trying to figure out where I'm going to get the money for my obamacare

[haele]

94. We have always had high "deductible" issues in our family, with "good" employer insurance.

And I know what it means to live paycheck to paycheck, even now that the family income is between $50K and $60K, which should be good; I'm the only worker in a family of four, with a disabled spouse (Laz, a long-time DU'er) on SSDI.

Stick with me a bit here, because I have to explain what we have going on before I tell you what we have done that we can fix the costs overage issues.

Without insurance, Laz's annual medical costs are around $90K between doctor's visits, lab-work, and medication. Medicare D does not cover two of his critical medications; which includes a biologic injectable at $35K a year (retail) that keeps his joints from further degeneration and allows him to walk with a cane for 500ft or so at a time. My employer's insurance won't cover me and the kids with the PPO and sell me a supplemental for Laz that would cover his meds, so we can't see the savings he would get using Medicare.

Previously to this year, with insurance, Laz's usual out of pocket medical costs run around $8K - and that's what it was when our insurance had a deductible of $5K up to last year, which meant after that, all we had to pay was the minimum co-pays of $10 per doctor's visit and $5/$15/$35 monthly tier costs for each of his medications...
The kidlet has chronic stress issues landing her in Urgent Care and the ER several times a year, which usually costs us $3K a year.
At the beginning of the year, insurance was a cluster-fuck with a $9K deductible, and the introduction of "co-insurance" because my employer changed the way the plan was structured; they paid less and "we were more responsible for our health"...which is a savings to the average family if there is not a disability or unplanned medical emergency involved. And Laz ended up in the ER and then hospitalized for two days with bronchial pneumonia this summer.
So, this year, we already paid most of a total of $12K after the insurance got through with bills out of pocket. That's even after the $9K deductible; right now, we still have to pay for medications, 10% of specialists visits, and Urgent Care/ER/Hospitalization costs.

Because we know we will end up with a minimum of $9K out of pocket, I decided years ago to try and minimize the risk of bankruptcy and credit problems by enrolling in the company medical FSA plan that maxed out at $7200 a year.
Last year, my employer added an $5300 HSA plan and kicked in $1K to the HSA at the beginning of the year (but dropped the FSA to $2500).
This sort of plan easier for us to pay out of pocket medical bills by spreading the cost out by $160 a paycheck (I'm including the $140 a paycheck tax reduction due to a lower "gross income" ), and it also lowers our taxable income for federal, local, and state by $7800 a year.
(especially the FSA, which is more like a $2500 no-interest federal medical loan on Jan.1 that you pay off in pre-tax installments)

I do pay $300 a paycheck, there are offestting tax savings, and it's something I can budget as an installment plan. As the HSA rolls over to next year if I don't use all of it, and collects about .75% interest annually, if for some reason I don't use it all over the year, I can modify my deduction and have more money in pocket, or I can continue saving it for when I retire and need long-term care.

This has enabled us to not worry too much about that money, except for what we didn't have as the HSA was catching up to the bi-weekly payments. So what has worked for us this year to cover pre-deductible and "co-insurance/co-pay" costs what can't be covered by the HSA and FSA:

1) KEEP ALL YOUR MEDICAL RECEIPTS! Your out of pocket medical bills (including transportation estimates from house to doctor's office for visits) are tax deductible once the amount over the HSA/FSA or any other medical tax-exempt disbursement that exceeds 10% of your adjusted gross income. Some items such as pressure braces or hose for chronic conditions, walkers, medical canes are also tax deductible; anything with an FX or RX notation next to it on the receipt when you get it at a drug store or medical supply store can be used.

2 If you need to plan for expensive medical issues, get an HSA (through the insurance company or through your employer) and an FSA if you expect significant dental or optical. Plan your FSA payments for all expected Dental and Optical. This year, we had a lot of dental, and three of us have glasses, so we are maxed out.
If you know there's a strong possibility or certainty you will exceed your HSA, use the HSA primarily for initial co-pays and medication up front, and pay little costs (lab work, shots, procedures) so long as you don't exceed your per-paycheck payments.
It hurt during the beginning of the year, because our HSA only advances by $220 a paycheck, and Laz's out of pocket pre-deductible that first month was $2,200. We found that we need to keep one paycheck's funds in the HSA, to cover emergency visits or medications.

3) Negotiate with the billing offices to small monthly payments per month, and keep the receipts and payment records. Little lab or procedure bills of under $50 can usually be paid out the HSA before they get past 60 days, but big bills (like that $300 UTI diagnosis procedure) can be negotiated to a $15 to $25 a month payment. Hospitals and labs have to take a payment, no matter how small, and so long as you are paying, it doesn't affect your credit rating. (BTW, we have 11 payments a month of $15 - $25, and will pay off the payment once it gets under $100 if we have the cushion in the HSA)

As of now, we have $2275 outstanding in medical bills that we are slowly paying down by installments, and crossing fingers for no more to be added. There is $420 currently in the HSA (with $1120 left to be put in this year), ~$200 left on the FSA (kidlet has a crown put on next month that this will cover), so if nothing else happens, we should have $700 in the HSA at the end of the year.

Now, If my company is going to be kicking in another $1K next Jan 1 for the HSA, we will pay off four or five of those outstanding medical bills, and be able to roll paying those into next year, giving us more about a hundred more dollars during the month to spend on smaller necessary things - like going to thrift or consignment stores to replace four-year-old office clothes that don't really fit anymore, or getting new underwear.

4) See suggestion 1 - At tax time, I will gather up the 2013 out of pocket/not covered by HSA or FSA billing, and if it is over $5K, I will submit those to the IRS as part of my tax return. It might not get me back all of my out of pocket expenses, but it will get me back some - enough, at least, to pay off the rest of our medical bills.

So long as there is not a single payer system, this is probably the best strategy one can come up with to keep medical costs to a minimum when one has a chronic medical condition in a "high medical deductible" world

Haele