Financial Independence Through the Unthinkable: A Healthcare Crisis

Summary

BiggerPockets Money Podcast

Episode: "Financial Independence Through the Unthinkable: A Healthcare Crisis"

Date: December 12, 2025
Guest: Regina Moore (Co-founder, Women’s Personal Finance)
Hosts: Mindy Jensen & Scott Trench

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Episode Overview

This episode dives deep into the realities of pursuing FI/RE (Financial Independence, Retire Early) in the face of a catastrophic personal crisis—a child's cancer diagnosis. Regina Moore, a pharmacist and early FI/RE achiever, shares how her plans were derailed by her son's illness and how the nuances of healthcare coverage and subsidy cliffs have shaped her financial decisions. The conversation explores the intersection of personal finance, the “subsidy cliff” for healthcare, and the political and philosophical debates at the heart of the U.S. healthcare system—all against the backdrop of a very personal, high-stakes journey.

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Key Discussion Points & Insights

Regina’s Path to FI/RE: Early Success & Savvy Moves

• Journey Begins

  • Regina’s interest in FI/RE sparked immediately after pharmacy school, starting with Dave Ramsey’s book but quickly gravitating to more in-depth blogs like Mr. Money Mustache ([01:34]).
  • Graduated pharmacy school at 23, with only $30K in loans thanks to parental help and scholarships ([02:58]).

• Early High Income

  • First full year as a pharmacist: earned ~$180,000 ([02:58]).
  • Prioritized paying off debts, bought a used car, then funneled savings into a house purchase ([02:58]).

• Home Ownership

  • Purchased a home in a new state (2013), putting 50% down, and paid it off within two years ([02:58]).
  • Peace of mind was more important than mathematical optimization—a choice that proved reassuring during ensuing turmoil ([08:55], [10:54]).

• Investing Basics

  • Consistently maxed out employer retirement accounts, utilized HSAs, and later moved investments primarily into VTSAX and VTI index funds ([13:55]).

  Quote:
  "Once the house was paid off, I realized that I needed to kind of step it up. And that's when I started to read a lot more personal finance content…"
  — Regina ([02:58])

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The Unthinkable: Child’s Cancer Diagnosis

• Crisis Strikes

  • In December 2018, Regina’s son was diagnosed with cancer at age two ([20:07]).
  • Immediate reaction: assumed FI/RE dream was over due to expected “financial toxicity” ([20:20]).

• Adapting to ‘Lean FI’

  • Shut down all non-essential spending; lived mostly at Ronald McDonald House; continued pharmacist part-time, 1-4 days/month ([20:20]).
  • Net worth at diagnosis (excluding home): around $400K ([20:20]).

  Quote:
  "You hear so much about financial toxicity with major medical issues… I just assumed, if he survives, I'm sure this is going to drain us and we'll be starting over from square one."
  — Regina ([20:20])

• Outcome

  • Markets improved, frugality helped, able to avoid financial ruin despite drastically reduced work and high medical expenses ([20:20]).

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Navigating the Healthcare Labyrinth

• Insurance & Out-of-Pocket Costs

  • Initially had a high-deductible HSA plan; out-of-pocket max $12,000/year, quickly reached due to cancer care ([23:40]).
  • By mid-2019, son qualified for CHIP (Children’s Medicaid) due to low AGI from reduced work ([23:40], [25:19]).

• CHIP/Medicaid Eligibility

  • AGI threshold (family of 3): ~$70K/year for CHIP; $50K/year for Oregon expanded Medicaid ([25:19], [36:45]).
  • Adjusted AGI via IRA conversions to remain under limits, ensuring ongoing eligibility ([36:45]).

  Quote:
  "I have to be really, really thoughtful about if increasing my income is actually paying off for my family, because we'll hit that subsidy cliff and potentially be out 15 to 20,000 minimal…"
  — Regina ([32:40])

• Healthcare Subsidy Cliff

  • Described the “cliff” effect: earning even slightly too much could immediately disqualify her family from affordable coverage, resulting in $15,000–$20,000/year extra in premiums and out-of-pocket costs ([35:54], [36:45], [39:22]).

  Scott’s Recap:
  “You might come out worse off by working 40-50 hours a week across a year at your highly paid profession than by just staying at home and not doing that. That's the effect of this cliff situation in the healthcare system… Is this the correct way to frame the situation? Am I doing right my rant here, Regina?”
  — Scott ([40:24])

• Work Disincentives

  • Regina explains how broken incentives force her (a highly trained pharmacist) to reject shifts and keep realized income low to avoid catastrophic healthcare costs ([36:45], [39:22]).
  • She balances financial impact with non-monetary costs, like lost time with family ([41:39]).

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Ethics, Policy, and the FIRE Community

• Fairness and Criticism

  • Hosts anticipate criticism: is it “right” for a net-worth millionaire to use social benefits?

  • Regina’s response:

    • She’s using systems as designed (and paid into them via high taxes as a worker).
    • Proposes a preference for universal healthcare, even if it means paying higher taxes later ([44:13]).

    Quote:
    "I am using [these programs] fully as they’re designed... I am not opposed to paying more taxes on what I do earn so that more people, myself included, have access to more affordable health care."
    — Regina ([44:13])

• Political and Structural Debate

  • Both hosts acknowledge the complex, highly politicized nature of healthcare coverage in America ([47:06], [51:16]).
  • They strive to present both sides:
    • Healthcare as a right versus personal responsibility.
    • Implications for FI/RE planners and the unique options (e.g., controlling income to qualify for benefits) available in this community ([51:16]).

