It’s true that the benefits of a parent cannot be measured or quantified in any meaningful way. It’s hard to put a price on the emotional commitment and special experience of raising a child as a parent, some of which may not even be realized by the parents themselves until afterwards. But it is undeniable that the experience of parenthood is a rewarding and special time in someone’s life.
Cutting Healthcare Costs
It’s not a secret that health care can be expensive. Many people pay two and three digit bills for their prescriptions. A visit to the doctor’s office can hurt the budget. Glasses cost hundreds of dollars? How can you cut this cost?
Drugs
If possible, go generic*. There is no difference between Trazorel and trazadone, aside from the cost. Wal-mart, Target, and many other stores offer common generic prescriptions for $4-5. When you are talking to your doctor, ask if there is an drug option that has an available generic. When you are talking to your pharmacist, ask if there is a generic alternative available.
Get the price match. The Cub Foods pharmacy near me matches the Target generic drug price, giving us $4 generics for the asking. This is often an unpublicized deal, so make sure you ask. If your pharmacy will not match nearby prices, consider going elsewhere.
See if there is a 90 day plan. Many insurance companies sponsor a 90 day prescription plan that gives you a 90 supply of drugs for the 60 costs as long as you are willing to accept the drugs by mail. For expensive prescriptions, this 33% discount can be a substantial savings.
Physician
Does your clinic offer online consultations with your doctor or nurses? Some clinics offer a chat or email option to talk to your doctor without requiring a visit that will add fees and copays to your expense sheet. Most clinics and hospitals have a free nurse line for basic questions, like “When is my baby‘s fever dangerous?” It’s a great chance to save some money. I know, from personal experience, that they won’t be shy if they feel you need to come in, but they generally won’t try to convince you to come in if aspirin will fix the problem.
Stay in-network. Check with your insurance company to make sure the doctor you want to see if in your network and therefore, available at the cheapest out-of-pocket price. If not, and you really want that doctor, ask your insurance company if they accept nominations for the network and ask your doctor if he’d be interested in being nominated.
Stay home for your cold. Don’t go to the doctor for every minor problem. The best remedy a doctor can give your for your cold will reduce it to a seven day malady. On the other hand, if you do nothing, it will go away in about a week. Why waste the money? This counts double for the emergency room and urgent care. Strep throat is not an emergency. Wait until morning and go to the clinic, paying the lower fees instead of the large ER costs. Make an appointment for a doctor visit, if possible. Urgent care is billed the same as a regular visit, but most insurance plans double or triple the copay for urgent care visits.
Cash Flow
A Health Savings Account(HSA) is a pre-tax account to save for qualifying medical expenses similar to a Flexible Savings Account(FSA). The main differences are that HSAs are only available for people with high-deductible insurance plans and do not have to be spent on medical expenses. Non-qualifying expenses move from pre-tax to post-tax, meaning you will be charged federal income tax for non-qualifying withdrawals. FSAs are “use it or lose it” plans. If you don’t use it, it will go away, usually at the end of the year. That makes December a great time to stock up on over-the-counter medicines and possibly replace your eyeglasses, as both of those are qualifying expenses. Find out if you have either option available. If you use either one, set aside a place to store every imaginable medical receipt, so you can be reimbursed. Make sure you understand the FSA-eligible expenses.
An Ounce of Prevention
Get routine checkups. The earlier you find a problem, the more options you have. This goes for everything from cancer screenings to blood tests. Get a physical every year and know what is happening with your body. We may be living in the future, but replacement parts are still hard to come by.
Maintain Your Health
It’s cheaper to be healthy. Eat right, exercise, quit smoking.
I enjoy a good meal. It’s one of my favorite things. I won’t cut rich foods out of my diet, so we reduced portions. Beyond the first few bites, the flavor isn’t nearly as enjoyable or even noticeable. There’s no more enjoyment for huge servings than small ones.
Get more exercise, even if it’s just a 2o minute walks twice a week parking on the far side of the parking lot, or taking the stairs instead of the elevator.
