In the last article, we took a basic look at concierge medicine, and why it’s worth exploring. But where concierge plans aren’t available or are too costly, there is always basic direct pay. The American Association of Private Physicians has a growing network of physicians listed that are straight cash doctors. And paying cash doesn’t cost nearly as much as you would think, either.
Why Pay Cash?
First of all, most of these physicians won’t take any form of insurance, government program or otherwise. As such, they avoid one of the largest cost drivers in medicine, the paperwork burden to get reimbursed for the work they do. In addition, you’re in charge. You have a much greater say in which tests you take, and why, and you never have to worry about a medical visit being “denied” by your insurance company either. Cash payers also get scheduled for appointments far more easily, and faster, than is otherwise the case.
There can be tax advantages as well. Most people completely overlook the line in their tax forms about “allowed medical expenses”, but if you’re close to moving from one tax bracket to another, those deductions can make a real difference. By using an online tax filing program and checking out both the itemized and non-itemized tax burden, you might find you save a good chunk of taxes by paying cash and taking the allowed deductions.
With many direct pay doctors, you have negotiating room. All of the cash only doctors I know in my area have discount rates available for seniors and the working poor, and many also do a great deal of pro bono work. Quite a few take barter, credit cards, checks, cash, debit, Paypal, and precious metals. Five doctors I know also take Bitcoin.
In many states, there are now medical barter networks, and in my area, there are over one hundred medical professionals of all types willing to barter their services for everything from janitorial services to car care. You might even find doctors advertising barter deals on Craigslist. Other places to look would be a general search for “barter networks” in your area, or freecycle. If you are a professional or have a marketable skill of any kind, joining some of the larger barter networks can also help you grow your business.
Barter networks are the best way to get into trading, as they keep all the paperwork in order for tax purposes, and offer you the widest variety of ways to use your “trade credits” efficiently. This also offers the “safest” introduction to the wide world of barter, as the people and businesses that belong to such networks tend to be highly reputable.
When Cash Is A Good Idea
Cash is a great idea if you’re young and healthy. In Tucson AZ, an annual physical and a complete blood screening will cost about 150-200.00. If you use one of the nine different ways to get out of paying the fine for not having obamacare, and you take the money you would have paid in insurance premiums and invest it in precious metals, then you have a stash of cash handy if you do have a real emergency at some point.
As a typical example, a 26 year old male who has to buy insurance through his job at a local school district is paying just over 100.00 a month for that insurance. Were he able to “opt out” of the employer’s health insurance program, he’d have on average an extra 1000.00 a year to invest in precious metals for emergencies, or pay off old debts. If his girlfriend did the same, between the 2 of them they’d have 2000.00 a year more than they do now.
Many employers will be happy to get off the hook for your insurance also. Several local companies give their employees an extra 10-15% in their paychecks if they opt out of company insurance, as long as they can document they are either in compliance with obamacare, or have been waived. This translates into an extra 90 cents to 1.35 per hour at our local minimum wage. When you combine that extra money with paying cash or bartering, the financial advantage can be significant.
But What About Emergencies?
This is where things can get interesting. Most people don’t realize that hospitals will negotiate bills. In some cases, if you have your own direct paid doctor that has hospital privileges, you can have your doc take care of you, for starters. And if you’re willing to be direct and persistent with the hospital billing department, it’s not uncommon to get a hospital stay cost reduced by 50-60%, or more, before you even start paying, and when you do start paying, you’ll have low monthly payments with no interest.
Many states require hospitals to accept whatever good faith payment a patient makes, even if it is as little as 20.00 a month. And most hospitals are more than willing to work out payment plans, if you show them what you can afford and stick with it. Some hospitals also have private accounts that are funded by benefactors to partially cover medical care for those who can’t afford it as well.
Instead of an ER visit, it’s also a good idea to look into the urgent care clinics in your area. Many of these are open on average 18 hours a day, and a typical visit is around 100-150.00. The wait times are also considerably shorter in most cases than an ER visit, and also significantly cheaper. Many direct pay physicians, like their concierge care associates, will make house calls if you’re actually sick as well.
Direct Pay And Diagnostic Testing
Another thing many people don’t know is that you can pay cash for diagnostic testing, and in many places you can even order simple blood work, like complete blood counts, without a doctor’s referral. This varies from state to state, but it’s worth checking into so you know your options should you need tests. Imaging centers have basic cash fee schedules, and many also offer discounts for seniors, cash payers, and the working poor.
If your employer doesn’t offer an HSA and you want to go the cash medical care route, then it’s a good idea to open a savings account, and deposit anything you can afford into it at least once a month, if not more often. Whether it’s a “keep the change” savings account at your local bank or credit union, or a traditional savings account, setting aside money starting right now for those emergencies is the wisest option.
Saving For Your Medical Independence
The best way to save for medical expenses is actually precious metals. With the price of gold and silver artificially low right now, you can easily buy a few silver dollars or 1/20th of an ounce of gold once a week, and put it aside. Make arrangements with friends or family to have them buy the metal from you privately at market value should you need to cash it in for bills, to avoid having to declare the sale on taxes. Different coin shops will charge different “premiums” on your purchase, so shop around for the best deals.
Precious metals are the savings of choice because they actually do appreciate in value, effectively earning “interest” in excess of what a savings account would pay, and as long as you sell them privately, they are essentially not tracked by the government. At current prices, a few silver quarters will cost about 20-30.00, and are easily stored in a small fireproof safe or even a change bowl on the top shelf of the closet. Just be sure that any real silver coins are kept totally separate from household change. When buying silver for savings purposes, you’ll want to ask for “junk silver”, and steer clear of “numismatic coins”. Junk silver coins are very worn, or very common (like Roosevelt dimes), and so they sell at or very near “melt value”.
It’s also a good idea to check your change when you get it, especially dimes, and half dollars. There are a very large number of 1964 and earlier Roosevelt dimes still in circulation, and they are silver. You can check a large pile of dimes quickly by stacking them and looking at the edges–one or two without the copper stripe really stand out that way. This is especially good if you run a small business and get a lot of change. We have found quite a few silver coins among the change we get from customers over the years.
As for half dollars, the 1965-1970 Kennedy Half dollars were 1/2 silver, and all pre-1965 were full silver. Nickels minted during the WW2 years are also silver, and sometimes show up in change. It doesn’t hurt to ask your doctor if he or she will take gold and silver coins at market value, either. As a rule, direct pay doctors tend to be independent minded people, and often very flexible when it comes to forms of payment.