High Deductible Plans

Now that we are 8% into 2013, many people are feeling first-hand the effects of new payment formulae for healthcare. Patients are responsible for a larger part of their medical bills and this is taking many by surprise.

Every January we note that the office visit copay for many plans increases – I am not surprised at $40 per visit. Not everyone has a copay anymore. An increasing number of employers have signed on for large deductible plans.  In this case, the office files a claim with the insurer on behalf of the patient and once we receive the explanation of benefits that delineates the patient responsibility we bill the patient. Patients usually have some notion of how much the office visit will cost. What many people finding upsetting are the charges that they previously did not see, such as laboratory fees. The lab too will bill the insurance company first, but if the deductible is not yet met the patient will get a bill.

Many patients find that large deductible plans give them more freedom. If a patient is unlikely to reach his deductible ($2500 to $5000) he may not feel limited to only using doctors “on plan.” When sick, a patient can have an office visit with the doctor of her choice since she will be writing a check for the visit no matter what. If a major illness does occur the maximum monetary exposure will be the amount of the deductible.

The large deductible plans do require a bit of budgeting. We budget money to change the oil in the car and we can take our cars to the dealer (“on plan”) or to the neighborhood shop. Healthcare is not so different.