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Posts tagged with: medical care

Open Enrollment


First, thanks so much for the many thoughtful (and kind!) comments on my budget post. When I saw the comment count shoot up it made me nervous to read through them, but almost everyone was really very kind and forgiving (and generous in offering support, tips, advice, etc.) THANK YOU!

Speaking to one of the common comment themes I saw – many people asked about my take-home pay. For a $95k salary, my take-home ($2440/biweekly) is pretty low. The reason for this is that I have a LOT of things withheld and/or paid from my check pre-tax. This list includes the following (all numbers from my most recent paycheck):

  • Medical insurance ($125.50/check)
  • Dental insurance ($52.28/check)
  • FSA – Health ($68.37/check)
  • FSA – Dependent Care ($136.75/check)
  • Retirement account (required and already investing at the lowest amount so no chance to reduce – $256.91/check)
  • Parking permit ($38.45/check)

Plus, of course, all my taxes as well ($552.13 from my last check).

If I added this all up correctly, that comes to a whopping $1230.39 taken from my check before it hits my direct deposit! WHOA! That’s a third of my check!

So the question came up – can I change some of these things so I can get back more money per paycheck. And the answer is – YES! Right now is my open enrollment period and I’d LOVE to have some help with figuring things out! Let me address things one at a time.


I can likely lower my tax withholdings per check, but have opted not to make any changes right now. Taxes are not part of my open enrollment, so I can change those at any time. Based on what feels best to me (and many comments/advice I’ve received), I’m going to do our 2017 taxes ASAP once the new year hits. That will give us a better feel for how much we really owe and we can make adjustments accordingly. Given our huge tax debt (that we’ll be paying on for what feels like a lifetime), we’ve opted NOT to reduce our withholdings for the time being. We’re likely over-paying a little this year, but we feel okay with that – any extra money can go to help reduce the tax bill and we can re-adjust after the CPA has gone over everything.

Retirement, Dental, Parking

These are all pretty well “set” and cannot be changed. We have limited options for dental – I can decline the insurance, but we use it and need it. So it stays. In terms of parking, I live too far to walk/bike and don’t have anyone living nearby to ride-share with. So unless I switch up my Mom car for a motorcycle (never happening), this bill is pretty much “set” too. Retirement is required by my employer. I used to invest a full 10%, but have reduced down to the minimum (7%) already. No way to make this any lower.


So here is where I could REALLY use some advice. Currently, we have a PPO plan and this entire year I’ve been thinking that, come open enrollment, we’d switch to a HSA. But when I started really doing some research to compare the two options, I think we’d end up spending MORE with the HSA. Yes, we’d save on monthly premiums, but the out-of-pocket costs and deductibles are much higher.  Here are some side-by-side comparisons I put together. What do you think?

Health Savings Account PPO 
Per-paycheck Premium $61 $150 (note: this is more than listed above because premiums are going up)
Overall Deductible In-network:

$1300/employee; $2600/family


$500/employee; $1,000/family

Other Deductibles Non-preventive prescription coverage:

$1300/employee; $2600/family

Out-of-pocket limit In-network:

$2,000/employee; $4,000/family


$1,000/employee; $2,000/family

Not included in out-of-pocket limit Premiums and health care not covered by the plan Premiums, drug co-pays, and health care not covered by the plan
Annual limit on what the plan pays None None
Costs for common services with in-network providers.

Primary care to treat illness or injury

Specialist visit

Other practitioner office visit

Preventive care /screening

Diagnostic (x-ray, blood work)

Imaging (CT/PET/MRI)

Mental health

Generic drugs



10% co-insurance

10% co-insurance

10% co-insurance

No charge

10% co-insurance

10% co-insurance

10% co-insurance

non-preventive: 100% until deductible is met. Preventive: $10 copay



$15 copay

$30 copay

$10 copay for OB/GYN

$15 copay primary care; $10 OB/GYN

No charge

No charge

$15 copay

$10 copay


I receive biweekly pay (26 checks/year). So the HSA annual premium is $1586. The PPO annual premium is $3900 (a difference of $2314). But if we’re having to pay $2600 for our family health deductible + $2600 for the prescription deductible (compared to a $1,000 deductible for the PPO plan), I think it’s just too much money out-of-pocket! (though, caveat, I’m no expert with healthcare – does the out-of-pocket max only apply to healthcare, or would that also include prescription coverage??)

My thought is that we’d be better to stay in the PPO. It also scares me to think of paying 10% of any imaging, diagnostic, etc. We’ve been lucky thus far (knock on wood), but we have young kids – broken bones are a given at some point, right?

Those more experienced than I am – thoughts?