• Community Reflections

  • Urge FI/RE planners to bake in more conservative assumptions about future healthcare costs; discuss alternative options (medical tourism, health-shares) but stress the need for catastrophic coverage ([53:32], [54:03]).

  Memorable Final Moment ([55:28]):

  • Scott & Mindy, wryly, decline to give out their emails for this highly charged debate, welcoming only respectful, non-extreme feedback.

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Timestamps for Important Segments

• Regina’s FI/RE Journey & Methods: [01:34] – [16:47]
• Paying Off the House/Philosophy: [08:55] – [10:54]
• Investing Choices & Progress to $1M Net Worth: [13:55]
• Crisis: Son’s Cancer Diagnosis and FI Impact: [20:07] – [23:34]
• Transition to CHIP/Medicaid & Navigating Eligibility: [23:40] – [26:35]
• Treatment Timeline and Financial Implications: [26:35] – [32:40]
• Healthcare Subsidy Cliff Discussion: [32:40] – [41:39]
• Policy & Ethics Discussion; System Critique: [44:13] – [48:24]
• Implications for FI/RE Community & Wrap-Up: [51:16] – [56:08]

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Notable Quotes

• “If you have a hope of retiring early, if healthcare spending for individuals and families doesn't change very soon with some sort of major healthcare reform, it's making it feel less and less achievable and accessible.”
  — Regina ([32:40])

• "You can't know what the future is going to look like. And... I didn't have to worry about liquidating money... to keep paying the mortgage while we went through that process. So the math says it's not ideal. Um, but it... really did work out for peace of mind for me and my family."
  — Regina ([08:55])

• “This is so dumb what you just said here about the system.... You might even come out worse off by working 40 to 50 hours a week across a year at your highly paid profession than by just staying at home and not doing that. That's the effect of this cliff situation.”
  — Scott ([39:22])

• "I think it's a really tough situation... The challenge for the FIRE community will be thinking, planning around that. What are healthcare costs going to look like...once you hit early retirement and have the option to control your income?"
  — Scott ([51:16])

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Tone & Takeaways

The episode is candid, deeply empathetic, and at times blunt—mirroring the emotional highs and lows of Regina’s journey and the hosts’ honest grappling with the system’s flaws. The story personalizes thorny, highly political issues for real-life FI/RE planners but avoids caricature or blame, instead calling for nuanced, respectful debate.

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Where to Find Regina & Women’s Personal Finance

• Main site and social links: womenspersonalfinance.org/socials
• Active on Threads, Instagram, Facebook, TikTok.
• Weekly newsletter available via website ([49:19]).

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Summary:
Regina Moore’s story is a must-listen for anyone serious about early retirement and financial independence, especially families. Her experience puts a human face on the abstract problems of “subsidy cliffs” and healthcare costs in the U.S., challenging conventional wisdom and forcing listeners to confront uncomfortable but vital policy questions.

Transcript

[A]

Today's guest, Regina Moore hit millionaire status before 35, but not by following the typical fire playbook. In fact, as a pharmacist, she was able to earn very high income, keep her expenses low, pay off her house, and reach a million dollars in net worth before age 35. But those plans were derailed by a diagnosis of cancer of their two year old son. Today's episode is going to talk about her journey to fire and the preposterous situation that she and her family are placed in due to subsidy cliffs. This is a major issue for the fire community and has elements of political discussion around it. We'll try to grapple with those as best we can in a moderate side that presents both sides of the issue while presenting Regina's story and her positions on this.

[B]

Hello, hello, hello and welcome to the BiggerPockets Money Podcast. My name is Mindy Jensen and with me, as always, is my Not Slow FI co host, Scott Trench.

[A]

Thanks, Mindy. You put on a clinic with these introductions. You'll get that later, guys. We are so excited to be joined by Regina Moore today, co founder of Women's Personal Finance. She has an amazing FI story which we're going to be talking about today. Without further ado, welcome Regina.

[C]

Glad to be here. I feel like I've been wanting to get together with you all for a long time. We finally made it happen.

[B]

We did finally make it happen. Shout out to fincon for for finally connecting us. Let's go back to the beginning of your FI journey. When did you discover the concept of financial independence and early retirement?

[C]

Probably about when I graduated from pharmacy school with a story that I think many people will share. Someone gave me a copy of Dave Ramsey's book as I was graduating and I was interested and I skimmed through it and thought like, oh well, yeah, of course people pay off debt and that. It seemed like a good intro, but not the full story. And pretty quickly from there I dived into reading personal finance blogs and I remember one of the main ones that I found first was Mr. Money Mustache. So I spent a lot of my first year out of pharmacy school when I was sometimes sitting late in the evening on slow hospital pharmacist swing shifts, diving deep into all that stuff Pete wrote and kind of branching off from there and deciding that I would find a way to be able to retire early someday. And I had never had a dream job. I did a job that I knew would have a decent paycheck, but had never really considered that I wouldn't have to do it. Forever.

[B]

So.

[C]

So that was my jumping off point.

[A]

Can you tell us a little bit about that journey? Like, how did things go? What did you do to pursue fire? And can you give us a couple of key milestones along that journey?

