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- An alternative to exorbitant monthly health insurance premiums for many Americans is to opt for a high deductible diet.
- These plans have lower monthly premiums, but their high deductible creates other problems.
- Franchises can reach several thousand dollars, forcing some people to do without care.
- Discontinuing preventive care or failing to meet prescriptions can lead to more dangerous illnesses – and higher costs thereafter.
Filling a prescription for Lyrica, a medication that would relieve her pain after a back surgery, is not part of Robyn Hodgson's budget. In fact, her insurance plan provides a deductible of $ 7,300, which means she has to pay for medical care until she reaches that limit, and then her insurance coverage comes into effect.
"We are overwhelmed with medical bills," said Hodgson, 48, a university assistant professor in Pennsylvania. She states that she and her husband also pay about $ 6,500 a year in health insurance premiums for the police that her husband receives through her work. "It's frustrating," she said, "because I need drugs that I can not afford, I'm angry at the insurance system."
Hodgson is among the growing ranks of Americans in high-deductible health care plans, a form of insurance coverage that negotiates lower premiums for higher deductible counterparties. According to the US Centers for Disease Control and Prevention (USC), high-deductible plans now cover more than four in 10 Americans, who define such plans as a deductible of $ 1,300 per person and $ 2,600 per family .
Ruthless medical mathematics
Many workers insured in such plans must pay thousands more than this each year. Medical computation forces them to consider their health insurance as a solution to worst-case scenarios – such as major hospitalization – rather than insurance to pay for doctor visits and prescriptions.
Lianna Patch, a 29-year-old writer in New Orleans, said her $ 6,500 individual deductible was causing her to delay visits to her doctor. "I am firmly in the camp of resignation and bitterness," said Patch, describing his attitude toward his insurance plan, which also provides for bonuses of $ 50,000. about $ 300 per month, in addition to the annual franchise application. "I have to pay for it in case something terrible happens, I consider it a disaster insurance."
Some insurance plans now include deductibles of over $ 7,000 for an individual and $ 15,000 for families. According to a survey conducted in May by the Kaiser Family Foundation, among the 156 million Americans benefiting from health insurance through employers, one in five has franchises greater than 3 $ 1,000 for individuals and $ 5,000 for families. In comparison, the survey reveals that only 1 in 7 Americans benefiting from employer insurance do not have a deductible.
Of course, all insurance plans provide for maximum fees, which the consumer will have to pay for most – with the exception of monthly premiums – in a calendar year. Generally, the lower the premium, the higher the pocket max. Health care plans sold for 2019 through the Affordable Care Act markets currently have a maximum of $ 7,900 for an individual plan and $ 15,800 for a family plan, according to Healthcare.gov.
Hodgson and Patch are not the only ones to feel run out of money by their insurance. Americans with high deductible plans by their employers "I am more frustrated with the system," said Liz Hamel, Kaiser's director of opinion surveys and polls. "What was really striking in the results of this survey was that for all survey questions, people in high-deductible diets gave the most negative answers."
The rise of these diets may explain the growing interest in "Medicare for All" defended by several Democratic candidates, including Senator Bernie Sanders. His bill, which sees health care as a universal right, would extend the Medicare People's Health Program for seniors to all Americans, regardless of age.
Health Savings Accounts (HSA) are not a panacea
As with any insurance coverage that includes a deductible, once a consumer reaches the deductible limit, the health insurance payments come into play. But more than half of the people benefiting from High deductible health care plans said they did not have enough savings to cope with their needs. deductible, according to the Kaiser survey. "It was worrisome, given the level of financial risk these people assume," Hamel said.
Some Americans benefiting from high deductible plans have a Health Savings Account (HSA) that can help them save money for their future health expenses in a benefiting account. a tax benefit. But only 19% of workers have access to an HSA, the CDC found. And HSAs are not a panacea. Kaiser has discovered that nearly 7 in 10 workers who hold the accounts use them for their current health expenses, rather than saving for the future. And few are able to save significant amounts in their HSA accounts, as Kaiser discovered that half of those with high-deductible plans had less than $ 1,000 in their accounts.
Some Americans with high-deductible plans make compromises, for example by not consulting a doctor or reducing their drug use. Half of Americans surveyed told Kaiser that a family member or family member had delayed or missed health care or dental care in the last year due to expenses incurred. This is even more common among people with high-deductible diets, with 62% of them saying they missed care because of costs.
"For a group with an employer-sponsored cover, you would expect that they would not have to make those compromises," Hamel said.
"I know it's a bet"
One of the reasons for the rise in these plans is that employers are shifting the burden of higher health care costs to their employees. Employers on employer's insurance pay an average of 12 percent of their income, or more than $ 7,200 a year, in premiums and deductibles, up from 7.8 percent a decade ago, said the fund. Commonwealth in a December report.
Certainly, workers sometimes choose the higher deductible scheme because they want to reduce their monthly premiums. Some wealthy workers opt for high deductible plans because the lower premiums allow them to spend money in their HSAs, which allows them to save for future health expenses as long as they do not. they remain reasonably healthy and their investment options in HSA grow over time. Given that HSA contributions are tax deductible and that gains on HSA investments are tax free, and that the money can be used tax – free. it is spent on medical expenses, these plans can help with financial planning for retirement. Kaiser found, however, that only 1 in 10 workers with a high-deductible plan had saved more than $ 5,000 in an HSA.
These trends are alarming for health care experts. Dr. Michael Munger, Kansas Family Physician and Chairman of the Board of the American Academy of Family Physicians, said he sympathized with patients struggling with financial difficulties, but he were worried about the risks they were running.
A lower premium "may be the difference between a trip to the grocery store this month," he said. "It's not that they want to put more into their savings account – they're overwhelmed and want to cut back." Some people say, "I know it's a gamble," that makes me nervous as a doctor because you are not … not want to play with your health. "
The cost of chronic diseases
High deductible diets are particularly problematic for people with chronic conditions such as diabetes or asthma, experts said. The Kaiser study found that about 75% of people with chronic illness or a family member who benefits from the most tax-deductible plans said they skipped or delayed medical care or made a prescription because of the cost .
Dr. Munger said he witnessed this problem earlier this year when a diabetic patient with a high-deductible diet decided not to take insulin because of the costs involved.
"They ended up in the hospital in a diabetic coma," he said. "It's something that could have resulted in death.Now they have to bear the cost of hospitalization at the ICU and get out with even more drugs."
The cost of hospitalization is "several tens of thousands" rather than several hundred for insulin, he added. The patient had to pay up to his deductible, then a percentage of the cost thereafter, he recalled. In simple terms, trying to save money by reducing doctor visits or medications, some patients may end up with a higher bill.
Being young and healthy helps
If there's a place for high-deductible diets, it's probably among young and healthy people, experts said. But the CDC found that high-deductible plans are as common among workers aged 45 to 64 as they are among Americans under 29 years of age. "Someone who just needs a catastrophic coverage, someone who needs it once a year for this subset of people, a plan like this could certainly work," he said. said Dr. Munger.
He said his group of doctors was pushing for the adoption of the Primary Care Patient Protection Act, a bill requiring high-deductible health care plans to include a set of primary care visits each year, free of charge and no share of the consumer. "If we could at least encourage people not to let their health deteriorate," said Dr. Munger, "it would be a huge success."
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