Terminally ill, help me figure things out
I have terminal cancer. (yes it's very sad, thank you for your sympathy, let's not focus on that part)
I don't know what to do with my money and I'm not sure whether referring to the flowchart is going to be helpful given my unusual circumstances. The insanity of 2020 has meant financial stuff all got away from me and I've incurred a number of substantial and unexpected expenses. The dust is now settling and I am finally trying to sit down and have a think about the way forward. I will sum up the situation as concisely as I can:
- I currently have £45k, £12k of which is in a maxed HTB ISA, the remainder of which is in low-interest savings accounts
- I make ~£40k/yr in a secure job, am still working full time, and intend to continue for as long as possible
- My expenses are zero (I live with my parents)
- I have no debts of any kind
- I do not own any property and have no meaningful assets bar this money
- I am projected to live for somewhere between (worst case) a couple of months to (extremely optimistically) 5 years. The average lifespan of someone in my position I am told is 1-2 years
- My sole objective is to leave as much money as possible behind for my family
I'm aware you can apply for certain benefits if you are terminally ill, but I understand that you do not get them unless your oncologist is confident you will die within 6 months, which mine isn't. I am thinking about buying a cheap house to realise the extra £3k from the HTB ISA but I don't know if that would be more trouble than it's worth and/or would end up losing me money anyway given the current housing market.
Primarily I am trying to figure out what to do with the money I have that is just lying around not doing anything, and what to do with my monthly after-tax income of ~£2.5k. There has to be something more productive it can do than earn 0.7% AER in a Goldman Sachs Marcus. From consulting the flowchart, if I were healthy, it seems the recommendation would be S&S ISA + low cost global index trackers? Should I just do that on the understanding that the ownership of any investments I have can be transferred to my next of kin when I die?
I would welcome any advice anyone has.
edit: Everyone has said some variation of "spend the money on doing whatever will make you happy". This is a totally understandable sentiment :) I've had this talk with my family and really there isn't much left I both want to do and can do (COVID-19 + chemo means I basically cannot leave the house). Rest assured I will use some of the money to buy a Nintendo Switch or something, but the #1 thing that will make me happy is ensuring my family will be OK financially after I am gone.
submitted by jerome_87
A Doctor's Guide to Private Health Insurance
I recently posted on here about Salary Packaging and there was qutie a bit of interest around my planned post about Private Health Insurance, so I figured I would expedite it!
Here is an overview of PHI from the PoV of someone working in healthcare that has seen how care pans out for both those with and without PHI. I'm happy to answer any questions, but probably will hold off on answering anything about specific situations etc!
The post is on my blog ( https://quickfireaus.wordpress.com/2020/11/15/what-private-health-insurnace/
) but I have put it in text form on here for everyone. What is Private Health Insurance?
Put simply, Private Health Insurance (PHI) is insurance that kicks in when you need in-patient hospital care. In theory, by paying for this you get access to care in a private hospital for no additional cost (more on why this is “in theory”). However, it is significantly more complicated than that. I’ll give a basic overview here, but will not go into specific policies / companies.
What does PHI actually impact if I need an operation?
This is best understood by working through a theoretical scenario.
Let’s consider Bob, he is a 65yo man that has been experiencing worsening left knee pain over the past few years. He has had enough and decides to see his GP. The GP does the neccessary workup and diagnoses Bob with osteoarthritis of that knee (essentially a breakdown of the joint, typically an unfortunate consequence of aging that results in pain). He is given some exercises to perform, visits a Physiotherapist and starts taking pain medication. Unfortunately 3 months later the pain is still there. He revisits his GP and the decision is made to refer him to an Orthopedic Surgeon to see if surgery (a knee replacement) would be of value.
Up until this point whether Bob had PHI is irrelevant. His care would have not been delivered faster or in a more comfortable manner, nor would it have been cheaper (with the exception of the Physiotherapist appointment that would potentially be subsidised by his insurer).
