Deductible decision

[old medic]

This almost seems to be a no brainer but figured to get the opinion of the fine folks of the forum.

My HDHP insurance has an out of pocket of $8000 with me paying it all before it pays a penny. Now I have to have another surgery and its been scheduled for Dec 21 so its covered under this year, as are the office follow up appointments. But no PT. Then I may also need special shoe adjustments, wont know till after the surgery. There is a slight possibility of a 2nd surgery depending on how the healing goes. I also will need a chest CT and a normal physical next year, figure $1K for that.
I'm seriously considering on cancelling the surgery until next year, pay out the $8K and not worry about the rest of next year. Since it is with the same hospital I already have a payment plan set up with, hoping I can combine them into one payment.

Thanks...

 

[Aerides]

I'm assuming you have already met this year's deductible, and that, without this surgery, you don't particularly hope to greatly exceed it next year either?

If so, yes I would say, book me for Jan 2, 2024 (unless you are in pain or this is a must-do-now situation). I'd also have a good chat with your doctor to make sure he doesn't cringe at the idea or strongly recommend against waiting.

I've done that with non-emergency stuff. Especially when you're talking a 2-3 week delay, not 2-3 months.

ETA: In general, I'm a big advocate of spending money on health without penny pinching. The ROI is almost always worth it. If you need it now and are suffering, get it moved up to next week vs. 12/21. I would pay good money to relieve pain and avoid complications and speed recovery in most any situation. If you can't BTD on your health everything else seems silly! (but yes for something not terrible urgent I would bump it 2 weeks for a new deductible).

 

[Car-Guy]

We (DW and I) have both delayed some medical "stuff" by calculating the max "out of pocket" (OOP) cost for one year vs the next. I'm not sure we would delay a procedure for many months but we "have" delayed things for a few weeks to play the max OOP game. Of course it depends on if it would be detrimental to our health by delaying or if we were in debilitating pain.

 

[MichaelB]

This almost seems to be a no brainer but figured to get the opinion of the fine folks of the forum.

My HDHP insurance has an out of pocket of $8000 with me paying it all before it pays a penny. Now I have to have another surgery and its been scheduled for Dec 21 so its covered under this year, as are the office follow up appointments. But no PT. Then I may also need special shoe adjustments, wont know till after the surgery. There is a slight possibility of a 2nd surgery depending on how the healing goes. I also will need a chest CT and a normal physical next year, figure $1K for that.
I'm seriously considering on cancelling the surgery until next year, pay out the $8K and not worry about the rest of next year. Since it is with the same hospital I already have a payment plan set up with, hoping I can combine them into one payment.

Thanks...

Are you able to itemize and deduct medical expenses? If so, it would make sense to wait. You also might find another health insurance plan with a slightly more favorable total cost (premiums plus total out of pocket).

 

[ivinsfan]

Is it too late to switch to a plan with lower deductibles for 2024...

 

[Teacher Terry]

Maybe I am missing something but not sure why you wouldn’t have it this year to avoid the 8k deductible.

 

[Aerides]

Is it too late to switch to a plan with lower deductibles for 2024...

For us, the HD/HSA plan is the best for coverage and overall economics, and we do take the HSA part as deductions to offset taxes.

We pay a lower premium, no co-pays, and have a good plan that includes our preferred docs. In a year when we don't have anything major come up, it's a real bargain. I have looked at other plans if we assume we'll have to pay the whole deductible, and it's usually a wash, or not worth the change. We will be happy to stay on the same plan until MC. I believe OP is pre-MC also.

 

[ivinsfan]

For us, the HD/HSA plan is the best for coverage and overall economics, and we do take the HSA part as deductions to offset taxes.

We pay a lower premium, no co-pays, and have a good plan that includes our preferred docs. In a year when we don't have anything major come up, it's a real bargain. I have looked at other plans if we assume we'll have to pay the whole deductible, and it's usually a wash, or not worth the change. We will be happy to stay on the same plan until MC. I believe OP is pre-MC also.

A good point but Old Medic should at least look at the numbers

 

[MichaelB]

In the middle of extended repairs, Old Medic would not want to change policies without absolute assurance his network of care is entirely included.

If he does have the option of changing, however, here is a useful spreadsheet that compares the total cost of health care, including premiums, deductibles, and copays. It’s possible he may find the same policy with a different mix of cost sharing ends up costing him a bit less. https://www.early-retirement.org/fo...nd-coinsurance-copay-68965-3.html#post1374536

 

[ivinsfan]

In the middle of extended repairs, Old Medic would not want to change policies without absolute assurance his network of care is entirely included.

If he does have the option of changing, however, here is a useful spreadsheet that compares the total cost of health care, including premiums, deductibles, and copays. It’s possible he may find the same policy with a different mix of cost sharing ends up costing him a bit less. https://www.early-retirement.org/fo...nd-coinsurance-copay-68965-3.html#post1374536

Absolutely and given the extent of his injuries from his accident, his out of pocket expenses will likely continue for the foreseeable future.

 

[old medic]

Too answer some questions.
Aerides----I'm assuming you have already met this year's deductible.
Oh yes... met it before the helicopter got to the hospital.

MichealB----Are you able to itemize and deduct medical expenses.
We still don't have enough to beat the standard deduction.

Ivinsfan----switch to a plan with lower deductibles for 2024
This is the best plan with HSA and was very pleased with them with this years mess.

I talked to my case worker from BCBS and she agreed that it a good idea to put it off due to the probability of further services needed following the surgery. Especially with the possibility of another surgery.

Pain and mobility is the main complaint. I can get around with a cane, but that aggravates the problem. I'm considering switching back to crutches.
The possible 2nd surgery is on the other leg, and if done at the same time, I'm basically back in a wheelchair again. I literally get chocked up even thinking about that.