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8 ways to make your high-deductible health plan work

By Posted : January 30, 2019

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Nearly 90 percent of Americans now has health insurance, thanks to the Affordable Care Act (ACA) and to a low unemployment rate. However, even those with insurance are foregoing medical care because they can't afford the costs.

"The burden of higher and higher health care costs has been shifted to the consumer, through higher deductibles, instead of the insurance companies," says Dr. Dana Simpler, a doctor of internal medicine at Mercy Medical Center in Baltimore.

Political leaders haven't reined in exorbitant prices or price gouging by drug companies, hospitals or other health entities, but have instead left consumers footing more of the costs, says Simpler.

This can be especially true if individuals are unfamiliar with how to buy health insurance in ACA Marketplace exchanges.

A study by Families USA found one-quarter of consumers who bought their own health insurance skipped medical care because they couldn't afford it, and high health insurance deductibles were often to blame.

The report found half of those who bought their own insurance paid a deductible of $1,500 or more, and 30 percent had a deductible of at least $3,000.

Some policies even have deductibles above $6,000 for an individual and $13,000 for a family.

Related >> Guide to Health Plans

Consumers who get health insurance coverage through their employers are also being hit with higher costs. A recent Kaiser Family Foundation study found workers who participate in their employer's health plan pay an average of $1,573 in deductibles for a single person and $1,286 annually for premiums. Family premiums average of $5,574 per year. Premiums have also been fairly stable over the past decade, but deductibles have taken off. 

Now, 85% of covered employees have a single plan with a deductible. That's an increase from 78% just five years ago. Insurers have also increased the deductibles. More than half of employer-sponsored health plans have a deductible of at least $1,000 and 26% are over $2,000. 

In order to reduce costs for your high-deductible health plan, here are eight ways to contain your costs and still obtain needed care.


1. Get the right level of care

right_level_care

Get care sooner and less expensively instead of waiting until your situation becomes acute and you're heading to the emergency room, says Sam Ho, chief medical officer for UnitedHealthcare.

You can also visit your primary care physician for routine and preventive care. The ACA mandates that its marketplace health plans must cover certain preventive health care services without charging you a copayment or coinsurance, even if you haven't met your annual deductible. Many health plans provide a similar benefit, so be sure to understand your coverage. Examples of preventive services include: alcohol misuse screening and counseling, blood pressure screening, cholesterol screening and Hepatitis B screening for patients in defined demographics.

Other options include urgent care and drug store clinics.

You might not even have to leave your house to get care. Your insurance may cover telemedicine, through which you consult a physician online or via a mobile device. This is often a low-cost option to treat ailments such as the flu.


2. Shop around for health care services

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Before seeking care, you can shop in advance to check the prices of procedures and medical services.

Some options are Guroo.com, which provides average service prices in various locations around the country, and Health4Me, a mobile app from UnitedHealthcare that offers quality and cost information for hundreds of medical services, according to Ho. A few other options include Fair Health Consumer, which gives estimates based on claims information they receive on medical and dental services across the country, and Healthcare Bluebook, which bases its information on a database of rates paid by private insurers.

You also can call providers in your area to see what they charge for various services. Explain that you have a high-deductible health plan and need help minimizing costs.


3. Use in-network providers

In_network_providers

Getting care outside of your network can increase your costs substantially. A HMO likely won't reimburse you for any out-of-network services. A PPO may charge you double or more for out-of-network care. 

"Know what health care providers are in your insurer's network," advises Ho. "You'll pay lower rates for services provided by hospitals, physicians and others in your network."

You may also pay a lower deductible when you receive services from health care providers who are in your network.

Your insurance company should have a provider directory or "Find a doctor" tool so you can see what providers are in network.


4. Save on medication costs

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Generics are the way to go, if possible.

"To save on drug costs, try generic medications," Simpler advises. "Or if it's a new medication, ask if your doctor can provide you with a free sample. Otherwise, you might buy a month's supply of medication and three days into it, find you can't tolerate it."

Pharmaceutical companies may offer their own assistance. Patient assistance programs (PAPs) are run by pharmaceutical companies and give away billions of dollars' worth of drugs to patients who meet certain eligibility criteria, says Richard Sagall, president of the nonprofit NeedyMeds. You don't necessarily need to be indigent to qualify. Criteria vary from program to program.

Drug makers may have co-pay cards available, which help reduce the price you pay for medication. You can receive a card by your medication's maker, get one from your physician or find one online.

Another option is a drug discount card, which also lowers how much you pay for your medications. Cards may be available from state governments, pharmaceutical firms, retailers or nonprofits. But Sagall cautions some carry high upfront fees. Those obtained from nonprofits are often free or low-cost.


5. Ask questions about reducing health care costs

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Don't be afraid to ask your physician about costs upfront, Simpler suggests, and inquire if there could be a less expensive alternative to what your doctor recommends. Be upfront about the fact that you are trying to minimize costs due to your high-deductible health plan and need to explore the least expensive viable option.

You can also question whether all the tests your doctor orders are essential. "Try conservative things first" before you opt for surgery, she says.


6. Negotiate prices

negotiate

In some cases, you can negotiate with your provider to pay a lower price for services, or you may receive a discounted price if you offer to pay your bill in cash.

You also may be able to pay your bill over time, rather than in one lump sum.

Some providers might consider bartering for services. Do you have a skill that you can offer in exchange for a reduction in cost? Your provider may be willing to reduce your bill if you are able to offer marketing, web design, social media or other services in exchange for a discount.


7. Take advantage of wellness incentives

wellness

"An increasing number of employers are offering wellness incentives. These programs provide rewards if you quit smoking, lose weight, or make other positive health changes," Ho observes.

You might earn a major discount on your health insurance premium or gain other perks for taking part. Bonus: you may also improve your health.


8. Set up an HSA or FSA

HSA

A health savings account (HSA) can pair well with a high-deductible health plan. You can use the money you contribute to pay for eligible health care costs. Your contributions to an HSA are tax-free.

If you have insurance through your employer, you may be able to set up a flexible spending account (FSA). You (and sometimes your employer) contribute to the account and you can use it to pay certain out-of-pocket health care costs. You don't pay taxes on your contributions.


High-deductible health plans can pay off

High_deductible_plan

While high-deductible health insurance plans aren't for everyone, they may make sense for those who are generally healthy and prefer to pay the lowest possible health insurance premiums. Carefully consider the pros and cons of high-deductible health insurance.

Once you have compared insurance quotes and selected a high-deductible health plan, follow these eight recommendations to minimize your out-of-pocket health care expenditures.

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