The Bottom Line, Part 2
Despite the comorbid conditions, Mary estimates that 70 percent of her family's medical expenses are ADD-related. From the time of David's diagnosis five years ago until Joe's diagnosis two years ago, the family's insurance covered fully 70 percent of their expenses. But due to a series of work-related changes, the family, who lives about an hour outside of Houston, no longer has such coverage.
After much consideration, Mary left her full-time teaching job at the beginning of 2004 and began tutoring in the afternoons and evenings instead. The move allowed her to be more available to her kids. Unfortunately, it also meant the family could no longer take advantage of the Flexible Spending Arrangement (FSA) offered by her school district, which they had utilized to its full extent annually ($2,500). Under her former employer's plan, "the pre-tax dollars we elected under the FSA were placed into an account, and we were given a debit card to use with that account as we incurred medical expenses," Mary says. "It was an excellent thing." The family decided not to take advantage of the FSA that husband John's employer offers because it requires that the family pay medical expenses upfront before being reimbursed from the FSA account.
To complicate matters, John's employer changed its health insurance options for 2005. "We are learning what will be paid for and to what extent it will be paid as we go, because we did not find out about the change until the end of December," Mary says. "Two HMOs were offered, and we chose the one that covered our pediatrician and our daughter's asthma specialists."
David and Joe see a psychiatrist every three or so months, an expense that is not covered under the family's new medical plan. After Mary's husband explained their situation, however, the psychiatrist agreed to give the family a 20 percent discount on each appointment. Mary reports. "He was very responsive to our situation." The boys' therapist, whom they see every other week for both individual and group therapy, accommodates the family by accepting their insurance, a plan her office has discontinued otherwise. "She does this out of the goodness of her heart," Mary says, "because she also has children with ADD." Unfortunately, under the new HMO, the family has a higher co-pay for the therapist ($25) than for its other doctors ($15).
Medication is another headache. The boys do best while taking Concerta; their HMO favors a generic medication. The result: Not only do they need a doctor's note each month stating that Concerta is medically necessary, but the co-pay for Concerta is higher than that for other ADD medications.
Yet, like many families in their position, Mary and John have found ways to manage. Thanks to a tax-preparation computer program, they learned that the costs related to their children's conditions bring the family's total medical expenses to more than 7.5 percent of their adjusted gross income annually, meaning they qualify for the Medical Expense Tax Deduction. As a result, they are able to lower their taxable income, and thus their taxes, by a significant amount.
Private schools in their area are cost prohibitive, so the boys attend public school. Their parents fill in the educational gaps with private tutors. To pay for tutors, Mary has devised money-saving arrangements such as employing the services of an astute high school student or swapping tutoring sessions with her son's teacher.
This article appeared in ADDitude Magazine.
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