Vision
Go online. This one is worth a write-up all by itself. I have 6 pairs of prescription glasses–all varieties of frames and coatings–that have cost a grand total of about $150. There is no noticeable difference between my cheapies and the designer alternatives. While I work on the write-up, the best site to introduce you to the concept of online glasses is GlassyEyes. Reviews, coupons, and discount likes. They have step-by-step instructions on turning an intimidating idea into a simple and cheap solution to an expensive problem.
How do you save money on health care?
* There are no generics available on new drugs until the initial patent expires. This gives the pharmaceutical companies a change to recoup their research and development costs. Without this patent period, new private drug research would evaporate. Don’t hate the brand names, but don’t show undue loyalty.
Budget Lesson, Part 8
This is a continuation of the budget series. See these posts for the history of this series.
This time, I’m looking at our discretionary budget. These are the things that don’t have a fixed cost. Any individual item is largely optional, and, ultimately, we don’t track these purchases closely. At the beginning of the month, I pull this money out of the bank in cash, except for 1 category. When the discretionary budget is gone, it’s gone.
- Groceries/Dining – At the beginning of the week, we sit down with a meal planner and (Can you guess?) plan our meals. The planner we use has a weekly calendar with a checklist below each day to build the grocery list. At the bottom of the page is another checklist for staples that don’t apply to a specific day’s meal, like milk or snacks. We build the list, then transfer it to another sheet, broken out by grocery department. That keeps me from having to criss-cross the store. I make one lap. When I go to the store, I only bring that week’s grocery budget in cash, so I keep close track of how much is going into the cart. Recently, we’ve gotten so good at making our meals cheaply from scratch that I reduced our monthly food budget by $50. I enjoy good food, so I wouldn’t reduce this budget item if it was a sacrifice in quality. For example, the Rainbow Foods store-brand chips actually taste better than Lay’s for half of the price. We stock up when things are on sale and cook creatively. Sometimes, if time has been too tight to make a meal plan, we eat solely from the pantry for a week, buying nothing but bread and milk. By sticking to the list, and not fearing the store’s brand, we are able to feed our family of 5 1/2 for $450 per month and still eat well.
- Discretionary – This is for the random things that come up, and some of the not-so-random. Toiletries, activity fees, admissions, and fund-raisers all come out of this fund. At the end of the month, whatever is left gets tucked into a box and forgotten. When the box gets full, it goes to the bank to be applied to debt. There isn’t a lot to cut here, since this line-item is only $200.
- Baby stuff – This category is continually shrinking. Our middle kid is recently potty-trained and our youngest is trying. There is no baby food and no formula, just 1 pack of diapers every month. In 6 months, this category will be eliminated.
- Gas/oil – This is the single category that isn’t cash-based. It makes no sense to take the kids out of the car to pay inside, especially in the winter. Also, all of the temptation is inside. It’s much better to spend the money at the pump. There isn’t much we can do to reduce this, at the moment. Our next car won’t be a full-sized pickup, but we are several years from that purchase. We’ve started clipping oil-change coupons to keep this down to the minimum amount possible.
- Clothes – We only allocate $15 per month for clothes. In a good month, we don’t spend it. We can’t eliminate it completely, because things do come up. Over the summer, I’m hoping to completely leave it alone to save up for a new(used) winter jacket for our older daughter, who doesn’t get hand-me-downs.
- Blow Money – This is the safety valve. It can’t get reduced and still work.
We’ve now addressed out entire budget, including what we can do and have done to keep our costs under control. Looking back, I don’t see too many cuts I’ve missed.
Budget Lesson, Part 7
It’s been a month(again!) since I’ve written a post for the budget series, so I’ll be continuing that today. See these posts for the history of this series.
This time, I’m looking at how to reduce my “set aside” funds. These are the categories that don’t have specific payout amounts and happen at irregular intervals. One of the convenient features of our set-aside funds–also a feature of our non-monthly bills–is that the money sits in our checking account, providing a buffer against overdrafts. The buffer is big enough that I can withdraw our entire month’s discretionary budget on the first of the month.
