it, and bring it back. 

It’s also not a bad idea to send a copy of your policy plus your itinerary to someone back home. They can quickly hop on the claims process without needing to get login information or policy numbers from you.

 

What to expect when you file a travel insurance claim

I won’t lie, dealing with the claims process was extremely frustrating. My husband was super stressed waiting for us to be reimbursed for our out-of-pocket expenses. He called and emailed every couple of weeks to make sure things were still moving forward.

We had to re-submit paperwork twice, our entire claim was denied the first time (I will explain why in a minute), and it took a full seven months before our claim was paid.

What I didn’t realize is that what we went through is more common than you would expect. Travel insurance companies are very specific with how they accept paperwork and the process for filing claims. 

Here’s what you need to know about the claims process:

  • File your claim ASAP. This gets the ball rolling, you’ll be fresh on the details, and most companies require you to submit claims within a 90-day window.
  • Everything needs to be submitted electronically. You’ll have to take pictures of your receipts or scan them. Pictures need to be crystal clear (this is why I had to resubmit paperwork). 
  • Medical claims need to go to your health insurance company first. Because your health insurance might cover the expenses, you’ll need to submit it to them first. My travel insurance claim was denied at first because we didn’t have an official denial from my health insurance company.
  • Keep any document related to your travel costs or emergency expenses. Even if it seems redundant or useless, keep it. A handwritten note in broken English is why insurance covered our expensive flights home, and we almost didn’t submit it.
  • Your claim will take longer than you expect to process. It can take a minimum of three months for your claim to be processed, and this feels like forever if you’re waiting to be reimbursed for out-of-pocket costs.

I know it’s hard, but be patient. You can always email your claims agent if you have questions or want to be reassured that they’re working on your claim.

 

Should you buy travel insurance?

Moving forward, I will always be buying travel insurance when I leave the country. It’s an extra expense we’ll have to budget for and build into the total cost of our vacations. 

What I went through is pretty small, but the majority of our cash savings would have been wiped out without travel insurance. 

It was really scary being injured in a foreign country where I didn’t know the language. You can’t put a price on this, but believing that the majority of my expenses would be covered helped me get through those couple of days until I got home. Okay, painkillers really helped too.

But the point is, travel insurance is peace of mind. Buying it is a choice, but I hope you realize what a beneficial choice it can be in the long run.

Do you usually buy travel insurance? Do you have anything that you’d like me to add to this travel insurance review?

The post My True Travel Insurance Story – A Broken Leg & Surgery in the Dominican Republic appeared first on Making Sense Of Cents.

Source: makingsenseofcents.com

Two Years Without Health Insurance (and What I’m Doing Now)

Two years ago, I was unsatisfied with my options for health insurance. The premiums were rising even as the quality dropped in the form of an ever-increasing deductible. I am guessing that you might feel the same way these days – most of us Americans are in the same boat.

I felt like I was being squeezed from both ends and it was starting to piss me off. So I decided to take some action, by doing the math for myself using a spreadsheet. I needed to answer the question, “Is this insurance really as bad a deal as I think it is?”

Sure enough, the risks and rewards of the coverage did not justify the premiums, so I decided to try an experiment and simply drop out of the market and insure myself. In other words, just rolling the dice and going through life with no form of health insurance at all.

Doubling down on the bikes, barbells and salads, I did my best to eliminate any risk factors that are in my control, while accepting that there are still much less likely but more random factors that are not.

Figure 1 – DIY Health Care

Almost two years and $10,000 in premium savings later, I have found the experiment to be a success: I have slept well and not worried about the fact that I could be on the hook for a big bill if I did ever need major care. And as luck would have it, I also enjoyed the same good health as always over this time period – probably the best in my life so far because the extra healthy living has been working its magic.

But.

This situation has not been quite ideal, because my life is not a very useful model for everyone to follow. Most people don’t have the luck of perfect health, many have a larger family than I do, and very few people are in a financial position to self-insure for all possible medical bills.

Also, I found myself wishing I had a doctor that actually knew me, who I could call or visit on short notice if I ever did need help.

Finally, I wanted to switch back to having some form of insurance so that I could learn about it and write about it as time goes on. But was I really willing to be part of that unsatisfying and broken insurance model?

Then something magical happened: I learned about the new and vastly improved world of Direct Primary Care physicians.

What is DPC?

DPC is a fairly new trend in the US, but it is also a return to a very old tradition: a direct relationship between you and your doctor, with no insurance company in the way. 

