Real Life Planning Podcast Episode 22: Make Better Healthcare Decisions with Kelley Long

In Episode 22, I have a conversation with Health Savings Account expert and financial wellness coach, Kelley Long, CPA/PFS, CFP®. We tackle what to consider when selecting a healthcare plan, the benefits of a Health Savings Account, and hacks to help you receive great medical care at a better cost. Stick around for the second half of the episode to learn how Kelley began her financial coaching program for women, Find Your Financial Bliss™.

“A healthcare plan that minimizes your financial risk, a.k.a the ones with low deductibles, is not that great of a benefit if you are not someone who regularly needs healthcare.” - Kelley Long

This week on Real Life Planning Podcast, Cynthia will cover:

Takeaway Quotes:

“ Don't ever swipe your HSA card to pay a bill unless you would have to carry a balance on a credit card.”- Kelley Long

“People would often choose the plan with the lowest premium cost, which might not necessarily be the right plan for their family.” - Cynthia Meyer

“ Common expenses that most of us incur that we don't think of as HSA eligible expenses are things like menstrual products or BAND-AIDs®  or sunscreen.” - Kelley Long

Connect with Kelley Long:

• https://www.financialblisscoach.com
• Kelley on Linkedin
• Kelley on Instagram

Connect with Cynthia Meyer:

• Cynthia Meyer on Facebook
• Cynthia Meyer on LinkedIn
• Cynthia Meyer on Twitter
• Cynthia Meyer on Instagram
• Cynthia Meyer on Pinterest
• Duolingo: CynthiaCafe
• Email: cynthia@reallifeplanning.com  

About the Real Life Planning Podcast

Host Cynthia Meyer welcomes fascinating guests to share real life stories of how they are realizing their financial potential. Each episode explores practical, realistic steps to create results.

Transcript - Real Life Planning Podcast - Episode 21

[00:00:06] Cynthia Meyer: You know, It's that time of year. It's open enrollment. So those of you who work for other companies are getting notices from your HR departments with requests to make your benefit selections for 2023. And the biggest and most difficult thing to do is to decide on healthcare plan. Should it be high deductible? Should it be not a high deductible? Should you have an HSA or not? I thought this was the perfect time to invite CERTIFIED FINANCIAL PLANNER® and independent financial coach, Kelly Long. Kelly and I worked together for many years in the financial wellness space. She is brilliant and she has a lot of important things to say about making better healthcare decisions.

[00:00:50] Kelley, what's important to know about you? 

[00:00:53] Kelley Long: Cynthia, thank you so much for having me. It's such an honor to be invited to join you on this podcast. Probably the most important thing that people need to know particular to this topic of healthcare is that I live with a chronic healthcare condition that requires a very expensive monthly drug.

[00:01:10] I tend to go in five year cycles where I'll have four years of pretty decent health, and then a fifth year where I hit my out-of-pocket maximum. So I'm very experienced in consuming healthcare and I've made a lot of mistakes. Throughout the course of my career when we worked together, I've become a bit of an expert on health savings accounts and I am passionate about- I don't know if I can be passionate about a tool, but I get really excited about them because I think they're highly under utilized, strongly misunderstood, and often misused. If used in the best practices by people who are generally healthy and have a little bit of financial wiggle room, I think they can be super powerful wealth building tools. Really excited to talk to- just also open enrollment for those of us on the healthcare.gov; Affordable Care Act Exchange.

[00:01:54] Cynthia Meyer: Oh, good point. 

[00:01:54] Kelley Long: Also in the process of choosing my own healthcare as a self-employed person. So this is a great time to be talking about why it's worth giving those higher, high deductible, and I use air quotes because I hate that. It's a misnomer. But giving those HSA eligible healthcare plans a second look. If you're one of those people who just has always thought like, "Nope, that's a good way to destroy your finances." 

[00:02:18] Cynthia Meyer: So certainly one of the things that I know about you, Kelley, you are a super clear communicator, right? You can take these really complicated concepts and put them in real people language and use these wonderful analogies that helps everyone understand what exactly is happening.

[00:02:35] And I will say, I work with a lot of really sophisticated investors, who are building rental property portfolios. A lot of them made their money, say in tech or pharma or something like that. Or they're highly paid professionals and to a person- everybody is bamboozled by healthcare terminology.

[00:02:51] What do we need to know? 

[00:02:54] Kelley Long: The reason for this and the perspective shift that I think needs to happen from a benefits perspective, and communicating this in the HR department all the way down through you and I having this conversation, is this idea that an employer or a healthcare plan that minimizes your financial risk, aka the ones with low deductibles, is not that great of a benefit if you are not someone who regularly needs healthcare.