- Parties – Twice a year, we have large parties. We have a barbecue(not necessarily low and slow, I’m in the midwest) and a Halloween party. We also have three kids with birthdays. Each year, we try to do something exotic at the barbecue. One year, it was a turducken. This year, we’ll be skipping the show-off portion of the show. The Halloween party is never expensive. I don’t drink much, so the bar stays well-stocked without frequent expensive shopping trips. We throw two large parties for less than $300 combined, and our guests start RSVPing a year in advance. We’re fun. The kids are getting gypped this year. I am over my addiction to expensive birthday parties for my kids. There will be a small party for one, a sleepover for another, and a party combined with some cousins’ birthday parties for the third. It sound horrible but all of them will have fun.
- Gifts – We set aside money for presents, but we don’t feel we need to spend all of the money we have set aside. Anything left over stays here. Eventually, it will be something nice for all of us.
- Pet Care – We have 4 cats and a dog. Cat litter and food are expenses that we can’t make disappear. We don’t buy the fancy food, but we also don’t buy the stuff that uses cardboard as filler. We have set a new limit at 3 pets, but that limit will only be reached through attrition. There’s nothing to cut here for a few years.
- Car Repair – This is another category with nothing to cut. If we don’t spend it, and something catastrophic happens to a car, we’ll be covered. If it doesn’t, we’ll have a bit more cushion in our checking account.
- Furnace Warranty – When we bought a new furnace and air conditioner, we got the extended warranty. This is an unlimited renewal warranty, so, in 5 years, we’ll have to buy it again to keep it. If we keep it forever, they will eventually replace our furnace when it dies.
- Medicine/Medical – It’s a sad fact that people get sick. We set aside a small amount to cover our costs. The costs rise and fall, but over any given quarter, I don’t think I’ve been off by more than $5.
I’ve taken a hard look at most of the bills over time, so there isn’t always a lot to cut. Next time, I’ll be addressing our discretionary spending.
Decision Making Made Easy
Have you ever had to make a difficult decision? Not necessarily a decision that’s difficult because it’s life-changing, but a decision that’s difficult because there are two phenomenally wonderful, yet mutually exclusive options?
For example:
- Should you put caramel or strawberry sauce on your ice cream?
- Should you go to Disney Land or Disney World?
- Should you subscribe to Live Real, Now by email or RSS?
- Should you take the job with the stellar benefits package or the higher salary?
These are all real decisions that you may be called on to make.
For most decisions, there are some alternatives that are easy to discard.
MadDog 20/20 isn’t a good alternative to caramel sauce on your ice cream. The local BDSM museum probably isn’t a great choice for a family vacation. Sending me hate mail is obviously worse than subscribing.
Then you’ve got some choices that are both okay, but one is clearly better. You’ve got free airfare and hotel. Do you go to Topeka, or Paris? Neither is horribly, but I think the choice is obvious. You’re going out to dinner. McDonald’s or…nevermind, this fits the first category.
After you’ve discarded the obvious bad choices and the okay-but-not-great choices, how can you decide between what’s left?
This is the point that starts to cause stress. What if you make the wrong choice? What if you regret it forever? What if you’re still not happy? Gridlock.
The reason your stuck is because it’s not apparent which is the better choice. All of your experiences and knowledge are telling you–on some level–that the options are identical in terms of your life, happiness, and goals. It truly does not matter which one you choose. You will probably be equally happy, either way.
Given that it doesn’t matter, you have two choices for making the final decision:
- Pick the one you want. The rational decision is a tie, so make it an emotional one. Does one job match your dreams, but with a bit more risk? Has one vacation destination been a goal since you were little? Do it!
- Flip a coin. If the decision doesn’t matter, leave it to fate. That way, if it doesn’t work out, you can always blame the quarter.
