Friday, October 14, 2016

Medical insurance: phase one deductible met

Image: http://wheelingit.us/wp-content/uploads/2015/11/co-insurance.jpg

My new medical insurance "year" took effect 9/1/16. As of this week, we have met the first of a 2 tier deductible system as part of my High deductible/Heath Savings Account (HSA) plan.  We pay all costs, luckily at a discounted rate if "in plan" with a provider, until we incur $4000 worth of expenses. I am calling this phase one. Yeah, it only took us about 5 weeks.

From this week on, all expenses, while in plan (rare for us to go out of network with the exception of one MD) whether for medical or RX, there is another phase with a co-pay system where we are responsible for 10% of costs. This continues until we have met the second deductible of an additional $2000.

$6000, if in plan, is a LOT of medical costs to absorb. How do I address this? I make sure that $6000 of pre-tax monies are deposited into my HSA account, from which I pay out on the aforementioned costs. I know that $6000 is the maximum that we would incur, so I plan accordingly. My monthly budget doesn't include this cost as it is based on take home pay(prorated for 12 months, and now at the retirement level).

Knowing how this system works, we plan accordingly. For example, DS #1 needs to return to the eye MD, but is making a low salary. Although his in network provider visit will be covered as it's a medical and not just an eye aka vision screening appointment (another insurance loophole), even if charged $200, he'd only be incurring a $20 co-pay fee. Very do-able, even on his wages. One of my maintenance RX's costs over $800 for a 3 month supply. I refill based upon the status of our deductible. The aforementioned RX is ready to be refilled (I had stockpiled a bit last year as a stopgap measure on all of our RX's whenever possible) as of Oct. I will refill in Oct, Jan, April and July during this current insurance plan year, which will expire come the end of August, 2017. In the interim, I am guessing within 5 months, we will meet this second deductible, at which point all medical costs, if remaining with in plan providers, will be covered at 100%.

It's a bit of a game, but I am very familiar with it. We've got this.

2 comments:

~Carla~ said...

Oh my... *faint* our family deductible is $50.00. For the entire year, for all of us. Prescriptions we have to pay $1.50 for each (dispensing fee) but thankfully my husband has good medical at work and it covers 100% of any meds needed. Good luck with all the medical stuff... I can't imagine the stress of having to deal with that.. :(

CTMOM said...

Carla, without socialized medicine, one is pretty much on their own down here in the states. That said, I DO have "good" insurance. Every year, it is chipped away at: increased premiums, less benefits, higher OOP costs, etc. I'm very used to the game, plan accordingly. I set aside the $6000 with pretax earnings, the monies are there when needed, including a bit of a slush fund to cover things like First Aid care items, vitamins, eczyma OTC creams etc.