[00:03:22] I hear my young healthy friends all the time say, But they have such great benefits, I don't pay anything for my healthcare and I'm like, " Do you use healthcare?" 

[00:03:31] Like, we had at our last employer. We worked for a small company, so there were tax incentives for the company to pay for our healthcare insurance.

[00:03:38] So they, the company, covered our premium employees' premium at least, which was an awesome benefit. But we had a choice of multiple plans, and if you chose one of the plans that was lower premium to the employer. They actually compensated that us for that by putting that extra money into a health savings account.

[00:03:56] And I'm so grateful that our colleague, Eric Carter, had written a blog post about this at the time of open enrollment, because I even- I didn't know this. And we, we were all experienced CFP®s and we didn't all fully understand why that was such a huge benefit. Our employer was giving us free money, to pay for future healthcare costs and I think that's the biggest misunderstanding people have about HSA plans is they see that high deductible and they think my deductible's $6,700. If I were to judge based on that, why would I want to spend $6,700 on healthcare? All that really means, the deductible, it's just like your car insurance. That's how much I'm willing to front before I get any help for my insurance. And so of course, it's cheaper for me to buy that coverage. Instead of thinking of it as like I'm putting myself on the hook for all of these potential expenses, think about you're paying less upfront in the premium and paying more for your healthcare when you actually consume it. And so that $6,700, yeah, that's a lot of money. I happened to come into that choice with a robustly funded health savings account because for years I was putting the money that I was saving on premiums into my HSA; not spending it even when I incurred expenses.

[00:05:08] We'll talk about that, right? And so then this year, April rolls around. I needed my gallbladder out. Learned an important lesson. And one of the keys to using HSAs is understanding how healthcare pricing works. And much has been written and there's a lot of opinions and they're very- most of them are founded in real life experience of getting price gouged.

[00:05:31] But there is a law out there now that requires healthcare plans to provide price transparency. So I could actually have shopped around for my gallbladder removal on my insurance's website. I failed to do that before I scheduled the surgery. I was already well into the process. So I went through a local surgeon who performed the surgery at a hospital.

[00:05:50] I got to my out of pocket maximum of $7,050 in April. So painful- I paid $7,000 for my own healthcare, plus the 300 plus dollars I'm paying per month for my insurance this year. That was an anomaly. I'm still choosing the HSA eligible plan next year. I only have one gallbladder. 

[00:06:09] Cynthia Meyer: Great. And (What is the most important reason to have health insurance?) the important thing that I want to interject here for anybody who's listening who might not be clear, is that once you've paid your deductible and your out of pocket maximum, right? Then there is zero costs to consuming healthcare services going forward. So God forbid if you got hit by a bus or something, you're still covered. We all need to make sure that we're covered at a minimum, for catastrophic events like that.

[00:06:34] Kelley Long: Exactly. Yeah. Good point. Yeah, so going back to your original question, what do we need to know? So deductible- the amount of money that you're going to pay before you get any type of coverage from your insurance. 

[00:06:43] And then there's typically a co-insurance amount in these types of plans. And that's just- and usually you'll see it as a percentage, 30 70, 20 80. All that really means is that's the percentage that your health insurance will cover the next cost. So let's say I go to my primary care and she charges a hundred dollars per visit. Before I pay my deductible, I pay that hundred dollars out of my own pocket. I can use funds in my HSA. Preferably, I have my savings account; I pay them out of there. I leave the money in my HSA to grow tax free for the future. I save my receipts. But let's say then I've met my deductible and I have a 70 30 co-insurance. What that means is the next time I go to the doctor, same thing, I'm just going to get a bill later. Instead of for a hundred dollars, it's going to be for $30 because my health insurance paid 70% of it and I'm on the hook for 30. And then those dollars keep adding up. The health insurance companies continue to add up. You look at your explanation of benefit, it'll tell you your progress. And once you meet what's called the out of pocket maximum, so for me, when I spent out of my own pocket, a total of $7,050, then everything going forward is covered.

[00:07:46] And so, I was fortunate enough that I hit mine in April. And so, I've actually taken advantage of that and I had to have a- I went to see the dermatologist, which I normally do, but had a- not necessarily elective, but there was a spot that he was a little worried about and would've cost like $500. But since I was at my maximum, I was like, "Take it off."

[00:08:04] I'm having a sleep study done this week that's fully funded by my health insurance; in office. That's an elective thing. I don't have sleep apnea, but I have had some sleep issues. Why not have United Healthcare pay for that?

[00:08:16] I'm seeing a nurse practitioner who performs chiropractic on lower back pain that's fully covered; every visit. Getting to your out of pocket is painful financially, but if you have that cushion, because the prior years when you were healthy, you were still electing these plans and taking advantage of the opportunity to put that money into that health savings account, S is the key word there.

