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Visit yamava.com/palms to discover more. You know, I gotta tell you, as we start to round out 2016 and head towards 2017, I don't really want to talk about health insurance today. I don't want to lose my entire audience right before going into a new year. But I do think that's what we need to continue on today.

I need to share with you a couple of wrap-up items that I've missed so far in the health insurance series. A couple of important points, a couple of important details. And because it's coming towards the end of the year, probably all in kind of a holiday mood--I certainly am-- we're going to keep it light, fun, and fast.

So let's get to it. ♪ Welcome to Radical Personal Finance, the show dedicated to providing you with the knowledge, skills, insight, and encouragement you need to live a rich, meaningful, and protected life now while also working on your plan for financial freedom in 10 years or less. My name is Joshua Sheets, and I'm your host.

And today we focus on that knowledge, ideas, and insight on risk management as we bring our health insurance series to bed for a short time. ♪ This series is going to have to continue in the future because there are many aspects of health insurance that I haven't covered yet that I don't intend to cover at this point in time.

I just want to kind of wrap up a couple of things here as we finish out December of 2016. While open enrollments for some of you are starting to close, open enrollment for others of you will be closing here at the end of the month. For example, in the future, we need to talk about Medicare.

We need to talk about Medicare supplement policies. We need to talk about Medicaid. We need to talk about TRICARE. For those of you who are in the military or for those of you who are in the financial industry, to educate you on TRICARE and the options there, I don't want to use my December to talk about that.

We'll come back in the new year at some point, probably not January, but who knows? Maybe February, March, April, we'll get back to some of those discussions. Medicare is one that I definitely need to provide some insight on. But today, I do want to round out some of the basics of this health insurance series for those of you who are like me, not facing Medicare enrollment, but just kind of trying to figure out how do I provide health coverage for my family.

On the last episode, we talked about health care sharing ministries. I missed a couple of important points on that. It was my own fault. I had a detailed outline, but I lingered a little bit too long on the beginning part of it, and then I ran out of time.

Anyway, so I missed a couple of important things that I just want to mention to you as far as those health care sharing policies. I want to talk about a few different alternative options, direct primary care options, aka concierge medicine, the self-insurance, how you would do self-insurance, the idea of catastrophic insurance, some of the new opportunities for health care, such as apps and doctors available on call or on video chat, things like that, and then just a couple of ways of covering some of the bases from a risk protection standpoint to kind of put together your own thing.

For example, dread disease coverage might be an excellent supplemental thing for you to consider, also called critical illness insurance, or you might want to do something like I discussed in a previous show, adjust your liability limits to protect yourself. So I want to give you some of these things and wrap it up.

I also have a great number of questions from many of you, a few via email and also a few via Facebook, our Facebook, Radical Personal Finance Facebook group. I don't intend to cover those questions in today's show, but I do intend to do some detailed Q&A for you in the future.

So I will invite you to come by and give me those questions. Some of them are specific and some of them are in terms of what do I do with these specific policy decisions. Some of them are more general, for example, some feedback on previous concepts thus far, concepts on Joshua, OK, if you're opposed to health insurance, in terms of when I talked about the ideology of why I'm opposed to universal mandated taxpayer-borne health insurance coverage.

Are you opposed to other kinds of insurance coverage? It's a worthy question, not particularly practical because I have no chance of changing the law and neither do you, but it's at least interesting to think about. Other objections to the health care sharing ministry, several of you said, well, this is really discriminatory.

I don't get it. I'm not a Christian. I don't understand even how you think. So I'll explain some of those things. We'll do that at a different time. So welcome to the show. As we get started, a sponsor of today's show is the YNAB budgeting software. I want to make sure that I bring you this sponsor today as we start to wrap up 2016.

Here at the end of the year, you have a tremendous opportunity to have a fresh, clean start. The calendar year can be oversold in terms of its importance in your life, but it can also be undersold. What I mean by oversold is people will say, well, I'm magically going to somehow do something in January 1st as a New Year's resolution that I wouldn't do previously.

You know, you're an intelligent person. You know that in order for you to follow through on a New Year's resolution, it can't just be a resolution. It needs to be a specific, meaningful goal, something you're working towards. You need to have a plan of action associated with it. You probably should be able to start that plan of action on December 15th or March 15th or any other day, including January 1.