As a customer, you pay for a monthly subscription (somewhere around $100), and in exchange you get unlimited access to super elite, personalized medicine for the vast majority of your medical needs. Diagnoses, prescriptions, skin conditions, stitches, even fixing a broken bone if you don’t need surgery. All covered, with no co-pay and in an environment that feels to me like Presidential-level health care, in striking contrast to some of my past experiences where I felt like an anonymous numbered ticket in a sloshing sea of bureaucratic institutional medicine.

Oh, and direct email, phone and text message contact with your doctor, prescriptions over phone or video call, and in some cases even house calls depending on the practice and the situation.

Through some sort of magic, the Direct Primary Care model offers much better medical care and much lower prices, at the same time.

How could it be? It’s because of the incentives.

Figure 2: The Insurance Model for Health Care

In our famously broken US healthcare model, an insurance company is wedged in between you and your doctors, and it has different objectives than you do.

You just want the best overall health for yourself, and when the shit does hit the fan and you need medical care, you want it to be quick, effective, and at minimum cost. And you don’t want to be hounded with years of stressful stray bills after an expensive medical procedure.

Your Doctor wants to help as many people as possible and make a good living, without having to wade through a sea of paperwork or stress or lawsuits.

Your Insurance company wants to make as much profit as possible, which means maximizing the amount they collect from you, and minimizing the amount they pay to your doctor. In theory, they benefit from helping you to stay healthy. But they have also developed elaborate contracts (putting in as many loopholes as possible to allow them to drop your coverage or deny claims), become masters of delaying payments, limiting which procedures and tests they will authorize doctors to do, and just generally throwing the biggest monkey wrench into the system that they can.

Over the decades, there has been a complex battle of lawmaking, lobbying, compromise and complexity to try to regulate away some of these problems. Sometimes the new laws help, sometimes they don’t, but the end result will never be optimal simply because there are a lot of people involved, and big crowds of humans make for slow and shitty decision making.

The Direct Primary Care Model

Figure 3: The Direct Primary Care Model

With DPC, it’s just you and your doctor. You both have the same incentives, but now the model works much better because there is no chaotic and expensive force in the middle to mess things up.

And because you operate on a subscription, the doctor gets paid whether you come into the office or not. At the same time, you are free to come in whenever you do need something, at no additional cost. So she has an incentive to keep you healthy, so that you have no need to come into the office in the first place. 

On top of this, you get to decide together what is the best course of healthy prevention and treatment, without the overhead and complexity of constantly fighting with insurance companies. This drastically cuts the costs by eliminating the large staff of paper-pushers and attorneys that you normally need to operate a medical office, and frees up the doctor to spend more time with each patient during each visit.

How could the doctor possibly make a living with such low fees?

As it turns out, a small practice with one or two doctors and a few credentialed medical assistants can handle over 1000 subscribers while still giving each person much more time than they get under the old model. At $100 per month, this is $1.2 million in annual gross subscriber income, which is enough to pay everybody well, and rent a suitable clinic space. And as you scale up the operation, some economies of scale on things like space and equipment make it even better.

Just as importantly, running a practice like this tends to make a dramatic improvement in a doctor’s quality of life. It’s better medicine, with more flexibility and less hassle and stress. No wonder this model is growing rapidly and has become a favorite of physicians who happen to be MMM readers, as I hear from more of them every month.

Direct Primary Care is now a nationwide movement, with many hundreds of practices spanning the country and many more opening each year. Today’s screenshot of https://mapper.dpcfrontier.com/ shows the current state of the market. 

Direct care locations everywhere

In fact, it turns out this whole trend might even be a Mustachian-originated phenomenon, as I joined my own local practice called Cloud Medical, met the founder Dr. David Tusek, and he revealed halfway through our introductory visit that he was both a founder of DPC pioneer Nextera Healthcare in 2009, and a lurking reader of this blog for several years before I discovered him right here in my own town. 

A note for locals: if you are considering joining Cloud, mention that you would like the MMM discount to save a further $12/month! (we have no affiliation, they are just looking to expand the practice and I’ll remove this notice if they fill up)

My experience (so far) with Cloud Medical

Cloud Medical’s Longmont office – definitely a step up over past medical office experiences! (although they do need to add a proper bike rack)

I signed up with Cloud this past summer, about five months ago. Although I have been feeling great, I figured it was time to put myself through an extensive battery of “middle-aged man” tests just to make sure I am not missing any hidden problems. 

