The Pro’s and Con’s of High Deductible Health Insurance Plans

Are you familiar with the term “high deductible health insurance plan” (HDHP)? This type of coverage saves you money on monthly health insurance premiums in exchange for higher deductibles—the annual upfront amount of covered health expenses you must self-pay (out-of-pocket) before your plan pays for medical expenses. Read today’s post to better understand if these plans are right for you.

Autumn brings a change in the weather, the onset of fall colors, and for many, it signals the annual rite of choosing a health insurance plan for 2015. Employers are increasingly offering HDHPs to their employees. In fact, according to a National Business Group on Health survey, of the 136 large companies studied, almost 33% offer HDHPs to their employees. These plans are also available from the health insurance marketplace for individuals and families who do not receive their health insurance through employers.

Before deciding on whether or not this plan is right for you and your family, it is wise to evaluate your own and your family member’s mental health care needs.

Compare your options

The Good: High deductible health insurance plans tend to have lower monthly premiums, making health coverage more affordable for many, especially workers earning lower wages. Basic preventive services, such as an annual physical, preventive vaccines for flu and pneumonia provided by in-network health care providers, and generic drugs are often covered at low or no cost to the patient.

The Bad: Consumers with HDHPs must pay for health expenses, including co-pays before the deductible kicks-in. Charges for out-of-network providers or services or drugs not covered by the health plan don’t apply toward meeting the annual deductible. The hope is that users will become more responsible for their health care and will comparison shop. While in principle this is a good idea, in reality, when one chooses an in-network provider for their care, it may turn out that the recommended subsequent lab work is out-of-network, or that the necessary prescription is not a generic brand.

The Ugly: Beyond paying monthly premiums, in 2014, the out-of-pocket limits are $6,350 for covered individuals and $12,700 for families.

The Challenge: Patients must be prepared to seek covered treatment by in-network providers, and have the financial resources to cover a greater share of the cost of unanticipated medical costs. When reviewing mental health care needs, it is important to find out how many clinicians are available in the carrier’s network. A common complaint is that there are not enough in-network clinicians to handle the capacity. Call the doctors listed in your plan before you enroll. Make sure they are not only taking new patients, but learn how long it will take to actually see the clinician.

Learn more
It seems astounding that one could have health insurance and yet feel completely vulnerable to health care costs due to high out-of-pocket deductibles, for mental health care, medications, costly labs, and other diagnostic tests. To learn more about how to evaluate health insurance coverage register to attend a webinar offered by the Depression and Bipolar Support Alliance on November 13, 2014.

The Questions

  • What changes have you made in managing your health care to meet the cost of high deductibles?
  • How have you evaluated the benefits of low premiums versus the high cost of upfront out-of-pocket expenses?

Facebook Comments