Wednesday, February 18, 2015

That Good Old HDHP

We've had a high deductible health plan since 2012, but in a way this is the first year that we're really experiencing what it's like. Since Pickle was born, she has been classified as disabled by the state, and receives medical assistance as a secondary insurance. They cover any bills that our primary insurance doesn't cover, which is only the deductible ($3,300) and 20% cost sharing up to an additional $3,300. Most years, we really only have her medical expenses, so we haven't had to spend much on medical care despite having a high deductible health plan. (I should also note that we pay no premiums, as those are covered entirely by Peanut's employer.)

This year, that's different - Baby Bear and I have both had doctor visits, and I had a lovely trip to urgent care for food poisoning and mastitis last week. We'll have to pay for all of that out of pocket - I remember being kind of slumped against the check-in desk wondering rather bitterly what this fantastic evening was going to cost me. It was an inane thing to be thinking about, because a) I really, really needed antibiotics and b) it'll all even out in the long run - I essentially got two pregnancies and deliveries for free, so it's probably time I started paying some bills!

It's going to hurt opening those bills when they show up, but I'm trying to remind myself that this plan is actually a good thing - we already know the maximum amount that our out-of-pocket medical expenses can be for the year and I know that they will actually be less than that (since Pickle has had an appointment as well, and has more scheduled for the early part of the year, and those will be covered by MA but will count towards our deductible and out of pocket). It's nice that it's a known entity, so that we can save up in anticipation (and use a health savings plan to get some tax savings on that money as well). In the grand scheme of things, $6,600 a year for the excellent level of medical care we've received is an absolute bargain.




6 comments:

  1. I am writing a lot about health insurance and your situation sounds similar to mine, except I don't have any recent experience with plans with deductibles. How do you keep track of your spending and do you have to inform your insurance company that you met the deductible? I've only dealt with out of pocket maximums in which case I am responsible for notifying the insurance company when I hit the max that year.

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    1. We don't have to inform our insurance company of anything. We have all of our providers file a claim for every service, even the ones that we will owe out of pocket. That way, everything we pay counts towards the deductible and out of pocket max and the insurance company keeps track of it.

      We keep track of all our spending just because we do, which is handy for being reimbursed from our HSA.

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  2. Does secondary insurance cover your deductible so you haven't actually paid any out of pocket deductibles since Pickle was born? If so, that's incredible! Also, if you don't mind my asking is there criteria for when Pickle will no longer be classified as disabled? Is this primarily due to her feeding tube issues?

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    1. We have paid for any care that wasn't Pickle's - the MA only covers her as a secondary insurance. So in 2012 and 2014 we paid for my pre-pregnancy visits and prenatal care that wasn't covered by the ACA (labs and stuff) but in 2013 we paid $0 - Pickle was still in the hospital and one day of critical care used up our entire deductible + out of pocket max. In 2015, we will pay a much greater share since newborns and post-partum moms have so many appointments. The timing plays a big role - Baby Bear was born at the end of last year so most of our doctors visits were right after the deductible rolled over, and I keep Pickle out of doctor's offices as much as possible during cold and flu season, so it just happens that she hasn't had as many appointments as she would during the summer.

      I have no idea when Pickle will stop qualifying for MA. I know it's at least partly based on her gestational age and weight at birth (25 weeks, 1 day, and 1 lb 5 oz) so it's possible she'll qualify forever, maybe. I have to reapply quarterly, and the paperwork doesn't ask me anything about her medical conditions - I just provide a snapshot of our financial situation, and so far we have been reapproved every time, even though I know we don't qualify based on finances alone. I assume they are checking with her pediatrician and/or specialists about her conditions, since I had to provide their contact information when we applied.

      I certainly don't think of her as disabled simply because she has a feeding tube, but the financial assistance has been really helpful since that's where the majority of her medical spending now comes from (supplies, specialist visits, and we are now starting weekly feeding therapy). My understanding is that MA exists as a secondary insurance for these kids because they are SO prone to health problems, so the state wants to make sure that there's one less obstacle to getting them needed and/or preventive care. Whatever the reason, I am super grateful for it, because it's made my not working not a burden on our family.

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    2. Thanks for the lengthy response. The worst thing about being sick is trying to find coverage and figuring out how to pay for it. When your child is sick I can only imagine that this would be 1000% times worse. I'm glad that you don't have to suffer through financial hassles. Your guess about the tendency towards long term health problems may very well be correct. After I left the comment I realized the feeding tube probably wasn't the deciding factor since she received that awhile after birth. I hope she continues to strengthen and that her weekly feeding therapy is successful.

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  3. If you have time, you might try signing up for a credit card that will give you miles for spending $x in the first three months - you may as well get some miles for the money!

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Thanks for commenting!