[C]

Yeah. So I graduated as a pharmacist pretty early. I was the youngest in my class. I graduated at 23 and I was pretty low debt to begin with. I had about $30,000 in loans. I had some help from my father with tuition and scholarships. So I came into things doing pretty well. And actually my first year out of school as a pharmacist was my highest earning year in my career, or I should say like my first full year working. I made about $180,000 that year, which seemed like such a huge amount of money to someone who had just been kind of a broke college student PR and decided really quickly to pay off all the debts that I had. I ended up having to buy a new used car that year, paid that off and just really kind of grasped that if I started saving, I would be saving a lot of my income. I would be in a really good spot. Initially, I was focused more on because I had some of that kind of Dave Ramsey influence on not having any debt and being able to potentially pay off a home that I bought at some point. So I funneled a lot of that, that income into home purchase savings and in 2013 moved to another state and ended up buying a house with, I think we put about 50% down on the house and ended up paying that off in under two years. So I own my home outright and let's see, that would have been, I think, early 2014 that I had the house paid off and I had been investing like in my 401k. I had opened up an account with a robo advisor because I didn't really feel comfortable with investing on my own. I didn't really trust myself that much. But once the house was paid off, I realized that I needed to kind of step it up. And that's when I started to read a lot more personally personal finance content, dive in again with a lot of the blogs. Shortly thereafter, started my own blog. And I'd say that was really when I started to get going on the kind of pursuit of fire versus just kind of I'm going to try to not have debt. And yeah, I've stayed heavily involved since then and have a whole, a whole timeline of events.

[B]

We'll be back with more right after this short break. My husband and I have multiple investment accounts across several different companies. Throw in vehicles, investment properties and private equity holdings and it can be difficult to get a good idea of our actual net worth. And frankly, between the kids, work and just life in general, I don't have time to be logging into 47 different places. So I just didn't. Scott walked me through setting up my Monarch account and suddenly everything was easy. It's all in one spot so I can check in quick. Just like everything else on Monarch, the dashboard is customizable so I can see at a glance what's most important to me and dive deeper when I need to. Feel organized and confident in your finances with Monarch, an all in one personal finance tool that brings your entire financial life together in one clean interface on your laptop or your phone. And right now, just for our listeners, Monarch is offering 50% off your first year with code [e-mail] don't let financial opportunities slip through the cracks. Use code [e-mail] in your browser for half off your first year. That's 50% off your first [e-mail] with.

[A]

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[B]

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[C]

Yeah. So I. I don't actually remember what the interest rate was, but it was not high. Nothing like it is now. And if I was to do things over again, knowing what I do now, I probably would have chosen a different path and probably would not have paid off the. But it felt like something that bought me a lot of peace of mind at the time. A sense of comfort in knowing that I wouldn't ever have to worry about making a house payment. I'd only have to worry about covering my property taxes and maintaining a home. And that decision was made a lot earlier on in my personal finance journey. So I did not know all the things that I do know now. And I'm still happy with the decision. You can't know what the future is going to look like. And it's possible that the markets would have taken a different turn. But we had some big struggles with my family where I was not able to have consistent income for a while due to some major medical issues. My son was diagnosed with cancer in 2018. And I think one of the. One of the saving graces for my sanity through that process is that I didn't have to worry about liquidating money for my 401k or something to keep paying the mortgage while we went through that process. So the math says it's not ideal. Um, but it. It really did work out for peace of mind for me and my family and was the jumpstart to the rest of the process for us.

[B]

Okay, so a jump start to the rest of the process. How long did it take you to become financially independent?

[C]

I still feel like I'm really working on what that number means for me. And if I. If I want to say I'm financially independent largely depends on my mood that month. I'm pretty comfort saying that I'm lean phi. I would say I've been there about two years. So wait, let me do the math. I'm 30. Yes. So about two years, actually, two years this month in December. So my initial number that I had aimed for, for considering myself financially independent because the house was paid off and that wasn't part of the calculation anymore was a million dollar net worth. And I hit that in 2023, in December. Money nerd stuff. In the 4% rule, I had worked out that our basic needs for the family were at that point about $40,000 a year. So nothing extravagant, but you know, we could eat and we could stay in our house and that's kind of been, I'm like a, I'm a worst case scenario type of planner. So that was my initial goal that I wanted to achieve. Now that we've hit that, I'm a little more flexible in, in how I think about financial independence numbers. Because once, once I knew I had those basic needs met, I allowed myself to start thinking more about what I want, not just what I need.

[A]

You live in Oregon. Which part of Oregon do you live in?

[C]

Yeah, I live out on the Oregon coast, so pretty, pretty small communities. I'm about three hours from Portland.

[A]

And would you say this is a high cost, medium cost or low cost living area, given that you spend 40 grand and have a paid off house?

[C]

This is such a hard question to answer anymore because everywhere feels like a high cost of living area. I would say it probably is in the medium to high cost. If I had to pay for housing that would, that would be a different discussion for me. There's like a three bedroom apartment in the town next for me renting right now for $2800 a month. So I, I think that's on the high end of things. But I admit to being a little bit out of the loop on that and that the, the housing part of that equation is really skewing things for a lot of people. And because, because I bought my house in 2013, I'm a little bit protected from that.