With the doctor’s guidance, I did a very thorough blood test, plus an electrocardiogram scan of my heart performance and ultrasound Carotid artery scan which involves a practitioner lubing up your neck and sliding a Star-Trek-style probe around on it while recording images of your body’s most critical plumbing to check for signs of clogging. Plus the usual checks of an annual physical exam. All clear.

I also finally got around to a long-awaited diagnosis and prescription for my Adult Attention Deficit Disorder condition, something which took me seven years to get organized enough to achieve, paradoxically one of the crippling effects of ADD. Although this is a very personal health detail, I mention it here because there are many friends and readers who also suffer from this condition, and I encourage you to learn more about it and seek help if appropriate. It can be life-changing.  I found this process was much easier in a DPC environment, because of the more personal nature of the doctor-patient connection. 

This DPC model addresses perhaps 90% of typical medical needs in-house, and a “menu” of optional specialists knocks out another 5%. 

Cloud and other DPC practices have a “menu” of standardized prices, typically much lower than traditional offices. Full PDF here.

But there is still a chance you will need the more rare (and expensive) services of a hospital or specialist. In this case, your DPC physician can provide referrals and guidance to allow you to get the right help at a discounted, direct-pay price, or even handle your needs with a conventional insurance company.

Part Two: But What About Bigger Expenses?

Health share options, with the one I chose (Sedera) in the center.

At this point, you can add another layer of protection: High deductible conventional insurance, or a health share membership which offers a similar end-result while being careful not to be classified as insurance. 

A Disclaimer before we begin:

I think of health shares as a form of “emergency medical bill reimbursement”, rather than full fledged insurance. They are suitable for mostly-healthy people who want financial protection in the event of a major medical event. But they are not insurance, and often not too useful for someone with an existing, expensive condition.

Update 11/12: This blog post has triggered lots of fine-print-reading and discussion among readers, which led us to follow up with various insurance and health share companies.

The final word on one issue of debate: most conventional insurance and health shares do not cover voluntary abortions, while they do cover medically necessary ones, just under the different name of “Maternal Complications”.

Health shares in particular also don’t offer much ongoing drug reimbursement, which includes a lack of coverage for birth control. While I disagree with this policy, from a practical perspective it just means you need to budget for this expense separately.

For situations where a health share membership falls short, the subsidized and regulated insurance available through employer-based plans or the state exchanges via the Affordable Care Act, are probably a better bet.

But with all that in mind, I still chose one for myself, so let’s get into it!

Health sharing groups started out catering only to members of certain religions. Then a provider called Liberty Health Share opened up the market slightly while still requiring some fairly specific spiritual affirmations.

The latest incarnation is a company called Sedera* , which has addressed some of the shortcomings of earlier companies, has far less religious basis, and now seems to be the place that most of my more analytical friends and their families are ending up. Even my DPC physician Dr. Tusek is now recommending Sedera.

Sedera is worth a whole separate article in itself, and in fact I am starting a dedicated page for questions and answers and discussion on the experience. But for now, we’ll take a shortcut and just say that I was convinced and willing to give it a try, so I signed myself up as a Sedera customer.

A quick comparison of the closest standard insurance plan I could find on the standard Colorado health insurance exchange, versus what I got from Sedera (click for larger version):

For me, Sedera cuts my monthly cost in half, even while delivering better coverage.

Another thing I like about all this is that there is no concept of “in network” and “out of network” doctors or hospitals. You can even use hospitals in other countries while traveling, and get reimbursed in US dollars after you return home. It’s simpler, cheaper and more flexible.

So in the end, by combining DPC with a health share membership, I am hopefully ending up with the best of all worlds:

  • The best personalized, advanced medicine and quick response time, possibly anywhere in the world through my DPC subscription, with unlimited “free” (zero co-pay) doctor visits.
  • Flexible coverage for any additional needs and support for decision-making and billing, even when traveling internationally
  • A financial backstop just in case things get really expensive
  • At a total monthly cost that is still lower than the most basic ho-hum plan on standard insurance
  • A further bonus – Sedera incentivizes you to be a member of a DPC, with a solid discount if you are, because they know their costs to cover you will be lower if you are healthier and have hassle-free access to a doctor.

This all sounds good to me, but it is important to state that this is an experiment. I still don’t have much experience with the US healthcare system – it helped deliver my son in 2006, and then repair that same boy’s broken arm in 2016. Conventional insurance offered some halfhearted support for both of those expenses, but aside from that I don’t have many stories to tell. 

