I have been struggling to find the breakeven point for me and my family. On one side, it keeps getting more and more expensive even though we are young and healthy. On the other, if one of us needs an expensive operation or months of treatment, no amount of HSA savings will be enough. I don't know if there is a 3rd option that would be more reasonable.
Third option is pay what you can reasonably pay and file for bankruptcy. Which sucks, but is an option.
Try to get assets into bankruptcy protected holdings when possible (401k, house, etc, depending on state of residence), so you have more flexibility post bankruptcy.
Bankruptcy is not an easy path out of debt. I've seen others go through it and it's stressful: they pry into all your finances, you still have to pay it off (just at a lower amount), and it destroys your credit. There are weird restrictions also like not being able to pay it off early even if you're able to.
EDIT: don't forget you have to pay the bankruptcy lawyer too.
There's a reason that medical debt is the #1 cause of bankruptcies in the US.
Another option for the U.S., fly to Mexico and take advantage of the "medical tourism" that is gaining in popularity.
> I don't know if there is a 3rd option that would be more reasonable.
There may be something less extreme, but leaving the US is one way out of that mess.
That unfortunately is not an option for us. We talked about it when we were younger, but both sides of our family live within a two hour drive of us and it important to us to be present in their lives and have them be present in ours.
If I had no personal ties, I would very much like to live abroad.
The third option that becomes more tantalizing every year in the US is to not have insurance, pay OOP for routine matters, and when something catastrophic happens let the medical debt go to collections and settle for pennies on the dollar. It doesn't feel right, but it's the direction the medical-pharmaceutical-insurance cartel is pushing us.
This is pretty much what I'm doing now.
Be warned: ageism is very real in tech.