Do Americans still need extra health care / medical insurance after reform to health care? [U.S.]
I think it is too early to tell. They changed so many variables in an incredibly complex system, and a lot of it will depend on how the requirements in the legislation look once the bureaucrats and insurance companies get a chance to interpret them and implement them as policy. My gut feeling is that for most people, you should plan on some pretty price increases for insurance in the next few years as insurance companies try cover the costs of removing lifetime caps and insuring people with pre-existing conditions. That said, the personal finance issue that you really should be planning for is your portfolio not your insurance costs. The bill includes almost a 4% increase in capital gains taxes.
"The general answer to this is ""yes"".  When you're dealing with single-digit millionaires, the answer is that their insurance habits and needs are basically the same as everyone else.  When you get into the double digit and triple digit millionaires, or people worth billions, they have additional options, but those basically boil down to using ""self-insurance"" rather than paying a company for an insurance policy.  The following is based on both what I've read and a fair deal of personal experience working for or with various stripes of millionaire, and even one billionaire. Addressing the types of insurance you mention: This is generally used to provide survivors with a replacement for income you can no longer provide when dead, in addition to paying for costs associated with dying (funeral, hospital/hospice bills, etc).  Even millionaires and billionaires have this, yes, but the higher your net worth, the less value it has.  If you're worth 9 or 10 figures, you probably already have trust funds set up for your family members, so an extra payout from an insurance policy is probably going to represent a small fraction of the wealth you're leaving your survivors, and as has been noted, insurance makes a profit, so the expectation by the insurance company is that they'll make more money on the policy than they'll have to pay out on death.  That being said, the members of the 9+ figure club I've worked for all had multi-million dollar life insurance policies on them, which were paid for or heavily subsidized by the companies they owned or worked for.  I doubt they would have held those policies if they had to pay the full cost, but when it's free or cheap, why not? Absolutely.  As health insurance in America is an untaxed employment benefit, owing to regulations from World War II, all the wealthy folks I've had contact with got outrageously good plans as part of the companies they work for or owned.  Having said that, even their trust fund beneficiaries held health insurance, because this type of insurance (in America, at least) is actually not really insurance, it's more of a pre-payment plan for medical expenses, and as such, it provides broader access to health care than you'd get from simply having enough money to pay for whatever treatments you need.  If you walk into a hospital as a millionaire and state that you'll definitely be able to pay for your open-heart surgery with cash, you'll get a very different response than if you walk in with your insurance card and your ""diamond-level"" coverage.  So, in this case, it's not as much as about the monetary benefits (although this is a type of ""insurance"" that's generally free or heavily discounted to the individual, so that's a factor) as it is about easier access to health care. Although this is required by law, it's one of the common forms of insurance that the very wealthy can, and often do handle differently than the rest of us.  Most (if not all) US states have a provision to allow motorists to self-insure themselves, which amount to putting up a bond to cover claims against them.  Basically, you deposit the minimum amount the state determines is required for auto insurance with the responsible state organization, get a certificate of self-insurance and you're good to go.  All the high wealth individuals I know when this route, for two reasons - first of all, they didn't have to deal with insurance companies (or pay sky-high rates on account of all the speeding tickets they picked up) and secondly, they made their deposit with government bonds they had in their portfolios anyway, and they could still collect the interest on their self-insurance deposits.  Of course, this meant that if they wrecked or dinged up their Maserati or Bentley or whatever, they'd be out of pocket to repair or replace it... but I guess if you can afford one $200,000 car, you can afford to buy a second one if you wreck it, or get by riding one of your other luxury automobiles instead. Since someone else mentioned kidnapping insurance, I'll point out here that what Robert DeNiro did in Casino when he put a couple million dollars into a safety deposit box for his wife to use if he was kidnapped or needed to pay off a government official is essentially the same thing as ""self-insurance"".  Putting money away somewhere for unexpected events in lieu of buying an insurance policy against them. In real life, the very wealthy will often do this with US treasuries, government bonds and other interest-bearing, safe investments. They make a little money, diversify their portfolios and at the same time, self-insure against a potential big loss. This is another insurance area where even the very wealthy are remarkably similar to the rest of us, in that they all generally have it, yes, although the reason is a little different.  For normal folks, the home they own is generally the largest part of their net worth, or at least a very substantial fraction, for those older folks with retirement savings that exceed the value of their homes.  