When the “Right” Financial Choice Feels Wrong
What plantar fasciitis taught me about my own financial advice.
I.
For a few months last winter, I’d wake up each morning dreading having to get out of bed. Not because it was cold and rainy but because my feet hurt.
My athletic friends told me that I’d likely developed plantar fasciitis so I bought some Hokas and ignored it for a few months hoping it would go away.
Unsurprisingly, it didn’t. I stopped running and while it improved, I still wasn’t back to normal. I needed to go see someone about it, but I knew it would cost me so I put it off.
As a self-employed financial planner, I purchase my health insurance from my state run ACA Marketplace. I choose a high-deductible health plan (HDHP) that allows me to contribute to a Health Savings Account (HSA).
For those unfamiliar with HSAs, many financial planners are obsessed with them, and here’s why:
A Health Savings Account (HSA) offers a triple-tax advantage, meaning your contributions are tax-deductible, the funds grow tax-free, and withdrawals for qualified medical expenses are also tax-free. Unused funds roll over each year and can be invested for long-term growth, allowing the account to double as a supplemental savings vehicle.
In order to contribute to an HSA, the plan has to meet the requirements to be considered a “high deductible health plan” which means the out of pocket costs are intentionally higher. The general idea is that you can use the money in your HSA to help pay for the costs.
But the financial planning opportunity is to pay from cash flow, invest the funds in the HSA, and let it grow. My friend and fellow advisor Jake Northrup of Experience Your Wealth wrote a great post about how to better take advantage of your HSA here.
But this is not about why HSAs are great. It’s about how hard it is to pay for high out-of-pocket medical expenses that you weren’t expecting.
And how, at this junction, my own financial plan no longer worked for me.
II.
I did have a plan for unexpected medical costs. My emergency fund includes enough cash to fully cover my $8,050 out-of-pocket limit. But in my head, a medical emergency looked like a bad ski accident or car crash, not an overuse injury.
I’m a bit embarrassed to admit this, but I didn’t build non-emergency health care spending into my regular budget because, till now, I’ve been privileged enough that I haven't needed to. As a relatively healthy woman in my 30s, I don’t really go to the doctor that often. Preventive care was covered and I figured that if I ended up in the emergency room, that’s what my emergency fund was for!
The problem here is not a lack of money, but that I didn’t expect to have *feelings* about paying for non-emergency care.
I felt reluctant to go to the doctor and spend money on it, and irritated that my body needed more help to recover. Lastly, I felt embarrassed that I didn’t anticipate these costs in the first place!
Eventually, I went to the podiatrist ($$$) and bought inserts ($) and then after much metaphorical and literal foot dragging, I went to Physical Therapy ($$$).
After a few months, I started to see improvement. My Physical Therapist gave me exercises to do which I could track in an app and I thought, “Great! I can stop going now that I’ve got a handle on it.”
Flash forward to the spring when I traveled to Europe for three weeks, didn’t bring my Hoka’s, did my app exercises once, and somehow also developed a knee injury.
I came home in pain and even more disappointed in myself! But I was also not surprised. Working with a financial planner is commonly compared to working with a personal trainer. You get better results when someone you trust is holding you accountable. The partnership, accountability, and personalized guidance is what actually helps you follow through. (Now I can confidently tell clients that metaphor is true from personal experience).
III.
Even though I’m a financial planner, max out my Health Savings Account, and have a healthy emergency fund, it still felt bad to pay for medical expenses out of pocket.
I tell my clients all the time that if a High Deductible Health Plan is going to make you less likely to go to the doctor and you value prioritizing your health, then that’s not a good fit.
And yet here I was, hesitating to spend money on my health!
That’s a misalignment of my financial plan, my values, and my life. The "mathematically optimal" HDHP created an unintentional behavioral barrier to seeking care and I fell into the very trap I warn clients about. At the end of the day this is not a math problem, it’s an emotional one.
But that’s okay! These feelings are giving me good feedback on my plan and part of the financial planning process is making space for things to evolve and change over time.
So what are my options?
Option 1 is to change the plan. I could switch to a plan with lower out-of-pocket costs next year to remove the mental barrier.
Or
Option 2 is to change my budget. I could keep the HSA plan but proactively build healthcare spending into my regular budget, like a gym membership.
I’m not sure which option I’ll choose yet but I feel better knowing I’ve at least identified the misalignment and have options to fix it.
In the meantime, you can find me back in Physical Therapy…
This was an awesome read Audrey! I used to have a high deductible plan as well and even if I had trouble with my ears and went to see a specialist it would be a crazy bill I’d have to pay back monthly. Adjusting my budget a bit and switching to another plan helped me a lot. Plus, it encouraged me even more to make sure I’m eating healthy and remaining active. It’s not a fix all, but it helps.💪💪❤️
I relate to this a lot. My physical health is very good, but my mental health struggles. My High deductible plan made me reluctant to go to therapy( $$$$), but I really needed to. I’m now meeting with a therapist weekly and blowing through HSA money, but it’s worth it. Also just not how I expected to use it.