One thing you can do but might be to late this year..... sign up with FSA with your employer and get the whole amount upfront tax free. Of course each pay check will have a certain amount removed. But if you have been putting in 401K maybe you can stop that and start this for a year and be done with it all. That's what I did and it was great.

thanks and that is a great suggestion. The most I have ever been able to dedicate is 5K, I would be very surprised if I could dedicate 20K. I have been using the flex plan for years, but with another employer. I am working for large non-profit now and their benefit year is the same as their fiscal year- July to June. So, you are quite right, July would be the time to try the 20K. I think I will just be bummed if I have to wait another year, but it just might come to that. Thanks for the idea, hopefully, it will be my plan C.

20K You better start looking around that is out of line.... I wanted to go to Mexico but my wife stopped that.... I found Dr Thomas Umbach in Vegas for 9,900 and I felt nothing from the surgery. Excellent doctor. You must be at the high end.... with the plane trip and hotel just a bit over 10K half of what you are talking about.