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Zina Kumok; Derek Abella for BI
In 2018, I found out I had a BRCA1 mutation that would increase my risk of breast and ovarian cancer. I knew I wanted to get preventive surgeries — a mastectomy and a removal of my fallopian tubes and one ovary — to lower my risk.
While I worried about how I would choose the best reconstruction option or how long it would take to recover, my biggest fear was more practical: How would I pay for everything?
Eventually I figured it out. And though it's been more than five years since my last surgery, I remember how stressful it was to manage those payments. Now I'm a peer counselor with the organization Facing Hereditary Cancer Empowered.
I believe that how you'll pay for treatment is one of the most important questions to ask yourself. I did three things to make it work.
Right before I was scheduled to get my first of three surgeries in May 2019, I became a full-time W2 employee after years of being self-employed. I signed up for the highest-tier health-insurance option, the gold plan.
That meant my monthly premiums would be high but my out-of-pocket expenses would be low. I chose that on the recommendation of a nurse who told me that if you're having surgery, you're hitting your deductible. Choosing the gold plan would mean I'd pay less over the course of the year.
I also scheduled all three of my surgeries in 2019 so that I'd have to meet the deductible in only one year. My total cost for all three surgeries was $5,000.
Since I was self-employed for years before my surgeries, I opted for a health plan with a health savings account, a special savings account just for medical expenses.
I love HSAs because they're triple tax advantaged. Contributions are tax-deductible, even if you don't itemize your tax deductions. HSA earnings and withdrawals are also both tax-free, as long as you use the money to pay for qualified medical expenses. Fortunately for me, preventive surgery counted as a qualified medical expense.
I'd maxed out my HSA for several years before my surgeries to lower my tax bill. Now those savings were finally going to come in handy.
Though I wasn't on an HSA-eligible plan at the time of my surgery, I could still use the money in my HSA to pay for surgery. The money in an HSA stays yours no matter what kind of health-insurance plan you have; for many people, that makes HSAs better than flexible spending accounts, in which you have to use the money that calendar year or lose it.
After I got the bill from my surgeries, I contacted the hospital and asked whether it offered special savings if I paid my bill in full.
My old doctor's office gave me a 20% discount if I paid in full. But my new network didn't offer that — instead, it offered a 0% APR payment plan for up to 36 months. I could pay my balance over time with no interest charges, and there was no fee to sign up.
I signed up for that plan and chose my HSA debit card as my payment method. Every month the amount due would come out of my HSA account. Fortunately, I had enough in my HSA to cover my whole bill.
I also looked into my hospital's patient-assistance program. These programs are usually designed to help low-income and middle-class families pay for medical expenses. Every hospital has its own income limits and rules, and it never hurts to apply. Unfortunately, my income was too high to qualify.
My great-aunt, a survivor of breast cancer herself, gave me some money, which reduced my costs. I'll always be grateful for her support. And though some friends encouraged me to start a GoFundMe, I knew I couldn't do that since I had the money in savings.