No reason for you not to start January 1, but don't just think that somehow a magical resolution without a plan of action associated with it is going to make a big difference. But when it comes to planning things, especially finances, the New Year is a great time to build new habits.

It's a very clean time to do it. You can get an entire year's worth of data. One of those important new habits for you to have is have an excellent tracking system and budgeting system for your money. Now, I use YNAB. In the past, I've done all kinds of things.

I've used Mint. I advocate. Mint is great. I use Personal Capital to track all of my accounts there. In fact, I haven't done an ad for them in a while, but on the website you'll see an ad for Personal Capital, and I use Personal Capital. If you're going to use that, please click through my link so that I get credit for your using that link.

The way that I do it, I use Personal Capital to track a lot of my accounts, and I use YNAB to track my checking and cash flow accounts. Now, YNAB has a brand new--it was six months ago-- a brand new system where it's a web-based system. Here at the end of 2016, they are canceling support for their old desktop application.

I'm finishing up--I was on the desktop application. I like the desktop application. Myself, I'm finishing up 2016 on the desktop application, and then January 1, 2017, I'll be using the web application exclusively. So I've learned the new system myself. We can talk about that more in the future, but it's great.

They do a great job. The web application solves some of the problems that you've had previously with it. For example, automatic import of transactions-- a very, very helpful feature--and a number of other features as well. So YNAB is the budgeting solution that I think is fantastic. If you are looking for one thing that you can do to start to build a solid foundation underneath you, it's called budgeting.

Telling your money where to go instead of wondering where it went, as the saying goes. Budgeting. And the very best solution that I know for that is YNAB. It actually allows you, in the context of all of your digital accounts, to tell your money where to go and to track it really easily.

You can get a free--what is it--34-day trial--a free trial of YNAB at radicalpersonalfinance.com/ynab. You need a budget. It's the YNAB budgeting software. radicalpersonalfinance.com/ynab. Now, let's seek to wrap up this health insurance series for now and put it to bed. Health sharing ministries. Discuss those on the previous show where I talked in detail about them.

There are a couple of--and I told you how I love the model. It's not perfect for everyone. I tried to point out some of the problems with it, who it might be right for, who it might not be right for, but I shared some of the reasons why that I like them.

But I missed a couple of important points that I do want to cover so that you are fully informed as you are shopping. This conversation came up in the Radical Personal Finance Facebook group, which I've opened up to any member of the audience. Just go to Facebook and search "Radical Personal Finance" and click to join the group.

Great conversation, and I'm very, very pleased with how that is developing into a community of people who can answer one another's questions with expertise. We've got some great conversations going in there. One of the questions was, "What about higher limits of coverage?" Because in reading the materials on health-sharing accounts, a couple of listeners noticed that health-care-sharing ministries are capped, and this is true.

With health insurance policies that are qualified under the Affordable Care Act, these policies are not permitted to have any lifetime limit on the amount of the benefits that they provide, as long as those benefits fall under the category of what are called "essential health benefits." These essential health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services, including oral and vision care.

Basically what that means is if you have a policy that is qualified based upon the Affordable Care Act regulations, which you have to have in order to avoid that penalty, that policy has no dollar limit of cost that it won't cover. Now this has not always been the case in the past.

You used to be able to buy health insurance, and although many health insurance policies did have an unlimited amount of coverage, many of them were capped. For example, many years ago I had a policy that was capped at a million dollars of benefit. Now, a million dollars is a lot of coverage.

When you move over to the world of health-care-sharing ministries, that is not the case. Because these organizations are not health insurance companies, they do not follow these rules. So they do have caps, maximum amounts that will be covered. Now each organization handles this differently, and you'll have to read the guidelines for the organization that you're interested in if you're interested in it, in these options.

But what most of them do is they have a lower level of coverage, usually about $100,000 of coverage, and that's available as part of the standard plans. And then they have an additional higher amount that's available as an optional benefit. So for example, the health-care-sharing ministry that we use is Samaritan Ministries.

Under the terms of my policy, we're covered for any health insurance claims that are up to $100,000. Anything in excess of that is not publishable to the subscribed members. So if I have a $200,000 hospital bill, $100,000 of it will be publishable to the membership, and I could expect to receive the financial help that I need with that bill.

