Healthcare and Open Enrollment with the Happy Hour Ladies

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Healthcare and Open Enrollment with the Happy Hour Ladies

Today is the last Friday of the month and my regular listeners know that on the last Friday of the month, I host a happy hour on the podcast where I gather great friends with me to drink cheap drinks and talk about money topics.

Today we are talking about health insurance, the types that we have, the types we’ve used, how we budget for it, and how you should prepare during open enrollment time.

What are we drinking?

Melanie from Dear Debt and Lola Retreat — Malbec

Tonya from Budget and the Beach and Tonya-Stumphauzer.com — Huckleberry Vodka

Liz, Mrs. Frugalwoods, from Frugalwoods.com — Bota Box Malbec

Shannon —  Smirnoff Kissed Caramel Vodka

Podcast Notes

  • Tonya is part of Covered California, which is subsidized health insurance. You can’t make too much income, but you have to make at least a certain amount.
  • She worked with a broker to find her plan. She gambled and took a lower premium plan with a higher deductible, because she is in good health. Most of her doctor visits are preventive medicine.
  • Tonya lost the bet, because she got injured playing beach volleyball and thought it was just a jammed finger. It turns out her finger was dislocated and she waited too long to get it fixed, so she needed surgery to fix it.
  • Her deductible is $5,500 and her max out of pocket is $7,500.
  • If you have already hit your deductible or max out of pocket, do what you need to do for the last month of the year.
  • Tonya starts occupational therapy and that will be $75 every time she goes in. She is hoping to only go a couple of times. She is very motivated to get her pinky working.
  • Melanie has an HMO. Her mom works for a large utility company and does their benefits. She has been doing this her whole life. HMO is a network. She picked a better plan, because she is on medication and she wants to make sure she has the coverage she needs.
  • She is paying about $358 per month for insurance, and she just renewed her plan. She was looking at other options and the premiums were about $50 less per month but the deductibles were crazy.
  • Melanie doesn’t have a deductible with her current plan. The new cost will be $366 per month. It has been going up for the last two years.
  • It is through Covered California. Her medications are cheap and it has been going really well.
  • Three or four years ago, when Melanie first became self-employed, she tried Liberty HealthShare, which is a Christian alternative healthcare.
  • Melanie was saving a lot of money, but she found out they don’t support birth control or mental health care. This was the year she was having a mental health breakdown and she was paying $250 out of pocket to see a psychiatrist and a lot of money for medication. Any savings she had was gone.
  • If you have any kind of mental health history, even if you are doing really well, Melanie suggests to be safe and not go that route. You never know what will happen, and having the options under Covered California has saved her a lot of money.
  • In 2017, Shannon talked about open enrollment on this episode.
  • There is a reason why open enrollment only happens once a year. You have to make a decision now and decide for the next year.
  • The Gym is paying $325 per month for each employee, and the premium is going up to $360 per month for 2020.
  • The Gym uses JustWorks, because they get pooled together with other employers. They have Aetna and for the last several years, Shannon has been on a high deductible health plan (HDHP). She rarely goes to the doctor and she is on birth control that is covered.
  • If you feel like you don’t really need the coverage, hedge your bets and use a HDHP. This plan allows you to use a Health Savings Account (HSA) to save for medical costs.
  • If you are on any kind of medication, you may not want to be on a HDHP. Check your prescriptions, before you sign up. One of Will’s prescriptions went from $40 a month to $190 a month. If you go to the doctor a lot, it will add up fast, but it is hard to guess what you will need the next year.
  • Liz has a PPO and it has been fine for them. They have a lot of regular, preventive care visits, because of pregnancies and kids.
  • Her family has medications and it is important to know what tier they fall into. Be aware if there is a generic or similar over-the-counter medication available.
  • When Shannon worked for Bank of America, she never paid for much. It cost $2,000 to have her son from beginning to end. Now, she sees clients with $6,000 in medical debt from having a baby.
  • Tonya found out her finger was dislocated when she went to one of her preventive appointments. Her doctor wanted her to go to the emergency room to get her finger put back in place, but she would have had to pay 100 percent.
  • They were able to squeeze her in with an orthopedic doctor, and she paid less. Had she went to the ER, they wouldn’t have been able to fix her finger anyway, since the injury occurred two weeks before.
  • Tonya opened a Chase Sapphire credit card to use for her medical expenses, and she earned travel points.
  • You get suspicious of the advice you are getting. Tonya went out of network and paid $350 to get a second opinion.
  • It is like taking your car to the mechanic: you don’t know how much it will cost you, and you wonder if they are just trying to get more money out of you.
  • This was the first time Tonya had surgery. It was a surprise, as was the cost.
  • Melanie’s biggest healthcare surprise was when she had to pay out of pocket for her mental health care. Her doctor visits were $300 an appointment and they wanted to see her in two weeks, then a month, then every two months.
  • Shannon spent $275 every time they went to their son’s doctor, and they had to go monthly. It made sense when they were figuring out the medication dosing, but after a while they didn’t do much.
  • Shannon’s son had a kidney stone earlier this year. He had to get an ultrasound, go to the specialist, stay in the hospital over night, etc. That day and a half cost $3,500 out of pocket.
