Insurance Coordination

It’s the beginning of a new year which means all my work insurance limits reset. The primary number I’m concerned about is the out-of-pocket maximum which I believe is $3,400. Usually for each medical claim, there is a co-pay: $25 for primary care, $40 for specialists, 15% for hospital services, etc. I need to pay the co-pay each time until my payments for the calendar year hits $3,400 at which point insurance will cover 100%. I think dialysis is covered under hospital services. Here are totals from the January 2019 statement:

The first number ($30,703,23) is the cost without benefits or the MSRP. Second column ($22,413.46) is the plan rate or the rate negotiated by Blue Shield with my clinic. The third column ($19,176.95) is what my insurance paid, which means the balance is my responsibility. In February, the plan rate was $20,939.61 (probably less days than January) but I paid $0 because with the $3,235.50 that I paid in January and some other doctor visits, I’ve hit my $3,400 out-of-pocket maximum. I also paid $0 for the rest of the year for dialysis.

For 2020, I also signed up for the maximum amount on a FSA plan which is $2,700. This amount is a pre-tax deduction on my payroll so I will save about 1/2 of that on taxes. I can use the $2,700 on most medical expenses, including my share for January 2020 dialysis. But wait… I’m supposed to get Medicare starting 1/1/2020 with a monthly premium of ~$144. Medicare is supposed to pay for anything my insurance does not so it should pick up the 15%. In that case, I will then continue to pay co-pays for doctor visit (unless Medicare covers non-ESRD costs) and prescriptions. Knowing I can use the FSA money for my pending root canals and crowns that don’t count towards my medical out-of-pocket maximum, what should I do? Pay for January 2020 dialysis co-pay with the FSA or let Medicare pay? What about dental bills? If I continue therapy and start acupuncture, I will pay $40 co-pay for each session unless I max out. This is like a math puzzle. I think I need to sit down and calculate out each scenario and associated payments.