Lets assume he does not have PHI and is thus required to go the public route. He can either be referred to the public hospital clinic or to a private surgeons’s rooms. The benefit of public clinic would typically be that it’s free (like attending a bulk-billing GP), but it comes with the negative of having an often long waiting time to get into the clinic. The waiting time is the big issue here, it is HIGHLY variable and could be 1 month or 2 years! This comes to the first question I would advise you to consider when deciding if PHI is for you:
If you developed a condition that decreased your quality-of-life (due to pain etc.) but was not life-threatening what annual value do you place on the impact?
The case of osteoarthritis of the knee is a very good example for this. Bob is in pain, and thus it decreases his quality-of-life. He may not be able to walk long distances and do the things he previously did due to the pain. But, this condition will not kill him, and thus in the eyes of the public healthcare system it is appropriate for him to wait quite a long time. It could get to the point where he cannot walk, and in that case it would become urgent. But I have seen patients wait 1-2 years to see a surgeon (just for the appointment!) in situations like Bob.
Back to the clinic.
Another negative many will mention about the public clinic is that you’ll see different doctor each time you attend, and this doctor will be in training (not a fully training surgeon). The negative impact of this is debatable. Training doctors may not have all the answers, but they will get you one that will be made by either their boss (the person you would have seen in the private clinic), or a training doctor that has almost finished their training.
Let’s say Bob attends the public clinic and the doctors agree he needs a knee replacement. This is where we get to another cross-road. Does he go public or private? An operation done in the public system will be done in a public hospital by a fully-trained surgeon with assistants that are training doctors. You’ll be provided an exceptional standard of care (my personal opinion is that the care you receive once you are admitted to hospital is superior in a public hospital compared to a private hospital) during this admission and at the follow-up appointments (you won’t be waiting months/years for these – it’ll be 1-2 weeks after discharge regardless of if you go private or public). The BIG negative here is again the waiting list. It could be months or years.
So overall if you go to public clinics and have public operations you’ll get an exception standard of care, but you will be waiting. The amount of waiting depends on where you live and what you need done.
Bob in theory could chose to have a private operation (without PHI). But he will have to pay this himself. I would strongly advise against this as you won’t just pay for the fee quoted, but if things go wrong and you have a prolonged stay you’ll pay for that as well (we are talking $1,000s for this).
Let’s now rewind to the referral to the surgeon and imagine Bob still doesn’t have PHI but this time decides to see the surgeon in their private rooms. He will have to pay an out-of-pocket fee for this. The amount will depend on the surgeon, but essentially they set a fee and you pay the difference (typically $100-200 / visit) between this and the amount Medicare will pay. Benefits of this approach is you get in quickly and you get see the fully-trained surgeon. Negatives are you have to pay! Whether you have PHI doesn’t impact this step! PHI will not pay the out-of-pocket fees for outpatient appointments. The surgeon will ask the same question about the operation being done publicly or privately (refer to previous few paragraphs about this).
Overall Bob’s care up until the referral to the surgeon wasn’t impacted by PHI (except paying for physiotherapy appointments). Whether he had a public or private clinic appointment also wasn’t impacted. The fact he had no PHI meant he had to have an operation done publicly. He received an excellent standard of care, but did have to wait a while for this.
But what if he did have PHI?
He would have been referred to the surgeon (most people with PHI will pay for the private surgeon clinic appointment from experience) and could have said yes to the operation being done privately.
Typically, he would be booked onto a list at the private hospital. The operation would be done by the surgeon that he met in the clinic and all after care (care in hospital and after discharge) would be provided by them. I think there are very few situations in which this care is superior to the care in the public system. However, the waiting times will be significantly less (typically) and the private hospital will typically be “nicer” (quieter, single room and better food!).
You can be a private patient in a public hospital still. This means you get the benefits of the public hospital (lots of doctors around 24/7 if anything goes wrong – this far outweights the private benefits of good food etc.) and the benefits of the private care (you have the surgeon you met in clinic). Whether this is an option will depend on the waiting list situation at that hospital (private patients can’t just jump the list).
