High-deductible health care plans become widespread, survey finds

[CseMgr1, ASN, RN]

Many more workers this year have health benefit plans with a deductible of at least $1,000, a new employer survey has found.

Those hefty deductibles, along with the steady rise in health premiums, have combined to squeeze consumers, the survey sponsors said.

http://www.ajc.com/gwinnett/content/business/stories/2008/09/25/high_deductible_insurance.html

[icyounurse, BSN, RN]

I know mine went up this January...........its getting harder and harder to keep health insurance ,gas in my car, go grocery shopping, ect............

[RN1989]

Ours is way more than a measly $1K to keep it affordable. Such is the nature of healthcare today.

[SwampCat, BSN]

Our health insurance (through dh's work) is everything prevenitive is covered and all else is out of pocket (up to $4000...whoopie!) It is killing us. Ds often has ear infections so $90 doc's visit + $50 medication every couple months is making me second guess this whole college thing...I should just go work in a warehouse so we can survive!

[Jolie, BSN]

What we are seeing is a shift (out of financial necessity for employers) back to what insurance was originally intended to be: protection from catastrophic loss due to prolonged, extreme and/or unanticipated health care expense.

Insurance was not originally designed to be prepaid health care. That model was unsustainable, and we are seeing the fallout of that. We all need to plan for predictable health care expenses and budget and save accordingly. High deductible plans encourage that by making participants aware of their financial responsibility upfront, allowing participants to save tax-free dollars in spending accounts to use for health care expenses and negotiate non-emergency fees in advance with healthcare providers.

Many high-deductible plans cover preventive services in full (preventive PCP visits, immunizations, age-related health screenings, etc.) without regard to deductible, which is a valuable benefit that greatly reduces costs to the participant.

I've had a high deductible plan for years, and prefer it to standard insurance where most preventive care is not covered and to the HMO model where I had to have everything approved in advance.

[icyounurse, BSN, RN]

What we are seeing is a shift (out of financial necessity for employers) back to what insurance was originally intended to be: protection from catastrophic loss due to prolonged, extreme and/or unanticipated health care expense.

Insurance was not originally designed to be prepaid health care. That model was unsustainable, and we are seeing the fallout of that. We all need to plan for predictable health care expenses and budget and save accordingly. High deductible plans encourage that by making participants aware of their financial responsibility upfront, allowing participants to save tax-free dollars in spending accounts to use for health care expenses and negotiate non-emergency fees in advance with healthcare providers.

Many high-deductible plans cover preventive services in full (preventive PCP visits, immunizations, age-related health screenings, etc.) without regard to deductible, which is a valuable benefit that greatly reduces costs to the participant.

I've had a high deductible plan for years, and prefer it to standard insurance where most preventive care is not covered and to the HMO model where I had to have everything approved in advance.

You are right about insurance not originally planned to be prepaid health care, but I must point out that health care costs have SKYROCKETED to levels that no one would have predicted when health insurance was being thought up.

I mean I am all for planning and saving, and currently my plan is a catastrophe only plan basically so I have to, but have the wrong set of circumstances hit you and it wouldnt matter how prudent and practical you are or how much you have responsibly saved. The rising price of health care in this country is a huge problem and it keeps getting worse............

[Jolie, BSN]

You are right about insurance not originally planned to be prepaid health care, but I must point out that health care costs have SKYROCKETED to levels that no one would have predicted when health insurance was being thought up.

I mean I am all for planning and saving, and currently my plan is a catastrophe only plan basically so I have to, but have the wrong set of circumstances hit you and it wouldnt matter how prudent and practical you are or how much you have responsibly saved. The rising price of health care in this country is a huge problem and it keeps getting worse............

I understand your point, and agree with you.

One of the factors that I believe has to happen before costs begin to fall is this: Insurance needs to get out of routine, predictable health expenses. On the surface this sounds contradictory: Health care is expensive. We can't afford care with out insurance. But I believe that costs are double or triple what they would otherwise be because insurance is involved. You would never pay $10 for an aspirin, but you don't question when your insurance does.

