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What It's Like to 'Celebrate' Deductible Season

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For many people, the day after Thanksgiving starts the holiday season. For those of us with a chronic illness, especially in the United States, the beginning of
the year is the beginning of the deductible season. This is when health insurance resets the deductible on their plans, and out-of-pocket maximums are much higher until the deductible is met. In January, my concern is not weight gain, brain fog, or dry mouth, but which pills to take and which to skip to save costs.

For healthy people, this process can take most of the year, depending on their healthcare needs. For those of us with a chronic illness, deductible season hits us with a heavy financial burden. I have been on disability for many years, and I know the drill. I save what I can before it, and plan on working off the debt after it. The deductible season is shorter for me than it is for most people. I usually make my deductibles for medication by the end of January and for medical treatment by the end of February.

For myself, the deductible season is more difficult than the holiday season because I am consistently going to doctors and physical therapists and racking up huge bills. I have a sitting disability, which means it hurts when I sit because of low back problems. I also have fibromyalgia and bipolar disorder. Juggling these three things together is difficult enough without thinking about how much it costs.

For the chronic pain in my low back that causes my sitting disability, my doctor has me on a prescribed opioid. This newer generation opioid isn’t supposed to have the side effects such as constipation, the risk of addiction, and damage to the liver that opioids mixed with acetaminophen have. It also costs $600. I need to choose between the new opioid and the older one based upon my finances, not upon the risk for addiction or my liver.

I ended 2017 already knowing where all of my 2018 physical therapy insurance dollars were going to. In fact, I stopped physical therapy in November because I ran out of insurance dollars for it. I was then being treated for my shoulder and ankle, sidelines in my struggle with a sitting disability, and was waiting for the new year to start a specialist therapist for my pelvic muscles related to my overactive bladder and hip problems. Too much.

For bipolar disorder, I take a generic medication that gives me dizzy spells strong enough to make me not want to leave the house. The newer option doesn’t have the same effect, as long as I eat a hearty breakfast with it, but again, costs about $600.

With both medications, I face a dilemma. At the beginning of each year, I tried to get away with taking the cheaper version as long as I can before my deductible is met. On one hand, these costs are overwhelming to somebody on disability. On the other hand, paying the extra cost for the medication will get me further toward the proverbial finish line: meeting my deductible. I have to decide based on my financial situation at the beginning of the year.

For fibromyalgia, I am in a patient assistance program that allows me to get my medication at no cost. This is great because going off it has terrible effects for me. I shake uncontrollably and can’t see straight. Before I went on this program, I was consistently going on and off due to my insurance company. They would approve it for one month, and I would start taking it, waiting a couple of weeks for it to kick in. And then the next month, they would decide it was not approved, and I would start to go through withdrawal symptoms. After going back and forth between the insurance company and my doctor, eventually, I would be pre-approved and start on it again. This cycle continued for over six months until I went in the patient assistance program. I’m glad that I don’t have to go through that anymore.

I wish I could celebrate this season by putting up decorations or sending cards to my pharmacists. The only solace I can take is that I do not celebrate this holiday by myself. Plenty of people in this country also suffer this financial fate, as they struggle with their illness.

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Originally published: January 13, 2018
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