By collecting more information from readers and from my new helpers at Cloud Medical and Sedera, we should be able to make more sense of all this. And hopefully continue to expand and improve this new, better form of health care so it is accessible to more US residents.

If it gets big enough, we might end up solving this whole problem together – better, cheaper health care for everyone.

But What About the Affordable Care Act?

I think that DPC and ACA could work together perfectly – we keep the idea of the personal relationships, the subscription-based model, and the open and competitive pricing from hospitals for all procedures. But we just don’t need conventional insurance companies. If our society wants to help less-wealthy people to afford the best health care (which I think is a great idea), we could just subsidize their DPC memberships and offer a public insurance option at low or zero cost which covers hospitalizations. The reason this is better than the ACA: direct care and no insurance companies.

Conclusion

My past articles and experiences have shown that for many of us, a big hurdle when considering early retirement or self-employment is “what about health insurance”? Hopefully the is DPC + Healthshare method will put that question to rest for many of us. After all, shouldn’t our career and life choices be separate from our healthcare?

—–

Interested in Learning More?

A long-time friend of mine (and fellow early-retiree, and co-owner of the HQ coworking space) Bill and his family have been Sedera customers and enthusiasts for about two years. So much that he even took it upon himself to meet the company’s management, sign himself up as a representative to streamline some of the inefficiencies he perceived when joining, and then teach me about the whole thing.

Because of that, I am sharing Bill’s Sedera signup link in this article. His is unique among the Sedera affiliates in that he charges zero administrative fee, typical brokers charge $25 per month and up.

https:/sedera.community/thefireguild1

*note: Sedera does pay its affiliates a small referral fee for new customers, which does not affect your monthly bill – in fact, this link offers a lower price than subscribing directly through the company’s website. Thus, we believe this is the lowest cost way on the Internet to get this coverage.

As mentioned above, I’m giving Bill his own page to maintain on this site, where he can share his ongoing research and updates and answer questions: mrmoneymustache.com/sedera

Further Reading:

I was quite moved by this piece that Cloud Medical’s Dr. David Tusek wrote about “the ten heartbreaks” that led him to work since 2009 towards accelerating this better way to do healthcare.

An interesting story from Bill’s hometown, from a doctor who took this path way back in 2013:

South Portland Doctor Stops Accepting Insurance, Posts Prices Online
(from the Bangor Daily News)

Source: mrmoneymustache.com

Should I stay or should I go? Wrestling with the decision to quit a career

J.D.’s note: In the olden days at Get Rich Slowly, I shared reader stories every Sunday. I haven’t done that since I re-purchased the site because nobody sends them to me anymore. But earlier this year, Mike did. I love it. I hope you will too.

Earlier this year, I sent my wife a text message: “On a scale of 1 to 10, how freaked out would you be if I quit my job this afternoon?”

My wife and I had only been married a short while, but she’d known since our second date that I didn’t plan to work in my traditional job until normal retirement age. She also knew that I hadn’t been very happy at work in recent months.

We’re very compatible financially — both savers raised in working-class families that didn’t always have a lot. We make a point of having what we like to call “Fun Family Finance Day” from time to time. On Fun Family Finance Day, we do everything from competitively checking our credit scores to discussing questions that get at the root of our money mindsets to help us create our goals.

But this question wasn’t part of the plan. Not then.

And it was never on any of the lists of questions that we’d discussed with each other. It was like a pop quiz, a pothole in the smoothest relationship road I’d ever traveled…and I was the one putting it there.

Dreams Remain Dreams Without Doing

My wife and I rarely argue, but when we do it’s usually about food. It’s the kitchen and the grocery store that are our battleground. Our finances are fine. Thankfully, when you’re confident in the life you’ve created and the person you chose to build it with, it’s a lot easier to be honest about what’s on your mind.

That still doesn’t always mean you get the answer you want. Or the answer you were expecting. She responded: “Wait what. Kinda. What would you do?”

A completely reasonable and fair question. Not to mention one that I’d probably have to get comfortable answering from a lot more people.

I think my immediate reaction was: We talk about this stuff all the time, where is my, “No worries baby, YOLO!”? (I must have watched too many romcoms back before we cut cable from our lives.)

Being a grownup, it turns out, is actually really hard sometimes. I was about to learn that talking about something, and actually doing it, are a world apart.

Life is full of dreamers and doers. Sometimes those two personalities cross over. But there are plenty of people who go through life talking about so many things they’ll never have the courage to try — or the discipline and determination to follow through with.

