The gamble

Having an injury that still at a bit of an unknown place this time of year turns into an interesting game of betting on your recovery.

Right now, things are improving. I’m off crutches, and able to drive with my right leg again. Still a bit limited, but getting better.

But… there’s still the risk that if the scar tissue doesn’t tighten the kneecap down more, that it could happen again. So if it doesn’t heal tightly enough, even if I’m walking on it better now, it still could mean surgery.

The obamacare plan I’m on right now… my amount to pay would be 20%, up to $2,400 out of pocket.

But, it has no deductible, and my physical therapy visits, xrays, labs, and regular doc visits are completely covered with no copay… and the ortho doc visits are only a $25 copay.

Not too bad… better than the work insurance would offer and cheaper actually. I end up paying about $50 a month.

But, it would not be a good scenario at all for me if surgery were to be involved.

There is another plan… that is actually $20 less a month on premiums.

And that plan, has a max out of pocket of $500. So, obviously, that would be a whole lot more doable for me if surgery ends up being in the picture.

But… every physical therapy visit would be $40. And all of my prescriptions would be an additional $10 each. Primary doc visits would be $20, and the ortho doc would be $40.

And, it has a $250 deductible.

So… with the higher copays on everything, I would probably hit that $500 out of pocket easily even without surgery being involved. So I’d definitely be paying the $500, and it would likely be all in the first few months. But, it would cap my total costs including premiums at just under $650 for the year as the most I’d be paying.

So… how confident am I in not needing surgery in the next year?

Essentially, I can pay $500 out of pocket in the next few months to make sure I don’t have to pay an additional $2000 (or anything else) later….Or pay at least $300 out of pocket (more if I got sick or had any other injuries) spread throughout the year but risk a financial mess if the knee acts up again.

So… its actually only a $200 difference looking at the whole year, which seems like a fair amount to have the assurance. But all at the start of the year instead of spread out makes it a lot harder to pull off.

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