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

[haele]

159. Medical Deductibles are not like other Insurance Deductibles -

First off, you don't pay them up front when you go to the doctor or get a procedure done. There's usually a co-pay you'll pay first, then the hospital/clinic/lab/medical facility will bill the insurance, the insurance will negotiate costs, and then you will get billed for whatever is left until your deductible.
I have gone through this for the past seven years with employer based health insurance. And we always meet our deductible for the year sometime around April or May, so we always get a nasty set of bills we have to pay off over the year (this year, it's $9K, plus another $4K or so far in "co-insurance", something most of the plans I've seen in the ACA plans don't have)

There are a few things I have done over the year to ease the financial pain (I have student loans, too...)

First thing, the insurance company doesn't care if you pay whatever your bill is going to be after they're through with the negotiations of the provider and the co-payment is made are done or not. That money in the "you owe" line goes straight onto the "deductible" ledger so far as they are concerned.

Second, you don't have to pay medical bills up front or right away. First thing I do is to contact the billing department, and set up payments for the bill - even if it's five dollars a month, the "good faith" keeps you out of collections.

Third, ask if there is additional assistance you can sign up for or discount. As in, Walgreen's gives us a discount on some of the medication through their family plan, and because we keep regular payments, we managed to get recovery therapy payment assistance - an additional 15% off - through the local hospital where my disabled spouse has doctors. There are also charities that sometimes will pitch in for orphan conditions or one a major donor has an interest in. This year, we still owe that hospital about $2K for everything that went on prior to the deductible kicking in, but they are working with us, and several times over the past years, have cut us a significant deal to pay off the bills when they come close to closing - the old "if you can do $100 today, we won't bill you the remaining $60" agreement.

Finally, keep all your receipts. Your deductible will be over 10% of your annual income, correct? If you're making $40K a year, $4K in annual medical expenses - even if you are making payments - that are not already tax deductible can be taken off your income taxes. Include the transportation estimate to and from therapy, doctor's and lab visits, etc. If you are making payments, you can estimate how much more you will be paying on the services fin the year that that billing was initially invoiced, and include that.
If you don't already have a significant tax deduction such as a business or a mortgage deduction, that can really help around tax time.

Most people don't take a medical deduction because there are usually not enough out of pocket medical payments that are not already covered through either an HSA/FSA or through other subsidies that are tax-exempt (as in, the premiums that are taken out pre-tax in employer coverage) Every year, we have been able to use the return from the medical deductions to pay off the out of pocket costs that are still outstanding for the previous year.

It's a sucky position to be in. But we're able to just pay our medical bills - and under our "uniquely American" model of health as an investment business, until we can get single payer, we take the best options we can operate under.

Haele