You can shop around quite a bit for non urgent care, and get good cash discount.
Had I self-funded with a (non-existent) nest egg, I would still be in debt over $600k. Instead, my insurance had to deal with that...
Your insurance company got the last laugh by a long shot. A typical family on insurance would pay $600,000 (between their take-home and the reduced wages paid by employers to cover insurance) in just 25 years, and that's before considering the opportunity cost of lost investments/yield.
I have been working for 30 years and have never once paid more than $10K a year for insurance across 10 jobs 15 of those years were a family plan.
Hell one of those jobs was with Amazon - the company with the shittiest benefit package in all of BigTech and even then I only $12K with a family plan. Right now we pay around $10K - my wife myself and my adult but under 26 (step)son
You might claim that if your employer didn't offer that benefit they'd just pay nothing, but required health benefits function much as payroll taxes which economists have showed are largely reflected in the form of reduced incomes. That is, you are paying it ~all one way or another.
You’re not wrong - I think it’s around 2/3rds so for me it would be around $36K a year all in if I had to do COBRA.
There is no way that $600,000 is the cash price for cancer treatment (especially 20 years ago, but also today).
The average cost of cancer treatment is $150k [1], and lower with cash price + shopping.
And it's beside the point. 99% of Americans can't afford to build a $600k nest egg just to cover medical expenses. THAT'S WHAT INSURANCE IS FOR!
And heart surgery is ~$60k. [1]
That's <36 months of insurance premiums according to the earlier poster.
[1] https://cost.sidecarhealth.com/ts/heart-bypass-surgery-cost-...
And if you want data instead of anecdotes
https://www.business.com/articles/health-insurance-costs-thi...
I think we can all agree that the current system is just... ridiculous
I used to be fearful of health concerns, but now I'm a carnivore and just feel great.
All incompatible with 99% of the upper class, neither do they want to eat ramen to retire early.
You're also one medical disaster away from being "very very wrong"
That’s the thing medical expenses when young are unlikely enough insurance is a viable strategy. Long term it’s worthwhile to move to a country with a less expensive medical system. You can move basically anywhere in retirement and be better off.
LTC not discriminating against pre-existing conditions is also post ACA.
Further FIRE doesn’t mean crap if you get something serious and die at 23, that’s just the reality of human existence.
There are plenty of conditions where the difference between life and death is being able to get health care
Most people didn’t do FIRE style early retirement while dealing with pre existing medical conditions. There however was plenty of expats pre ACA who very much left the country for early retirement.
US healthcare is ruinously expensive but on average it’s not particularly good if you’re in the income bracket where 1/4 million over a few years is a serious issue.
Brit’s will also call themselves expats. https://britishexpats.com/forum/ ditto Canadians https://www.expatden.com/global/canadians-living-abroad/ Also, the US imposes taxes on Americans who leave until they renounce their citizenship on the upside they still get to vote. It’s an unusual relationship to your former country.
If you're saying that people who have permanently left the US call themselves ex-pats, that is news to me, and I can understand the confusion.
Oh and catastrophic insurance plans only have to cover pre-existing conditions since the ACA - which one party is actively trying to kill.
You can easily derive that this is possible from the median household finance statistics published by BLS, never mind the upper class. It isn’t that hard if you care to do it.
I’ve already researched the residency requirements for both there and Panama
I already don’t pay state tax living in Florida and I would pay federal tax either way.
People who have poor money management skills believe that FIRE=Ramen and no health insurance... In fact, it's about getting a 30K car (the one I bought new 3 years ago) instead a 70K car despite having the money.
Even on a pretty good Kaiser plan, we're paying $200+ per day in the hospital, etc. On a high-deductible, more. They say they have a $1M annual limit, but that they've never enforced it. I hope we never have to find out.
If you have an extra couple million dollars above and beyond your regular retirement fund you could self-insure your medical costs. But then you could just buy the health insurance.
and as for the medical disaster: heart attack and stroke are actually preventable with a plant based diet (keep your LDL under 80 and you'll vastly decrease your chance of a heart attack). i know a lot of people will hate on that, but those are the facts and any evidence based nutritionist can tell you this.