In terms of the amount you pay for this admission to the private hospital the “hosptial” costs are covered in most instances (ie: you don’t pay a fee for being there). But the surgeon / anaesthetist fee may not be completely covered. This is because the surgeon might charge $5,000 for the operation but the PHI company will only pay $3,000 (so you pay the gap!). There are some very well known surgeons out there that charge extremely high fees and having PHI really won’t make much of a difference here. Please remember for healthcare in Australia more money DOES NOT equal better care! For more details on what your insurer will pay the surgeon you really need to speak to them.
In what cases does it not matter if I have PHI?
If you NEED medical care it won’t matter. Please remember though this isn’t when you think you need it, but when the Australian healthcare system thinks you do. Things like broken bones, cancer and heart attacks will be treated just as quickly in the private system as the public system. People may tell you anecdotes of when someone they knew with one of these conditions had inferior care to someone with PHI. I’d advise you to take this information with a grain of salt. The public healthcare system is very efficient at providing care to those that need it most in a timely fashion.
What benefits beyond access to private hospital care does PHI give me?
LOTS! This is something that varies between insurers and by the level of cover you have. Things like paying for the first $X of dental care per year is a common one. I would advise you to look at what amount of $ you spend on healthcare annually then when you look at a policy determine how much of this the PHI would cover. This helps you work out the cost-effectiveness of the insurance. This brings me to next question you need to ask yourself when considering PHI.
How much do I spend annually on health care (dental/physio etc) and how much of this would PHI cover?
For those of you that are interested this is where you can look at the quantitative benefits of PHI (ie: it’ll only cost me $X annually when I consider extras like paying for dental). Everything up to this point has been qualitative benefits (ie: I’ll wait less time for an operation).
The simplest saving PHI can provide you is not having to pay the Medicare levy surcharge. The ATO provides a great explanation of how much you’d save if you have PHI. For a single person earning $90,000 they’ll pay 1% of their income – $900. For someone earning $140k they’ll pay 1.5% – $2,000. If you are a high income earner without PHI I would strongly suggest looking into it. You may actaully save money by getting PHI.
The next thing to look at is Lifetime health cover. This is a government initative to make it cheaper to get PHI early in life. Put simply if you are 31 and DO NOT have PHI you pay a 2% fee on top of any premiums (if you do get it after 31) for each year you are over 31. For example if you are 40 years old you’ll pay 2% x 10 years (20%) extra on premiums. This keeps going until you get to 70% but only has to be paid for 10 years of premiums.
Both of these iniatives give reasons for young people to get PHI. This takes the strain of the public system and saves the government $$$.
This comes to the third question:
Are there any government incentives that would save me money if I got PHI now?
You’ll find if you either make lots of money or are young and intend to get PHI in the future getting it ASAP may be a big money saver.
Am I covered for existing conditions?
This is something you’ll need to talk to the insurer about. But typically if you didn’t have the condition when you signed up for the PHI they will cover it. This is frustrating for those with conditions that won’t be covered. But it does make sense. You can’t just sign up for insurance when you need to use it.
Do I have PHI?
I do. I’m young and was keen to get in whilst I had no pre-existing conditions and would have to pay the 2% loading. As I am young and healthy my premiums are quite cheap additionally I’ll save money on the dentist etc. I also value access to timely care for things that could impact my quality-of-life.
So do I go out and get PHI?!
There is no easy answer. I’d advise you ask yourself questions 2 & 3, get some quotes and see how much it would cost. Then see if the cost is less than or equal to your answer to question 1. If it is the answer is clear. If it’s more then it depends on how risk-averse you are.
Overall, you will not die or become disabled if you do not have PHI. We have an excellent healthcare system in Australia that I am proud to be a part of and plan to work in exclusively throughout my career. But PHI will possibly save you from having a decreased quality-life for what could be a prolonged period (at a cost!)
submitted by howfastfire