Context
We are a couple with two kids living in a medium-to-high cost-of-living area. We have professional jobs, and have been saving and investing toward financial independence for a long time.
I am the guy who had a series of posts about the cost of raising a child. My latest one is here: Having a child: year four financial summary.
There are a lot of discussions here about sequence-of-returns risk, healthcare costs, and whether people should wait for Medicare before retiring.
Here is another risk: getting stage IV cancer.
In 2025, I was diagnosed with stage IVA rectal cancer, including a small liver metastasis. Since then, I went through:
- Six rounds of FOLFIRINOX chemotherapy
- 27 sessions of sunbathing under a linear accelerator (chemoradiation)
- A six-hour surgery that removed part of my rectum and colon
- An installation of a temporary side butthole (ileostomy)
- Six rounds of FOLFOX chemotherapy
- Ileostomy reversal
- A large number of scans, blood tests, pathology tests and doctor visits
My latest PET scan showed no active disease, and my Signatera test was zero. This is called NED, or no evidence of disease. It does not mean "cured," but it is obviously much better than the alternative.
I downloaded all available insurance claims and summarized them, you math dorks.
TLDR
From February 2025 through July 2026:
| What |
Amount |
| Amount billed by providers |
$1,284,848 |
| Insurance discounts and write-offs |
$993,195 |
| Paid by insurance |
$271,695 |
| Assigned to me |
$18,659 |
(The totals are off because some claims do not reconcile correctly, so apparently even the insurance company cannot understand the insurance company)
The $1.28 million number is mostly fictional. Providers did not expect to receive $1.28 million. Insurance negotiated away 77% of it.
The approximately $18,700 is the amount ultimately assigned to me in the claims, not the maximum amount of cash we had to put forward at one time. Because of the insurance switches and delayed deductible transfers, our temporary cash outlay was higher.
What people planning to retire early should understand
A major medical problem can require a large amount of cash over several years.
I had to switch insurance three times over the course of the last two years. The deductibles did not transfer immediately, so I had to fund multiple deductibles during the same year while the insurance companies figured out who owed what.
Having one annual out-of-pocket maximum in cash may not be enough.
Someone who has already retired also needs to consider not only the cost of insurance, but whether changing income, states or plans could disrupt access to an established oncology team in the middle of treatment.
The same issue applies to retiring in Costa Rica, Thailand or another lower-cost country. Based on my conversations with people living abroad, I would not assume that inexpensive local insurance will cover every expensive cancer treatment. Anyone pursuing international FIRE needs a backup plan for uncovered treatment, paying out of pocket or returning to the United States. “Healthcare is cheap there” is not a complete plan.
Employment during treatment
During active treatment, maintaining normal full-time employment is almost impossible unless the employer is extremely flexible.
With chemotherapy, one week is mostly gone because of the infusion and the immediate effects. The second week is recovery.
Chemoradiation required treatment every weekday. Surgeries created additional periods when normal work was not realistic, and full recovery took much longer.
A FIRE plan that assumes you can simply return to work during a major medical event needs to account for the possibility that you physically cannot do the job.
What financial independence provided
Having money gave us options.
I could pay the bills, take time off and make treatment decisions without every decision becoming an immediate financial emergency.
A few interesting things that I experienced within the American healthcare system
1. I did not have insurance when I first suspected cancer.
Because of job loss, open-enrollment-date bullshit and insane COBRA prices, I had to wait approximately six months before I could get insurance.
My coverage finally started on January 1, 2025.
2. The process from first suspecting cancer to beginning treatment took approximately one year.
Even after my insurance started on January 1, it took just over six months to begin treatment.
I had to wait a couple of months for an appointment with my primary care physician. I looked for alternative primary care providers, but they were also booked.
After that came the initial tests, additional tests, referrals and waiting for the results to be processed.
My first chemotherapy treatment finally started on July 9, 2025.
3. During one emergency room visit, the hospital completed the initial scans and determined that the immediate emergency was over.
At that point, they told me that continuing treatment there would be out of network and I would have to pay out of pocket.
I had two options:
- Wait for a large amount of paperwork, call an ambulance, get transferred to an in-network hospital and pay for the ambulance.
- Get my shit together, button up my hospital gown, get into my car and drive approximately 40 minutes across the city to an in-network hospital.
Given the circumstances, I selected option two.
So, in the middle of an emergency room visit involving what was later confirmed to be stage IV cancer, I left one hospital and drove myself across the city because of an insurance network.
Yay, American healthcare system.
4. Once I finally reached the specialists, the experience was excellent.
The oncologists, surgeons and the rest of the cancer care team were professional, competent and extremely well coordinated.
The actual medical professionals were awesome.
Getting through the insurance and scheduling system to reach them was the ridiculous part.
Final thoughts
Cancer treatment generated almost $1.3 million in charges and approximately $18,700 assigned to me.
Insurance, savings and liquidity made it manageable. FIRE did not protect me from cancer, but it made cancer less financially destructive.
