What I Spend For Medical Care In A Year

It’s difficult to explain how important it is to lower my monthly expenses by paying off my student loans- as well as other debt- without explaining where a huge chunk of my annual income goes without any real choices… my medical expenses.

​For someone like me who has chronic illnesses, maintaining health insurance coverage can literally be the difference between a fairly normal life and absolute destruction. I make the joke that I work for health insurance but to be honest it’s not much of a joke. According to BCBSTX the billed amount for my medical expenses in 2018, a really good year for me with only one chronic illness really causing problems rather than all three, was $46,823. That’s a full time salary for many in the US and it doesn’t even take into account costs that I incur outside of the insurance plan for uncovered medications and services. In order for me to ever be fully financially independent I need to eliminate as many of my monthly debt payments as possible while also building a large emergency savings so that in the event of a job loss I could afford to maintain my healthcare costs without going bankrupt.

For this reason, I thought taking you through a summary of my anticipated costs for 2019 would be helpful. So here we go. First, some important terms then a summary of this year’s insurance plan and then a quick run through of additional costs.
This post is part of a series that will look at ways to save money on medication, questions to ask your HR representative during Open Enrollment season so that you can make an informed decision and more. Insurance and healthcare are, understandably, a huge passion of mine which I have only dug deeper into since beginning to work in Human Resources four years ago. I hope that this series can be beneficial to you.
 
Important Terms

• Premiums: This is the amount you pay in order to be covered by insurance. Typically this number is expressed either as a per month or annual cost.
• Deductible: This is the amount that you have to pay for your care (of covered services, some services are not covered depending on the plan you are under) before the insurance company will pick up any of the cost. This does not mean you are not gaining benefit from having insurance though. If you are ‘in network’ you are only going to pay for the negotiated prices of services which can be a significant cost savings.
• Out-of-Pocket Maximum: This is the highest amount you will pay for covered services in a given period, typically a year.
• Co-Pay: This amount is a set fee for certain services such as a doctor’s visit or a prescription. You will typically not see these on the type of plan I am on- High Deductible Health Plans- but if they are on your plan you will likely see them as a set of tiered costs, some for prescriptions and others for types of doctor’s visits.
• Co-Insurance: This is the percentage of bills you are required to pay while you are in that gap between the deductible and out-of-pocket maximum.

 
My Insurance Plan
I currently have a fairly good plan but it is a High Deductible Health Plan which can get very costly if not budgeted for and fully understood. Being an informed consumer is of utmost importance with this kind of plan as 100% of the cost for services is on you from day 1 until you meet the deductible. Here are the details for my exact plan:

• Premiums: $544.26 per month, of which I pay $61 and my employer pays the difference. Annually this amounts to $732 which is low. It is a High Deductible Health Plan though so most of the cost comes in from the other costs throughout the year as a rule.
• Deductible: $2800 annually, this means that I pay all costs 100% until I have paid $2800. For me this is typically February. This year it is March due to a medication being filled on 12/31/18 rather than actually in January so I didn’t have to pay costs usually on my budget for January which was lovely.
• Out-of-Pocket Maximum: This one is $5400 annually… for an individual plan. Like I mentioned earlier, most of the costs for a HDHP tend to come in areas not related to premiums.
• Co-Pay: I have no co-pays on my plan. I either pay 100% or my co-insurance rate depending on how much I paid already in the year.
• Co-Insurance: My co-insurance is an 80/20 split so I will pay 20% of costs after I meet my deductible until I hit the out-of-pocket maximum after which I will pay $0 for care (so long as it is covered).

My insurance plan does not cover two of my currently prescribed medications (up from one in 2017) or any of the over-the-counter medications that my doctor utilizes as part of my treatment plan. This part is standard though, no prescription drug plan will cover OTC medications as a rule and have exclusions for covered prescription medications. Since this particular medication is purchased at a compounding pharmacy is was pretty much known up front to be an uncovered expense. 

It also doesn’t cover some of the testing I have to do at my allergist/immunologist’s office when I am in a flare, vitamins and minerals that I supplement with when symptomatic, or any of the alternative treatments that I have found helpful to maintaining my health. While it is true that most of these costs boil down to personal choices that I have made to seek these treatments the quality of my life has increased drastically since introducing them so keeping them in my treatment plan if possible is ideal.
 
