Advice on Surviving a High-Deductible Health Plan
A high deductible health plan (HDHP) means that you have to pay the amount agreed upon between you and your insurance company before the insurance company will make any healthcare payments on your behalf. There are some plans that have high deductibles of several thousand dollars in exchange for lower monthly premiums. But the average deductible for an Affordable Care Act’s (ACA) Silver Plan this year is $3,572 for an individual and $7,474 for a family. More people are skipping or postponing medical care because they can’t afford to pay so much up front. I am an amateur magician, but I don’t have a crystal ball on what part of the ACA will remain in place and what parts will be replaced. Let me provide you with some suggestions for surviving a high deductible health plan.
It may make cents!
It’s not that high deductible plans are a poor choice for everyone. If you’re healthy, you have a savings cushion to cover your deductible, an HDHP, allowing you to pay lower monthly premiums may be a reasonable option.
Many routine health services intended to keep you well or catch problems early (including colonoscopies, mammograms and vaccinations) are free in all insurance plans now even if they have an HDHP. So, make sure you go to a doctor for the care you’re entitled to get.
Comparison shop before you drop…lots of bucks.
Most health insurance sites provide information on where to find in-network services. And some offer cost-estimator tools that give the price you’ll pay different providers for diagnostic studies and procedures. Most people aren’t aware that these tools exist.
Prices for medical treatments can vary considerably from provider to provider, even within the same city. In New Orleans, for example, the average price for prostate gland surgery is $5,500, but it ranges from $3,136 to $10,150. For medication, one of the biggest out-of-pocket expenses for consumers, I recommend GoodRx.com, a website where you can compare prices for thousands of prescription drugs.
But don’t shop by price alone.
Among the insurance websites, www.consumerreports.com is highly recommended, as the site provides an unbiased review of the largest insurance carriers. The site provides quality information on the insurance carriers as well as the cost of the premiums and the amount of the deductible.
Have an open dialog with your doctor about costs.
Your doctors are a valuable resource on finding less expensive prescriptions, diagnostic tests or other health services. You can also use online resources such as ConsumerHealthChoices.org or ChoosingWisely.org, which suggest questions to ask your doctor about medical tests and treatments.
Keep track of your spending against your annual deductible, which resets usually at the beginning of every year. If you expect you’ll need an expensive procedure that will get you close to or over your deductible, schedule it early in the year if possible; that way, if you need more care later in the year, your insurance will kick in.
Saving for a rainy day. You can ease the pain of high out-of-pocket costs by putting money into a health savings account (HSA), which most people in IRS-designated HDHP are eligible. That’s pretax money—up to $3,400 annually for individuals and $6,750 for families—that you can use to pay for qualified medical expenses, including your deductible. And the best news is that, if you don’t use your HSA funds, they roll over and can grow tax-free year after year.
Don’t freak out before you pass out (your bucks) on healthcare. High deductible insurance can be expensive, but at least there’s a limit to how much you will be required to pay out of your own pocket for health services. After you’ve hit the max, the insurer must pay 100 percent of in-network costs.
If possible, stay in your network of providers. Reason: only in-network charges count against your out-of-pocket limits (or your deductible, for that matter). So, if possible, stay in-network. That’s good advice for all of us, whether we’re in a high deductible plan or not.
Bottom Line: Unfortunately, deductibles are going to be part of every insurance plan for the near future. If you follow a few of these ideas, you can survive high deductible health plan.