[A]

And so you earned this, you know, this very high income in your first year and this kind of 60 to $70 equivalent, you know, inflation adjusted equivalent over the ensuing years. What did you invest in in order to build this million dollars in wealth outside of your primary residence? Sounds like you bought a primary residence, put a lot down, paid it off. Where did the rest go?

[C]

Let's see. So when I was working, I was always, from the minute I was eligible for my 401k, I was using my 401k and investing at least up to the match on there, often quite a bit more. And then at multiple times in my working career. I also had access to an HSA account. So my HSA has about $100,000 in it, which is invested in whatever the closest to a total stock market fund was. So I tried to spread things out. So I have my HSA, 401ks and IRAs and was typically investing in those every year. I usually maxed out my HSA account and have been trying to track my expenses in a way where I can potentially reimburse myself later or have access to that money if I need it for healthcare spending. And with my 401k for the first few years at least, probably the first three to five years, it was probably in a target date fund. I didn't really start to change things around until I started to dig into the personal finance sphere around 2017 or so. And at that point I think I've transitioned. I've transitioned some of my investments into things like BTS X and most of my new investments when I had income to put into those, went into things like that as well. And with my older accounts, the things that are in the 401ks, some of that is just whatever it was in when I rolled them over from the employer funds, they've been performing pretty well and I haven't really wanted to dig into sorting out strategies around transitioning those into more simple investments. As long as it stays within the 401k, I've just kind of left it alone. But yeah, mostly for things that I've had my own hand in, it's mostly been like vtsax or vti. I can't even explain why one versus the other. That was back when I was reading all those great blogs of the people who really like to get granular and dig into things and it made more sense at the time. And right now I just know they perform pretty well and keep growing and that's a solid strategy for me.

[A]

This will be our final ad break and we'll be right back after this.

[B]

My husband and I have multiple investment accounts across several different companies. Throw in vehicles, investment properties and private equity holdings and it can be difficult to get a a good idea of our actual net worth. And frankly, between the kids, work and just life in general, I don't have time to be logging into 47 different places. So I just didn't. Scott walked me through setting up my Monarch account and suddenly everything was easy. It's all in one spot so I can check in quickly. Just like everything else on Monarch, the dashboard is customizable so I can see at a glance what's most important to me and dive deeper when I need to. Feel organized and confident in your finances with Monarch, an all in one personal finance tool that brings your entire life together in one clean interface on your laptop or your phone. And right now, just for our listeners, Monarch is offering 50% off your first year with code pockets monarch.com don't let financial opportunities slip through the cracks. Use code [e-mail] in your browser for half off your first year. That's 50% off your first [e-mail] with.

[A]

The code pockets Support for BiggerPockets money comes from Northwest Registered Agent. Your business identity is everything that shows what your business is about, from what customers see to what they don't see, like operating agreements, meeting minutes and compliance paperwork. Get more for your business, more privacy, more guidance and more free resources with Northwest Registered Agent. Northwest Registered Agent has been helping small business owners and entrepreneurs launch and grow businesses for nearly 30 years. They are the largest registered agent and LLC service in the United states with over 1500 corporate guides and they have real people who know your local laws and can help you and your business every step of the way. Don't wait, protect your privacy, build your brand and get your complete business Identity in just 10 clicks and 10 minutes. Visit North Northwestregisteredagent.com money free and start building something amazing. Get more with Northwest registered [e-mail] Moneyfree.

[B]

AutoTrader is powered by Auto Intelligence, the hyper personalized way to buy a car. AutoTrader's tools sync with your exact budget and preferences to tailor the online car shopping experience totally to you. Budgeting lets you input your info to see listings in your price range. Search and inventory helps zero in on your dream car. You can choose from new or pre owned, the style of the car and features like engine size, color, all the way down to whether you want a trailer hitch. Go ahead and get picky. Don't worry about scrolling endlessly. AutoTrader powered by auto Intelligence only shows you vehicles based on what you can afford and what you want, and pricing shows you which listings are the best deals so you can feel like you're winning the negotiation without negotiating. You can even choose how to close the deal online at the dealership or a little bit of both. AutoTrader powered by auto Intelligence makes the process of buying a car less of a process. Try it today. Visit autotrader.com to buy your perfect ride. Let's jump back in. I have several questions regarding healthcare and your HSA. You you really glossed over this cancer diagnosis in 2018 when you were telling your story. And I want to come back to that, because this healthcare is a big hot topic right now. And specifically that's like, in the middle of your five journey, your son got diagnosed with cancer. How old was he when he was diagnosed?

[C]

He was 2, almost 3 years old.

[B]

A child's cancer diagnosis is traumatic, but he's a baby getting this diagnosis. How did that affect your phi journey?