So for us, we have home owners insurance to prevent a catastrophic event from wiping out the lion's share of our net worth. If you're an ultra-wealthy individual who can afford an 8 figure home, that's not really the case (at least with the ones I've dealt with, who made their fortunes in business and are good managing their wealth and diversifying their assets - could be different for sports stars or the entertainment industry), and these people generally own multiple homes anyway, so it's not as big a deal if they lose one. However, no one actually buys a multi-million dollar home by writing a multi-million dollar check.  They get a mortgage, just like the rest of us.  And to get a mortgage, insurance on the property is a requirement.  So yes, even the ultra wealthy generally have insurance on their home(s).  There is an element of not wanting to shell out another 20 million if the place burns down, or someone breaks in and steals your valuables, but the bigger part of the reason is that it's required to get a mortgage in the first place, which is generally done for financial reasons - interest on your mortgage is a tax deduction, and you don't want to sink millions of dollars all at once into buying a property that's not going to appreciate in value, when you can get a mortgage and invest those millions of dollars to make more money instead." "You can deduct what you pay for your own and your family's health insurance regardless of whether it is subsidized by your employer or not, as well  as all other medical and dental expenses for your family, as an itemized deduction on Schedule A of Form 1040, but only to the extent that the  total exceeds 7.5% of your Adjusted Gross Income (AGI) (10% on tax returns for year 2013 onwards). As pointed out in KeithB's comment, you cannot deduct any health insurance premium (or other medical expense) that was paid for out of pre-tax dollars, nor indeed can you deduct any medical expense to the extent that  it was paid for by the insurance company directly to hospital or doctor (or reimbursed to you) for a covered expense; e.g. if the insurance company reimbursed you $72 for a claim for a doctor's visit for which you paid $100 to the doctor, only $28 goes on Schedule A to be added to the amount that you will be comparing to the 7.5% of AGI threshold, and the $72 is not income to you that needs to be reported on Form 1040. Depending on other items on Schedule A, your total itemized deductions might not exceed the standard deduction, in which case you will likely choose to use the standard deduction. In this case, you ""lose"" the deduction for medical expenses as well as all other expenses deductible on Schedule A. Summary of some of the discussions in the comments   Health care insurance premiums cannot be paid for   from HSA accounts (IRS Pub 969, page 8, column 2, near   the bottom) though there are some exceptions.  Nor   can health care insurance premiums be paid from an   FSA account (IRS Pub 969, page 17, column 1, near the top). If you have a business on the side and file a Schedule C as a self-employed person, you can buy medical insurance for that business's employees (and their families too, if you like) as an employment benefit, and pay for it out of the income of the Schedule C business, (thus saving on taxes). But be aware that if you have employees other than yourself in the side business, they would need to be covered by the same policy too.  You can even decide to pay all medical expenses of your employees and their families too (no 7.5% limitation there!) as an employment benefit but again, you cannot discriminate against other employees (if any) of the Schedule C business in this matter.  Of course, all this money that reduced your Schedule C income does not go on Schedule A at all. If your employer permits your family to be covered under its health insurance plan (for a cost, of course), check whether you are allowed to pay for the insurance with pre-tax dollars.  The private (non-Schedule C) insurance would, of course, be paid for with post-tax dollars.  I would doubt that  you would be able to save enough money on taxes to make up the difference between $1330/month and $600/month, but it might also be that the private insurance policy covers a lot less than your employer's policy does.  As a rule of thumb, group insurance through an employer can be expected to offer better coverage than privately purchased insurance. Whether the added coverage is worth the additional cost is a  different matter.  But while considering this matter, keep in mind that privately purchased insurance is not  always guaranteed to be renewable, and a company might decline to renew a policy if there were a large number of claims. A replacement policy might not cover pre-existing conditions for some time (six months? a year?) or maybe even permanently.  So, do consider these aspects as well.  Of course, an employer can also change health insurance plans or drop them entirely as an employment benefit (or you might quit and go work for a different company), but as long as the employer's health plan is in existence, you (and continuing members of your family) cannot be discriminated against and denied coverage under the employer's plan." Single payer health care, aka socialized, has been shown to be superior. If you haven't noticed we already do the free market thing. That is why insurers have been booting people with pre existing conditions and hospitals and pharma companies hugely jacking up the rates. Epi pens are up over 700% from a few years ago. Martin Shrekli bought rights to a life saving drug and jacked the prices astronomically. The free market works great for consumer products and services, but when it comes to services that are meant to benefit society, the free market does a horrendous job. Health care in other counties' goal is to provide adequate health care for the lowest cost. Here it is trying to charge people as much as they can get away with and marginalizing those that can't afford. And funny enough you are paying more for health care in your taxes than in any other country in ADDITION to your private insurance for lower quality care so the pharma execs can increase their share prices. Generally, the HSA is self-reported.  