10 Tips to Make the Most of Your High-Deductible Health Plan
By Karen Datko
As employers try to cut their costs for providing health insurance to workers, they're offering more high-deductible health plans. The premiums are lower, but you'll pay $1,000 or more -- sometimes a lot more -- out-of-pocket before the insurance coverage kicks in.
High deductibles also are the rule for many plans available on the federal and state health insurance marketplaces.
How do you get the best use of this kind of coverage? Here are 10 tips:
1. Claim your freebies. Under the Affordable Care Act, certain preventive health services are free to you, even with a high-deductible policy. Make sure the doctor's office or hospital accurately codes any such procedure you have. That way, the insurance company will know it's one of the free services and will cover the cost.
You can find the list of free procedures and screenings at HealthCare.gov. There's a separate list for women and for children.
Before you have a test or screening, check to make sure which costs are covered. Money Talks News founder Stacy Johnson found out the hard way that some of his annual physical was provided at no cost to him, but that much of the rest wasn't.
2. Ask for a discount. Tell your doctor's office or the hospital that you have a high-deductible plan and ask if there's a discount for paying cash. (My dentist provides a discount, but the doctors and hospital where I live do not.) You may even find that a doctor will give you a considerable discount if she knows you have to cover the entire cost out-of-pocket.
If you can't afford to pay, ask the doctor or hospital for a low- or no-interest installment plan. Some still offer them.
Needless to say, you should ask whether a less expensive, alternative treatment is available.
3. Save on medications. Ask your doctor if a generic exists for the drug he or she wants to prescribe. If so, don't stop there. A couple of years ago, Consumer Reports found a 447 percent difference in the price when it surveyed stores for the cost of generic versions of five widely prescribed medications. Costco was the cheapest, CR said.
Also, see our post about 10 ways to save on prescription drugs.
4. Compare prices of medical providers. We've previously reported that hospital prices across the country vary wildly for the same procedure. While cost shouldn't be the sole basis for selecting a health care provider, it should be part of your process.
The New York Times has a tool that lets you see how prices at your local hospitals compare with the national average. The federal government makes data available, too. Other websites can also help you find the best prices for the procedures you need.
When you call around to compare prices, make sure you identify your insurance company so you're quoted the rate charged to it and not the so-called "chargemaster" rate normally used for people who don't have insurance. The latter is likely much higher than the rate your insurance company has negotiated with the provider.
5. Stay in your network. Even though you're paying out-of-pocket, you'll typically pay the lower in-network rate if you stick with the health providers in your insurance plan's network.
6. Open a health savings account. With qualifying high-deductible plans, the Internal Revenue Service allows you to create a health savings account -- a savings or investment account where you can deposit pretax earnings to spend on health care.
Any money and interest earned that you don't spend remains in the account year after year. Many employers kick in some money too.
This year, high-deductible plans that qualify for an HSA have a minimum deductible of $1,300 for individual coverage and $2,600 for a family. An individual can set aside $3,350 in an HSA this year, and a family can save up to $6,650. Increase the number by $1,000 if you're 55 or older.
For 2016, minimum deductible amounts remain unchanged. An individual again can set aside $3,350 in an HSA next year, while a family can set aside $100 more than in 2015 -- $6,750. Again, increase the number by $1,000 if you're 55 or older.
7. Have a super-solid emergency fund. It's asking for trouble to buy a high-deductible plan without having money at least equal to the deductible in a savings account or HSA.
That healthy emergency fund will keep you from racking up interest on the unpaid balance you owe to the local hospital or clinic, or prevent you from putting your bill on a high-interest credit card.
8. Keep good records. Keep copies of all your medical receipts, just in case the insurance company makes an error.
9. Do some research. It's unwise not to go to the doctor when you have a problem. But you don't need to see a professional for a simple case of the sniffles. Many insurance providers have online information and nurse advice lines that can help you understand symptoms.
Of course, if any of this feedback indicates that you require care, don't delay. Waiting to see a doctor could end up costing you substantially more if the condition worsens.
10. Work the system. NPR told the story of a man who met the $4,500 deductible of his plan when his appendix had to come out. After that, the insurance covered the cost of a nonemergency procedure he'd put off.
In some cases, you may still owe a copayment or coinsurance after you reach the deductible, but you'll still pay for less.
Are you among the growing number of Americans with a high-deductible health plan? Were you surprised about how much you had to pay out-of-pocket? Have you delayed medical care because of that?
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