[C]

Well, I thought the phi journey was over when we first got the news. You hear so much about financial toxicity with major medical issues and families, and especially with cancer diagnoses that I just assumed, if he survives, I'm sure this is going to drain us and we'll be starting over from square one. I believe at the time he was diagnosed, I had a net worth, not including the house. And just to be clear, when I talk about my net worth, I generally don't include the value of the house in that. It's easier for my brain to think about numbers of money that I can work with. So when he was diagnosed, my net worth outside of the house was about $400,000. And that was at the end of 2018, actually. We were admitted to the hospital with suspicion that it was cancer on Christmas Eve, 2018. So December is an interesting month for me emotionally, but I remember because that was also right at the height of when I was starting to blog and really get invested in this community. I think it was in January of 2019 that there was a very small dip. Dip. A little micro crash. And I definitely thought it was all over for us financially. What ended up happening was I already had a very strong frugal streak. My blog back then was that frugal pharmacist. And it's a skill or habit that me and my husband both share, and we just really shut down spending as much as possible. While my son was sick, we mostly lived at Ronald McDonald House. We didn't spend much of anything if we could avoid it. I ended up being able to work a little bit as a pharmacist. I think maybe three or four days a month. I would find a shift about two hours away, maybe not two hours, maybe an hour away. So I drive and I'd work a pharmacist shift, and then I'd come back to the hospital and share the bed with my son. And by whatever luck and navigating on our part, we didn't end up any worse off. By the end of his cancer treatment, if anything, the markets had started to pick up and we were doing better off by the time he was done, even though I had worked significantly less. And that was pretty eye opening for me and definitely inspired me to shift gears a little bit with an intention to not go back to work full time.

[B]

Did you have an HSA during your son's cancer treatments or did you have traditional health insurance?

[C]

I had. I had an HSA high deductible plan. And if I remember right, the out of pocket maximum was about $12,000, which is not nothing. But if you've budgeted and saved for that, it was something that was manageable, especially because we had been saving money in the HSA account already. So the. When he was initially diagnosed, that was in December. We hit our maximum out of pocket for that year based on the process leading up to him being diagnosed. And then we also hit the maximum out of pocket in January of the first full year he was sick. So 2019, just due to the expense of cancer treatment. Partway through 2019, I think it was probably in like July or August based on that. I wasn't working much. He was able to qualify for Medicaid under the CHIP program. The. I forget the acronym, but it allows children to access Medicaid although the parents don't themselves qualify. So at a higher AGI, the kids can get it. And he's been on CHIP since then.

[A]

What is the requirement? How does one become eligible for chip?

[C]

CHIP eligibility is. It's based on your adjusted gross income. And I believe for a family of three, it was around $70,000 a year AGI. So we have stayed underneath that every year since 2019. And he's been able to effectively have free health care. There's some extra hurdles to navigate with that because specific providers aren't accessible and things like that, or take more effort to get to. But for all of his main needs, it's been fine for us.

[A]

That covers 100% of healthcare costs for him pretty much.

[C]

I mean, there are certain things that would be qualified as not, you know, if it's not considered medically necessary. Like if he went to the dermatologist and had a wart that wasn't bothering him or something. Like they might say that it's not medically necessary to remove that and he might not be able to get that done. There's. That type of thing can come up from time to time. But as a kid who doesn't really have any cosmetic concerns, we haven't run into anything like that.

[B]

I was gonna ask, how long was he in treatment?

[C]

He. So my Son was in cancer treatment from the end of December 2018 until mid January of 2020. So we went home right as Covid.

[B]

Started, and he is now in remission.

[C]

Yes and no. Different types of cancers have different ways that they qualify it. His does not have something they call remission. They just say no evidence of disease. But he's officially five years off of treatment as of this summer. So more or less considered cured. And it's assumed that this cancer wouldn't come back. Cancer treatment does make you more susceptible to other forms of cancer, like leukemia. So that's something we'll have to monitor for and then long term health effects from that treatment, which is very intense. But, yeah, I think we're in the clear with his specific cancer diagnosis.

[A]

It's just awful that you guys had to go through this. I'm glad that we're in a great spot now, it sounds like, and doing much better. Can you just let us know? From the story around finances, it sounds like this treatment did several things. This diagnosis and the treatment did several things. One is it had you stop working or stop working a considerable amount, Reducing those hours a considerable amount for a very extended period, at least the next year, probably presumably up until 2020, and then. And then thereafter as well. Is that correct?

[C]

Yeah. I worked between like, one and four days a month through his treatment. And I think even the first three or four months, I didn't work at all. And then I went back part time when we were able to come home because I needed time off for ongoing appointments. He still had a lot of visits that we had to go to three hours away and overnight stays. So I tried to work part time for a while. So I would have went back to work in January or February of 2020. I ended up taking a leave of absence by May of 2020. With everything going on with COVID and being a pharmacist in a retail pharmacy kind of front lines there. I was very, very stressed out. Like, it was not working out well for my health. I was having migraines sometimes daily, super stressed. And also none of the restrictions with things like mask mandates or anything like that had come into effect yet. And I had already been masking before the pandemic because he had had a bone marrow transplant. So some of the things that I had already been doing to kind of protect the health of my son Became extremely politicized. And luckily, I was able to get unemployment, which was not a lot of money, but it was a little bit. And I took three months off kind of at the height of COVID as a caregiver. So I got approved for it because of being a caregiver of someone who was high risk. And I tried to go back to work after that. And this is when everything was very much a mess with the healthcare industry. A lot of understaffing pharmacies were closing. We had lines of of patients out the front door of the building and they were scheduling everybody at least at 40 hours a week. And most people were getting significant overtime just trying to cover all of the needs at the time. And because of that, I ended up leaving altogether. They had told me that I didn't have a choice in choosing to work less while they needed me to work more. And I said that didn't work work and I am now a per diem employee. So I work just a little bit. They'll ask me if I can help out from time to time and if I'm available I can go and choose to take a shift, but I don't have any obligation to come in.

