Insurance questions (tacked on tax questions)

[Pamela H in Texas]

I think I'm starting to understand the insurance.  And I think it is stupid.  LOL  Anyway, but I have a question.  Let me outline this and maybe someone can catch any mistakes and answer the question.

 

Soooo...

 

Individual deductible is $600.  Family is $1200.  We've met $984 (all of mine plus some family).

Individual out of pocket is $3500 (mine will be done Monday). Family is $7000 (once family deductible is met, then half of this will be met). 

Doctor's appointments ($30 each), specialist appointments ($45 each), psychologist appointments ($30 each), medication, physical therapy appointments ($45 each), etc do not count towards out of pocket! 

 

So question:  Will I still have to pay all the things that don't go towards the out of pocket after the out of pocket is met?  Part of me says I shouldn't because I shouldn't have to have ANY out of pocket costs once I meet my out of pocket.  The other part of me says that if they don't count towards the out of pocket, they probably don't count after the out of pocket is met either.  That would really stink because obviously that is the majority of my medical costs (according to the bcbs website, not just in my mind).  

 

Anyway, so we're trying to get a ton of other things done this year.  Hubby is in need of a couple tests as per doctor.  And he and ds should have sleep studies done.  I * really* want youngest to see neuropsych and the ARND clinic at Children's also which should help.....ohhh, 'nother question:  If Medicaid picks up difference (they don't always), does that count towards our deductible and out of pocket since BCBS didn't?  I can see it both ways.  First, it isn't out of our pocket so it shouldn't count for us; and yet, it *is* what BCBS would say was ours to handle.  We just use Medicaid to pick it up (when it will).  

 

Okay, and tax questions (again, I can see some of these two ways):  

 

1) Do you have to itemized to deduct medical expenses?

2) Is it per person?  Or a family with multiple things going on counts?

3) does the medical premium count towards that?  

4) what if the family is reimbursed for the medical premium? (yeah, we're fortunate in that way -- anyone in Texas with a family member on medicaid, please contact me and I'll tell you how)

 

My big question is really whether I'm still going to have to pay for physical therapy and doctor visits now that my out of pocket has been met (again, as of Monday).  

[QueenCat]

I think you probably need to call BCBS and ask............. there are so many different kinds of plans, and the way one person's works may not be the way another's works. For example, when we had BCBS, all we paid was the deductible. No other coinsurance, copays. Once the deductible was met, BCBS paid everything. Our current plan with Aetna is the same way. I know others with different BCBS and Aetna plans that are very different from mine.

[Amy in NH]

I think I'm starting to understand the insurance.  And I think it is stupid.  LOL  Anyway, but I have a question.  Let me outline this and maybe someone can catch any mistakes and answer the question.

 

Soooo...

 

Individual deductible is $600.  Family is $1200.  We've met $984 (all of mine plus some family).

Individual out of pocket is $3500 (mine will be done Monday). Family is $7000 (once family deductible is met, then half of this will be met). 

Doctor's appointments ($30 each), specialist appointments ($45 each), psychologist appointments ($30 each), medication, physical therapy appointments ($45 each), etc do not count towards out of pocket! 

 

So question:  Will I still have to pay all the things that don't go towards the out of pocket after the out of pocket is met?  Part of me says I shouldn't because I shouldn't have to have ANY out of pocket costs once I meet my out of pocket.  The other part of me says that if they don't count towards the out of pocket, they probably don't count after the out of pocket is met either.  That would really stink because obviously that is the majority of my medical costs (according to the bcbs website, not just in my mind).  

 

Anyway, so we're trying to get a ton of other things done this year.  Hubby is in need of a couple tests as per doctor.  And he and ds should have sleep studies done.  I * really* want youngest to see neuropsych and the ARND clinic at Children's also which should help.....ohhh, 'nother question:  If Medicaid picks up difference (they don't always), does that count towards our deductible and out of pocket since BCBS didn't?  I can see it both ways.  First, it isn't out of our pocket so it shouldn't count for us; and yet, it *is* what BCBS would say was ours to handle.  We just use Medicaid to pick it up (when it will).  

 

Okay, and tax questions (again, I can see some of these two ways):  

 

1) Do you have to itemized to deduct medical expenses?  You did in the past, but it might change with the ACA.

2) Is it per person?  Or a family with multiple things going on counts?  Everything for all dependents listed.

3) does the medical premium count towards that?  Yes, premiums paid out of pocket by your family.

4) what if the family is reimbursed for the medical premium? (yeah, we're fortunate in that way -- anyone in Texas with a family member on medicaid, please contact me and I'll tell you how) Then I think no, because now someone else has paid the premiums.

 

My big question is really whether I'm still going to have to pay for physical therapy and doctor visits now that my out of pocket has been met (again, as of Monday).   AFAIK, only the co-pays.

 

 

 

[LMV]

You need to look at your insurance policy.  IF they specify that certain coinsurance will still be in effect after the out of pocket maximum has been met then you will have to pay this.  Sadly, it sounds like that is what your policy does say.  You might see if you can get these costs credited towards your family OOP maximum but since it sounds like your policy doesn't count PT towards the OOP maximum that probably will not work either.  I'm sorry.  

 

As for your other questions:

1) Do you have to itemized to deduct medical expenses?

Unless the tax code/regulations change you will need to itemize to deduct medical expenses. 

2) Is it per person?  Or a family with multiple things going on counts?

If you're referring to itemizing deductions, as long as you file as married filing jointly, you can add all of the family out of pocket medical expenses (including costs for uncovered medications, durable medical equipment, dental, eye glasses, mileage reimbursement for travel for medical appointments, etc) as long as you have documentation to support all of your costs. You can't deduct costs paid by someone other than you (for example if Medicaid pays your copays you can't count that) or costs paid from a HSA account if you have set that up.  In order to use the deduction your medical expenses must meet (or exceed) 10% of your adjusted gross income in 2013 and beyond  unless you are over 65 or disabled.  *If you and your husband file separately then usually only one of you can itemize deductions and you can only include the deductions for the individual (and any of their claimed dependents) named on the return.

3) does the medical premium count towards that?  

That depends on how you are paying your insurance premium.  If you have insurance through an employer then it is taken out pre-tax (so if you pay $5,000/year for your insurance this amount will not be reported as income on your W-2) and you can not deduct it as a health care expense.  If you pay your insurance premiums directly with post tax dollars then I believe that you can deduct that.

4) what if the family is reimbursed for the medical premium? (yeah, we're fortunate in that way -- anyone in Texas with a family member on medicaid, please contact me and I'll tell you how)

You can only deduct what you actually pay, so, if you write a check for the premium but then receive a check in the same amount reimbursing you then you haven't really paid anything and shouldn't be able to deduct it.