With all the talk of repealing, replacing or repairing Obamacare and potential changes to Medicare and Medicaid, the future of health insurance in America is incredibly uncertain. No matter what happens in Congress, however, you’ve still got 10.5 more months with the plan you’ve chosen for this year.
For a growing number of people, that now means a high-deductible plan — in other words, a plan generally meant for people who don’t expect to need their health coverage much or one designed to turn patients into consumers in order to hold down health care spending.
For 2017, the IRS defines high-deductible plans as those requiring individuals to shell out $1,300 or more ($2,600 or more for a family) for covered services before the insurance company begins to pay. But the deductibles on such plans tend to be much higher than those minimums. A study by HealthPocket found that the average deductible for 2017 Bronze-level policies, the lowest tier Obamacare plan, is just over $6,000 for an individual and more than $12,000 for a family.
“The whole purpose of high-deductible plans is to shift the financial risk back to you as an individual,” says Gerald Kominsky, director of the UCLA School for Health Policy Research. “The theory is that it will make you more price-conscious and more careful because you’re spending your own money out of your pocket up to the deductible.”
Whether such plans have succeeded in that aim is debatable. Multiple studies have found that consumers with high-deductible plans are putting off necessary care due to the cost.
Still, it is possible to get quality care on a high-deductible plan without going broke, and there are even some benefits to the savviest users. Follow these steps to make the most of your coverage:
1. Have an emergency fund for health expenses. Since you’ll be responsible for every dollar of your health care costs until you hit your deductible, you’ll need to set aside money so that a large medical bill doesn’t torpedo the rest of your finances. Ideally, you’d keep those emergency funds in a health savings account (see below), but you’ll want to have at least enough cash to cover your deductible and keep that money easily accessible.
2. Stay in network. As health insurers continue to narrow their networks, it’s gotten increasingly difficult to get all of your medical needs met by doctors and providers who are under that umbrella — but it’s worth trying. At a minimum, your primary-care physician and any specialist you see should be in-network. Even though you’re going to pay bills out of pocket until you hit your deductible, staying in network means you’ll be paying the rate your provider has negotiated with your insurer.
You should also make a plan for where you’d go if you or a family member needs after-hours care. For a true emergency, you’d head to the closest emergency room, of course, but for other after-hour treatment needs, you should research whether there’s a local walk-in clinic or urgent-care treatment center that’s in your insurance network. Many companies and insurers now also offer telemedicine, a lower-cost option that allows you to consult with a doctor via video chat.
3. Shop around for treatment. For outpatient procedures and lab work, you’ll find a wide range of costs even among in-network providers. Use an online tool (often offered by your insurers) to get a sense of the out-of-pocket cost you’d face for the same treatment at various locations, and call the provider to confirm the price. “A lot of doctors aren’t used to patients asking about price yet and you may have to push a bit,” says Sam Gibbs, executive director of AgileHealthInsurance.com. “But at the end of the day, you’re the one writing the check for the service, so you have a right to know how much it costs.”
4. Cut your drug costs. Prescription drug prices are often one of the first areas where patients new to a high-deductible plan see high out-of-pocket costs. If you find that a prescription isn’t covered by your insurer’s formulary, speak to your doctor about whether there’s another drug or a generic version that might be just as effective. If not, reach out to the manufacturer to see whether they offer any discount programs.
5. Get all preventative care. Under the current law, all health plans must cover preventive health services without any patient copay or deductible. Covered preventive treatments include blood pressure screening, vaccines and contraception. Taking advantage of such free treatments can help you maintain your health and keep costly medical issues at bay.
6. Max out your HSA. More than nine in 10 health care plans come with a health savings account, the most tax-advantaged account available to consumers. The tax benefits are threefold: You won’t pay to put money into the plan, your contributions grow tax-free and you won’t have to pay to take money out for qualified medical expenses. The money never expires, so if you’re healthy now with low medical costs, the HSA can serve as an extra retirement savings vehicle. “It will just give you more money to help pay for health care down the road,” says Steve Wojcik, vice president of public policy at The National Business Group on Health, which represents large employers.
Employers are also starting to help employees seed the account, with the average employer contributing $600 to employee HSAs and $1,100 for family accounts.
7. Bunch up your expenses if you do hit your deductible. If you spend enough in a calendar year to hit your deductible, your insurance will kick in and you’ll owe either copays or coinsurance for the rest of the year until you hit your plan’s out of pocket maximum for the year. If you’re only paying copays or you’ve hit the out-of-pocket max, consider scheduling any other covered, elective procedures before your deductible resets at the beginning of next year.
8. Check your bills carefully. When your insurance paid the bulk of your bills, you may not have paid close attention to every line item on your explanation of benefits. Now that the onus is on you, take the time to read those bills, which are notoriously error-riddled, and call your doctor if anything looks out of whack.