[A]

In 2018, we get the diagnosis in December. In 2019, we step back and have a greatly diminished hours. This extends through 2020 when, when we get good news that things are in a much better place for your son. But we also have health risks from COVID that are particularly acute for your family and that continues to disrupt your ability to generate income in various ways due to your very reasonable lack of comfort with returning to work in that environment. And so this is a multi year, 5, 6, 7 year disruption to your income flows. This healthcare event and its ramifications downstream. On the income side, what were the costs? How do you think about the costs? And one of the things I think that's particularly top of mind for people right now is fire. And healthcare is a particularly acute challenge for people to grapple with here in 2025, especially in the context of ACA subsidies going away or uncertainty around ACA subsidies. How does one think about that? If you're giving advice to somebody else who's thinking about fire has young children and this could happen to them in there, God forbid. But how does one think about that in the context of this risk, this healthcare risk that is so clearly delaying and damaging to your fire journey, how do they think about it in the context of today?

[C]

Unfortunately, I think healthcare is the number one factor that's the wild card for anybody planning to potentially retire early. Factoring in how we are going to manage that is definitely my biggest ongoing struggle. I think one thing to keep in mind, if you're wanting to potentially retire early is being really cognizant of what you feel like you need to live a good, quality life and how expensive that really needs to be. So I come at a lot of this from that frugality angle, thinking about what my minimal needs are and then just building on that as I reach certain goals. And for a lot of people, if you have a hope of retiring early, if healthcare spending for individuals and family doesn't change very soon with some sort of major healthcare reform, it's making it feel less and less achievable and accessible. That being said, if you decide to be content and live a lifestyle that can be had at a lower income, you do potentially open up some of those subsidized channels for yourself. So, like I said with my son, he's been on the state Medicaid program with Chip since 2019. That's definitely made things a little bit easier. And we have been on a marketplace plan with the ACA subsidies for what would that have been? 2022? Probably. I don't remember the exact year, but that's when I finally got kicked off of my employer health plan. And then actually just this last year, mid-2020, we, in my state of Oregon, they expanded the state Medicaid program, so they increased eligibility levels. And when we applied for our ACA plan, where you go in and plug everything in, planning for it for 2025, we actually got kicked over to the. To the state Medicaid program, too. So that for 2025, we haven't paid anything for healthcare. However, it puts me in a really unique situation now, as someone who is still earning some income, which obviously is nice to have, in that I have to be really, really thoughtful about if increasing my income is actually paying off for my family, because we'll hit. Hit that subsidy cliff and potentially be out 15 to 20,000 minimal between deductibles and premiums for insurance for me and my husband, at the very least.

[A]

So this is a central issue. If your fire number is 1.5 million bucks, $60,000 a year in annual spend, for example, and this number is either zero or it is $20,000 a year, that's the difference, right? This cliff effect is so real and so acute. Is that literally the difference here? If you go over the $70,000 limit in household income and that incentive, you literally drop your coverage and have to spend this amount more starting next year in 2026, if subsidies expire. Or how does that work in your situation here? Because it seems so preposterous. The situation that you are in right now based on the rules of health care in this country?

[C]

Yeah, it's a completely ridiculous situation. So for the family of three in Oregon to qualify for this extended Medicaid program, the AGI is right about $50,000 a year. And then for children or a child to qualify, in my family of three, it was about $70,000. I don't know exactly because it's been a few years since I looked at that number. So my household AGI is under $50,000. And some of that is achieved by moving money from my brokerage account into traditional IRA savings so that our AGI stays at a certain level. But yeah, I mean, between the premiums and then my husband has chronic health needs and I figure with medications that he needs, that would probably be 500 to $1,000 a month. Between the medications and doctors visits and co pays and all the deductibles and everything. Yeah, I estimate that it would probably be about $20,000 a year. So I'm forced to make decisions around working less because it wouldn't just be $20,000 that I would need to earn to offset that. It's additional because there's taxes and, and whatnot. And to consider if earning that additional income provides any benefit to my family because I'm also not home as much, I'm not available for childcare, et cetera, et cetera. And it's unfortunate because like with the career that I have being a pharmacist, there's another developing pharmacist shortage. And I have capacity and interest in potentially working a little bit more. I don't ever want to go back full time or even at a steady part time rate. But if there's a couple weeks here and there where there's something going on and I can go in and work, I'm not opposed to helping my colleagues out so that things aren't as chaotic at the pharmacy. But I really can't make that decision and maintain things where they need to be for my household.

[A]

This is so freaking stupid. This is so dumb what you just said here about the system. What you're doing is perfectly smart, but the situation that you're in is preposterous. This is ridiculous. Let's lay out what is happening here. You went on a fire journey. Your goal was literally to become a multimillionaire, financially independent retiree in your 30s or 40s. You did pretty good on that journey. You paid off a house, you built a lean fire barista fire portfolio. Then tragedy struck and your Kid got a horrible illness that took years to treat, was very expensive and it forced you to basically live on a poverty level income or realize poverty level income across your portfolio such you could qualify for Medicaid chip in your state across that plan. You also, it sounds like have, have a, your husband I think has some chronic health issues that require treatment to a lesser degree on an ongoing basis as well. Is that right?

[C]

Yep, that's accurate.