The bank/financial provider will allow you to withdraw/spend whatever you want from your HSA.  They report to the IRS the total that you withdrew for the year (your gross distributions) on a 1099-SA form.  At tax time, you use a form 8889 to report this number of your gross distributions, and how much of it was used for medical expenses.  Ideally, all of it was used for medical expenses.  If it was not all for medical expenses, there will be extra taxes/penalties due.   Different HSAs work differently, but for mine, which is held at a credit union, I can get money out several ways.  I have an HSA checkbook and an HSA debit card that I can use anywhere.  I can also transfer money out of my HSA into my regular checking account to reimburse myself for an expense, or even stop in at the teller window and take out cash.  The credit union doesn't need to see any receipts for any of this.  They don't care if I'm spending it at the doctor's office or the casino.  It is up to me to make sure I'm spending the money in accordance to the law and that everything is reported correctly on my tax return. Nothing is verified unless you get audited.  You definitely should keep documentation on the expenses, because if you are audited, you need to be prepared to account for every withdrawal.  Make sure you are very familiar with the rules on eligible medical expenses, so you know what is allowed and what is not.  IRS Publication 502 has all the details on what is allowed. As far as how it gets counted towards your deductible, you need to make sure that all of your medical bills get sent to your health insurance, even if you will eventually have to pay for it.  For example, let's say you go to the doctor, and the bill is $150.  Even if you know that the deductible is not met yet and you will be responsible for the entire $150, make sure the doctor's office submits the bill to your insurance.  The insurance company will inform the doctor's office that you are responsible for all of it, but they will apply the amount towards your deductible. [It's so well-known that the ACA will contain costs relative to doing nothing that it's almost not worth citing a source.](http://www.nejm.org/doi/full/10.1056/NEJMp1006571)  Edited: That came off snarky. I don't want to ignore the importance of long-run cost containment in health expenditures. But instead of raising costs, the ACA is really just a small but important first step in cost containment.   More sources: [Affordable Care Act: Implementing Medicare Cost Savings](http://www.cms.gov/apps/docs/ACA-Update-Implementing-Medicare-Costs-Savings.pdf)  [The Affordable Care Act Will Bring Down Costs](http://www.healthcare.gov/blog/2011/08/bringingdowncosts082911.html)  [Only the First Step in Containing Healthcare Costs](http://www.nytimes.com/2012/07/22/business/health-care-law-and-cost-containment-economic-view.html) "Um... Read what I said more closely. I said it wasn't perfect for the long run. But obstructing and causing it to fail is very different from ""fixing"" it. Does he want to fix it? Based on his actions, it doesn't seem like it. Literally the only thing keeping me alive right now is the fact that insurance companies can't exclude you or charge higher due to pre existing conditions. The ONLY way that works is if everyone has insurance. High risk pools are not an option. These supposed republican traitors understand that literally killing off God knows how many Americans just do Trump can say he ""won"" is ridiculous. I'm not a huge fan of the ACA either. I want socialized medicine for all. Why burden businesses to pay for insurance? You want business growth and to foster entrepreneurial growth? Reduce the risk of literally dying from cancer by offering socialized medicine. I am very lucky to be in a situation where I can work for a startup and not have to worry about my Healthcare (for now). Now to answer your questions... Is he for a national health care system? I don't know. It's impossible to know exactly what trump wants. He is purposely elusive and only comes out to bash things when it makes him look good. You never know exactly where he stands so he can always spin the table and said ""OH I never said that"". If he had legislation he wanted to push forward, why doesn't he work with congress to define it and push t forward? No matter how fucked up congress is there's nothing stopping trump from creating and proposing legislation for discussion. But he hadn't done that. Why? We can speculate all day, but I think at thr core if it he has a psychic imbalance. I think mental illness is the wrong connotation. But his spirit is sick and until he is healed, he will continue to damage the people of America. And the fact that he has such a massive following indicates that there is a spiritual and emotional illness spreading like wildfire through this country. I fear that we will never be a court filled with compassion, civility, and reason. That might not be what the majority wants, and that's fine too. I'm thankful to be very high income and in tech, so I can GTFO when the time is right. Anyway I don't think this post will have changed your mind but maybe it will get some others out there to who are on the fence to reconsider their world view." Technically, everyone would be fine with you not being insured. As long as you pay your fair share in taxes for the time you break a leg or something and suddenly you're really glad it doesn't cost you the arm as well, if you catch my figurative drift.  It is literally proven by reality outside of the us that it works. It's sure as hell not perfect, but miles ahead of privatized health care. Low costs for the individual, access to every necessary treatment and drug for close to nothing. 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