But the extra $100,000 is my responsibility. It's not publishable. That is a risk that you have to plan for and you have to consider. Now you should do it thoughtfully. Thoughtfully means considering that it may happen but also considering that it may not happen. With insurance, there's a very difficult line to walk.

It's not possible for you to afford all of the insurance that you might like to have for every possible eventuality in your life, to have zero financial loss. It's just not possible. There are so many things that can happen that wouldn't be covered by insurance that if you bought insurance for all of those things and tried to minimize everything, you would have very little money left over to pay for anything else.

So with insurance, there's always a balance. We want to always cover from the most catastrophic things that could happen to us, but we don't want to have too much, and sometimes you can't afford all the insurance you'd like to have. So we want to do it in a sensible way.

Now in some ways, this is a major problem with health-sharing ministries because they in some ways pick up what you could handle yourself, the easiest, the smaller bills, the $10,000, $15,000 bills. You could save for those. You could build an escrow account, and the catastrophic coverage is left in the dust.

What if you have a million-dollar hospital bill? So that is a drawback to these companies. More on that in a moment. Most of the companies I mentioned have a second tier, and you can join the second tier if you'd like to get additional coverage. Samaritan Ministries has a second tier.

It's called Save to Share. It's their program. Under that program, you can voluntarily choose to participate in it, and it will give coverage up to the $250,000 level. So you can be covered for some of your larger hospital bills. But most of the ministries will cap out somewhere around that $250,000 coverage.

If this is a problem for you, you will need to find another solution. I have a few ways to possibly mitigate this, but you would need to find another solution. In many ways, if I could find a health insurance policy that was only catastrophic, that only provided catastrophic coverage, that's what I would choose to buy, and here's what I mean.

I wish that somebody would offer a policy that covered nothing below $100,000 of billing, but that covered everything above $100,000. To me, something like that would be very, very helpful. It wouldn't be a fit for most people who don't have $1,000 put together, but for many of you astute listeners who do have enough money that you could effectively self-insure through many of these problems, that would be tremendously helpful.

Self-insurance is the concept that you are responsible for providing for your own needs out of your bank account, out of your savings. As you build wealth, you should more and more self-insure for risks that would not destroy you. A good example would be homeowner's insurance. In Florida, as I've had homeowner's insurance in the past when I owned a home, we would carry hurricane coverage.

Hurricane coverage would be something that we're required to have by the mortgage company, but it's a very expensive homeowner's coverage. Now, I've been through enough hurricanes to know that the chances of catastrophic loss in my house in a hurricane are very small, assuming, of course, that I live in a sensible place.

I don't live on a barrier island. I don't live eight feet below sea level. I live in a normal place. Been through enough hurricanes, probably not going to be a big deal. I've also repaired enough houses to know that I can handle fixing a roof. If you put new shingles on, it's no problem.

I can handle water damage. It's generally not a problem. Floods are what gets you in hurricanes, the people who are the most damaged are those who are flooded because when a flood goes through your house, basically everything has to go out. You strip the drywall down to the studs, everything goes out.

A lot of money comes from a flood. A little bit of rain blowing in the window because you have a broken window is usually not a problem. Although in hurricanes, there are sometimes isolated areas of tornadic activity that will take your roof off, it's not generally widespread and the risk is relatively low.

So when I looked at my homeowner's insurance in the past, because I had a mortgage, I was required to have it. But if I didn't have a mortgage and if I had savings, I would have very quickly canceled my hurricane coverage. I would have kept something like the fire insurance coverage.

I would have canceled the windstorm and kept the other coverage because the risk of fire is very low. Thus, the cost of the insurance is very low. But the catastrophic effects of the fire could be high. Now, I'm ignoring liability on the homeowners just to focus on property damage and the risk that property damage has.

I think homeowner's insurance is one of those things that very reasonably in your wealth plan, you can effectively self-insure at a certain point in time. If you have some skills in terms of being able to fix your house, if you take proper and prudent precautions, you know your house is well-wired, the fire hazard risk is low, you're not doing a lot of loose sloppy work on it.

You have fire extinguishers throughout the home. You have proper smoke detectors, carbon monoxide detectors. You're prudent with your safety. You don't keep a lot of flammable materials in your garage. You think ahead. You take the proactive steps. You have – for us, very common, you have shutters on your windows or a hurricane.