You really just need to build an innate understanding that the hedonic treadmill doesn't make you happier long-term and develop a resolution to get your expenses down and stay disciplined about it.
If the median income is $70k a year, after taxes they should be able to save $23500 a year and have an HSA compatible healthcare plan and max out their HSA?
To answer your question directly, $70k income is independent of the cost of living in high cost of living cities (like NYC or SF) vs. low cost of living areas. If you make $70k/year in NYC, no you don't have the spare income to max out 401k/HSA. If you make $70k/year working for Walmart in Bentonville, Arkansas, then yeah, I expect that you ought to be able to max them out.
I bet you also your idea of upper middle class is not statistically valid.
If you are betting on the stability of the US health care system outside of employer funded health care, that is a monumentally stupid bet with one party actively trying to kill the ACA.
This also happened to you while you were working and slightly between jobs. So it's not really a FIRE concern if the concern is the US messing up the health care system even more in that it would effect everyone whether working or not. Generally speaking, an answer to mitigating a lot of types of risk with a FIRE model is: you just go back to work for a while. This is easier the younger you are.
Edit: Also I thought COBRA would have been a more recent thing but it was Regan era. So did you not have employer-sponsored coverage with the startup?
Also, just so happen I did end up in the hospital three weeks later because something happened that affected my breathing for an entire year.
And how do you “go back to work” if the entire reason you need to go back to work is that you have a health condition?
If you haven’t checked, jobs aren’t that easy to come by quickly in 2026 in tech like they use to be. Sure I could find someone to give me a contract if not hire me full time - but we are still back to not having insurance .
The US messing up insurance on the open market is the concern and it being back like it was pre ACA. That only affects the unemployed under 65.
As far as being between jobs - usually you can get COBRA for a limited amount of time - not an option for FIRE.
Oh yeah, that brings up another point, I did pay for COBRA for two months back then. The contract I had paid more than enough to afford it. Then the acquiring company shut down their insurance plan and COBRA wasn’t even an option
So the top 10% is a household income of $250K and most of those couples didn’t reach that until their 40s. They aren’t making $225K as an L5 at 25 years old like a former intern/new grad I mentored when I was at BigTech
Most software developers won’t even see above $160K inflation adjusted during their career. Most work in second tier cities in the “enterprise”z.
The problem is, at core, fear. Fear of taking responsibility for your life.
https://www.cdc.gov/chronic-disease/about/index.html
90% of adults will have a chronic condition by the time they are 65.
https://www.aarp.org/health/conditions-treatments/most-commo...
I, on the other hand, only eat beef, butter, bacon, and eggs and everything is getting better. BUT, I may be in a cult, but this cult has benefits.
Again, I'm a nut job that has a HbA1C of 4.7 because I only eat beef, butter, bacon, and eggs.
Serious question, what makes us so addicted and dependent to money that we can't imagine any way of life without a lot of it?
Here is the crazy thing, I went carnivore after I retired because one thread that worried me about shitty insurance is the risk. Now, I'm pretty sure if I only eat meat and work-out, then I might not even need insurance. Like, my labs are phenomenal.
By taking away the fear and the addiction, I've got a level of calm and control of my life that makes me realize the "modern world" is deeply sick.
For acute accidents, who knows!
With carnivore: I'm off almost all meds, my mobility and flexibility are amazing these days (I am sitting on the floor right now with crossed legs).
Doesn't matter how well you take care of yourself if a random cell decides to divide in just the wrong way.
edit: to add clarity, I'm going to leverage full placebo and happiness to my advantage: https://pubmed.ncbi.nlm.nih.gov/12883117/
I'm refute any negative emotions as they are counter-productive. I reject fear of the unknown, and I instead believe happy thoughts.
Keto helps with some cancers that are powered by glucose.