The one thing you don’t want to do is wait. Failing to decide is still a decision and one that is guaranteed to keep you from being satisfied with your choice. Don’t wait until you have all of the possible information, because that kind of perfect world doesn’t exist. Get to about 85% of fully informed and run with it. You’ll usually be happier making a decision–even the wrong one–than sitting back wondering “What if I had done that?”
How do you make hard decisions?
Money Problems: Day 9 – Health Insurance
Today, I am continuing the series, Money Problems: 30 Days to Perfect Finances. The series will consist of 30 things you can do in one setting to perfect your finances. It’s not a system to magically make your debt disappear. Instead, it is a path to understanding where you are, where you want to be, and–most importantly–how to bridge the gap.
I’m not running the series in 30 consecutive days. That’s not my schedule. Also, I think that talking about the same thing for 30 days straight will bore both of us. Instead, it will run roughly once a week. To make sure you don’t miss a post, please take a moment to subscribe, either by email or rss.
On this, Day 9, we’re going to talk about health insurance.
The first thing to understand is that there is a difference between health care and health insurance. Health care is what the doctors do. Health insurance is when the insurance companies pay for it. Or don’t. They are not the same thing. I won’t be addressing who should get care or who should be paying for insurance. That’s political and I try to avoid that here.
I won’t spend much time discussing health care as a “right”. It’s not. If a right requires somebody to actively do something for you, it’s not a right. It can’t be. The logical conclusion of requiring somebody to provide you care gets to be a intellectual exercise to be completed elsewhere. That, too, is political.
What I will discuss are the components of a health insurance plan is the U.S. and what to watch out for when planning your insurance coverage.
Premium
This is the amount you pay for your health insurance. For people with employer-sponsored insurance, this is usually paid out of each paycheck, deducted pre-tax. For those with an individual plan, it’s almost always a monthly payment. There generally isn’t much you can do to lower this much. Most employers offer, at most, 2-3 options, ranging from a good plan for a high premium to “we’ll mail you leeches if we think you’re dying” for a much smaller price.
Copay
This is a flat fee paid out of pocket when you get medical care. Depending on your plan and the type of visit, this could be $10-50 or higher. For example, with a plan I participated in recently, the copay was $15 for an office visit, $25 for urgent care, and $100 for an emergency room visit. The office visit and urgent care visit were billed the same amount to the insurance company, so the price difference was entirely arbitrary. Currently, all health insurance plans are required to pay preventative care visits at 100%, meaning there is no copay.
Coinsurance
This is the payment split between the insurance company and the insured. 80/20 is a common split for plans with coinsurance. That means the insurance company will pay just 80% of the bill, until the insured has paid the entire out-of-pocket maximum. After that, the coverage is 100%.
Deductible
This is the amount that an insurance company won’t pay. It has to be covered by the insured before the insurance company does anything. For example, if you have an insurance plan with a $25 copay, 80/20 coinsurance and a $100 deductible, and paying for an office visit costing $600 would look something like this: $25 for the copay, followed by $75 to max out the copay, leaving $500 to be split 80/20 or $400 paid by the insurance company and $100 paid by the insured. That office visit would cost $200 out-of-pocket. The next identical visit would be cheaper because the deductible is annual and doesn’t get paid per incident. That one would cost $115 out of pocket.
HSA
Health Savings Account. For people with a high-deductible plan–that is, a plan with a deductible of at least $1200 in 2011–they are eligible to open an HSA. This is a savings account dedicated to paying medical expenses, excluding OTC medication. It can be used for vision, dental, or medical care. Payroll contributions are taken pre-tax, which makes it a more affordable way to afford major medical expenses. Unfortunately, there are annual contribution limits. Currently $3050 for an individual account and $6150 for a family account. HSAs do not expire, so you can contribute now, and save the money for medical expenses after retirement.
FSA
Flexible Spending Account. This is similar to an HSA, but the contributed funds evaporate at the end of the year. It’s “use it or you’re screwed” plan.
Individual Plans
If you’re not getting health insurance through your employer or another group, you are on an individual plan. These cost more because they A) don’t benefit from the economy of scale presented by getting 50 or 100 or 1000 people on the same plan, and B) you don’t have an employer subsidizing your premium.