You have a well-built roof. You have properly strapped and buttressed trusses in the attic. The risks are low. The cost is high. And as you build wealth, your house will represent a smaller and smaller portion of your net worth. And so I would be very comfortable with moving to self-insurance with homeowner's insurance.

The same thing could be applied to other things. We talk a lot about disability insurance. Well, once you are more – as you become more and more financially independent, your need for disability insurance progressively declines. So if you're 50 percent of the way on your way to financial independence, then you can dramatically change the structure of your disability policy to just protect you against the most catastrophic of coverage.

And that will dramatically reduce your premium. And then as you move more towards financial independence and you reach financial independence, by definition, you no longer need disability insurance. You become self-insured. I think the same thing can and should happen with regard to health insurance. See, no reason why somebody who's focused on building wealth couldn't systematically build themselves up to the point where they could handle a 10, 15, 20, even $30,000 hospital bill.

And if you go and you look at the median price of hospital bills or of medical costs, there's a small percentage of them that become those massive numbers. Most medical bills that people face are going to be less and those things can be negotiated. They can receive a cash discount, et cetera.

And so we should be moving toward self-insurance, raising deductibles, lowering costs, et cetera, unless you have some mitigating health problem that would make you a higher risk and you know about that. But it's very hard to move to a place where you could be completely self-insured. If I'm out driving with my family and we suffer a catastrophic car accident and I'm in the ICU, my wife is in the ICU, our children are in the ICU, maybe one's dead and the other two are in the ICU, we got a major, major financial problem.

We may burn through hundreds of thousands or millions of dollars of expenses and that's where we need that catastrophic protection. Chances of it happening, relatively small. Potential cost, if it does happen, huge. Thus, an appropriate use of insurance. My perfect world, that's what I would have. Healthcare sharing ministry is a way to maybe mitigate some of the lower costs, progressively moving to the place where I'm self-insured for events up to, I don't know, $50,000, et cetera.

And then I would just have that catastrophic coverage for the $100,000 and up. Unfortunately, I'm not aware of the existence of these policies. If you are aware of one, please tell me. I will profile it on the show. I'm not aware of any companies in the United States offering this coverage.

So, we have to try to figure out a few other ways where possibly this could happen. Now, here are some ideas. One I've mentioned is the concept of liability insurance. If you think, for example, that the most likely source of injury to you is car accident, well, you can substantially increase your coverage for your medical benefits as a component of your car insurance coverage.

You could have a million dollars of medical coverage for your car insurance. That way you're covered if you and your wife and your kids wind up in the ICU. But that would take over in the case of the car accident and that would supplement something like your healthcare sharing ministry.

You should also consider and you could dig into things like dread disease coverage, aka critical illness coverage. And this would be the type of thing where you've seen advertised things like cancer policies. The big player in this game in the United States is Aflac. Aflac is the quacky duck where you see the commercials on TV and they always will show up to your workplace.

The Aflac representative – I was actually appointed with Aflac at one point. I never sold any of their coverage but I did get appointed with them. You show up at a workplace and they'll come and they'll do a presentation to you as the employees. And the way it works is they will negotiate with your employer the option for your employer to deduct the cost of the insurance premiums from your insurance.

Then the agent will come and will present to you, the employees, and you have the choice to sign up for the policies. If you choose to sign up for the policies, your employer will just simply coordinate the deduction with Aflac. And Aflac does big business in the United States.

Everyone really likes it. Most people really like it. The employers like it because it allows the employees to have access to some benefits and insurance programs without the employer having to pay for them. All the employer has to do is coordinate the payment for them. The employees like it because they get access to some insurance policies.

Aflac has very sensible policies in some of the areas and they can be very helpful and very appropriate for certain instances. And the agents like it because they get access to obviously a pool of prospective clients with the simplicity of employer billing. Well, with Aflac, you can buy various types of policies.

You can buy a policy that just gives you coverage for cancer. So if you were concerned with – let's say you had something like a healthcare sharing ministry covering most of your bills but you're concerned about the risk of cancer because it runs in your family. You can sign up and you can buy a cancer policy and those policies would coordinate.

They have other critical care policies that would cover you in the case of certain named diseases such as heart attack, stroke, sudden cardiac arrest, third-degree burns, coma, paralysis, major human organ transplant, end-stage renal failure or persistent vegetative state. I'm reading from one of their brochures here. So these would be examples that you could layer on at a reasonable cost to give you more of that comprehensive coverage.