[A]

You are, you are a highly qualified, capable worker who could make command a very high wage, but you can't do that because the choice is either work full time and go throughout the year, pay full taxes, but you're pay taxes in a much higher tax bracket and pay for an insurance and health care costs, you know, overall healthcare costs that will cost you $20,000 more overall, which is just not worth it. You might even come out, you know, might come out worse off by working 40 to 50 hours a week across a year at your highly paid profession than by just staying at home and not doing that. That's the effect of this cliff situation in the healthcare system. And it's not like you want this. This is not like something you like. This is what you are stuck in because of the preposterous absurdities of healthcare in this country. In your situation that requires, that requires really complete coverage for really devastating health situations that are not your fault, that are completely just bad luck. Is this the correct way to frame the situation? Am I doing right my rant here, Regina?

[C]

Yeah, more or less. I mean, I don't know exactly what the full repercussions would be. I haven't quantified that. But the thing you didn't add into that is also that then I lose my time and my time with my family and probably come out somewhat in a worse situation financially right now. That might mean that I have significantly more money in my retirement years, but I'm not really concerned about that at this point. I've dialed in my preloading on my investments in a way that I'm not concerned with my retirement income or retirement savings. Everything that I'm doing right now is just navigating living over the next five to 10 years. And yeah, I don't feel like I have the flexibility. I would like to be able to go out and earn more money. And it's not just about the money. Right. I'm okay with where I'm at, but if I'm going to do work, I want to be compensated for it, obviously. And I don't have the flexibility to make decisions about working a little bit more without having major financial ramifications.

[A]

You're in a crazy situation here because like we said, this cliff has to be front and center and there's no real world where you'd work the full time because that was never your plan. You pursued fire so that you would have flexibility, but you would work more possibly above this cliff if it didn't have such immediate and devastating consequences for your ability to qualify for healthcare from the state. Essentially. I can hear, Regina, some people, let's acknowledge that you had a son with cancer at 2 years old. Terrible tragedy. Nothing you can do, not your fault. Okay, but I can hear some people, they're shouting at their podcast feed on their car player or their phone or watching here on YouTube and they're saying, hey, this is not how the system was supposed to be designed. Why is this multimillionaire paid off homeowner receiving Medicaid chip for their family? And how does that work and how do you think about that? How would you answer that challenge from somebody who maybe doesn't like that that situation is unfolding to a certain extent?

[C]

For one, I would say none of this system is how it was supposed to be functioning. I think if you ask most, most average people, I don't think any of us expected that, you know, 20 to 30% of our planned spending should be going towards maintaining healthcare. So the system's not working for anybody really. You know, I, I paid fairly significant taxes for a good portion of my career when I my short care, when I was working full time. I didn't have a child then, it was just two adults earning. So I've paid into these systems and I am using them fully as their design based on the income limits and all of those things. And I'm a proponent for things like universal healthcare. I am not opposed to paying more taxes on what I do earn so that more people, myself included, have access to more affordable health care. I wouldn't mind having a system where my annual taxes were higher and I didn't have to do so much long term planning about budgeting and planning to afford healthcare. I would prefer to just have that taken as some percentage of my income and know that the bulk of our medically necessary health care is going to be covered perhaps with some low co pays or things like that. And based on the way I've had to set up my situation, I continue to put money into my tax deferred accounts which I will likely realize some pretty high taxes on by the time I do retire and start to. To tap into those because I won't have a child that is factored in to my annual taxes owed. My husband's a bit older than me, so it's possible that I'll be a multimillionaire with RMDs that are pretty significant when I'm in my 70s and I'll be taxed at a pretty high rate then. And if, if that high rate means that people are having access to health care and I still have a pretty good income that makes me comfortable enough to live off of, I'm okay with that. Like, taxes aren't necessarily the worst thing. I just want to make sure they're going towards actually helping people who pay them to live better lives.

[A]

Yeah, I think it's a really tough subject here. And this. We tried to debate this. We tried to not debate this. We tried to frame it with, with a representative from kff, I think last week. When did that come out? That came out on Tuesday, November 25th. And it's a really hard and interesting debate and discussion for America at large and particularly acute in the fire community because the healthcare strategy in the fire community is so heavily dependent. Dependent on realized income. Right. Whether that qualifies you for Medicaid chip or whether that it qualifies you for subsidies for ACA plans and how much, how many. How much in the form of those subsidies that you're getting. And I think that's a really challenging political issue for this country right now. And your situation is. It brings it to just, just such stark reality because of the tragedy that struck your family and how you were forced to navigate it based on the way the current system is set up. And so thank you for sharing it and taking on some hard questions about that situation here today.

[C]

Yeah, I hope more people are willing to be outspoken in some of these things and dig into those conversations a little bit more deeply. Definitely is an area that maybe a lot of people haven't put much thought into and should think about a little bit more.

[A]

Hopefully this conversation will spark debate and thought about it inside of the fire community as well, because I think it's just such a. It's such a challenging issue. And I just admire and appreciate you sharing your story and how you've handled things. And I'm glad that the system was there for you in this really challenging time, personally.

[B]

Regina, thank you so much for your time today and thank you for sharing the story about your journey with this navigating the horrible healthcare landscape that we find ourselves in right now. Where would one find Women's personal finance because you used to be a Facebook group and that has since closed.