Which person was I? The dreamer? The doer? Or that fortunate combination of both?

Standing on the Ledge

There’s a quote perched atop my bucket list of long-term goals:

“At some point, you will need to take a long look in the mirror and ask yourself not just if this is something you wanted to do at one point, but if this is something you will want to have done.”

Words are meaningless without action. It was time for me to take that long look in the mirror. I thought back to one of the questions that my wife and I had previously discussed: What does money mean to you? To me, once I grew out of the “stuff accumulation” phase of my early- to mid-20s, my answer had always been freedom. Money meant freedom. To my wife, the answer was security. Money meant security.

You can probably see how freedom can conflict with security. That was the case here. Not only that, but I was asking to change the perfect plan, one that she was comfortable with and excited about.

That’s not one, but two shots against financial security. If I’d thought more about our financial blueprints and how they differ, I might have seen this coming from a mile away!

As I was standing on that ledge, about to quit my job, thoughts started to race through my mind. What did I actually have to lose if made the leap? Lots.

  • A happy relationship and marriage.
  • A secure job with solid income, not to mention a sixteen year investment in my career.
  • Great benefits, including lots of time off, health insurance, 401(k) — even a pension.
  • The ability to afford anything at any time without any real worry. (Our finances were already on autopilot.)
  • My work friends and work prestige.
  • The general day-to-day purpose of a job.
  • The opportunity to create generational wealth. If we worked until 65, the power of compounding would likely make us ridiculously wealthy.

Today at Get Rich Slowly, let’s perform a little exercise. Come stand in my shoes for a minute, won’t you? Join me on the ledge. Do you see the beautiful view? The endless opportunity? The excitement that’s felt only at the beginning of a grand adventure, an adventure where anything is possible?

Or do you get a queasy feeling in your stomach? Do you feel like you’ve lost your balance, like you’re on the edge of some great catastrophe? Do you see a frightening fall from grace? Does it make you want to back away immediately?

Let’s go back to what it felt like to make this decision…

Sitting on the ledge

My Situation

I’m 38 years old. I’ve worked for the same company since I was 22. Corporate insurance is all I know. I’m well paid. I work from home for a solid company with good benefits, plenty of time off, and I really enjoy most of the people I work for and with.

It’s the definition of stability — a solid guardrail protecting me from what lies over the ledge. So what’s the problem?

A year ago, I took a new position that seemed like a great opportunity. Only it wasn’t. The first misstep of my career. A year in, that spot has killed my enthusiasm and engagement. For the first time at work, I’m struggling to get things done.

As an extrovert that derives meaning from helping others, this feels like a prison. My job isn’t hard because it’s stressful. It’s hard because it’s boring me to death! And what are any of us doing thinking about personal finance and early retirement if we aren’t trying to make better use of our limited time on this planet?

There’s a project looming that would require some weekend work once in a while for the foreseeable future, I’ve avoided it in the past, but my luck is running out. My team — and, more importantly, my position — need to take it on. I understand completely. I just don’t want to do it.

At this point in life, my time is way more important to me than money. The weekends and vacations are what I live for. Adventures in the mountains with my friends, quality time with my wife, our dog, and our families – that’s what makes me feel alive.

Insurance? Meh.

No little kid ever said they wanted to work for an insurance company and play with spreadsheets and Powerpoint presentations when they grow up. I wanted to be a baseball player, a sports writer, even a professional forklift driver. (Because what’s more badass than a forklift when you’re a little kid and your dad works at a marina?)

A Glimpse of the Other Side

My wife and I just got back from a delayed honeymoon to Alaska. To say it was incredible would be an understatement. Denali. Kenai. Majestic train rides. Fjords. Glaciers. Bears. Bald eagles. Whales. Hikes.

Life slowed down.

I somehow managed to read five books while doing so many other amazing things. During our more than two weeks off, I got to see what my mind was capable of when it wasn’t drowning in useless information and mundane tasks that consume my braindwidth.

We talked to people who had ended up in this wild place through a history of taking risks. Parents that had hitchhiked cross-country and ended up there back in the 70s. Can you imagine? Where we live, a fair number of people never leave their town or state!

Before the trip, I had tried to apply for a few positions. For whatever reason, it just didn’t work out. I came home from an amazing glimpse into what life could be to a job that seemed like the polar opposite. (Isn’t that every vacation though?) I’ve felt like a square peg trying to fit in a round hole for a while now. Maybe normal life just isn’t for me anymore. Maybe I need something just a little less ordinary.