And that would stretch some of the benefits that you have under a healthcare sharing ministry if you were concerned about that higher amount of risk. So I think these are options that you should be aware of for yourself as help for that catastrophic coverage. But it was incomplete of me not to mention those limits in the previous show.

Another major drawback that I mentioned or should have mentioned is that most of the healthcare sharing ministries have a provision for pre-existing conditions. And this is now the exception in the world of health insurance rather than the rule. In the past, it was always the rule. But again, one of the major components of the Affordable Care Act was that for a policy to be qualified under the terms of the Affordable Care Act, that policy cannot exclude any type of pre-existing condition.

Now, this brings up an interesting problem. The interesting problem is this. If you cannot be excluded from health insurance, aka the affordable care policies on the healthcare.gov, if you can't be excluded from health insurance by any new job, although that was where pre-existing conditions were covered previously, was through the context of group policies.

If you can't be denied coverage as long as you're enrolling during open enrollment or based upon a qualifying life event, then what incentive do you have to make sure that you're always covered? In the past, when there were pre-existing conditions, it was a big, big deal to make sure that you never had a lapse of coverage.

Thus, prudent financial planning would have always made a big deal of maintaining coverage through COBRA coverage, etc., if you were between jobs because you needed to have that continuity of coverage so as not to expose yourself to the risk of your pre-existing conditions being a factor. But when that goes away, it changes the incentive slightly.

It makes it so that you don't necessarily have to have coverage. Here's the difficult wrinkle, especially as it relates to healthcare sharing ministries. Let's say that I'm a member of a healthcare sharing ministry, but I'm diagnosed with some sort of long-term significant illness, diagnosed with cancer, etc. Now, this year I'm starting to use my healthcare sharing ministry, but now we're coming up on open enrollment for Obamacare, and I recognize that I'm going to be burning through my benefits here under this healthcare sharing ministry.

Now, remember, insurance is open to anybody. I can go over now and sign up and under the terms of that program, I'm qualified for health insurance with no pre-existing conditions exclusions, and now I'm able to buy a policy on the healthcare exchange that doesn't have any maximum limit. That's a major problem, and it's an ethical conundrum to try to figure out would that be the right thing to do, would that be the wrong thing to do.

You're not breaking any laws. You're not breaking any rules that I'm aware of to do such a thing. So is that a wrong thing to do? Not an easy question. It's important to know that that's an option because it can provide a backstop for you in terms of your other choices, but it's one of those things where if that were to become a significant trend, it would possibly lead to very difficult legislative changes or something.

I mean the world of health insurance right now is so difficult to navigate just in terms of expectations. We don't know what the future is going to bring. It's a political morass. So that is an option as well, and you need to be aware of that, and this again is where one of the problems even why I've mentioned that you have to keep an eye on this.

One of the problems in today's world and one of the things that's happening with policies that are issued under the Affordable Care Act is because there's no exclusion of pre-existing conditions. Because of that, anybody can come and so they're experiencing significant adverse selection where all the sick people are signing up, but the healthy people like me and my family are not inclined to sign up and so thus actuarially they're having problems, significant problems.

Now, I do not know how this is going to be solved. I have no idea. I am very thankful that it's not my job. Very thankful because I don't know how to solve it. I have no idea. But I can at least recognize the challenges and at least recognize the problems.

So you do need to know however that if you have pre-existing conditions, those will face some sort of exclusion under the healthcare sharing ministries. Now, these exclusions are very reasonable. They're very reasonable. It's just a simple integration time period. For example, perhaps needs that you're experiencing for pre-existing condition won't be covered for the first year.

It's not a permanent pre-existing exclusion. It's not enforced forever. But you do need to know that if you have some sort of pre-existing condition, that would be – that's a problem in terms of your ability to get coverage. Simplest example, let's say that I didn't have – wasn't participating in a healthcare sharing ministry and then my wife and I were pregnant expecting a baby and then three months later I decided to sign up.

Well, the coverage for that pregnancy is going to be covered. It's going to be mitigated based upon the terms of that. It's going to be excluded for a certain time under the terms of the individual ministry. You need to know that. That's important. One significant drawback of the health sharing ministries is they do not entitle you to participation in a health savings account.