Employer-Sponsored Plans
If your employer provides health insurance, you have an employer-sponsored plan. Possibly the fastest way to correct problems with the health insurance industry would be to make individual plan premiums tax-deductible, while eliminating that deduction for employers and letting insurance companies work across state lines. That would eliminate the mutated pseudo-market we have right now, and force the insurance companies to compete for your business. Honest competition is the most sure way to increase efficiency and service while reducing costs. It beats “one payer” or “socialized” care which add overhead to the process and hide the premiums in increased taxes.
Open Enrollment
Most employer-sponsored plans only allow you to make changes at a specific time of the year, unless you have a “life changing event”, like marriage, divorce, death, or children.
Explanation of Benefits
After you use your health insurance, the company will send an EOB, showing you what was billed, what they paid, and what you’ll be responsible for. It’s fascinating to see the difference between what gets billed by the doctor and what the insurance company is willing to pay, by contract. You should read this, to at least understand what you are consuming and how much is getting paid for you.
Maximum Dollar Limit
If your insured care cost more than your maximum dollar limit, or maximum annual limit, the insurance company stops paying. this was supposed to be going away under the Patient Protection and Affordable Care Fraud Act. Unfortunately, if an insurance company offers a crap plan, they have been allowed to apply for waivers based on the fact that they offer a crap plan. The deciding factor in whether the waiver is granted seems to be the amount of the political contributions the insurance company has made to the correct political entities, but maybe I’m just bitter.
Out-Of-Pocket Maximum
This is the most you will have to pay directly with coinsurance. After you pay this amount, the insurance company will cover 100% of expenses, subject to the maximum limit.
COBRA
The Consolidated Omnibus Budget Reconciliation Act of 1985 is, in short, an opportunity to continue your employer-sponsored health plan–minus the subsidy–after you have left the employer. It’s expensive, but it keeps you covered, and will eliminate issue with pre-existing conditions when you get a new plan.
Catastrophic Health Insurance
This is an extremely-high-deductible plan, typically $10,000 or more. For the people who can’t afford coverage, this is insurance-treated-as-insurance. It’s coverage when you absolutely need it, not when you feel a bit ill. $10,000 isn’t a bankruptcy-level bill, while $100,000 usually is. This plan prevent medical bankruptcy for a small monthly fee. For the people who got screwed by a PPAACFA waiver, it bridges the gap between a plan that’s useful for minor things and protection when something goes really wrong.
Things to Watch Out For When Applying For Health Insurance
Now that we’ve looked at the terms you need to understand, we’re going to talk about some things to check before deciding what coverage is right for you.
Individual, Individual + 1, Individual + Family
Do you need coverage for yourself, or yourself and your family? If you and your spouse are both working, make sure to run the math for every possible combination that will cover everyone. Is it cheaper to have one of you cover yourself and the kids, while the other just gets an individual plan?
Maximum annual coverage
It’s really easy to blow through a $3000 annual maximum. If you’ve got a low annual max, look into a supplemental catastrophic plan.
Primary and Secondary Coverage
For years, my wife paid for insurance that covered herself and the kids, while I covered myself. When we were expecting brat #3, I added her to my insurance plan, without having her cancel hers. When the bill came, my insurance plan covered the coinsurance and deductible, which saved us thousands of dollars when the baby was born.
Pre-Existing Conditions
If you’ve got a pre-existing condition, it can be difficult to get insurance if you don’t already have coverage. This makes sense. It prevents someone from corrupting the idea of insurance by waiting until something goes really wrong before getting a plan. Without this, all of the insurance companies would be bankrupt in a year. This is one of the biggest benefits of COBRA. It’s a short-term bridge plan that eliminates the idea of a pre-exisiting condition deadbeat. If you’ve got insurance, you can transfer to a different plan. If you don’t, you can’t.
Homework
Your homework today is to get a copy of the details of your health insurance and look up all of the above terms and situations. How well are you covered? Did anything surprise you?