How to Manage Increasingly Higher Medical Deductibles

How to Manage Increasingly Higher Medical Deductibles
September 25 01:00 2015

How to Manage Increasingly Higher Medical Deductibles

DESPITE recent gains in the number of Americans who have health insurance, many people are still faced with paying for care out of pocket because of high deductibles.

A new analysis from the Kaiser Family Foundation, released this week, found that while health care premiums were growing modestly, employers were continuing to shift costs to workers in the form of higher deductibles — the amount patients must pay before their insurance kicks in. More workers have general annual deductibles, and the average this year is more than $1,300 for a single person, Kaiser found.

Beth Landrum put off getting an M.R.I. that her doctor had recommended after the deductible on her family’s health plan increased to $3,300 a year.Health Insurance Deductibles Outpacing Wage Increases, Study Finds

Insurers and employers say that the idea is that if people are responsible for more of the cost of their care, they will be more careful about how much they spend. But many Americans continue to be surprised by big bills for medical care they thought their health plan would cover, according to research from Consumer Reports. Almost a third have received a medical bill, Consumer Reports said, for which they had to pay a greater share than they had anticipated — and many ended up paying the bill in full.

In addition to care that is increasingly subject to a deductible, patients are often tripped up by charges for out-of-network care. Most health plans negotiate a discounted rate, which applies when patients obtain care within the approved network of doctors and hospitals. But if patients go outside the sanctioned list — even unwittingly — they will pay more.

For instance, if you go to an in-network hospital for elective surgery, like a knee replacement, you may still get a bill from an anesthesiologist or radiologist who isn’t in your plan’s network. The professionals are working in a hospital that’s in your plan, but they don’t necessarily have to belong to it themselves.

Since you are more likely these days to end up paying for some treatments, it’s important to be familiar with the details of your health plan, health care experts say. Be sure you can really afford a plan with a high deductible — especially if you have chronic condition that requires frequent doctor visits or tests, said Mark Rukavina, a health care consultant near Boston.

Open enrollment for employer-based, as well as Affordable Care Act, plans is approaching in the fall. As you weigh coverage for the next year, you may want to consider paying a higher monthly premium, if you can afford it, to lower your deductible, Mr. Rukavina said.

“It’s tempting to go with the lower-premium plan,” he said. “But the important question to ask is: ‘Can I come up with that $2,000, or that $5,000, if I had to?’”

Here are some questions and answers about managing medical costs:

■ How can I make sure a doctor I am seeing is in my health plan’s network?

Your plan should provide a directory, either in print or online. But such lists may be outdated, so you should always call your insurer and your doctor and double-check before you arrive for care, said Lisa Gill, a deputy editor at Consumer Reports, which looks at medical bill “sticker shock” in its November issue. “You can’t really rely on your insurer’s website,” she said.


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Ms. Gill advises that if you are having elective surgery, contact the surgeon’s office or the hospital and request a list of every anesthesiologist or professional who could potentially be assigned to treat you — then, contact your health plan to find out if they participate in your plan’s network. “It’s a huge burden,” she said. But it’s the best way to protect yourself from unexpected charges from an out-of-network provider.

■ What if I can’t afford a medical bill?

Ms. Gill suggests that, for major costs, you call the billing office to make sure you are being charged your insurance plan’s lower, in-network rate.

It is also wise to carefully compare the bill with the explanation of benefits provided by your insurer, to make sure you actually owe for all of the charges, said Erin Singleton, chief of mission delivery at the Patient Advocate Foundation.

If it looks as if you owe the money, don’t just stick the bill in a drawer, Ms. Singleton said. Contact your provider to discuss any options, like discounts or payment plans. “Be proactive in seeking out help,” she said. Patients with certain conditions may qualify for help with co-payments for some drugs and treatments from the foundation’s co-pay relief program.

With deductibles growing, it is becoming more common for hospitals to offer financial assistance to patients who have insurance, Mr. Rukavina said. Help is not restricted to those who are uninsured. So you should ask your provider if financial aid or a discount is available.

“People shouldn’t assume that because they have insurance, they won’t qualify, because they may,” he said. You are more likely to get help from a nonprofit hospital, he added, but it doesn’t hurt to ask even if it is a for-profit institution.

■ How can I plan for costs if I have a high-deductible plan?

Many health plans with high deductibles offer the option of a health savings account, which lets consumers set aside pretax money to help pay for treatment before they reach their deductible. Ms. Singleton suggests that patients put any savings they may see from the lower premium they are paying for a high-deductible plan into the health savings account. Balances roll over year to year, so you don’t lose the money if you don’t spend it in a given year.

Knowing ahead of time which emergency room or urgent care center is in your plan’s network can also help save costs if you need treatment for unexpected injuries or illnesses, Ms. Gill said. Also, check your plan to see if ambulance transportation is covered. It may not be, she said.

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