Flex Spending Accounts

The dependent care account contributions will decrease in 2018 and even moreso in 2019. Right now, we still have hefty monthly bills. Our girls are in kindergarten and, though half-day kinder is state-subsidized, the state does not cover the costs of full-day kinder. We pay that. The total was actually right about $1,000/month, but we paid out of our FSA a huge chunk for one of our kids’ entire semester of tuition (for which we received a discount). We’ve been paying the remaining costs out-of-pocket (the dependent care FSA was depleted months ago).  For next year, we’ll only have one semester worth of full-day kinder costs (the second half of the year they’ll advance to first grade – totally free!), plus the costs of care for summer and after-care, as needed. (Note: several people have suggested that hubs take over childcare so I just wanted to address that here:  hubs does handle the bulk of childcare. Where we live, half-day kinder is 8:30-11:30am. Hubs is in classes full-time that extends well beyond that timeframe. The full day kinder program is 8:30-3:00pm. Currently, hubs gets the girls at 3:00pm every day except Wednesday – his long day – so we pay very little in “after care” at the present time. Just one day per week. This arrangement is unlikely to change for the rest of the academic year).

Bottom line, we should be able to lower the amount of FSA money withheld for dependent care for next year, thus increasing the size of my take-home pay.

The health care FSA is entirely dependent upon whichever medical plan we choose. If we get the HSA, we’ll use the health savings account. If we keep the PPO, we’ll keep a flex spending account for medical expenses. This year, we put $1750 in our health FSA and it was not nearly enough. If we keep the PPO, we’ll increase our health FSA contributions probably to about $2250-ish (though I’d need to crunch numbers first).

So the big question is…..HSA or PPO (with a FSA)? Pros and cons? What are your thoughts and why?

A Dental Kind of Day


Today was a double dental appointment day for DD and DS (the two from my previous marriage).  Our first stop was the oral surgeon for DS who is 12 1/2.  He’s been under orthodontic care since Kindergarten having had a severe cross bite that was caught early.  We’ve done 2 rounds of the palate expander, one round of braces and a good year with a retainer.  Now we move to the extraction phase with a crowding issue up top and two missing permanent teeth on the bottom.  We will have the baby teeth pulled on the bottom so that the permanent teeth can move into place.  I had never heard of permanent teeth missing below the baby teeth but the orthodontist says he sees it on occasion.  We could have left the baby teeth but then as he aged he would likely face problems asking baby teeth to do the job of permanent teeth for life.

Dental professionals—particularly specialists–always have that little “financial room” that you go to after seeing the doctor.  I always laugh in those little rooms as I picture someone elsewhere in the office calculating the financial damage this is going to inflict.  We have excellent health insurance and with all of the recent talk on this issue–we do not take that for granted.  I was bracing myself for the worst as DS opted for IV sedation…instead of “laughing gas.”  Imagine my excitement when the news came back at a total of $60!  For four teeth?!  I still can’t believe it but the dental insurance covers extractions at 100%.  The $60 is our portion for the IV sedation.  We are blessed.

Our next appointment was with the orthodontist for DD.  It appears that she got all of the worst dental traits from both parents!  She too has a cross bite but because her upper teeth are “still erupting” we won’t start treatment until early 2013.  Now…the orthodontist’s office REALLY amazes me when it comes to several things.  First of all…it is the only medical provider that runs on schedule almost 100% of the time.  In the near 8 years we’ve been going to this orthodontist, they were running behind ONE time.  Why is it that I know it has been only one time?  Because they called me and told me to come in 30 minutes later b/c they were running behind!  I almost hugged the receptionist when I walked in the door.  I’ll save my rant regarding “professionals” making patients/clients wait for a Friday rant…but talk about a pet peeve!  And I don’t just bark the bark about this issue…I am vigilant about NEVER having someone wait on me at the office or otherwise.  Loathe tardiness….LOATHE.

The other great thing about the orthodontist is how they approach finances.  Now, we might have about $1,500 in insurance coverage to put toward orthodontic care but for today’s discussion we did not consider that (because my ex needs to look into some issues surrounding the plan).  So, worst case scenario for her top teeth only (the lowers look very manageable and likely won’t need treatment until she’s much older) is about $2200.  Now, that’s a lot of money certainly but here’s what I love…it’s all inclusive!  There are no additional charges for however long the treatment takes to accomplish what the doctor said (and we agreed to) would be accomplished.  They offer no interest payment plans but we’d get a 5% discount if we pay in full.  I split that $2200 with my ex-husband 50/50 so we are looking at $1,100.  The payment plan (again divided by 2) is a $590 deposit and then 12 payments of about $135 per month.  The treatment is going to take near 2 years they think.

I share this not really because of the financial aspect–we have 6 months notice and can make adjustments to the budget and hopefully pay in full and get the discount.  Instead I share because I just like the system that orthodontists have going on!  I know an orthodontist office is no primary care physician’s office and the two are oranges and apples (really!  I know this!)—but it is so refreshing to see things so organized, well-managed and known.