  • If you have medical debt, the worst thing you can do, unless you are credit card hacking, is putting it on a credit card. Most medical providers can put you on a payment plan and it is 0% financing.
  • There are options you can look into. Hospitals have hardship provisions. When Shannon’s mom got sick a couple of years ago, and she was in the hospital for a week, the hospital helped because her mom qualified.
  • Talk to the hospital about programs they have available. There is always a way to negotiate. Even if you have health insurance, it can be very cost effective to pay your providers in cash. Often they will take less money to avoid billing the health insurance.
  • Three or four years ago, Tonya had a shoulder impingement, and she couldn’t get an MRI through her insurance. She paid the provider about $150 and was able to get it.
  • A lot of health care costs are inflated, because of the health insurance. The prices are inflated, so the providers can actually get what they need after the insurance discounts the services.
  • Look over your bill with an eagle eye. In the past, Tonya went in for a routine visit and she mentioned that she was experiencing ocular migraines. Her doctor gave her a sample of something and it showed up as a pre-existing condition that Tonya suffered from migraines. It was months of back and forth and they finally took the charge off. Be diligent in making sure you are not getting overcharged.
  • Between 70 and 80 percent of medical bills have errors on them. It is really important to look at the fine details. Look at the codes.
  • In 2016, Shannon did a podcast called Medical Billing Questions Answered.
  • Liz’s biggest medical expense was her pregnancies. Liz did a lot of work ahead of time to figure out how much she should expect to pay. She ended up being double charged for one of the births. She called the provider and they fixed it.
  • Don’t pay without looking over the bill carefully. If you have any type of lead time, like a birth, try to figure out what you should expect to pay.
  • For the birth of her first child, the hospital gave a discount if Liz paid her copay in advance. Liz had her girls two years apart with the same insurance and she paid $450 for the first birth and $975 for the second birth.
  • Knowing this ahead of time was a big peace of mind. She knew how much it would cost if she had an epidural and she was able to attend a free childbirth class.
  • About 11 years ago, Liz sprained her ankle badly in a ballet class. She looked at her insurance booklet and found that they would not cover an ER visit without a referral from her primary care doctor first. She contacted her primary care doctor and requested the referral so she would be covered in the ER.
  • Most medical providers are not trying to be malicious. It is frustrating for the providers as well. It is difficult to manage.
  • Shannon’s gynecologist retired, because he couldn’t make money because of the insurances.
  • If you are planning to get pregnant, look at a PPO plan instead of an HDHP. You spend a lot of time going to doctors.
  • When Shannon was looking at the costs to have her son, a c-section was three times the cost of a natural birth and an epidural was $500. It can get really expensive.
  • Melanie did not really like the HealthShare plan she was on. They are a private, religious organization and she is not religious. The language was vague and she never really understood how it worked. When she needed coverage for birth control and mental health issues, there was no coverage.
  • There is a lot of hype about this types of coverages, but it depends on your situation. It can be cost effective, but it also might not be.
  • Medicaid is an option for a lot of people, depending on your state and how it is run. It doesn’t necessarily come up as an option. The hospital helped Shannon’s mom get on Medicaid and it is only about $30 a month.
  • Shannon encourages clients to take mental health days to call medical providers and do research, call their car insurer, and other providers to do some financial planning.
  • Take advantage of everything that is covered under preventive health care, like mammograms, checkups, flu shots, etc. Whatever you can do to keep yourself in good health is worth it.
  • Liz got LASIK about six years ago (corrective eye surgery). Other than her epidural, it was the best money she ever spent. She paid up front and received a discount, used an FSA, and she found a vision discount. It was $4,000 for both eyes. She no longer needs to buy contacts or glasses. Take the time to research to find discounts.
  • Shannon got PRK (corrective eye surgery) 13 years ago. Her eyes were so bad, she couldn’t see the alarm clock. After she had Will, she couldn’t see him in the crib. She gets dry eyes pretty frequently, but it was life changing.
  • This is your physical health. Invest and take care of yourself. If you need to get medical care, choose a better insurance plan.
  • Some companies have programs where you can get rebates or discounts if you do preventive measures.
  • Tonya likes using Groupon for dental. It is like going to seminars on timeshares, they will try to up-sell you. You just need to be able to say no and it is a lot cheaper.
  • Costco doesn’t require a membership to get a discounted eye exam.

TAKEAWAY: My biggest takeaway is the importance of planning in advance for your healthcare needs. If you feel like you may have made the wrong choice already for 2020, set up an extra savings account with an automatic transfer with anywhere from $50 to $200 per month as a healthcare safety net to cover you until you get to select again next year

If you want to work with my team at the Financial Gym and learn more about how you can prepare and plan for your healthcare needs, remember that Martinis and Your Money Listeners get 15% off Financial Gym services. My financial trainers have seen it all, so no matter where you’re starting, we have the tools and resources to get you where you want to go. So head over to, or send friends to, financialgym.com.

If you have any topics you would like for us to talk about during happy hour, please feel free to email me at shannon@fingyms.com or tweet to me at blonde_finance or join the private martinis and your money Facebook group and let us know. Until next time, take care!!

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