Health savings accounts are very, very useful accounts. You don't get access to them under the current law. Now, I am aware that the healthcare sharing ministries are lobbying for a change in the law so that people will be able to be covered. But what that means is you can't use the health savings account as a tax-benefited way for you to save money for your basic medical expenses if you have a healthcare sharing account under – healthcare sharing ministry membership under the current law.

Then finally, there are significant questions regarding the deductibility of your membership shares under the healthcare sharing ministries. To the best of my knowledge, this is a gray area. In general, it would seem that many people would believe that the amount of money that you pay under your membership fees is not deductible as health insurance because it's not health insurance.

That seems to be the consensus that I'm aware of. However, I'm not aware of that being addressed in specific IRS – a specific IRS guideline or opinion. I'm also not aware of that being contested in tax court and I do know that there are those who are experts in this area who do have a dissenting opinion, who believe that the amount of your shares are deductible just like health insurance costs would be.

I do not know the correct answer on that. If any of you listeners have quality information on the subject, I would be happy to see that. Please come by the blog post for today's show and post that so that my listeners can have access to that information public. I do not know the answer to give you guidance on that.

The basic idea of why would you do it even if you didn't have deductibility is that the premiums or the membership amounts, which are not premiums, the membership amounts are so much lower that it's still in your best interest even if you lose deductibility. I don't know the answer on that and I cannot give you an opinion on that.

It's outside of my area of expertise. So those are some important points with regard to healthcare sharing ministries that I wanted to make you aware of. I've received a number of other questions. I'm going to save those other questions for a different occurrence, a different occasion, and I'm just going to talk about a couple of final things that you should be aware of.

Number one, you have options more and more in today's world to start to get medical care at cheaper prices. The prices that are charged for medical care in the United States of America are almost universally acknowledged to be high to outrageously high depending on who you talk to. And there are a number of difficult factors here.

There's a confluence of factors that I think is many, many problems with it. Depending on who you talk to, you get a different opinion as to what it is. I don't know the answers. I am not qualified to give you a firm answer. I would say that as with many things, it's just a combination of many factors.

But there are a lot of people working on it. There are people working on it from the legislative perspective such as passing legislation which is designed to hopefully reduce the cost. There are also people working on the supply side where they're seeking to just simply provide different options. And there are a few of these that you should be aware of.

The first thing that you should know is that you can negotiate the costs of your medical care. When you get out of the health insurance system as we are, out of the health insurance system, you start to become much more sensitive to those costs and you start to recognize just how much negotiation room there is.

Different health care sharing ministries handle this differently. Some of the organizations actually negotiate for you or on your behalf with your health care provider for their bills seeking to have a lowering of the bills. Some of them you do it yourself. For example, with Samaritan Ministries, I seek to negotiate the bills myself.

Any bills that are there, I try to get a discount and I report those discounts to the company and they do their best to help me and support me in that effort. Other organizations handle it differently. So these options – but what you find is that if you're willing to pay cash, all of a sudden, you can have different prices.

I have found that this applies in almost any service, not just health costs, especially if you're dealing with offices or with people who are smaller. Now, this applies in terms of hospitals. You can negotiate with hospitals, even big hospitals. But when you're working with people, always ask for a discount.

I have a friend of mine who says it's your job to – your job is to always ask for the discount. It's their job to figure out which one they're going to give you. I encourage this of you. Ask for the discount. Always ask for a discount of some kind, even if it's as simple as saying – negotiating a price and then saying, "What do you take if I give you $20 bills?" There have been many times in my life where I have found that after negotiating a price for a service of some kind or a product of some kind, if I just simply stop off at the ATM and pick up a stack of $20 bills on my way, then when I get there, we can get a substantial discount.

With medical care, this is absolutely applicable. When you understand how difficult the insurance billing process is for many medical providers and when you understand the difference in rates between what they are permitted to publish to you, the patient, versus what they actually recoup from the insurance company, you'll start to see why their incentives are very high to get cash today at a lower rate.

You can use that to your benefit. There's also a transformation that's happening with regard to medical practices. I think – I've watched this trend for some years and I think it will be growing in the future more and more and more. It seems to be slow but I don't know if it's slow because it's not working or if it's just simply slow because it takes time to prove these things out and people are watching it carefully.