[00:08:36] I had the $7,000 and so this wasn't a financial disruption to my family or the rest of our plans for the year. 

[00:08:43] Cynthia Meyer: Yeah, because I think we've seen, especially when we were both working in employee benefits, and (Is the lowest premium plan always the right plan?) people would often choose the plan with the lowest premium cost, which might not necessarily be the right plan for their family.

[00:08:55] So for example, if you have a large family and you have a lot of kids and they all play sports, right? Then yeah, maybe an HSA plan might not be the best thing to do, right? Statistically, the chances that somebody is going to have to go to the emergency room, for example, are just much higher, right?

[00:09:11] There's more people in your family and they don't even have to play hockey for that to happen. 

[00:09:16] Kelley Long: And that- I actually, Cynthia, I think that's one of the things that we should talk about is, you can elect in and out of these plans and keep the same HSA. 

[00:09:25] Cynthia Meyer: Oh, good point. 

[00:09:26] Kelley Long: So a mistake that I made early in my career was I elected the HSA eligible plan one year with my employer. They put some money into my account that kind of offset those first dollars. Besides paying my premium out of my paycheck. In that year, I didn't really have a lot of healthcare expenses. Technically, my employer paid for all my expenses because they were putting money in my HSA for me.

[00:09:45] But then the next year, I knew I was going to have some health events and so I elected a lower deductible plan that had more copays where I just paid a fixed dollar amount every time I went to the doctor. My prescriptions were a fixed dollar amount instead of just paying the full price. And I drained my HSA because I was thinking, I'm not on that plan anymore. I should spend this down. And I've heard really smart people tell me that, Oh, I went off the HSA plan, so I went ahead and got Invisalign this year, used my HSA dollars. You'd be so proud of me. I'm like, no, I should have saved that money because three years later, I went back on an HSA eligible plan and I had to start at zero.

[00:10:19] I missed opportunities throughout my twenties and thirties to build up some funds that would've helped with things like my husband and I went through fertility treatment and at the time, not either of us had any type of health insurance coverage, and so it was out of pocket in the neighborhood of, I would guess, 30 to $40,000. If I would've been taking full advantage of HSAs throughout the years that I didn't because I- pure ignorance, I could have had that money set aside and then suddenly we had to sell stock. I'm in a privileged place where that didn't cause us a financial hardship and we were able to go about that.

[00:10:53] But I think of all of friends of mine who weren't able to pursue fertility treatment because they didn't- they couldn't afford it. They also could have been electing this savings option. Particularly, if your employer's going to put money in the account for you, it's like that match in a 401k. And then again, pairing that with smart healthcare consuming decisions during the years when you may not need that. So don't ever swipe your HSA card to pay a bill unless you would have to put- carry a balance on a credit card. 

[00:11:24] Other smart ways to go about spending is a really simple one, and a lot of people know this, shop around for prescriptions. Let's say you go to your primary care physician, they charge you a hundred dollars. You think you have bronchitis. They want you to have a chest x-ray. So first of all, shop around, find out where the cheapest chest x-ray is.

[00:11:42] Don't just go to the ER. Don't just go to urgent care. There might be a radiology center that charges less. If you haven't hit your deductible yet, you're going to have to pay for that; you can shop those prices. 

[00:11:53] Cynthia Meyer: How do people shop those prices? Because I think people are just confounded by how would you even go about doing that?

[00:11:59] Kelley Long: Honestly, it depends on the facility. Some facilities you could call right up and say, Hey, I have this health insurance; what would you bill me? Or what did they allow as billable? Because when you have an HSA eligible plan, especially before you've met your deductible, essentially that's a discount network.

[00:12:14] So the doctor can or the provider can bill whatever the heck they want, but the insurance company says, This is what you can actually charge. My gallbladder removal was billed at like $33,000. But United Healthcare said no, you can only charge 7,000 for that. You could call the facility, but these days because of these new price transparency rules, you can go onto your insurance website. So log in as a member and search for the service or facility you're looking to see. When I was, again, going back to my example of the gallbladder after it was too late, I decided to do that research and I found that there was a surgical center in my community that would've performed the surgery for $1,500.

[00:12:55] So use your healthcare plan's website- can be hugely informative for that. 

[00:13:00] If you're in an emergency situation, you might not have the luxury of doing that. So ahead of time, it is smart to get a sense of what the ERs are around you, which ones are in network.

[00:13:11] Even among different in network facilities will charge different prices. This is a topic of great debate. There are innovative companies out there trying to solve this. But there are certain hospitals that are going to charge a higher cost, and those tend to also be the hospitals that don't work with you on payment plans and they're quick to sue you and garnish your wages.

