What I Do for Health Insurance Rant

Funny that health insurance should be our topic today. I'm in the process of navigating the travesty that passes for healthcare in these United States. I'm up for a hip replacement. I'm going to physical therapy first because I'm a firm believer that strengthening muscles around a bad joint might delay the necessity of surgery and if it can't, it will only speed the recovery from said surgery. But. Today, someone who works in a teaching hospital associated with a local university sat me down, looked me in the eye and said, "Get a second opinion." I must have looked blank. She shook her head at me and said, "Listen. Everyone in a medical specialty is making a Porsche payment. Don't be someone's Porsche payment."

I don't know whether to laugh or to cry. You'd like to believe that healthcare is there to care about you, but all too often, I find that isn't the whole story. Or even most of it. I think long and hard about the story of getting a hip replacement in Portugal. Surely you know this one. It goes:

For what it would cost to get a hip replaced in the USA, I could move to Portugal for a year, rent an apartment for that time, see all the sights, learn to speak Portuguese, even. Then I could have my hip replaced in a state of the art medical facility, pay cash, stay for two more months to recover, and STILL have paid less that what a hip replacement in the USA would cost.

We're all being taken advantage of in this country. Health insurance feels like a scam that could finally put a Nigerian prince to shame. Still. The alternative is ruin. So. We carry health insurance. I'm lucky. My partner is employed by a company involved in the healthcare industry so our insurance is -- reasonable. They don't like me much because I'm kinda complicated. They like to come at me from time to time with tsking letters about what providers I choose to see because I'm not impressed by their doc-in-a-box preferences. But for the most part, we get along while eyeing one another with distaste and distrust. Their current 'it's a benefit' shill is trying to assign me a nurse to 'help' me manage my healthcare. The sales person who called to get me to accept the 'benefit' made the mistake of mentioning that the nurse could give me all kinds of information about where I could go to get care. Heh heh. Yeah, no, nameless health insurance company. I'm not playing your game of asking permission to manage my own well being, thanks. 

There are a few reasons that I might one day leave the USA to live elsewhere but let me assure you this Machiavellian structure we call 'health care' is right at the tippy top of the list

The Good and the Bad of Writing

 Health Insurance

Last week I was invited to a friend’s house for lunch because she wrote a book!!! She had so many questions about next steps and her options. It got me all excited talking about the book world and how unique it is! 

Sadly, it’s not all champagne and chocolates and health insurance, our topic of the week, is one of them. 

I’m blessed to have a husband with a corporate job that provides medical coverage. My chronic disease isn’t very common, though sadly it seems to be on the rise, and requires specialists and what feels like endless lab testing. So yes, we pay my providers well for being out of network. It’s part of life. 

I don’t want anyone to jump into the book world and be blindsided. Which means authors need to talk about what it’s really like being an author. The good and the bad. And being mindful of healthcare costs while weighing the pros and cons of jobs and careers is important. 

But let’s not let the negatives overshadow the positives. Talking with my friend brought me back to my beginning and reminded me how excited I was to learn all about the book process and discover communities of people working towards the same goals. Listen to the words to the wise comments, but don’t let it diminish your joy! 

May your weened be filled with words and maybe some eggs!

Announcing My Mentoring Patreon! Also Health Insurance

 Exciting news! I've officially opened my Patreon: Jeffe's Closet, A Mentoring Community for Newbie, Intermediate, & Expert Authors. The Patreon leads directly to a Discord community where all kinds of conversations will occur. I'm super excited to make this into a vibrant community. Right now the Discord is open, but pretty quiet - which means you'll get a lot of personal attention from me. Come and join in!

As far as our topic this week, what we do for health insurance, I self-insure. As a full-time author, I have no employer to provide me with health insurance (or other benefits). My husband took early retirement from his career and was insured through them for quite some time, though each year the premium was sucking up more and more of his retirement stipend. Soon we were going to have to pay in - ugh! Then the concierge health insurance service became available through SFWA (Science Fiction and Fantasy Writers Association). SFWA collaborated with other writers' organizations to make this service available to our members. I was able to transfer my husband onto insurance via the Affordable Care Marketplace - and both of us together ended up paying over $1K LESS EVERY MONTH. I'm a fan! Thank you, Obama - seriously. 

