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Health insurance overuse question

39,031 5,498 September 17, 2024 at 09:36 AM
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TLDR - if you've hit your deductible for health insurance, is there any real reason to hold back on spending the insurance's money?

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It seems the Finance forum has died down a lot but I have a general health insurance question.

My wife is the primary on our policy which is through her employer. As she's a teacher, and which tends to be the case for teachers up here, the policy is excellent. We've been with Anthem BCBS for 20+ years, and are now on a HDHP but were on a PPO for years. When we transitioned to the HDHP, I ran the numbers and between premiums, deductibles and what the district gives her/us in an HSA, if you used the hell out of "in network" there was no way you'd spend more money on the whole with the HDHP vs. the PPO.

At any rate, last plan year (teachers plan years go from July-June, not calendar year) we had a banner use year. I had some shoulder problems which pushed us over our deductible ($5k), so I opened the flood gates. She got some vein treatments she'd been putting off for years, and when one of the kids (we have 4) got sick, we were more apt to bring them to see a Dr since it would now be "free". I refilled Rx when I usually wouldn't, anticipating that when the plan year ended I might save some $$ when the deductible reset (each of us only takes one routine med which are both pretty cheap like less than $10/mo). Also, my wife had a 3 week hospital stay and surgery, which was over $200k in expense by the insurance company. We paid $0 OOP.

When the deductible reset in July, I was still wondering if we'd wind up hitting it this year because my wife still needs to take Eliquis until the end of the year (it's like $600/mo oop). I knew it would be close with other things that would come up, but then in August one of my kids broke his arm which required a visit to the hospital, and of course that torpedoed our deductible yet again, so care will be "free" until the end of June 2025.

So my wife will resume her vein treatments (when done with the Eliquis), one of the daughters is doing PT, Rx are auto filling, etc etc.

My question is, is there any real incentive for us to hold back on healthcare usage? Note that it's not like I'm running to the Dr insisting on a CT scan every week, mostly small things like Rx's, perhaps taking the kids in more cautiously, more PT appts, chiro, etc.
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Joined Jun 2005
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komondor
09-19-2024 at 06:52 AM.
09-19-2024 at 06:52 AM.
No you are doing pretty well I would go for as much as you could. I I do hit my deductible it is usually in the last month of the cycle. My co-worker took his daughter to the ER for a kidney stone and it cost him 6K, hs year resets in December so he is trying to figure out what he can get done between now and then that he might have been holding off.

My rotator cuff needs surgery and I have just been waiting to see if I hit my deductible if I do then I am getting my shoulder fixed!
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Joined Sep 2009
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zzyzzx
09-26-2024 at 10:16 AM.
09-26-2024 at 10:16 AM.
My question is, is there any real incentive for us to hold back on healthcare usage? No.
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