BLOG: Consumer's guide to high-deductible health plans
If you work at a small business and have health insurance, odds are about 50-50 that you’ll have a high-deductible health plan according to a Kaiser Family Foundation survey.
This kind of coverage asks employees to pick up more of the tab for their health care costs. Workers pay out-of-pocket for health care expenses until they reach the deductible. Then the insurance kicks in.
The idea is to make consumers savvier about health care costs by asking them to spend their own money first. At the same time, the employer can save money by shifting more of the costs to the consumer.
But Dylan Roby of the UCLA Center for Health Policy Research says navigating these so-called consumer-driven health plans is no easy task.
Here are 5 tips to keep in mind:
1. More than the deductible
First things first: Once you meet your deductible, it’s not over. After reaching the deductible, coinsurance costs starts, when you usually pay about 20 percent of the care charges. You don’t have to share these costs indefinitely -- plans do have a cap on these expenses so check to see what it is. But Roby says to think of your expenses as the deductible plus additional out-of-pocket costs.
2. Put money aside
High-deductible plans were designed for consumers to have a pot of money they can draw on to pay medical expenses. Employers sometimes chip in or you can contribute your own money to these tax-free accounts. Roby says health savings accounts are the way to go, so you’re prepared to pay off unexpected medical costs that can add up quickly.
3. Check network of doctors
Most high-deductible health plans are PPOs, or preferred provider organizations. Some doctors will be “in-network” and others are “out-of-network.” Make sure to check this before receiving care, says Roby. It could mean the difference of paying 20 percent for in-network care, or twice as much, 40 percent, for out-of-network care.
4. Excluded benefits
Although the fine print can be dizzying to digest, Roby says pay attention to excluded benefits. For example, chiropractic, dental and vision services as well as some prescription drugs might not be covered under your high-deductible health plan. That means you pay for these services out-of-pocket and it doesn’t go towards your deductible.
5. Some things are free
Under the Affordable Care Act, high-deductible health plans must provide free preventive services, including certain cancer screenings, flu shots and well-child visits.
But Roby says that even with the incentive of free care, consumers are often still wary of going to the doctor.
He cites a landmark study from RAND that tracks how people avoid getting both unnecessary and necessary health care when they’re enrolled in high-deductible health plans.
Anne Lesemann, co-owner of a pet care service in Sacramento, knows all about this. She has a $5,000 deductible with her plan and says even though she recently has been having heart pain while exercising, she’s been delaying a visit to the doctor.
“It’s not bleeding, it’s not broken so I will watch it and go when I need to,” Lesemann says.
She talks more about the benefits and risks of high-deductible plans in this KQED story.