[00:13:33] There's horror stories out there, and so if you are electing a plan that might put you at greater financial risk, should an unexpected health event happen, do some research ahead of time of the facilities around you. I have the choice of three hospitals to go to in my community and I've done this research because two of them are notorious for just quickly going to collections.

[00:13:58] They don't offer payment plans, but the third one, it's affiliated with the university. If I were to incur a high bill, they automatically offer me a payment plan. And so, that would be the one, if I had a choice, I would go to in case of an emergency. So that I wouldn't find myself with financial stress in addition to healing from some type tragedy or accident. 

[00:14:19] Cynthia Meyer: So it sounds like the takeaway here is, even though this doesn't come naturally to any of us, is to understand the healthcare- the health insurance benefit that we have. Whether we're paying through it through healthcare.gov or our state healthcare exchange, or whether we are getting it as an employee benefit or something we're paying it for in our own businesses is to really understand, every year, what is it that you actually have as a benefit, right? 

[00:14:46] I know this is before I met you, my youngest son was in the pediatric ICU for about eight days and luckily we had very robust health insurance at the time and it covered most of it because it was almost a hundred thousand dollars; the bill.

[00:15:00] But afterwards, like for six months afterwards, we would get these little tiny bills, right? $35 for something that wasn't covered by the healthcare plan or like $750 for the respiratory therapist who wasn't for some reason, was not included and it was so confusing after what had been a very stressful time. I can't even imagine trying to do if you were the person that was really sick, right? A lot of folks are dealing with this after Covid, or had COVID related charges and they're still trying to dig through that.

[00:15:31] Kelley Long: Yes. And that's the criticism of our current healthcare system. I've read countless stories of people who ended up with a bill that didn't make sense. They couldn't get an explanation. They got the runaround from the insurance; from the hospital billing and they ended up just paying it because their credit was being wrecked. And that's a tragedy. That's just such an unfortunate situation. And I guess that's where at least having these HSAs thinking of it as part of your emergency plan can guard against those types of scenarios being so painful.

[00:16:02] There are just, are so many cases where the hospitals are kind of almost breaking the law to a certain extent. It tends to be hospitals that are the ones that are inflating and being super- unreasonable or aggressive. And so that's where some of that research can come in.

[00:16:17] There is some help in from a like regulatory perspective coming down and there are people inventing new ways of doing healthcare. I think that's the biggest thing is we need to not think of the healthcare industry, particularly for emergencies and hospitals the same way you did in the nineties.

[00:16:33] When I fell and broke my wrist; well my mom didn't think I broke my wrist. She thought I was being dramatic. Will it make you feel better if we go to the ER? So I remember riding to the ER and it was like $50 for her to take me in, get an X-ray, find out I'd be a lot more than dollars now.

[00:16:48] And they often don't even do anything for you at the ER. They send you to an orthopedic person. And so understanding that like, I knew that when I fell on the stairs and potentially broke my ankle a couple years ago. And so rather, calling 911 and going to the ER, I called an Uber and went to the closest urgent care that had an x-ray machine and paid $130 to find out that I had not broken my ankle. 

[00:17:12] Cynthia Meyer: Thank heaven. Thank heavens. So can I give you a couple of examples of kind of general situations and how would you coach that person to make their healthcare- what kind of questions would they ask? Yeah so let's take somebody- let's start with somebody who has some kind of a chronic illness, right?

[00:17:30] So something that requires, as you mentioned, expensive medication or maybe they need a lot of regular tests or they're at higher risk for being hospitalized. So if there's somebody in your family with a chronic illness, what kind of questions should you be asking? 

[00:17:44] Kelley Long: So the first thing would be making sure that you have a specialist in network that you have a relationship with. And even if you don't have an acute need to see that person, make sure you're an established patient with that person. So for me, that's a hematologist. And then, whatever types of testing might be needed as things come along, shop around in your network. Start on your insurance's website.

[00:18:05] So for me, I regularly need ultrasounds of my leg veins to find out if I have blood clots. So I have found a radiology center in town that's in network. Super easy to schedule, very inexpensive compared to going to the ER. So if I think I might have a blood clot, I try to get on the schedule at the radiology place first and pay their prices versus the ER and which is going to be a hundred thousand percent more expensive.

[00:18:31] And then from the medication perspective, if you have private insurance and you have to take a medication that is brand name only, like I do, most manufacturers offer some type of discount. Ask your prescriber, is this the only option to treat this? So I had three different medication options to treat my chronic blood clot condition. One of them is more expensive than the other, and the third one has too many side effects. The more expensive one has a manufacturer program, which I asked about at the pharmacy. I chose that one because it's one a day versus two a day; there's a lifestyle perspective.