That is where negotiation comes into play with routine, predictable and planned health expenses. My family doctor recently billed my insurance $200 for a yearly physical. The insurance reduced the payment per their contract, but covered the visit as a preventive benefit. Blood work was sent to a local med. center (simple labs such as CBC, metabolic profile) and cost another $150, which was also reduced, but covered under my preventive benefit.

In that same office, the doc will provide the same services (comprehensive yearly physical with labs run in the office) for $45 cash if it is paid at the time of service. The difference reflects the cost of her office doing business with the insurance companies, including the cost of employees who are paid to handle insurance issues, the wait for 30-90 days to receive payment, the denials and appeals of claims, etc. By paying cash, the patient reduces the cost of services to approximately 1/8 of the billed amount.

I have yet to find a provider (PCP, specialists, hospitals, out-patient services, etc) unwilling to negotiate prices up front and even reduce costs after the fact (ER) when I ask them to do so, cite my high-deductible plan and promise to pay promptly.

I think high-deductible plans are a step in shifting responsibility for routine and predictable expenses back to the consumer and help the consumer make their money go farther. But I firmly believe that removing insurance from the equation (with routine health care) is necessary for the system to work.

[RN1989]

While I think Jolie has some good ideas, I still don't have a belief myself of how to fix this mess.

Various hospitals that I have worked for, always had policies in place that had the bottom line numbers for surgeries, etc. for private pay patients. And the cost was significantly lower than what the insurance companies were charged and what the insurance company would pay.

Now I have a friend without insurance who is being charged MORE than what they charge the insurance companies. The explanation given was that the insurance companies won't pay the actual cost of the services, so they increase the private pay rates to make up for losing money on insured patients!

The hospital is also billing her a special charge because her physician rents office space/equipment from the hospital. Most MDs, dentists, veterinarians, and other professionals set their fees to help cover the cost of things like rent/equipment. Or they consider it an overhead cost as a part of doing business. I think it is really bad form to have someone bill you a separate fee and then let you know that it is to pay your rent!

Not sure of an absolute answer, but it is going to be hell trying to get there.

[Neveranurseagain, RN]

The $5 and $10 copay is what helped kill our health care system. When everyone had a $500 deductible, rarely would we see a child who woke up with a fever. Parents would wait a day or two, and use common sense--Tylenol, and other OTC, clear liquids, etc. Most kids would get better within a few days. Now, parents want their child seen immediately and demand an RX and leave the office ****** if they don't get one.

Face it--most people can afford to spend $500 per family member on health care. Yet the ones who say they can't and scream the most also drive around in new cars with a $400-$500 a mth car payment. They think nothing of going out to dinner/movie and dropping easily $100.

Health insurance was never meant to cover all health care costs. In the past it was meant to cover MAJOR health care costs from a catastrophic event-not everyday health care. Yet today, everyone wants free health care.

That being said, my monthly health insurance bill is over $800 a month. That is 35% of my monthly income. How much longer can I afford it? I'm hoping Obama will get in as he is our only hope of easing the health care and insurance crises we face. It may take a few years to get a program up and running but I have hope.

[Vito Andolini]

The $5 and $10 copay is what helped kill our health care system. When everyone had a $500 deductible, rarely would we see a child who woke up with a fever. Parents would wait a day or two, and use common sense--Tylenol, and other OTC, clear liquids, etc. Most kids would get better within a few days. Now, parents want their child seen immediately and demand an RX and leave the office ****** if they don't get one.

Face it--most people can afford to spend $500 per family member on health care. Yet the ones who say they can't and scream the most also drive around in new cars with a $400-$500 a mth car payment. They think nothing of going out to dinner/movie and dropping easily $100.

Health insurance was never meant to cover all health care costs. In the past it was meant to cover MAJOR health care costs from a catastrophic event-not everyday health care. Yet today, everyone wants free health care.

That being said, my monthly health insurance bill is over $800 a month. That is 35% of my monthly income. How much longer can I afford it? I'm hoping Obama will get in as he is our only hope of easing the health care and insurance crises we face. It may take a few years to get a program up and running but I have hope.

What makes you think he can do it? It is up to Congress, not the President. Granted, the Prez has a lot of influence, but it is Congress that makes laws.