[C]

So women's personal finance, we have a website, we don't do a whole lot with it, but womenspersonalfinance.org or womenspersonalfinance.org Socials has links to pretty much everything. We are most active on threads, which is like Meta's version of Twitter, but we're also on Instagram and on Facebook and TikTok. We're on all those things. We did have a very large Facebook group. We closed it in December of 2024. So just now coming up on a one year anniversary of, of closing that 82,000 member Facebook group so that we had more time to dedicate to our private communities and just we're feeling a little bit of burnout with the Facebook thing. So it's a little bit more fun being able to just manage social media instead of such a large Facebook group. But yeah, if you're interested in any of this, come check that out. We also have a weekly newsletter that goes out and you can find a link to that on that womenspersonalfinance.org socials link as well.

[B]

All right, Scott, that was Regina Moore and that was quite the wild ride that she had. I just want to take a moment and say that I don't think that healthcare should be a political issue. Literally everybody needs healthcare for exactly Regina's story. You can be fine. They were in Hawaii before he got his diagnosis. All of a sudden Christmas Eve, you have a childhood cancer diagnosis and a 14 month treatment plan ahead of you and your life completely changes in the blink of an eye. That's not political. That's a basic human right to be able to take care of your children. So for this like she is faced with a bunch of really bad options and she has chosen the option that is like the least bad for her.

[A]

Yeah, I think it's a really tough situation and I think that, that folks with different political views will view this situation differently. Right. Some folks who lean left will view the situation as healthcare is a right and this should not be a burden unfairly placed on this family that just had bad luck and tragedy strike for a two year old getting cancer. And I think other folks in the other political side will say this is a person who's capable of working and commanding a high income and they should pay taxes into that system or pay for their own healthcare if they're capable of doing it. Since she has a million dollar net worth. And I think that that's the crux of the political debate around healthcare in America today. And I don't know what the right answer is. I just think that this story highlights that problem really acutely here and the challenge that those confusing, conflicting viewpoints will have in agreeing on a way forward in a situation like this. I also think that it's really instructive in the fire community in particular, because the fire community right now has a lot of particularly good options that may not be available to the rest of the public. Right. Option one, go back to work and get a health insurance plan if tragedy strikes. Option two, control your income and qualify for Medicaid or CHIP or get heavy subsidies from an ACA plan. And option three, being to do some sort of alternative to health insurance. Either pay the premiums or get some alternative to health insurance like health shares. And I think that those options are excellent for the fire community, potentially going to be controversial as the debate around health care continues in this country. And I think that the challenge for the fire community will be thinking, planning around that. What are healthcare costs going to look like once you hit early retirement and have the option to control your income? What can you actually count on in the future, in the decades into the future as you approach traditional retirement age? That's going to be the challenge. I don't think we have a good answer for that right now. And I think the only real answer is be conservative with it and be ready for those costs to go up, whether that forces you to go back to work or whether that forces you to build a more conservative portfolio to potentially cover those healthcare costs in early.

[B]

Retirement or medical tourism. Alternative options for insurance include the, you know, the health shares, self insuring, doing, the concierge, doctors. There's a lot of different options, but when you have a catastrophe like this, you need a catastrophic plan that helps you, helps cover the, the costs. And yeah, I am looking forward to a really great alternative program to health insurance, but I'm not hopeful that I'm going to see it anytime soon.

[A]

Yeah, health insurance will always suffer from this problem. Right, because. Because again, capitalism is the allocation of scarce resources. That's all it is. And it works in a lot of different categories. The debate about whether it works in healthcare is again, a very political issue because healthcare can often mean the allocation of resources that mean life or death for people. And so it's a really challenging concept here. And again, I think the two schools of thought are we're all in this together and everybody, everybody's insured. And then who pays for it. And how do we encourage more responsible behavior, more cost conscious behavior inside the healthcare system in the single payer system? And the other alternative is allowing the free market to work. And the free market working will pool together people with lower risk profiles, like for example, potentially my family, and pool together people with higher risk profiles, like Regina's family, and shift those costs potentially unfairly into people that have pre existing conditions and away from people who don't. And that's the challenge with healthcare, right? And again, I don't know what the solution is. All I know is that for me in the fire journey that means be conservative, right? Make sure that there are these other options available and that you're planning on the worst case scenario or ready to handle the worst case scenario if it comes up with plan B or plan.

[B]

C. All right, Scott, should we give out our email address and in case anybody wants to send us emails?

[C]

Oof.

[A]

Not on this one. You want our email addresses, go listen to other episodes of the podcast where we put them out there pretty frequently, but this one's so political that I feel like we're going to get some interesting ones from folks who actually want to go hunting them down.

[B]

I would encourage respectful emails, but I know that that's not what's going to happen. So yeah, I'll be in my inbox.

[A]

Let us know in the comments. Assuming that you're not a hardcore cheerleader for the left or the right, how do we do today on this? Do we present it with a reasonable neutrality, a really hard issue, or do you have any coaching points for us that are, that are helpful and not, not provocative or trashing things because we won't, we won't tolerate extreme political views?

[B]

That wraps up this episode of the Bigger Pockets Money podcast. He is Scott Trench. I am indie sensit. Did I just mess up my name? See, I don't just get my husband's name wrong. I sometimes get my own name wrong. That wraps up this episode of the Bigger Pockets Money podcast. He is Scott Trench. I am Mindy Jensen saying don't pout sauerkraut.