[00:19:07] But then when that benefit runs out every year, I am on the hook for paying the roughly $500 a month that is charged. But that's something that the price varies by pharmacy. That's when I go to GoodRx and I put in my dosage and I put in my medication and I put my location and it shows me the different prices of the different pharmacies around within a 25 mile radius. And then, I call my doctor and say, I need you to transfer, or I can either transfer it myself or have the doctor prescribe it to this particular pharmacy. I do that with any medication. I take Adderall which is like $4, but it can be 12 at CVS versus four at my local Kroger. All that stuff you can easily shop and GoodRx is the most common. The one thing is if you do use a GoodRx coupon, that often doesn't apply what you spend towards your deductible. It's just a matter of finding the- want to stay in network so you benefit from the discount. 

[00:19:58] If there isn't anybody that is in network nearby, then there are rules that say that your insurance has to cover at least their in network cost and at that situation, so this often happens with anesthesiology. When you have any type of outpatient procedure, even in a hospital, oftentimes, the anesthesiologist is a contractor who comes in, they're out of network. Your insurance will- sometimes you have to ask ahead of time and arrange this, but they typically are required to pay what they would pay if that person was in network because in most communities there's not an anesthesiologist in network. That's just not how they work; they're like ambulances. 

[00:20:33] But then the anesthesiology company will often do what's called balance billing. So let's say...

[00:20:38] Cynthia Meyer: Try and bill for the remainder of what their rack rate is, so to speak. 

[00:20:42] Kelley Long: Yeah. And that's, unfortunately, that's totally legal.

[00:20:44] I've been in multiple situations where I've been had an out of network anesthesiologist and I've dealt with it different ways depending on the procedure. So when I was going to the fertility, the anesthesiologist was going to be a certain price if I ran it through my insurance, which I knew they would still balance bill me or it would be a lower price if I did self pay. 

[00:21:03] Cynthia Meyer: And you just negotiated yourself one to one with how much it was going to be.

[00:21:07] Kelley Long: So oftentimes, if you're seeing someone who's out of network or if you have a low- a super high deductible and you have low healthcare needs, and even if you're seeing someone in network, like my psychiatrist, I have ADHD so I see her twice a year for med management.

[00:21:20] She charges me $115 self pay, or 140 to run it through insurance. So if I think I might be meeting my deductible, I'm going to have her run through my insurance and pay that extra money. But if I'm like, it's October, I'm not close to my deductible. I'm like, self pay, baby. So even just asking at the desk, what's your self pay rate? Especially for those more less emergency type things, can help you to save the money because the key is to let your HSA build up. So that if you do have a large health event where you're not as in control, you're not as able to do that research, it's not as painful. But ideally when you retire, you have this large tax free pot of money to pay for the biggest wildcard that last third of your life, which is your healthcare. Your HSA can be used for things like Medicare premiums, long term care insurance. So it's just a great- or you can reimburse yourself for those past expenses. 

[00:22:08] Cynthia Meyer: (Will an HSA plan work if I have a chronic illness?) Even the person or the family that has somebody with a chronic healthcare condition where they know they're just going to have some out of pocket costs no matter what every year, that person could still benefit from an HSA plan if they manage their cash flow wisely enough so that they can cover those deductibles and co-insurance up to the out of pocket max with other cash, while they invest their HSA and let it grow. 

[00:22:33] Kelley Long: Yes. And it really depends on the consumption. Somebody with type two diabetes, totally different needs than someone who's going through cancer treatments. In that case, the HSA eligible plan just doesn't make sense. That's what the more robust health insurance is for. 

[00:22:46] And so I do want to acknowledge that this conversation is very ableist. For people who live with MS or chronic cancer that unfortunately, that's HSA points are not right for you. 

[00:22:58] Cynthia Meyer: Where could somebody who isn't sure if they should choose an HSA plan or just a normal deductible plan with whatever deductible they think is appropriate. What are some resources that they can use to try and figure it out? 

[00:23:12] Kelley Long: Typically, if you work for a large company offering benefits, they usually have some type of benefit selection tool. The key there is you have to have a good estimate of what your expenses are. So look back at your calendar; try and jog your memory.

[00:23:24] How many times did we have to go to the doctor? Did we need to go to that provider? Could we have gone to somebody who was less expensive? And have those numbers ready to plug into these tools.

[00:23:35] From a healthcare.gov perspective, little known fact, especially if it's healthcare.gov, I'm not sure about the state only exchanges, you can call them. The people are actually really helpful. I have an acquaintance who left her job as a teacher and was just swimming in all of the options and completely overwhelmed. She picked up the phone and called- and she's a millennial, and she's still called the 800 number. Spoke to a rep and the person helped her find a plan that was pretty much identical to the one that she had left in her job that was completely affordable. That is a resource that a lot of people don't think of. They assume it's the government, it must be red tape. But you may be able to find personalized help just by picking up the phone. 

