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Do Rich People Have Health Insurance? My Real Take

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Short answer: yes. Most do. But how they use it looks a little different. Think VIP line at the airport, not a whole new plane.
For a deeper dive into the nuances I’ve spotted, you can check out my extended analysis on how high-net-worth families approach coverage.

You know what? I used to think rich folks just pay cash. I even tried that for a year when I freelanced. I learned fast. Insurance—done right—still matters.

What I see rich folks actually do

  • They keep a strong PPO plan. Brands I see a lot: Aetna, Cigna, Anthem, Blue Cross. A PPO lets you see more doctors, even out-of-network, and then file for payback.
  • They add a concierge doctor. MDVIP, One Medical, Forward—these are common. You pay a yearly fee. You get longer visits, quicker replies, and help with referrals.
  • They stack extras. Travel medical evac like Medjet or AirMed. International plans like Cigna Global or GeoBlue if they live abroad part-time. Dental and vision with high caps.
  • If they own a company, the company may “self-insure.” Plain talk: the company pays claims up to a big number. A back-up insurer covers the rest.

If you’re weighing company plans from the employee side, I broke down the best health insurance companies to work for in a separate guide.

I’ve used some of these myself. Not the fancy private surgeon part. But I’ve carried a PPO, kept a One Medical membership for a year, and I had Medjet during a long trip. So I’m not guessing here.

Real people, real setups I’ve seen

Here are true examples from my own life. I changed a few names, but the details are real.

  • Mark, my old boss at a logistics startup
    He had an Aetna PPO Platinum plan with a low deductible. He also paid for MDVIP for his primary care. When his son broke an arm skiing, they chose the top ortho in town, who was out-of-network. They paid a big bill up front—about $3,000—and then filed a claim. The PPO sent back a chunk later. The MDVIP doc got them in fast. That part mattered more than the snacks in the waiting room.

  • Ava, my neighbor who works in TV
    She keeps an Anthem Blue Cross PPO, plus a Forward membership. Her migraine doctor in New York charges $900 cash for a consult. She pays, submits the form, and gets around 60% back. One time her heart felt weird on set. She walked into Forward, did an EKG, and got peace of mind in 30 minutes. Was the membership cheap? No. Was it stress-saving? Yes.

  • Leo, my cousin in Texas who owns car washes
    His company self-insures. An outside firm runs the claims. Staff get a decent plan with fair co-pays. For his knee, he pays cash to a sports clinic that sees him the same day and squeezes in an MRI. He still uses insurance for the hospital parts. He told me, “The cash rate we negotiated beat the ‘list price’ by a mile.” That line stuck with me.

  • Priya, a family friend who splits time between LA and London
    They use Cigna Global for worldwide care. She had an appendectomy while traveling in Lisbon. The hospital billed Cigna direct. She paid a small co-pay and sent me a photo of the clean room and the soup they gave her. Not a bad day for surgery.

  • Me, when I tried going cash-only
    I did a direct primary care plan at $80 a month. It was great for simple stuff. Then I needed an MRI. Cash price with a coupon at a local imaging center: $850. With a good PPO I had before? My part was $150. That was the moment I stopped trying to be clever. I even experimented with a nonprofit health insurance option—here’s the full story of my wins, bumps, and huh moments.

Why not just pay cash?

It sounds simple. It isn’t.

  • Hospital bills can hit six figures. One bad night in the ER can wipe savings.
  • Even rich people hate waste. Insurance rates are often lower than “cash” prices.
  • Good doctors who are out-of-network still need pre-approval sometimes. A strong PPO helps.
  • Travel adds risk. Med-evac flights can cost more than a car. A lot more.

Honestly, some very rich folks do skip standard plans. But they often keep disaster coverage and a flight service. They also keep lawyers. And a family office that handles billing. That last part? Most of us don’t have it.

What they skip or tweak

  • Narrow HMO networks. I hear “too tight” a lot. They want choice and speed.
  • Tiny deductibles, not always. Some pick a higher deductible to get more freedom with out-of-network care.
  • Waiting. They pay for time. Concierge offices, cash lines, and faster scans.

It sounds fancy. Sometimes it is. Sometimes it’s just smart planning with money.

The part that surprised me

Rich folks still shop. They use tools like Healthcare Bluebook and Turquoise Health to compare prices. They’ll even scan the hospital-quality guides over at ASQH to see how providers rank before they commit to an appointment. They ask for cash quotes. They ask me to call billing and push. Money likes a good deal, no matter how much you have.

Also, concierge doesn’t mean magic. A kind nurse who calls back on a Friday? That’s the real luxury.

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So… do rich people have health insurance?

Yes. Most do. It just looks layered:

  • A strong PPO for the base.
  • A concierge or membership clinic for speed and care.
  • Extra travel or global coverage if they roam.
  • Cash for special doctors, then a claim for partial payback.

That mix keeps choice high, bills lower, and stress down.

Want a “rich-adjacent” setup without being rich?

Here’s what I’ve used or helped friends set up:

  • Pick a solid PPO during open enrollment.
  • Add a membership clinic you like (One Medical or a local direct primary care office).
  • If you travel, get a med-evac membership like Medjet for peace of mind.
  • For big stuff, ask for cash quotes up front. Then submit the claim anyway.
  • Keep neat records. Photos of invoices saved me more than once.

My bottom line

I’ve seen both worlds. Cash-only felt brave until it didn’t. Insurance, used well, felt boring—and safe. Rich folks didn’t replace insurance. They added comfort on top.

And yes, I still keep a PPO. I still ask prices. I still keep a small travel plan when I go far. That mix works. For me. For Mark. For Ava. For a lot of people, rich or not.

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