Michael In the USA, it is quite common for people with good health insurance to pay for certain services themselves. I'm not just talking about a $10 copay, but amounts that the patient often pays as a deductible under their contract or services that the insurance company excludes from the outset or covers only to a small extent, such as dental crowns. Over the course of a year, these costs can easily add up to hundreds or even thousands of dollars, and with a trick, you don't pay taxes on them. In California, if someone earns a high income, that can quickly be 30 or even 40%, as we explained to you in Rundbrief 11/1999.
To save on taxes for medical services, companies often offer their employees a so-called "Flexible Spending Account" (FSA). The employee deducts a fixed amount tax-free each month and uses the money exclusively for medical expenses. The participant then receives, for example, a card with the VISA emblem, which they can use like a credit card to pay at the doctor's office, in hospitals, or at pharmacies and drugstores. To ensure everything is correct, every bill must be faxed to the FSA provider, who then authorizes the payment.
The process, however, has a catch: any deposited money must be used up within the calendar year, or the FSA user loses it completely. This often leads to people hastily buying new glasses or stocking up on large quantities of band-aids at the end of the year. It is also advisable to keep proper records so that you can squeeze out every last cent of available money from the account at the end of the year.