[00:24:19] Cynthia Meyer: So let me give you another example then. So let's take that, 25 year old, a 20 something. As far as they know, they're in good health, right? Their mom has been nagging them to make sure that they have health insurance, right? Which is a good thing to nag about. They may if- unless they have an accident or an unexplained illness, right? They may not use their healthcare providers very much. How should they be thinking about this? 

[00:24:45] Kelley Long: That's the perfect case for defaulting to HSA eligible. There are going to be cheaper plans that are not HSA eligible, but default to the HSA eligible. Just be super clear on the rules around using the service. Because if you have an Affordable Care Act- what's the term I'm thinking of? If you have an Affordable Care Act compliant plan.

[00:25:07] Cynthia Meyer: It's called a gold, silver, or bronze plan, right? It talks about how much your co-insurance is going to be. 

[00:25:12] Kelley Long: That's correct. Those are required to provide you with preventive care for free. So, you still need to select an in network primary care provider. I would look for a nurse practitioner versus a MD. They're often more personable as providers. But also use it for- be aware of the things that are covered and then use the difference in premium from what you would pay for more robust coverage. Do the math that way to figure out how much you could afford to put into your health savings account. Particularly, if you're doing this through one of the exchanges, you get to choose your HSA provider. I would strongly suggest- there are websites like Nerd Wallet and Bank Rate, I believe.

[00:25:54] There's another one that I can't think of that ranks HSA providers and that's the simplest place to look for where to go. I personally, my criteria has to do with paying no expenses to invest my funds; earning a little bit of interest on any cash, because I do keep some cash in my HSA.

[00:26:10] Cynthia Meyer: In case you need to spend it. Yeah. 

[00:26:12] Kelley Long: Yeah. And now if you're choosing through your workplace, then they typically choose the HSA provider so you have no choice but you can always move those funds to another HSA, maybe mid-year. Once you've got some money in there, once a year you can do an indirect transfer where you just cut a check for the full balance. Within 60 days put into your new HSA and you can still keep your employers wanting to get your payroll deposits and stuff, but that's another way if you want to prioritize investing sooner than later at a low cost; that you don't have to wait till you've left the plan or left the job to move the funds.

[00:26:43] Cynthia Meyer: How does managing your HSA fit in with managing your cash flow? 

[00:26:47] Two situations come to mind. One is somebody with ample cash reserves, right? They have a nice emergency fund. They have a high income, they're spending less than they make, right?

[00:26:56] So they could afford to have- typically even if there's a chronic condition in their family they have the ability to manage those costs outside of the HSA if they want to. And then there's the person that a family with a similar medical profile, but they're living paycheck to paycheck.

[00:27:14] So how would you think differently, like if you're coaching those folks, how would you treat that differently? 

[00:27:19] Kelley Long: If you're assuming that both my families have an HSA, I would suggest that both families pay their expenses using whatever their normal spending method is. Ideally, a rewards card so you can collect the rewards.

[00:27:31] Now, if you're the family that's living paycheck to paycheck and you would have to carry that balance, but you have the money available in your HSA, then it makes sense to then reimburse yourself from the HSA. So you're basically taking those dollars and cleansing the taxes off of them. Kind of similar to using a flexible spending account. 

[00:27:48] Common expenses that most of us incur that we don't think of as HSA eligible expenses are things like menstrual products or BAND-AIDs® or sunscreen. You're buying those things.

[00:27:57] Cynthia Meyer: You're not going to the dentist if you don't have dental insurance. Yeah. 

[00:28:01] Kelley Long: Yes. Going to the acupuncturist. Chiropractor. It doesn't have to be something that your insurance covers to be an HSA eligible expense. Just in that perspective, I would find some filing system for your receipts.

[00:28:13] I personally use a spreadsheet. And I do a tab per year. I maintain the spreadsheet for my own sanity, but you could just keep a shoebox of receipts. But basically, that's a backup emergency fund. 

[00:28:22] Let's say you are the family that's living paycheck to paycheck and you're saving all your receipts for your sunscreen and your condoms and all of the expenses that you're already incurring, and then you have a large family expense. You need new tires on the car. Costco says it's going to cost $600 and you don't have $600, but you have $600 in your HSA and you have $600 worth of expenses previously spent that you hadn't withdrawn. Pull that money outta the HSA, save yourself the debt. So it's a backup emergency fund even for regular life, because we are incurring eligible expenses without even thinking about it. 