Should I Stay or Should I Go?

I’ve been practicing the classic tenets of personal finance since I was in my mid- to late-20s. I found an awesome woman in my mid-30s who just happens to be down with this lifestyle as well. We’re probably two to three years short of where we want to be based on our master plan of a fully-paid house and a really comfortable number in invested assets.

We’d likely fall somewhere between Agency and Security on the stages of financial freedom.

I know good jobs don’t grow on trees, especially where we live. The seasons of the economy are always shifting and there’s a chill in the air. Economic winter can’t be too far off. My wife still has a solid job, and we live a pretty simple life — albeit in an expensive part of the country. Our main splurge is travel, but otherwise we live well below our means.

All of this knowledge and preparation comes with a cost. Having options can be a burden too, because then you’re responsible for making hard decisions. And you’re responsible for the outcomes of those choices.

What other options are there?

  • Be a crappy employee/teammate, and still get paid? Plenty of people have played that game. Get a surgery or two, go out on leave, let performance management run its course for however long that takes, and keep cashing checks the whole time. I don’t think I have it in me to put people I respect through that. It’s just not who I am.
  • I work from home, and I still can’t bring myself to abandon my laptop. What if someone needs me?
  • Am I giving up too soon? The finish line seems just around the corner — somehow so close yet so far away.
  • Should I just suck it up and sell a little more of my soul? Slump my shoulders a little bit more as I trade another piece of myself for money I don’t need to buy things I don’t want?

As I go back and forth, sometimes I briefly wish I’d never found the personal-finance community. Like Neo in The Matrix, why’d I have to take the damn red pill? Being a mindless consumer wasn’t so bad. I would have invested 6-10% in my 401(k) with a traditional pension on top of it.

Forty years on autopilot would have produced a comfortable life of work, nice things — and maybe some time in old age to relax and travel.

Facing Freedom

The whole point of everything I’ve done since I started this journey was to be in control of my own life. To not be owned by things or circumstances. To have options. Freedom of choice. F-U money.

I have the corporate battle scars and survivor’s guilt to understand why that’s important.

I’ve sat on the phone while I heard that my old department was closing down. The sadness and tears in the room. Everyone that had taken me in, given me my chance, taught me the job…basically gone, casualties of a business decision.

I’ve seen people get laid off who are petrified because they don’t know how they’ll pay their bills in a couple of weeks. People will be okay eventually though, right?

What about my friend who was struggling last year and left the company? He committed suicide a few months later. Maybe everyone won’t be okay eventually. Depression runs in my family. Am I really built for this? That thought is haunting.

It’s been said that one of the hardest decisions you’ll ever make in life is whether to walk away or try harder. Every bone in my body tells me it’s time to walk away, to bet on myself.

The End?

About six months after the text exchange that blindsided my wife, with her support, I hit send on the scariest, most exciting and important one-line email of my professional career. It would also signify the unofficial end of it: “I will be resigning from my position effective Wednesday, June 26th.”

To combine a few lines from my favorite movie, The Shawshank Redemption, some birds just weren’t meant to be caged. It’s time to get busy living, or get busy dying.

Source: getrichslowly.org

What Health Insurance Doesn’t Cover: Your Guide

Insurance of any kind can be confusing, but when it comes to medical insurance, it’s really tricky to tell what’s covered and what isn’t. Whether you’re shopping around for a new plan or recently just got on a new health insurance plan, it’s good to know the ins and outs of your health insurance coverage before you end up with a large stack of medical bills that you can’t afford. In this article, we’ll discuss the things that medical insurance surprisingly doesn’t cover so that you can make better decisions about your medical expenses. 

What health insurance does cover

In accordance with the Affordable Care Act (ACA), the Health Insurance Marketplace must now cover a specific set of services at little or no out-of-pocket expense to you. They are also required to cover at least 10 essential health benefits. These essential health benefits (EHBs) include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization and surgery
  • Maternity and newborn healthcare
  • Mental health treatment and substance abuse disorders including counseling and psychiatric treatment
  • Pharmaceutical drugs
  • Rehabilitation services that provide care for those suffering from disabilities and injuries. 
  • Laboratory services (blood and urine testing, etc.)
  • Preventative and wellness services
  • Pediatric services

In short, a lot of the basic care that you will get on a regular basis should be covered by your health plan. Most of the time your doctor won’t suggest treatments that are not covered by your insurance. In a lot of cases, they will try to familiarize themselves with your health insurance plan so that they can lead you in the right direction. However, don’t leave the all the responsibility in the hands of your doctor. It’s important that you make time to read through your health insurance policy and look for any holes before getting services. 