It does nothing to help with any other forms of cancer, of which there are plenty.
The thing is... no one has anything that I want to buy. I don't mean this in an elitist way, but more of a monk way. Like, I don't understand status and keeping up with people.
Like good meals, but I don't really understand the allure of owning a bunch of things.
The ego, when left to it's own devices, is a hell of a drug.
AI has freed me.
I am free to fully enjoy life as a nut case. Its fantastic as im living a second childhood right now.
Yeah, I have a pet theory that I give about a 0.01% chance of coming to fruition... Next couple decades, AI, etc is going to force humanity to confront it's sense of self and priorities and wake up. A man can dream lol.
Florida - especially when you live in the same county as DisneyWorld - is heavily subsidized by tourism
That happened to me right before the ACA went into affect. I was engaged to my now wife and we moved our marriage up early so I could get on her insurance.
https://mrmoneymustache.com/2017/11/05/when-your-shitty-heal... Regarding ACA >My family’s monthly health insurance premium, which had already more than doubled in the last few years to $674 per month, was going up a further 44% for the coming year. For no good reason, other than perhaps the the current government’s attempts to kill off the Affordable Care Act. (By cutting various parts of the structure, the insurance market becomes less stable and predictable, and thus more expensive).
Also besides that there is also the solution of barista fire that's working part time just to get insurance. https://www.reddit.com/r/baristafire/
While I can drag myself out of bed most of the time as long as I have my right hand that I can type with [1] and walk over to my office most of the time if I am not feeling well, that’s big an option for most people.
[1] about that whole pre-existing condition thing. I have cerebral palsy that mostly affects my left hand and slightly my left foot. Even though I hadn’t been to a hospital since 1995 at the time for foot surgery - my only CP complication, had been a part time fitness instructor and could easily run a sub 10 minute mile up to a 15K at the time in 2012 - I couldn’t get private insurance. Now at 51, I’m still a gym rat with no CP related complications.
Let’s say you maxed out your HSA for 20 years and have $200K - that can be wiped out with one uncovered major medical incident the HSA max is relatively low.
The mean household income for the 4th quintile is 115k a year. The mean of the middle quintile is 70k. There’s a theoretical 45k a year spread if you earn like the 4th quintile and spend like the 3rd (evidently possible since a lot of people live in the 3rd quintile).
Even ignoring compound interest, if you can hit that 4th quintile at 30 and you lose half the spread to taxes, by 55 you have 25 years of saving 22.5k/year for 562.5k in savings.
It’s probably not the most fun thing, but I do think it’s doable.
https://dqydj.com/household-income-percentiles/
The median household income doesn’t earn the median wage every year from when they started working. That’s just a snapshot and it’s highly correlated with age. I’m 51, I damn sure couldn’t afford to max out my 401K. That means I was 25 in 1999. I definitely could afford to max out my 401K - which was then $10K a year - when I was making $35K a year.
Especially when new grads are coming out now with student loan debt.
The first blow was when the Supreme Court killed the mandates. The second blow just happened when they killed the subsidies last year.
https://www.theguardian.com/us-news/2025/dec/14/aca-obamacar...
It’s about $25K a year for a decent plan which is doable. But you have to hope that Republicans - and yes this is a political issue - don’t successfully kill the ACA and make it impossible to get insurance at any cost if you have a pre-existing condition. If you are old - you will develop a pre-existing condition.
My parents are 83 and 81 and retired at 57/55. But my mom was a teacher who still gets benefits through the government and my dad gets benefits from the one factory that didn’t shut down in our hometown.
I’m 51 and even if I could retire early financially, I wouldn’t do it and stay in the US. Play the smallest fiddle for us. I “retired my wife” at 46 8 years into our marriage when I did a slight transition to an industry where remote work with travel is the norm (cloud consulting + app dev) and we have traveled a lot including doing stints as “digital nomads”.
We are staying in one of the countries that we might retire to as a Plan B for six weeks starting next week.