[00:28:54] A great resource for that is- there's a website called HSA store.com. Anything that you could buy is on there. Great resource also for people who have a flexible spending account year end coming. They haven't spent all their money. Use it or lose it. Go on that website, find out what you can buy and head down to your drugstore and stock up on things. A lot of people don't think about those- particularly those kind of ancillary healthcare services; that seem to be elective your insurance doesn't cover but you are engaging in seeing a naturopath or in some cases even some type of massage therapy, depending on how the- physical therapy that's no longer covered by your insurance. That stuff's still HSA eligible. So ideally save the receipts, let that money build up for big expenses. But you can always reimburse yourself the next day or in 30 years. 

[00:29:39] Cynthia Meyer: That's right. So yeah. As long as you were covered by an HSA plan at the time you can- at the time you incurred the expense. 

[00:29:46] Kelley Long: That's not true. The only time it matters that you were covered by an agency is when you're making a deposit. Once the...

[00:29:51] Cynthia Meyer: Got it.

[00:29:51] Kelley Long: ...in there, it's eligible for any future expense. So I always- even if you're not covered by an HSA plan...

[00:29:57] Cynthia Meyer: Yeah, in the future- like your kid gets braces and has them much longer than you expected. 

[00:30:03] Kelley Long: I like to tease young people who are just starting their careers; maybe like just fresh on the world. Okay, you would need to start saving money for children you're going to have with someone you haven't even met yet.

[00:30:13] Because you can use this money for their expenses. You have this coverage because your employer's providing it. Sock that money away. Save money on taxes. Get some investment growth going. It's just a powerful tool. A couple years of solid deposits with investment- decent investment returns you could have two digits before your comma in your account balance and that's a huge safety net. It can help you leave a job that you hate without having healthcare coverage. You can pay for COBRA...

[00:30:40] Cynthia Meyer: The 18 months where you can stay in your company's healthcare plan after you leave a company. You can pay for that with your HSA funds if you need to. 

[00:30:49] Kelley Long: Yeah, that's correct. The number one reason people, as you probably recall from all those phone calls we used to take, the number one reason people borrow from their 401k, it's for medical expenses.

[00:30:59] Wouldn't it be great to have that in a tax free account that you can withdraw? No penalties. No interest. No pain. 

[00:31:06] Cynthia Meyer: Before we finish up here, I just want to ask you because I have come across this a lot, particularly in certain regions of the country, is people have health sharing and not health insurance. I personally think it's a huge problem and I'm wondering what you think about it. Because a lot of those folks are like, Hey, I'm healthy. I don't need to pay in total insurance premiums. I'm participating in this health sharing plan. That should be enough.

[00:31:30] Kelley Long: I had that same opinion and I did a little bit of research on it because I wanted to be balanced. Health sharing plans are not health insurance, first of all. So, if the mandate ever comes back, you will- it won't qualify. If you were to live on a co-op and you all pull your money and you buy food as you need it. If you understand that it's not going to cover things like preventive care- I read an example of a man who took his family for their regular immunizations. He had four kids. They all went in, got their shots, got a thousand dollar bill. Because that is mandated to be covered by Affordable Care Act plans, but this is not health insurance.

[00:32:03] And so he thought, Oh shoot, if I would've known that, I would've gone to my county health department, which might have been even free. So you have to just be a lot more clear on what's covered. You can't Google it because what you're going to find out there is what health insurance offers and it's not health insurance.

[00:32:19] So the people that I know that love these are people that are- they're healthy. They're also very aware that if they have an illness, they're going to be on the hook for the cost. 

[00:32:28] Cynthia Meyer: Right. Or an accident that isn't covered by an auto insurance or a worker's comp or something like that. That's what makes me the most scared is the reason to have a basic level of insurance is so that you don't go bankrupt, right? If you get something, something really rare. 

[00:32:42] Kelley Long: Yes. Yes. So that's the risk that people take as the provider that you choose. Especially in case of an emergency, doesn't accept your health sharing plan- your health sharing plan won't cover. So again, If you're on this plan, I'm going to presume that you've done the research and you know that which hospital in your town will accept this plan. So if you have an emergency, you go there. Then your health sharing plan will pay your costs after you've paid your family share. 

[00:33:06] They're not ideal for everybody. It's usually- they're usually Christian based. You have to sign a thing saying I'm a Christian...

[00:33:11] Cynthia Meyer: ... and that you have a clean liver, right? Yeah. 

[00:33:14] Kelley Long: So, each plan has its own requirements... 

[00:33:16] Cynthia Meyer: Yeah. but I am not a fan. 

[00:33:16] Kelley Long: ...to use them. There's a risk tolerance aspect of it. If the alternative is no coverage, at least having some potential help would be better. Understanding that like the most likely healthcare services that you're going to use are probably- you're probably going to pay for them out of pocket. This is really not the catastrophic coverage that you think that it is. . 