What health insurance doesn’t cover

If you have a good insurance plan, most of your basic medical needs will be covered, but you might be surprised to know the services that generally are. Here is a list of services that health insurance does not cover:

  • Nursing home services: Most nursing home services are not covered by standard health insurance or even Medicare. However, nursing home care is covered by Medicaid. Many people are confused about this, because they confuse short-term care from a skilled nursing facility with long-term nursing home care. These two things are very different. For example, if you were to suffer from a fall or some other type of injury that required you to get surgery, you would need short-term care in a rehabilitative facility to help you get back on your feet. That kind of care is covered. Full-fledge nursing home care on the other hand, wouldn’t be covered because most health insurance providers place time limits on how long they will cover nursing home services. That being said, Medicare will only cover skilled nursing if the patient stayed for at least three days before staying in the skilled nursing facility. Additionally, the patient must be admitted to the facility for the purpose of seeking treatment for a short-term illness or injury as opposed to a chronic one. 
  • The shots you get before traveling abroad: At some point, health insurance companies decided that they would only cover services and procedures considered to be medically necessary, and travel vaccines didn’t make the cut. Now, we’re not talking about your standard health vaccines like the tetanus or flu shot; those are covered. But for those of you who like to travel, the cost of your Typhoid or Yellow Fever vaccine is coming out of your own pocket. This rule of thumb goes for the vast majority of health insurance policies, including Medicare.
  • Cosmetic surgery: Once again, health insurance policies will usually only cover what is “medically necessary.” It’s safe to say that Botox and lip injections will not be covered by your health insurance policy. However, there are certain surgeries that dance on the line between medically necessary and cosmetic. For example, if you wanted plastic surgery on your nose because you thought it was too big, that’s considered cosmetic. But if you had to get work done on your nose due to issues with your sinuses, then that’s probably going to be considered medically necessary. 
  • Acupuncture & alternative therapies: The rules surrounding acupuncture and other types of alternative therapies such as chiropractic care aren’t as black and white. Coverage for such services like massage therapy, acupuncture, and chiropractic care aren’t part of the requirements for most individual health care plans. However, depending on what state you live in, your health insurance plan might cover chiropractic costs. Say you are involved in a car accident that caused you to suffer from back injuries as a result. There is a good chance that your health insurance plan will cover these services. However, if you are a regular at the chiropractor just because you enjoy it, then it probably won’t be. While the standard Medicare plan does not cover acupuncture, there are some Medicare Advantage cans that can. Keep in mind that with most plans who do cover these types of services, there is usually a limit on how many visits you get. 
  • Dental, Vision & Hearing: If you are shopping around for health insurance plans with your employer, note that dental, vision and hearing services are not covered under a regular health insurance policy. If you want to get insured for these services, you will have to buy separate insurance plans for each one. Keep in mind that a lot of times, these insurance policies don’t have any limits on how much they can charge you in out-of-pocket expenses, so research different dental offices before receiving services. Some people choose to not include a dental plan at all. If you wear glasses or contacts, however, it’s probably worth looking into your options for vision insurance.
  • Weight loss surgery: If you’re considering having weight loss surgery, you might be in luck if you have Medicare or Medicaid. While there is currently not a requirement at the federal level for health insurance plans to cover bariatric surgery, Medicare and many Medicaid plans do cover it. Aside from those two plans, more than half of the states in the U.S. do require there to be at least partial coverage for bariatric survey as an essential health benefit (EHB). Remember that even if the state you live in mandates coverage for this procedure, you may still be responsible for some of the medical bills related to your weight loss surgery. 
  • Preventative screenings: Before we go any further, there are A LOT of preventative tests that are covered by your health insurance policy, but there are some that aren’t. This is where things get confusing for a lot of people. For example, mammograms, cholesterol screenings, and colonoscopies will be covered. But if you need to get Prostate Specific Antigen (PSA) screening, it most likely will not be covered.

  • Certain medications: Once again, there are a ton of prescription medications that are covered by most health insurance plans, since pharmaceutical services are one of the essential health benefits (EHBs). However, health insurers get to choose what to cover and what not to cover. Most healthcare insurance plans will choose to cover the minimum. This means that they will pick a drug from each class to cover, and not cover the rest. Many times, the generic version of the drug you are prescribed will be covered by your health insurance, while the name brand will not.