As for insurance not being meant to pay for everything, what about the Kaiser Permanente model? This started as KP setting up health care for its employees, easily accessible, on-site at the job. Workers originally lived very near the factory/mill. They and their dependents were valuable enough to the outfit to be deemed worthy of being kept healthy. Thus, the health care equivalent (sort of) of the company store was born. And I believe it did cover all or most of their care. Today, KP provides care for many people more than its own employees, in true HMO style. It is fine for simple, routine matters but don't get very critically ill. I guess like with a lot of other HMO's? They are decent at ER care, urgent care, too, as I recall.

The copay should be forever banned, IMHO.

[Neveranurseagain, RN]

My main beef with Kaiser is that they do not cull MD's when serious mistakes happen. They would rather spend thousands of dollars defending an MD than to fire them. And you are right--if you are seriously ill, Kaiser will probably let you die. It is cheaper to let a pt. die than to treat him for a major incident. Since you sign a binding arbitration agreement as being a member, hardly any malpractice attorneys will take a case against Kaiser. They know, statistically, you have only a 70% chance of winning, not matter how gross the error was. And believe me, if it goes to arbitration, there is no question that a major med/mal incident has happened. Due to the high cost of med/mal, attorneys will not accept 'frivolous' cases. Kaiser knows this and uses it to their advantage. They are aware that most the people they insure are low to upper middle income workers, and med mal attorneys will not represent you if you make less than $100,000 year. So no attorney/no med mal case against them. If they can save $$$ by letting someone die, they will do it with little reprisal from governing agencies.

I still have Kaiser right now (shudder) and live 1hr 15 min from a Kaiser facility. But by the time I drive 2 1/2 hrs round trip, pay for gas at $4.00 a gallon, and a $40 copay to see my PCP, and being sick to boot, it is not easily accessible. So I see a local PCP, who charges me $55 cash, and usually will get a few samples as well as a cheaper Rx.

Why not go to a single payer system that will guarantee basic health care to everyone? In most countries that have a single payer system private health insurance is still available for purchase. But everyone is offered basic health insurance.

And I do feel Obama will do do something about the health care crises. He is more in touch with the issue than McCain who just wants to deregulate the health care system, not guarantee basic health care coverage to everyone.

Right now we have 40 million uninsured people living in America. Will the economy heading the way it is, soon we will have over 100 million without access to basic health care.

[icyounurse, BSN, RN]

I understand your point, and agree with you.

One of the factors that I believe has to happen before costs begin to fall is this: Insurance needs to get out of routine, predictable health expenses. On the surface this sounds contradictory: Health care is expensive. We can't afford care with out insurance. But I believe that costs are double or triple what they would otherwise be because insurance is involved. You would never pay $10 for an aspirin, but you don't question when your insurance does.

That is where negotiation comes into play with routine, predictable and planned health expenses. My family doctor recently billed my insurance $200 for a yearly physical. The insurance reduced the payment per their contract, but covered the visit as a preventive benefit. Blood work was sent to a local med. center (simple labs such as CBC, metabolic profile) and cost another $150, which was also reduced, but covered under my preventive benefit.

In that same office, the doc will provide the same services (comprehensive yearly physical with labs run in the office) for $45 cash if it is paid at the time of service. The difference reflects the cost of her office doing business with the insurance companies, including the cost of employees who are paid to handle insurance issues, the wait for 30-90 days to receive payment, the denials and appeals of claims, etc. By paying cash, the patient reduces the cost of services to approximately 1/8 of the billed amount.

I have yet to find a provider (PCP, specialists, hospitals, out-patient services, etc) unwilling to negotiate prices up front and even reduce costs after the fact (ER) when I ask them to do so, cite my high-deductible plan and promise to pay promptly.

I think high-deductible plans are a step in shifting responsibility for routine and predictable expenses back to the consumer and help the consumer make their money go farther. But I firmly believe that removing insurance from the equation (with routine health care) is necessary for the system to work.

I agree with much of what you are saying. Although I am not sure what the solution should be, our health care system needs some big changes. I am going to try and negotiate a price like that when I go for my prenatal exam next week, since I am pretty much paying up front with cash. I never even thought that I could do that, thanks for putting the idea in my head.