Expert advice on high-deductible health plans
By Beth Orenstein, Insure.com – Last updated: Dec. 17, 2015
High-deductible health plans are a great option for people with low health care costs, but beware that you must meet a high annual deductible before your health insurance company kicks in any money toward your care.
In fact, that deductible could be as much as $6,550 for an individual or $13,100 for a family, according to the Internal Revenue Service. This could cause quite a dent in your pocketbook, so you’ll need to take advantage of ways to keep out-of-pocket costs down.
Here are tips from health insurance experts for containing out-of-pocket costs with any health insurance plan, but especially when you have a high-deductible health insurance plan:
Take advantage of preventive care. Under the Affordable Care Act, even high-deductible health plans must offer free preventive care with no copays and no deductibles, says Nicole Wruck, a senior director and health and welfare practice leader with Aon Hewitt in Chicago.
Preventive care could save more than 10,000 lives each year if Americans received that care, according to the Centers for Disease Control and Prevention (CDC).Preventive care can include vaccinations, cancer and other health screenings, and wellness visits. Combine preventive care with a healthy lifestyle, and it may keep you out of the doctor’s office and avoid having to pay for services that aren’t covered, says Abbie Leibowitz, chief medical officer and executive vice president of Health Advocate in Plymouth Meeting, Pennsylvania.
Shop for services. “When you have a high-deductible health plan, it makes you a consumer in your health care,” Wruck says. That’s why high-deductible health plans are often called consumer-driven health plans.
When you have an HDHP and need medical services, you should shop for not only the best provider but also the best price. “Just as you question things when you go to the supermarket or purchase a car, you have the responsibility to do it when it comes to your health care,” Wruck says.
Members of these plans are encouraged to use online price comparison tools for services.
Shop for the best prices on prescription drugs, too. Ask your doctor if there’s a generic or if he has coupons or samples that you can have, and talk to your pharmacist, Wruck says. The pharmacist may be aware of other options that will cost less, she says.
Speak up. Doctors don’t usually know what type of health insurance plan their patients have, Wruck says. Should your doctor recommend a test or treatment, it’s OK to say, “I have a high-deductible health insurance plan. This is going to cost me a good deal. Is it absolutely necessary? Is there a lower-cost option?”
Most people aren’t used to questioning their provider’s recommendations, says Wruck. But there’s no harm in at least asking and weighing options and costs.
Use in-network providers. Even though your insurance won’t pay until you’ve completed payment of your high deductible, your plan has negotiated discounts with providers and hospitals, and you’re entitled to those discounts as long as you use those in-network providers, Leibowitz says.
Some health insurance plans even have preferred provider networks. Leibowitz says the discount they negotiate with preferred providers is greater than those who are simply “in network.”
Question every bill. Before you pay that bill, compare it to the Explanation of Benefits (EOB) statement you receive from your provider, Leibowitz says. The bill could contain errors.
If you discover an error, ask your provider to resubmit the claim using the correct codes. Give it some time, and follow up with your insurance company to make sure the bill was reprocessed correctly.
Contribute as much as you can to a health savings account (HSA).HDHP plans can be tied to a health savings account that allows you to put money away tax-free to help pay for medical expenses.
Unlike flexible spending accounts, HSAs are not “use it or lose it,” Wruck says. The money will stay in your account and grow tax-free. The IRS has set the maximum contribution to an HSA for 2016 at $3,350 for an individual and $6,750 for a family. If you are 55 or older, you can make additional catch-up contributions of up to $1,000 annually. Contribute as much as you comfortably can.
Being willing to put in the work to research and compare providers, services and prescriptions could end up saving you a lot of money that you otherwise might have paid in premiums with another plan.