Release date 11/17/2016
YONKERS, NY - High-deductible health insurance plans present a range of challenges for consumers, a new Consumer Reports (CR) article reveals. High-deductible health plans typically have smaller monthly premiums than traditional insurance, but consumers are required to pay a lot more out-of-pocket before insurance begins to cover a portion of their bills. Putting consumers more on the hook financially for their medical choices is meant to make people more prudent about the care they get. But the reality is that many people are postponing the care they need because they can't afford the deductible, often leaving them sicker and with bigger bills to pay down the road. Now is the time of year when people must choose their health insurance for 2017 and the chances are growing that a high-deductible health plan may be the only choice you’ll get.
CR consulted health-policy and insurance experts, spoke with doctors, and conducted proprietary research for the article, “How to Survive a High-Deductible Health Plan,” to help consumers understand the most cost effective ways to use their high-deductible plan.
As healthcare costs rise, many companies are embracing these plans because they shift more of the cost to workers. High-deductible plans are also the norm on the Affordable Care Act (ACA) exchanges, and, within the next three years, almost 40 percent of employees that offer health insurance may make high-deductible plans the only choice for consumers, according to a survey by the consulting firm PwC. This is up from just 13 percent of companies in 2012. Even though there is post-election uncertainty about the ACA long-term, more than 14 million Americans are expected to get health insurance through the ACA exchanges in 2017.
“Consumers rarely have the full information they need to make a smart financial decision in their health care,” said Orly Avitzur, M.D., a neurologist and medical director of CR. “People have to be smart and strategic when navigating high-deductible plans in order to not break the bank.”
High-deductible insurance plans are part of a movement known as consumer-directed healthcare, which aims consumers to be engaged in managing the costs of their own care. Under these plans, individuals are paying an average of $2,295 before insurance kicks in, with families paying $4,364 on average, according to the Kaiser Family Foundation. CR and other consumer advocates say that too many people have plans they can’t afford or don’t understand.
How to Use Your High-Deductible Plan
CR offers simple ways to get the most out of your high-deductible plan:
Know what’s free: Many routine health services intended to keep you well or catch problems early are free on all insurance plans now. But, according to a 2012 study published by the journal Health Affairs, only 1 in 10 people with high-deductible health plans know such screenings are free.
Comparison shop: Few consumers take the time to shop around for medical services, but it can be worth it. CR’s Health Ratings Center studied 21 insurance plans and found that only 13 percent of people used the tools on their insurer’s site, even though 75% said they were concerned about cost and quality of service.
Don’t shop by price alone: Go beyond price and research details on doctor reputation and outcomes associated with healthcare procedures and providers. Sometimes the costliest tests or services aren't the highest quality.
Interview your doctor: Doctors can be a valuable resource for patients trying to balance cost and quality of care. You can also turn to other resources, such as www.ConsumerHealthChoices.org, which CR created as part of its partnership with the ABIM (American Board of Internal Medicine) Foundation’s Choosing Wisely campaign.
Get care on the calendar: If possible, schedule expensive procedures early in the year so if you hit your deductible and need care later in the year, your insurance will kick in.
Leverage tax breaks: Most people in high-deductible health plans can contribute to a health saving account (HSA). HSAs are for pre-tax money that can be used to pay for qualified medical expenses, including deductibles.
Don’t freak out: The ACA mandates that all insurance plans cap in-network, out-of-pocket costs, so there is always a limit to how much you’ll have to pay for out of your own pocket for health services.
CR’s Health Ratings Center recruited dozens of consumers to test out tools offered by national insurance companies that help consumers find out which doctors take your insurance, the cost of tests and procedures, or information about the quality of care from a specific physician or hospital. Visit www.CR.org/health-cost-estimators for more information.
Consumer Reports Position on High Deductible Health Plans
High healthcare costs need to be reined in, but CR doesn’t believe consumers should bear the brunt of that responsibility through insurance plans with enormous out-of-pocket costs. CR believes we need a different vision for consumers' role in healthcare. A few strategies CR recommends:
Focus on root of the problem: Encourage healthcare providers, hospitals, drug makers and medical-device makers to address high healthcare costs.
Change insurance plan designs to make costs more predictable.
Involve state regulators to understand health care spending in their state.
More information on high-deductible insurance plans can be found in “How to Survive a High-Deductible Health Plan” featured at www.consumerreports.org and in the January 2017 issue of Consumer Reports magazine starting November 29, 2016.