On top of all the questions about your new life after surgery, you may also be wondering how you’ll afford the
I’m assuming that you have health insurance through someone’s employer who also offers flex spending accounts. If you’re self-paying, you’d have to find ways to save money to pay for surgery. However, that topic is for another day. For now, we’re going to explore how medical flex spending for bariatric surgery works, the best time of year to start your weight loss surgery journey, some downfalls to this method and other costs to consider. While surgery can be expensive, you can use your company’s flex spending plan to help cover costs.
What is Medical Flex Spending for Bariatric Surgery?
A medical flexible spending account, or FSA for short, is a program through your employer where you allocate pre-tax dollars for medical, dental and vision expenses not covered by insurance. You use it for copayments, co-insurance and deductibles. If you get a prescription from your doctor, it can also cover over-the-counter products like cold medicine and allergy medication. You allocate your yearly amount when you elect your benefits each year, and they divide the amount evenly between your pay checks. For example, you estimate $1,500 in medical expenses for the year, and you get paid bi-weekly (26 times a year). You divide $1,500 by 26 pay checks, and get $57.69. This amount is what they’ll take from your paycheck (pre-tax) each time you get paid.
Some companies give you a debit card with the total yearly amount on it, and you swipe it like a credit card at point of sale. The funds deduct each time. Other companies require you to pay out of pocket, submit receipts, and they refund you either via check or payroll. Check with your company for specific details. Be sure to keep your receipts and any explanation of benefits you receive, as you may need to supply these as proof of eligibility, no matter which method your company utilizes. The law limits how much you can put into an FSA. In 2019, the maximum amount you can put in an FSA is $2,700 according to the Internal Revenue Service. For someone who gets paid bi-weekly, it’s $103.84 per paycheck.
Deciding How Much to Allocate
It can be hard to determine how much to allocate in your FSA because everyone is unique. If you know you’re having surgery within your next plan year, and your maximum out of pocket is more than $2,700, you might want to take the maximum amount out. If your maximum out of pocket is less than $2,700, then you might want to take out less. You’ll have to consider how much is coming out of your paycheck, and whether you can afford it. After all, we don’t want to create more stress!
First, estimate your yearly expenses without surgery. How much do you spend each month on prescriptions? How often do you visit your doctor, and what is your copayment? Are you sick frequently? How often do you buy medical items like contact solution, band aids and sunscreen? Next, add in the copays for the appointments you’ll need for your pre-op assessment. It can be hard to figure out how much testing is going to cost, particularly if you’re having complicated tests like a sleep study. Consult your insurance Web site to see if they can give you an estimate based on your plan.
Once you have a rough number, divide it by the number of times you get paid each year. Remember the money comes out pre-tax, so you’re saving money on taxes with an FSA account. If you can live without that money each paycheck, use that amount. Otherwise, play with the numbers until you find something that works.
How My Surgery was Free
When I started my journey, my benefit year ran January to December. I attending my first informational session for weight loss surgery in November 2017, just weeks before I elected my benefits. I knew I would get surgery the following year, so I put extra money in my FSA account. Since I hadn’t met my deductible yet in 2017, I paid for my initial appointment with the doctor, bloodwork and first nutrition class out of pocket. When my new plan year started in January 2018, I started hitting my pre-op clearances: cardiology, pulmonary, behavioral health and physical therapy. Since each of those specialists (other than behavioral health) ordered specialized testing, I quickly met my deductible.
After my deductible was met, I still needed some additional tests and doctor visits. I ran through FSA funds pretty quickly that year. By the time May or June came, I had already hit my maximum out of pocket for the year. Since I had my surgery in June 2018, and I already met my maximum out of pocket, my insurance covered the surgery and all my follow up appointments for the rest of year 100 percent. I was super lucky. If you can manage to time your journey in a similar way, maybe you’ll get lucky too! Since insurance is complicated and each plan is different, I can’t guarantee the same thing will happen. However, I managed to get my surgery for free since I met my maximum out of pocket. I feel obliged to share this information.
If you’re stressing about paying for all of your testing and doctor appointments, take a deep breath. If words like deductible, maximum out of pocket and co-insurance make your head spin, take a deep breath. We are trying to control our stress so that we don’t turn to food for comfort. We need to approach the financial side of surgery in a calm, rational manner. If you are serious about your health and improving your life, there is going to be some costs associated. Luckily, many hospitals will assist you by offering financial assistance or payment plans. I personally used a payment plan to pay off my testing. Contact the hospital or clinic where you’re getting surgery to inquire about financial assistance. They can help you through it.
Also, I really do highly suggest an FSA. I open one every year. It’s a life saver when it’s time to go to the doctor, or you get an unexpected cold. If you are worried about having the money, take out the maximum amount and adjust your budget to match. Remember you will be spending less on food over the year since you can’t eat as much. You’ll also be cooking at home more and eating out less. Also, if you don’t use all of your FSA funds in your plan year, you can roll over up to $500 to the following year. Or you could stock up on medical supplies like band aids and sunscreen. This surgery is worth every sacrifice.
Other Medical Items to Consider
There are some other items associated with surgery that cost money. Some can be bought using FSA funds and others cannot. You’re going to want to take these things into consideration as you’re setting up your budget and deciding on allocating FSA funds.
- Aftercare: Follow-up appointments with surgeon and specialists. FSA eligible
- Protein supplements: Required after surgery. Possibly FSA eligible, but you may need a special letter from your doctor.
- Bariatric multivitamins: Required after surgery. Possibly FSA eligible, but you may need a special letter from your doctor.
- Vitamin B12, calcium, biotin: Sometimes required after surgery, depending on your doctor. Possibly FSA eligible, but you may need a special letter from your doctor.
- Small, portioned containers: To meal prep and measure your food. Not FSA eligible.
- Gym membership: To increase your weight loss, it’s important to add cardio and strength training. Not FSA eligible.
- Clothes: You’re going to lose sizes quickly, and you’ll eventually need new clothes. Thrift stores are great for this transition. Not FSA eligible.
Flex Spending is a Great Option
While surgery can certainly cost quite a bit of money, using your flexible spending account is a great way to cover qualified medical costs. FSA take pre-tax dollars from your paycheck to pay for eligible medical expenses like copayments and co-insurance. When you have multiple specialists from whom to get clearances, the associated costs can add up. Using your medical flex spending for bariatric surgery can help save in out of pocket costs and in taxes.
Starting your surgical weight loss journey at the beginning of your plan year may help get your insurance to cover your surgery 100 percent, if you’ve already met your maximum out of pocket. Be sure to balance the benefits to the downfalls, like how much money will be taken out of your check each week you get paid and the maximum amount you can roll over from year to year. Also remember to factor other costs into your budget, like vitamins and gym memberships. Overall flexible spending is a great option to cover the costs associated with surgery. See what your company offers and find an amount that works for you.
If this article gave you some great ideas to incorporate into your life, just imagine what other amazing strategies I have for you! Share this post on social media by clicking one of the sharing buttons, and don’t forget to join my email list! You’ll be the first to get updates, access to my new products and lots of tips, inspiration and motivation to help in your bariatric surgery journey. Just for joining, I’ll send you a free weight loss coloring chart, as well as some other pretty awesome goodies to keep you motivated. Join today!
You can use medical flex spending on co-pays for the doctor appointments for your pre-op clearances, any prescription medications you need to take before or after surgery and hospital and doctor fees from your surgery.