How We’re Paying for Out-of-State Medical Care in Early Retirement

Nine months into early retirement, managing healthcare costs is still top of mind.

Health insurance options in early retirement are limited—and expensive. The bigger worry, though, has always been what happens if we have an expensive medical procedure.

A single medical episode can derail even a solid FIRE plan. It gets scarier when the safety net of a steady paycheck is no longer there. That’s why maintaining and improving our health has been such a big focus for us. But sometimes life throws curveballs—and one came my way.

WHEN MY HEALTH BECAME A FIRE TEST

I’ve been dealing with a painful TMJ disorder for over four years. Ironically, I’m healthier now than I’ve been in years, yet TMJ disorder isn’t something I could’ve prevented on my own with diet and exercise.

For a while, it was manageable. But it slowly worsened until I could no longer open my mouth fully. Eating even the softest foods became torture. So I found a local doctor who dealt with TMJ disorders. And that’s when I received devastating news—I would need jaw surgery.

The thing about TMJ surgery is that most doctors, even oral maxillofacial surgeons, are against it because the success rate is so low. For the surgery that I would need, I was looking at about a 10% success rate. With that kind of success rate, what’s the point?

But I had already spoken to multiple doctors, and I tried everything: medication, chiropractics, night guards, physical therapy, and even platelet-rich plasma injections. I was out of non-surgical options.

Then there’s the cost. A quick search showed costs as high as $50,000 for the surgery alone. That doesn’t include costs for consultations, anesthesia, medication, etc. And here’s the kicker—insurance often doesn’t cover TMJ surgeries.

Because the surgery deals with the jaw joint, it falls into a grey area when it comes to insurance. Dental insurance won’t cover it because they say it’s a medical procedure. Medical insurance providers, however, argue that because it deals with the jaw joint, it’s a dental procedure. So, I’m facing the reality of paying for medical care without insurance.

Being told surgery was my only option felt like a punch to the gut. I could either pay for surgery that won’t work or possibly spend early retirement eating through a straw. This looked like a lose-lose situation.

After receiving the diagnosis, I spent 30 minutes driving around the neighborhood to process everything. This helped me calm down and assess my situation and options.

While $50,000 is a lot, it wasn’t something I had to panic about. We had planned for large unexpected expenses like this before retiring. This is why we have an emergency fund and a portfolio that grows faster than our expenses.

I also reminded myself that my portfolio had dropped by more than $50,000 in a single day many times before—and recovered.

So the money wasn’t an issue. But paying $50,000 with a 90% chance of not seeing an improvement is a terrible return on investment. It’s too big a gamble.

A $50,000 DECISION

I decided to widen my search for alternative treatments out-of-state, and my diligence paid off. I found a doctor just a few states away, specializing in non-surgical treatments of TMJ disorders. After a lengthy video call, I was assured my condition could be treated with a very high chance of success.

I almost cried on the call, knowing that I still had hope. And then there is the cost. The nine-month treatment plan is $9,500, not including airfare. Since I would need to fly more than a dozen times for treatments, I estimate another $4,000 for airfare. That’s a much better return on investment.

HOW I'M PAYING FOR TREATMENT WITHOUT DERAILING FIRE

I already scheduled my first appointment for this month. Now I’m focused on how I can reduce my out-of-pocket expenses. While I can certainly afford $13,500, that doesn’t mean I want to pay the entire amount. Early retirement didn’t happen for us because we were careless with our money. FIRE is all about reducing wasteful spending and is something we continue to practice.

First, there’s the cost of the treatment plan. Insurance won’t cover the $9,500, but I do have several ways to pay for it:

• Office financing of seven installments with $300 in interest

• Pay by credit card

• Pay in cash with a $325 discount

• CareCredit

With the office financing, the annualized interest rate is very high because I have to pay back everything in seven months. This is the worst option.

Paying with my Chase credit card, I would receive 1.5% back in points rewards. That would be like getting a discount of $142.50. Not great, but it’s something.

Paying cash gives me a guaranteed 3.4% discount ($325)—more than twice the credit card rewards.

CareCredit, though, is where things get really interesting.

USING DEFERRED INTEREST TO LOWER REAL COSTS

If you’re not familiar, CareCredit is a fantastic credit card that can be used exclusively for healthcare expenses for you, your family, and your pets. Some healthcare providers offer promotional financing options that include deferred interest plans. With these plans, no interest is owed if paid in full within 6, 12, 18, or 24 months!

I love deferred interest financing, especially if the term is long, for two reasons. First, I can take advantage of opportunity costs. Assume I get a 24-month deferred interest plan. I could put that $9,500 into a 2-year CD for guaranteed interest. At a 3.6% annual percentage yield, the CD would generate just under $700 over the term. That alone is like getting a 7.4% discount.

But then there’s the “hidden” discount I could get with inflation now working in my favor. With 24 months of deferred interest, if I pay on time, I would have paid $9,500 by the end of the term. But assuming inflation averages 3% annually, in two years, that $9,500 is only worth about $8,950 in today’s dollars.

So, in today’s economic value, the $9,500 procedure would actually cost me about $8,250 ($9,500 - $700 interest - $550 inflation benefit). That’s like a 13% discount!

CareCredit is the winner based on the math, but it still depends on the terms of any deferred interest financing. The shorter the term, the less advantageous deferred interest becomes. With a 12-month term, I could still earn about $370 in a CD plus a $277 inflation benefit. With a 6-month term, it’s not much different from the up-front discount by paying in cash.

HOW I'M KEEPING TRAVEL COSTS LOW

The next set of costs I have to contend with is airfare. Fortunately, flights are only two and a half hours, making same-day round-trips possible.

Frontier Airlines is too unreliable and doesn’t have enough flights. So Southwest and Alaska are my best options. I probably won’t earn enough miles to score free seats, so I’m not counting on their loyalty program to help. I need to find other ways to lower costs.

My first option is to book flights through Chase Travel. Ticket prices are the same as booking directly with the airlines, but I get 8% back in points. These points can then be used to pay for tickets.

My second option is to look for discounted gift cards. Costco, Sam’s Club, and even DoorDash occasionally sell Southwest Airlines and Alaska Airlines gift cards at a discount of 5% to 15%. If I buy these cards with my Chase credit card, I get 1.5% back in points as well. Speaking of which, my Chase’s rewards program also offers discounted gift cards on a rotating basis.

These savings won’t be dramatic, but they’re easy—and they add up.

WHY FIRE IS REALLY ABOUT FLEXIBILITY

I love early retirement and wouldn’t trade it for anything. But I’m not going to lie; early retirement healthcare is not an easy beast to tame. I’m learning it’s really important to keep an eye on healthcare costs and look for any way to lower them.

Between the strategies to pay for the procedure and airfare, I should conservatively be able to save $700, if not more.

Searching for better options. Having an emergency fund. Using financing strategically. Letting inflation and opportunity cost work in my favor. Booking travel efficiently. None of this is flashy—but it works.

FIRE isn’t about get-rich-quick schemes. It’s about flexibility, thoughtful decisions, and making your money do more work than you do.

If you have ways that you save on travel and healthcare costs, share them in the comments section below. I’d love to hear from you.

Until then, see you at the finish line!

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Disclaimer: I’m not a licensed financial professional. This blog shares my personal experiences and opinions around money, investing, and early retirement. It’s for informational and educational purposes only—not financial, legal, or tax advice. Always do your own research or consult with a qualified professional before making any financial decisions.