What Health Insurance Doesn’t Cover: Your Guide is a post from Pocket Your Dollars.

Source: pocketyourdollars.com

The Average Salary of a Surgeon

The Average Salary of a Surgeon

Surgery is a prestigious field that requires a high degree of skill, dedication and hard work of its members. Not surprisingly, surgeons’ compensation reflects this fact, as the average salary of a surgeon was $255,110 in 2018. This figure can vary slightly depending on where you live and the type of institution at which you work. Moreover, the path to becoming a surgeon is long and involves a substantial amount of schooling, which might result in student loan debt.

Average Salary of a Surgeon: The Basics

According to the Bureau of Labor Statistics (BLS), the average salary of a surgeon was $255,110 per year in 2018. That comes out to an hourly wage of $122.65 per hour assuming a 40-hour work week – though the typical surgeon works longer hours than that. Even the lowest-paid 10% of surgeons earn $94,960 per year, so the chances are high that becoming a surgeon will result in a six-figure salary. The average salary of a surgeon is higher than the average salary of other doctors, with the exception of anesthesiologists, who earn roughly as much as surgeons.

The top-paying state for surgeons is Nebraska, with a mean annual salary of $287,890. Following Nebraska is Maine, New Jersey, Maryland and Kansas. Top-paying metro area for surgeons include Cincinnati, OH-KY-IN; Winchester, WV-VA; Albany-Schenectady-Troy, NY; New Orleans-Metairie, LA; and Bowling Green, KY.

Where Surgeons Work

The Average Salary of a Surgeon

According to BLS data, most of the surgeons in the U.S. work in physicians’ offices, where the mean annual wage for surgeons is $265,920. Second to physicians’ offices for the highest concentration of surgeons are General Medical and Surgical Hospitals, where the mean annual wage for surgeons is $225,700. Colleges, universities and professional schools are next up. There, surgeons earn an annual mean wage of $175,410. A smaller number of surgeons are employed in outpatient Care Centers, where the mean annual wage for surgeons is $277,670. Last up are special hospitals. There, the mean annual wage for surgeons is $235,770.

Becoming a Surgeon

You may have heard that the cost of becoming a doctor, including the cost of medical school and other expenses, has soared. Aspiring surgeons must first get a bachelor’s degree from an accredited college, preferably in a scientific field like biology.

Then comes the Medical College Acceptance Test (MCAT) and applications to medical schools. The application process can get expensive quickly, as many schools require in-person interviews without reimbursing applicants for travel expenses.

If accepted, you’ll then spend four years in medical school earning your M.D. Once you’ve accomplished that, you’ll almost certainly enter a residency program at a hospital. According to a 2018 survey by Medscape, the average medical resident earns a salary of $59,300, up $2,100 from the previous year. General surgery residents earned slightly less ($58,800), but more specialized residents like those practicing neurological surgery earned more ($61,800).

According to the American College of Surgeons, surgical residency programs last five years for general surgery. But some residency programs are longer than five years. For example, thoracic surgery and pediatric surgery both require residents to complete the five-year general surgery residency, plus two additional years of field-specific surgical residency.

Surgeons must also be licensed and certified. The fees for the licensing exam are the same regardless as specialty, but the application and exam fees for board certification vary by specialty. Maintenance of certification is also required. It’s not a set-it-and-forget-it qualification. The American Board of Surgery requires continuing education, as well as an exam at 10-year intervals.

Bottom Line

The Average Salary of a Surgeon

Surgeons earn some of the highest salaries in the country. However, the costs associated with becoming a surgeon are high, and student debt may eat into surgeons’ high salaries for years. The costs of maintaining certification and professional insurance are significant ongoing costs associated with being a surgeon.

Tips for Forging a Career Path

  • Your salary dictates a lot of your financial life, such as how much you can afford to pay in rent and the slice of your paycheck that goes to taxes. However, there are some principles that apply no matter your income bracket, like the importance of an emergency fund and a well-funded retirement account.
  • Whether you’re earning a six-figure surgeon’s salary or living on a more modest income, it’s smart to work with a financial advisor to manage your money. Finding the right financial advisor that fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with financial advisors in your area in 5 minutes. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.

Photo credit: Â©iStock.com/megaflopp, ©iStock.com/XiXinXing, ©iStock.com/shapecharge

The post The Average Salary of a Surgeon appeared first on SmartAsset Blog.

Source: smartasset.com