DEAR IDA: I’m a 42-year-old single mom with what everyone keeps telling me is a “good job,” but I’m still living paycheck to paycheck. Between rent, groceries, and my car note, there’s nothing left, and now my health insurance premiums are going up again this year. I just skipped a doctor’s appointment because I couldn’t afford the copay, and I’m scared this is how people end up one emergency away from disaster. How do I protect my health and my kid’s future when I can barely afford today? – ONE BILL AWAY IN TIOGA

Fair warning, this is a tough-love response.

DEAR ONE BILL AWAY IN TIOGA:  Worrying about being able to afford health care in itself can cause a rash of health issues. If an employer offers insurance coverage but it requires high deductibles, copays, or out-of-pocket maximums, it can feel more like a financial burden than a blessing. Employees may also be stuck with a policy that their doctors aren’t in-network, driving out-of-pocket costs even higher. According to the website KFF.org, health care costs and the prospect of unexpected medical bills rank as the top financial worries for adults and their families. The site also reports that nearly two in ten people polled reported that their health got worse after skipping or postponing care due to cost.

By skipping appointments, you may be exacerbating your situation and pushing yourself closer to the financial cliff you fear. Rather than skipping appointments, explore your options for telehealth appointments. The website everlywell.com has a great article about the advantages that telehealth offers. Also, check to see if your insurance provides an incentive program for completing certain health-oriented activities. By completing qualifying tasks or goals, you could be building up the cash reserves you need to be able to afford your copays.

It sounds like it’s time for you to schedule a financial wealthcare appointment with yourself. Prepare a budget and put your healthcare costs in the necessity column.

Check the local rental websites to see if more affordable options are available for housing. Downsizing might be a difficult but necessary decision. I encourage you do to the same for your vehicle. Consider downsizing to a more affordable model or explore your refinancing options if you are stuck in a long-term, high interest rate note.

Go through your credit card and bank statements to see if you have subscriptions or auto-renewal charges that can be eliminated. Check with your phone and Internet providers to see if more affordable plans are available.

Plan your meals weekly. Make a grocery list and stick to it. Check to see if any of the items on your list are on sale and break your list up by store according to sale prices. See if there are any digital coupons available and do a price comparison for generic versus name brand items. If you have a friend with a warehouse club membership, see if they are willing to go in “halvsies” for your kitchen staples, like meat, milk and eggs.

If transitioning to a better paying job with better health insurance benefits is not an option, explore picking up a side gig or second job.

Finally, do your homework on your health insurance options. Just because your employer provides health insurance, it does not mean that you have to accept it. The website legalclarity.org has a very informative article on this topic. If you are self-insured, make an appointment with a reputable insurance agent to explore your options. You likely won’t be able to make any changes until open enrolment season but you will at least be prepared for when that time comes.