Health Insurance: It's Private

 This Week's Topic: Health Insurance

It's likely you, dear readers, don't want to endure my lengthy diatribe on the rapacious US Health Industry, our longstanding corporate death panels, the staggering increases in insurance premiums so the insurance companies can rake in over $350Billion in annual revenue, private equity firms crippling private practices with undue administrative burdens, how the hulking medical complex routinely punishes the unmarried, nor my objections to religious groups operating medical facilities (thus imposing their beliefs on anyone seeking care).

Instead, I'll share what I --a single, self-employed, not-incorporated-- author does about the necessary evil that is health insurance. I have private insurance that is not through the ACA Marketplace. I got it after I left corporate, before the ACA was a thing. It is not part of a guild-sponsored program, so I can't speak to whether those are cost-savers or not. Naturally, I did (and continue to) look into plans offered by the ACA; however, aside from ridiculously high deductibles, the bigger problem is finding doctors who accept that insurance. I'm fortunate to live in a city where hospitals and medical specialists abound, yet it is still a struggle to find practices that accept ACA-provided insurance. Alas, my health insurance is more expensive than the mortgage I have on a 3br townhouse in an urban historic district in a major metro area. This year (last week, as matter of fact) my insurance company informed me of a 30% increase in my premium. 

30% Increase
30%
The national inflation rate
that incited political and cultural warfare was 7% by comparison

Funny how insurance companies send out those premium-increase notices after the ACA Marketplace open enrollment closes, eh? Yes, it makes me incandescent with rage that we have no recourse. Yes, I'm aware that the ridiculous congressionally-sanctioned robbery that is health insurance is all that stands between me and bankruptcy caused by medical expenses. Yes, I know there are tax deductions that can be taken, however, one still has to pay the premiums even if book sales are at rock bottom. 

Do I wish our federal and state governments would overhaul our healthcare system? Gods yes. Health Insurance is the greatest fraud and extortion perpetrated upon the US population.

Real Information on Author Finances

Our topic at the SFF Seven this week is again eerily timely. We're talking writer finances. How do you budget for uneven income? What’s your biggest expense?

With so many people struggling financially due to the #COVID19 shutdowns, managing money is heavy on many people's minds. It's odd to find myself well-equipped to deal with this because - as a full-time writer with no other income and with a non-salaried spouse who does not provide me with health insurance - I am always juggling the financial balls.

Though many people regard writers as wealthy, most are not. There's a huge spectrum of author incomes, from approaching zero to multi-millions. Various groups use surveys and data-mining to estimate median author incomes - eliciting huge arguments, too - but the short answer is that how much an author makes varies. And it doesn't just vary from author to author, but it varies over an author's career. There are good years and bad, feast and famine, upward trends and downward ones. Even within the course of a year, that income varies.

The bottom line is, if you're relying on writing income to pay the bills, then budgeting is a major challenge. There is no salary, so the standard method of budgeting - knowing your monthly income and keeping expenses below that number - doesn't work. So, what does work?

The simplest and lowest-risk method: many authors who write full time have a stable source of income that does not come from writing - a retirement annuity or a spouse's salary. In this scenario, budgeting can be done according to the reliable income, with income from writing counting as "gravy." Now, the reliable income budget can be pretty bare bones, meaning the gravy is pretty important, but this also allows for a percentage of writing income to go back into the business.

I'd love to be doing it this way! However, I'm not. My husband retired early from his state job, so while he does have a monthly stipend, there's not much left after his health insurance premium. (I self-insure through the ACA.) He's also non-salaried, so his income fluctuates wildly.

So, how do I handle budgeting when in some months I receive 15% of my annual income and in others 2%? (Those are my 2019 numbers.)

Very carefully?

What I'd love to be able to do is budget annually. I'd love to set aside a year's worth of fixed expenses - mortgage, utilities, groceries, etc. (which are, by the way, my biggest expenses) - and pay those ahead or out of an account set aside for that purpose. I've come pretty close to being able to do that, but not as consistently as I'd like. If I ever received good-sized advance - like more than $100K - I'd set it aside for that.

What I usually can do is budget quarterly. At any given time, I like to have enough money to cover projected expenses for the ensuing three months. That way, if what we have in hand looks like it'll dip, I have a few months to try to supplement the income.

One thing that helps hugely with stabilizing income is self-publishing. While an author still can't control sales, the retail platforms pay monthly, which really helps to even out the income. Diversifying income streams as much as possible helps, too.

Of course, keeping expenses low is ideal, but that's true of any budget. So is earning a Whole Bunch of Money!

In the meantime, we do our best to make the ever-shifting ends meet.