I'm watching it carefully. What I'm referring to is the concept of concierge medicine or direct primary care depending on how it's referred to. Those are the two terms that I'm aware of it. Basic idea is this. If you have just a primary care physician, a regular doctor who's going to work with you with most of your major sicknesses, not a specialty, not a high specialization, just a general primary care physician, then if you can come together in a membership situation with that doctor, that doctor by serving you directly and not accepting insurance but having a steady form of payment, a doctor may get very much what he or she is looking for, which is steady revenue.

Now, there are a couple of different models of this. First, there are doctors who only accept cash payments. They don't accept insurance. There are also doctors who work under this membership model. You buy in. You have a flat fee of X number of dollars per month and in exchange for this flat fee, you get unlimited access to the physician with no copays, no additional fees, etc.

You can talk to the doctor when you want to. This approach to concierge medicine is available at the relatively low end, inexpensive end. It's also available at the very high end of the market as well depending on what you're looking for. I think there's a lot of pressure on this and a lot of ways that this can get better in the future.

If a doctor can free up some of their practice from the hassles of insurance, from the hassles of serving all people, from the hassles of these different billing options, they can embrace some of the new technologies that make things a little bit easier, simple things as video conferencing, as simple as communication using the tools that we all use every day, FaceTime, very effective for doctors.

And it can allow one doctor to come together and build this type of membership practice. I've looked into my area. There aren't any doctors that are convenient under this model to me. But I think it's something that you should look around and you should consider. Do some research on it to see if it might work for you because if you put this together, if you put together something like a catastrophic policy if that were available, if you could find something like that, where you have your primary care physician that you are engaged with in a membership model and it's a concierge practice, they provide for you the service but it's just a flat fee and you have coverage for any massive higher amounts, you can put together a hybrid approach and provide for your healthcare expenses without the need for some of the more expensive insurance programs.

You should be aware of it. There's also a growth especially for those of you who are cash payers using a healthcare sharing ministry. There's a growth of these things from a virtual perspective and I think this will grow more and more where you can interact with a doctor that's entirely virtual through a variety of apps.

I'm intentionally not giving names because I don't know – I'm not aware of which ones are the best, which ones are not the best and I think they'll change. But you can look into some of these options where you can receive medical coverage or medical care via a telephone line.

This can be done and will be done more and more in the future where many medical tests are at this point in time commodities where they can be ordered by someone else. Half the time if the doctor is ordering tests, you don't have to see the doctor. The doctor sees the results.

Sometimes the nursing staff does it. Sometimes you go somewhere else and you have the testing done at a testing facility. I think there are more and more options where you can do it with home delivery and have stuff FedExed to your house and have different things like that done.

There's no reason why it can't be done. I'm hoping that these technological changes will impact the medical market. But you should be at least aware of them as an option for you. As these technologies grow, they are opening up options for lower price products and you can be more confident, say you make a decision to self-insure or to do something like I do where you join a health sharing ministry and I know that I have an upside risk.

I know that I don't have catastrophic coverage. I think these things can be done and you can take those risks on a straightforward way and consider your different options. Which brings me to my final point that I want to address here today which is that there are often many more options for medical care than you are currently used to looking at.

A big one would be medical tourism. Now I'd like to do more investigation into this area myself. I've read a couple of books on it. But the options in today's world for medical tourism are substantial. I think there are a variety of different ways. Let me start from simple to more exotic.

One of the things that I've observed is that there is always an abundance of options available to you right now that you may not be thinking about. Simple example, teeth cleaning. Where I live, there is a local dental college and you can choose to go down to that dental college and you can pay perhaps $30 to have your teeth cleaned versus going to a more higher market dentist and paying $130.

That could be a substantial savings especially if you're getting your teeth cleaned regularly, two, three, four times a year. Now your cost for that is of course that you are working with a student who is working on you under supervision and not with an older dentist. But the reality is it's probably – at least with dental cleaning, it's probably going to be the same person because the hygienist at most dentist offices is the one who does the cleaning anyway.

The hygienist may have just graduated from dental college. So it's practically the same thing but a substantial savings. That's something that most people aren't aware of or depending on your income. If you look around, you'll often find that doctors and dentists will volunteer their time to work with low-income – groups of people low-income locally.

