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Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: FiguringItOut on November 20, 2017, 08:29:30 AM

Title: HDHP and using medical services
Post by: FiguringItOut on November 20, 2017, 08:29:30 AM
This may be a stupid question, but I'll ask anyway.

For those who have HDHP, do you find yourself avoiding or postponing seeing a doctor or getting medical services just to avoid paying out of pocket deductible.  I do, and it's driving me crazy.  But I can't seem to change it.  The thing that gets me even more upset is that a) am looking for a new job, so I keep telling myself, if I payout a large chunk of my deductible now, once i find a job I'll have to start a whole new deductible all over again, and b) at my current job, health insurance year is June 1 to May 31st, not a calendar year, so it's not like I can wait another month and then have my deductible start over and even if I pay it out completely, I'll have a whole the rest of the year of really cheap (10% coinsurance after deductible) healthcare. 

My current insurance is crap and very expensive.  $720/month out of paycheck, deductibe/max OOP is  $4K/$7K for in network and $7K/$19K for out of network.  I would really like to start seeing a therapist again.  I have depression and I can't take any meds for it, and long term therapy is the only thing that helped in the past.  Also, I am thinking of an elective surgery that is most likely not going to be covered by the insurance, but would greatly improve quality of life.  Nothing life-threatening or anything like that, but really something I'd like to do.  I am about to schedule an appointment to find out if it would be covered.  If the answer is not, then it's out of the question.  I can't afford it.  But if it will be covered, that's basically $7K out of pocket and then come June, it all starts over.  Have cash savings that I could potentially use for this, but it would be a large chunk out of that amount and I feel like I need to have that cash as my emergency fund.  Single parent, one income, unemployed ex who's not paying child support. 

I have about $16K in my HSA account, but I really don't want to use it.  I look at as a secondary IRA account and since nothing in my life is life threatening right now, I don't feel like it's justifiable to use this HSA account. It is part of my paltry NW amount and I've been working very hard for the past 2 years to safe and grow my NW from scratch.   

As a side note, I find mid-year insurance plans to be very confusing and inconvenient. 

Title: Re: HDHP and using medical services
Post by: honeybbq on November 20, 2017, 10:54:53 AM
No, for two reasons:

- I use the HSA and consider it money at saved at a discount because it is pretax. So I save 30% on everything off the top.

- second, not going to doctors and taking care of your health is penny wise and pound foolish.

I mentally write off my deductible every year. If I don't go over my deductible, fine, I win. But if I do, I thank my lucky stars I have health insurance and a HSA.
Title: Re: HDHP and using medical services
Post by: acroy on November 20, 2017, 11:00:07 AM
Yes I treat HC the same as any good/service - weight the cost vs. benefit. Having to pay for a big piece of it myself makes a big difference in what we do.
Title: Re: HDHP and using medical services
Post by: SimpleCycle on November 21, 2017, 08:51:16 AM
There's actually some good research on this - the Rand Health Insurance Experiment.  It found that when you increase cost-sharing, people cut back on using health services, but also that they cut back equally on services that are necessary and services that are discretionary.

Think of taking care of your depression as protecting your health and earning power.  It's an investment in yourself.  You don't necessarily need to use the HSA money - you can pay with post-tax money and keep the HSA invested.
Title: Re: HDHP and using medical services
Post by: slappy on November 21, 2017, 09:13:28 AM
In your situation, I would do one of two things, depending on how promising the job search is going. 1) Wait until you get the new job, only if you expect something to come through quickly.
2)  Schedule the surgery and all other medical appointments asap. Get as much therapy as you can between now and when your insurance resets. If your insurance doesn't reset until June, you should have plenty of time to get everything taken of, depending on your schedule and lifestyle.

Title: Re: HDHP and using medical services
Post by: seattlecyclone on November 21, 2017, 11:10:52 AM
Your health is your most important asset. If you need to go to the doctor, do it. Forget about what it costs. You presumably chose a deductible that you were fully prepared to pay if necessary, right? If that's not the case, perhaps that's a sign that you should switch to a plan with a lower deductible next year if you have one available to you. What's best for your pocketbook isn't always what's best for you.

That said, a high deductible does and should cause you to be more choosy about going to the doctor when you don't need to. Ask questions. Look into things for yourself. For example my wife's obstetrician recommended that patients get three ultrasounds over the course of the pregnancy. However we looked into it and it seems the general consensus is that two is plenty for a low-risk pregnancy. That's what we chose to do, and saved a few hundred bucks in the process.