Not Covered Costs Breakdown

• OTC Allergy Medications: $326 per year, approximately (at current prescribed dosages)
• Inhaler: $55/each so, hopefully, $110/year
• Mast Cell Stabilizers: $468/year at current rates which have historically changed mid-year to account for increased shipping costs
• Tests and Treatments Not Covered: Varies. If it’s a breathing test at my allergist is may run $25 but if it’s extra sessions at the chiropractor’s office or a more expensive blood test that my insurance doesn’t cover it may be a few hundred or even thousands of dollars.
• If it’s outside of traditional medicine altogether it can get pretty pricey as well. For instance, I’ve been trying IV Hydration Therapy in seasons of high symptoms with really good success but that’s not covered at all and runs $75 to $150 per session in office. Its helped ward off migraines that would have cost me significantly more than that (as well as a lot of pain) as well as helped my boost low blood pressure related symptoms at times but for now it’s not something I can afford to use regularly.
• When it comes to alternative pain treatments the costs are similar to the last bit… all out of pocket and all things that I wish I could use more as they help my pain drastically but don’t fit in the budget regularly. The first one is massage. Massages and reflexology paired with chiropractic care has helped my pain levels significantly but the cost of a massage can be anywhere from $50-100 per hour in my area depending on type of massage and facility. I’ve been using reflexology more often recently as they costs are more reasonable. Other things that go in this category are OTC medications, TENS units (and the pads, batteries, etc. required for use), essential oils and etc.

Without any of the ‘not covered treatments’ category we’re looking at:

• Premiums + Out of Pocket Maximum + OTC Antihistamines + Inhaler + Mast Cell Stabilizer... $732 + $5400 + $326 + $110 +468= $7036
• If I include in a minimal amount of additional treatments I can easily get another $1-2k added to that
• I do utilize coupons and programs from manufacturers to save money so I will likely save $2-3k this year (it’s impossible to guarantee or know exactly how much due to the exact programs/coupons I will be using)
• So final expenses for the year, baring any emergency out-of-network expenses, will be between $6000 and $8000 more than likely.

 
Other Costs
One thing that isn’t accounted for in any of these numbers is the fact that I have to be careful about the foods that I eat and products that I use. I am allergic to a lot of things- most artificial scents, gluten, celery (random I know), bananas, and a slew of other things. This translates to needing to use more expensive personal hygiene and cleaning products in many cases as well as having a more heavily padded food budget than your average single person. I wish I could discount this but its part of my life and relates directly to my health issues so it likely should be mentioned. In my house you will find no scented candles, plug-ins, or etc. as they trigger migraines for instance and just this past Christmas I borrowed some basic laundry detergent while on vacation and was covered in hives for three days… so you can imagine a lot of shampoos, detergents and etc. can ruin my week pretty easily.
 
Ways I Lower My Costs

• Coupons on medications (yes they exist, I’m doing a post on them soon!)
• Copay/Deductible Assistance Program for my most expensive medication ($2,100-$2,600/month without assistance)
• Samples of medications and products before purchasing full size products to avoid unusable purchases
• Putting the maximum into HSA or FSA plans when they are available.
• Alternative medical treatments (pain medications are expensive, can be dangerous in high dosages and can lose effectiveness with long term use… and the last migraine that I wasn’t able to stop cost me $3k by the end of it due to needing someone to pick me up and drive me to the hospital to get stronger medication)
• Buying off brand and in bulk- medications and household products both. If something costs 20% more than normal in order to get something that doesn’t break me out or give me a migraine but I can buy in bulk and save 10% then its not really 20% more expensive. The same goes with medications. The costs of my OTC and other non-covered medications are all off-brand and bulk quantities as monthly 30 day supplies would be almost double in some cases.

 
I write all this out not to convince you to feel sorry for me or what have you, because I think that I am extremely lucky to be able to work at all as I have many friends who are not able to do so. And not only that but I have a job I love, that pays me enough to afford the life I have- including insurance and salary that can encompass these expenses, a life that’s amazing with hobbies that bring me joy and friends that bring light and happiness to it, and a family that is just without words wonderful. It’s more than I deserve and I will always be grateful for it all. I write this to show you a window into my life for better understanding of one of my largest “why’s” when it comes to becoming financially independent and debt free. Having a “why” for your goals is important as without one you will be more likely to convince yourself out of the hard but necessary tasks along the way towards reaching your goal.
 
Until next time,