So perhaps you can find something like that and if you would qualify under the terms that they're offering care, you may be able to find some care that way. You can do things like use the apps and there are places where you might have an expert physician with excellent experience from another country who's working with you through a digital communication system.

Just simply due to their location in another place, they're able to provide that service for you at a lower cost and you're paying for it through the app. There are other more exotic moves of coverage and this is where you get into it. Let's say that I were diagnosed with cancer and I were trying to need medical care.

I don't have to get medical care in the United States of America. There are plenty of other places in the world that have great options for medical care and more and more you see people doing this. There are entire regions of the world that are specialists in certain types of care, certain types of organ replacement or heart surgery, etc.

If you've never traveled abroad, I think you owe it to yourself to expose yourself a little bit to what's available because it's very easy in the US context to acquire this idea of US exceptionalism where by that name you think that everything in the United States is the best.

You think, for example, that we have the best medical system in the world. Now depending on what metric that you use, that may or may not be true. But just because you may have the best medical system, if that were true, I'm not arguing the point, just saying if it were true, doesn't mean it's the best in all circumstances.

I've been in clinics and other places in the world where the service is way better and everywhere I've traveled in the world, I can almost always find something that's done in the local area that's better than in my own home country. And as the world becomes smaller and flatter, these options become more and more compelling.

Whether you go to Mexico or Costa Rica to have a baby or whether you – there are just tons of options. You can afford in most of the world to pay for your medical care out of pocket, especially if you're earning your salary in dollars on a wage base that's based upon the US cost of living.

So be aware of that concept and if you're facing a medical problem, you need a root canal or you need surgery or something, and if you're finding yourself facing significant problems getting that coverage and affording in the United States, consider going elsewhere. Look around and see what's available for you.

My hope is that if you are exposed to some of these diverse ideas, you feel more confident to look at your situation, shop around for your options to see what's available to you within your context, and simply thoughtfully choose what's right for you. That's my hope. I think that's it as far as where I want to leave some of these wrap-up topics that I want to cover on today's show.

I do intend to do a Q&A show. That may come to you this week. Beginning on Monday, I am taking my family out of town for the last two weeks of the year. I'm planning to do a wrap-up show on what to expect on radical personal finance in 2017.

So I'll share with you what I've learned from my own end-of-year analysis, analysis of success, of failure, and what I'm going to be changing going forward and how that will affect you. I hope my hope is that you all will be pleased and happy with some of the ideas and the things that I'm doing.

One of those things will be more content, and we'll cover that in another show. So that's it for today. If you would like to ask a question regarding health insurance, please come by and join the Radical Personal Finance Facebook group. I've opened that group up to every member of the audience that would like to participate.

You can find us easily on Facebook. Just search "Radical Personal Finance" and it will show up for you as the community Facebook group. I have a page and also the group, and both of those are available to you. So please come by and do that and join that group and then ask a question there.

We have a health insurance thread going, and I will take those questions and filter them in through a Q&A show and share that with you at some point. I had great success there. 400, 500 members there. A couple of other things. Thank you to those of you who have been continuing to leave reviews for Radical Personal Finance in iTunes.

We're up to 371 of those. My goal is to get to 1,000 by the end of the year. So there are about 10,000 of you who listen to this show and download it through the Apple Podcasts app. If you are one of those listeners, please take a moment. Just click on the show in the Apple Podcasts app and do me a quick favor.

Leave a one or two-sentence review for Radical Personal Finance. You can do it right on your phone. One or two sentences is perfect. Just say what you think about the show. Leave a quick star rating and you'll be done. It should take only a couple of minutes. Please do that for me.

If you want to give me a Christmas present, that would be very, very helpful. We're at 371, and I'd like to get to 1,000 before the end of the year. I know that's a tall order, but it's very important to me. So I ask you to please do that.

If you listen on a non-Apple device, good for you for expressing your diversity and actually choosing for yourself. You can leave a review in the store or iTunes on the computer, whatever you like. Anywhere you listen to the show, that's helpful. Those things are always helpful because they help to raise the profile of the show.

If this has been useful to you, please come by and support the show at radicalpersonalfinance.com/patron. Be back with you soon. Hey parents, join the LA Kings on Saturday, November 25th for an unforgettable Kids Day presented by Pear Deck. Family fun, giveaways, and exciting Kings hockey awaits. Get your tickets now at lakings.com/promotions and create lasting memories with your little ones.