[00:33:35] Cynthia Meyer: What are you most curious about right now? In general?

[00:33:41] Kelley Long: In general or around...

[00:33:43] Cynthia Meyer: Either. Maybe around healthcare and then in life. 

[00:33:46] Kelley Long: In healthcare, I'm most curious about what I don't know about all of this pricing. I have my strong opinion about using healthcare plans that allow you to- couple with the HSA but I'm learning more and more about how that still backfires.

[00:34:03] I'm reading a book called The Price We Pay, which is a really enraging book about a physician who has toured the country and found all these abusive practices. I'm pretty passionate about advocacy in this area and so, just continuing to collect stories. 

[00:34:17] Generally speaking, what I'm curious about is is mental health stuff. Most of the work that I do one on one with clients, delves pretty closely into what's going on in your brain with emotional spending, and there's usually some other therapy based need that's there. I've been taking classes that therapists take for their CE as opposed to just getting a license. I don't really want to be a licensed clinical therapist, but I do want to make sure that I'm practicing ethically when I'm talking to people about what's coming up for them when they go to Target even though they know like they're in debt. It's been really interesting to learn more about trauma and even just how we project our own stuff onto our clients and transference and all those like clinical terms that therapists use. That's where I am spending a lot of my energy these days. 

[00:35:04] Cynthia Meyer: Kelly has a really interesting course, right? And it has a great title. Do you want to tell us a little bit about?

[00:35:11] Kelley Long: Sure. I have a coaching program called, "Find Your Financial Bliss™", and it's a five phase program, in the acronym B.L.I.S.S.. We begin and kind of level set and then and I'm going to have to look at my curriculum, which is on the wall.

[00:35:23] L is for "looking within". We explore our money stories. Why we are the way we are, and then we talk about what's possible. It's possible where we learn some techniques for changing our money stories, for motivating ourselves, for overcoming those bad habits that have kept us where we don't want to be.

[00:35:39] And then, only then, do we get to the specifics. That is when we talk about whatever money question you have. Do you want to learn how to invest? Do you want to figure out how to save more for retirement? Want to get your mind straight? Because some of the stuff that we might be suggesting, we know that one of the biggest problems with financial planning is people don't change their behavior.

[00:35:56] We can say, Oh yeah, you're on track as long as you do this and then they don't do this. So I want to set the stage for that first, and then the final phase is just settling to bliss and creating some routines and habits to stick with it. At this point it's a three to six month program that involves, six one-on-one appointments with me to go through it and then it's an online learning and exercises and worksheets. It is a commitment, but it's really fun work and I've seen the most incredible transformations among my clients. It like makes me cry to think about it. Clients expand their business. I had two clients buy new homes. I had another client pay off all our debt and redo their kitchen. These are all things that they didn't think they would ever do. 

[00:36:35] Cynthia Meyer: That's absolutely marvelous. So where can people find you online? 

[00:36:38] Kelley Long: My website is financialblisscoach.com or you can just Google my name Kelley C. Long and all over the internet. I also regularly write for the the Journal of Accountancy on Personal Finance.

[00:36:48] Easy ways to access some of my financial planning insights without having to get on my calendar. 

[00:36:54] Cynthia Meyer: Yeah, I would love to drop in some of my favorite blog posts of yours. I remember you wrote one a few years ago; had to dispute a medical bill. I think. I have a couple of my Kelley favorites that I'm going to stick in into the show notes.

[00:37:06] So Kelley, thank you very much for this conversation this morning. I feel like we could talk about it for ages and ages and I have no doubt all this work that you've been doing to try and make to try and coach people to make better healthcare decisions and to be a more proactive consumer in a way that is doable, right?

[00:37:26] Doesn't feel so completely overwhelming, right? With simple hacks. Things to do. Ways to think about it. I'm looking to see what you do with that, right? Is it a book? A TV show? 

[00:37:35] We'll see. 

[00:37:36] Kelley Long: I can. I don't know. 

[00:37:37] Cynthia Meyer: Nobody has TV shows anymore. It's on the internet. Thank you very much.

[00:37:41] Kelley Long: Thank you for having me. 

If you like this video podcast, consider joining Real Life Planning’s Question of the Week where CERTIFIED FINANCIAL PLANNER™ and rental property business owner Cynthia Meyer answer the most common questions about real estate financial planning directly to your inbox each week.

This blog is for general financial education purposes. Information contained in this blog should not be construed as financial, tax, real estate, legal, or investment advice. For educational purposes, blog posts may contain links to other websites which are not under the control or and are not maintained by Real Life Planning. Real Life Planning has provided those links for your convenience but does not necessarily endorse all the material on those sites. Please consult your financial, real estate, legal, or tax advisor for advice specific to your situation.