This Hidden Health Care Cost Keeps Heading Higher

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Health insurance is one of the most important benefits that employees get from their jobs. Yet even as the growth of U.S. health care costs starts to slow, employers are increasingly taking steps to hold their benefit costs in check. So even though you might not see your health care coverage premium go up in 2015, the quality of the coverage you receive won't necessarily be as good -- and you could find yourself on the hook for a big up-front payment before your insurance company pays a penny on your claims.

Looking Beyond the Premium

A recent report from the Kaiser Family Foundation and the Health Research & Educational Trust looked at the costs of employer-provided health insurance coverage, and the headline number seemed relatively promising. Compared to last year, average annual premiums for family coverage rose just 3 percent in 2014, continuing a string of relatively modest increases in premium costs. Moreover, workers pay only about 29 percent of the premiums charged for family coverage, shouldering $4,823 on average out of the $16,834 total cost.

But paying premiums is just half of the health care story. Workers also have to cover any copayments and deductibles on their health insurance coverage, and increasingly, they've had to pay more out of their pockets before their insurance coverage starts to make payments at all. This year, the Kaiser report found that 80 percent of workers have to pay an annual deductible before most services are covered, and on average, that deductible amount rose to $1,217. Many workers face even larger burdens, with 18 percent of all employees having a deductible of $2,000 or more.

In recent years, companies have steadily increased the amount of deductibles their workers have to pay. Just five years ago, the average deductible was only $826, making this year's amount a 47 percent increase since 2009. Nearly double the share of workers now have to pay $1,000 or more in deductibles compared to five years ago, and that trend appears to be taking hold and accelerating.

Understanding Deductibles

The most important aspect of understanding how a deductible affects your insurance coverage is to know which medical services are subject to it. The Affordable Care Act imposed restrictions on the ability of insurance companies to force policyholders to pay deductibles for certain types of services, with a special emphasis on preventive treatment. As a result, many immunizations, screenings and annual wellness visits are available at no charge even if you haven't fully paid your deductible yet.

Unfortunately, other rules governing deductibles and copayments aren't always uniform across different health insurance plans and providers. In some cases, you might qualify for a lower copayment on a particular type of service but be exempt from the full impact of your deductible, while other services might require you to pay your deductible in full before coverage kicks in. Contacting your insurance company can get you information about your coverage, but often, it's hard to pinpoint definitive answers to specific questions until a situation actually arises.

In comparing different coverage options with different deductibles, it's important to consider your own medical history. For someone who's relatively healthy, accepting a higher deductible could be worth it if it results in substantially lower monthly premiums. If you frequently need medical services, however, you might end up better off by paying higher monthly premiums on your insurance if it reduces your deductibles and other out-of-pocket costs.

Finally, many employers offer financial incentives of their own to encourage participation in wellness programs. According to Kaiser, 36 percent of large employers and 18 percent of small employers offer lower premiums, reduced deductibles or higher employer contributions toward health care costs if an employee participates in the company wellness program. The hope is that by encouraging preventive care, companies will save money in the long run by avoiding costlier treatments down the road.

Motley Fool contributor Dan Caplinger relies on his wife's employer for his health insurance. You can follow him on Twitter @DanCaplinger or on Google+. To read about our favorite high-yielding dividend stocks for any investor, check out our free report.
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