Knowing that you are tied down and will have to pay thousands of dollars in medical bills may make you more likely not to seek the medical care you need. Here’s how to save money and stay safe.
Prepare yourself: In a few years, your only option for health insurance through your employer may be a health plan with a very high deductible.
These plans have lower monthly premiums, but they come with a compromise: You have to pay a lot more out of pocket before your insurance starts to cover a portion of your bills.
The flip side of high deductibles
Why are people looking for health insurance opting for high-deductible health plans?
Sometimes it’s because they like the idea of paying cheaper premiums, and they assume they’re going to stay healthy so they’ll be able to save money, vice president of customer service at Direct Path, benefits, and insurance management firm. compliance. For others, there is no other option.
That was the situation 2 years ago for Monique Dow, a 46-year-old mother of 2 from Watsonville, California. She had a $6,000 deductible on her family’s health plan, which was the only option offered by her husband’s employer.
For months, she delayed surgery to remove what her doctor believed were benign fibrous tumors and a uterine polyp. When she finally scheduled her surgery after working out a payment plan with the hospital, they found the polyp to be cancerous and required a hysterectomy.
Do consumers really have control?
High-deductible plans are part of a shift toward what’s called consumer-directed health care. The idea is that if you are more financially committed to the choices you make, you are going to have more control. For example, when you consider less expensive procedures and providers, and do not rush to see your doctor every time you catch a cold.
If you share the cost of your health care, this idea goes, then this is going to lead to cheaper medical bills, overall.
Only that is not what is happening. Faced with overwhelming deductibles, many people like Dow are putting off getting the health care they need, sometimes ending up sicker and with bigger bills over time. This is what a growing body of research is showing.
How to Get Out of an HDHP Plan
It’s not that high-deductible plans are a bad option for everyone. If you’re healthy, don’t have to go to the doctor other than for routine checkups, and have a cushion of savings to cover your deductible, paying lower monthly premiums might be a reasonable option.
However, Consumer Reports and other consumer advocates say many people have plans they can’t afford or don’t fully understand.
At the moment, if you have a high-deductible plan or think you’re going to have one soon, you’re going to have to be more involved in your own health care decisions. But, there is much you can do to make your plan work better for you.
Consumer Reports consulted health and insurance policy experts, talked to doctors, and conducted our research to discover the most efficient and cost-effective ways to use your high-deductible plan while getting the medical services you need.
Learn what things are free. Many routine health care services that are intended to keep you healthy or catch problems early (including colonoscopies, mammograms, and immunizations) are free under all current insurance plans. Yet only one in 10 people on high-deductible plans told us they were aware those screenings were free, and nearly 20% said they avoided those preventive screenings because they thought it would cost them, according to a 2012 study published in the journal Health Affairs. So make sure you go to the doctor to receive the medical attention to which you are entitled.
Compare prices. High deductibles are supposed to push you to look for lower prices and non-emergency medical care. But few people are doing this. Most health insurance sites provide you with information on where to find in-network services. And some offer cost estimating tools that give you the price you’ll have to pay to different providers, for example, an MRI or knee surgery.
But a Consumer Reports Health Ratings Center study of 21 insurance plans found that only 13% of people used those tools on their insurer’s site, even though 75% said they were concerned about cost and quality of care. service. One reason for this is that people simply don’t know these tools exist. (If your insurance company doesn’t offer one, call your insurer directly and ask for estimates.)
The time you spend researching costs is well worth it. Prices for medical treatment can vary considerably from provider to provider, even within the same city. . For medicine, which is one of your biggest out-of-pocket expenses, check out, a website where you can compare prices for thousands of prescription drugs at more than 70,000 pharmacies in the United States.
But don’t look only for the price. Among the insurance websites that Consumer Reports reviewed, most rated highly on pricing information. But users said the sites were difficult to navigate and lacked information about the quality of services and sources, such as independent ratings of doctors and hospitals and user reviews. (See our ratings of 6 national insurance websites.
Interview your doctor. Physicians can be a valuable resource to their patients when patients are trying to balance quality with care, as Goen discovered. Duke University researchers analyzed taped conversations from 1,800 doctor visits. Costs were discussed 30% of the time. And in nearly half of those conversations, doctors offered ideas for how patients might find less expensive prescriptions, diagnostic tests, or other health services.
You can also use online resources like at ConsumerHealthChoices.org, which Consumer Reports developed as part of its collaboration with the ABIM (The American Board of Internal Medicine) Foundation’s campaign called Choosing Wisely. These resources provide questions you can ask your doctor about medical tests and treatments that are frequently abused. Many can waste your money and do more harm than good.
Get medical attention following the schedule. Track what you spend against your annual deductible, which starts over each year. If you expect to need an expensive procedure that will bring you closer to or over your deductible, make the appointment earlier in the year if possible. That way, if you need more medical care later in the year, your insurance will cover it. And don’t stop making your doctor’s appointments. Make sure your doctor has room in your schedule for an office visit before January 1, when your deductible resets.
Balance your tax advantages. You can ease the pain of high out-of-pocket costs by putting money into a health savings account (HSA), which almost everyone is eligible for in plans designated by the IRS as high-deductible health plans. This is pre-tax money, up to $3,400 a year for individuals and $6,750 for families, that you can use to pay for qualified medical expenses, including your deductible. And if you don’t use your HSA funds, they roll over and can grow tax-free, year after year.
Employers aren’t required to set up HSAs for their employees in high-deductible plans, but about 63% do. (You can open an HSA account on your own.) The account is portable, so the money is yours if you change jobs. To encourage the use of HSAs, about half of employers offer seed money. Some employers will put extra money into your HSA if you take advantage of preventive services like exams and wellness visits. “Employers don’t want their workers skimping on the health care they need,” says Steve Wojcik, the vice president for public policy at the National Business Group on Health.
Do not panic. Insurance with high deductibles can be very expensive, but at least there is a limit to the out-of-pocket costs to pay for health services. The Affordable Care Act requires almost all health insurance plans to cap out-of-pocket costs (not including premiums or out-of-network care). Once you reach the limit on your out-of-pocket expenses, the insurer must pay 100% of the costs incurred within the network.
