6 Tips for Navigating High Deductible Health Plans

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Most health insurance plans today have out of pocket deductible requirements that operate much in the same way as auto insurance deductibles (except on a per year basis rather than per accident basis) prior to health insurance coverage “kicking in”.  For those who can remember “the good old days”, they may remember when a doctor’s visit only cost them a $5 copay.

Today, the average doctor’s office visit costs over $100.  A routine child birth costs around $3,000 and a knee replacement is often well north of $50,000.  As such, you can easily imagine how quickly you could be biting into that health plan deductible prior to any insurance coverage helping alleviate the blow to your wallet.

While these deductibles may feel imposing and formidable, thankfully, there are some resources and creative ideas outlined below that are available to individuals on high deductible health plans.  When proactively employed, these can help you to save money and still accomplish your personal health objectives.

1. Keep in Mind the Health Care Chain of Command

You’ve heard it a million times, but here it is once more. When in doubt, keep in mind the following for those situations where you are on the fence about which type of treatment you need or the best place of care.

  1. 24 Hour Nurse Call Line (if provided by your health insurance) – It’s Free!
  2. Telemedicine – it’s a whole lot cheaper than a physician office visit!
  3. Primary Care Physician
  4. Check if Urgent Care is a viable alternative to the emergency room.
  5. Utilize Emergency Room only for life-threatening conditions or after exhausting the first four possibilities.

2. Don’t Neglect those Preventive Check-ups and Maintenance Medications

You may be tempted to skip the annual physical exam, mammogram, or the next month’s prescription drug supply because of the associated costs or fear of services being recommended that would cost you money.  Run from this temptation though and don’t look back!  Maintenance care is as critical to your health as it is to the health of your automobile.  A car with no oil or filter changes will certainly fail much sooner than one that meets the recommended servicing schedule regularly.  Likewise, having your annual physical and other preventive care services (which you generally have no out of pocket cost for most of these), will pay similar dividends for your health maintenance down the road. 

These types of services are critical to early identification of conditions that can become catastrophic and costly down the road if not identified soon enough or if the treatment of chronic conditions becomes neglected.

3. Health Savings Accounts

For individuals on an IRS qualified High Deductible Health Plan, you are eligible to set funds aside on a tax-free basis through payroll deduction to a health savings account with an established bank partner.  Unlike many flexible spending accounts, these funds roll over year over year and remain in your account and eligible to use for qualified medical expenses for you and your dependents.  Then, when you do have medical services, you can pay for these or reimburse yourself with funds from your HSA, effectively giving yourself a 25% to 30% discount (or whatever the value of your tax bracket that would apply) at the doctor!

4. Prescription Drug Savings Opportunities

Prescription drugs can be expensive.  However, exploring the following with your physician or insurance plan may help you to save money.

Mail Order

Mail Order enables you to get generally a 90-day supply mailed to you directly for routine, maintenance medications.  This not only saves you a trip to the pharmacy, or the time waiting in line, but generally reduces your out of pocket cost compared to paying for three individual monthly supplies.

Retail 90

Similar to mail order, you are also often able to fill multiple month’s drug supply at a retail pharmacy for cheaper than three individual fills.

GoodRx or similar

There are many drug coupon programs that you can use outside your health insurance plan.  Sometimes the coupons the drug manufacturers are willing to provide make the drug less expensive than accessing it through health insurance. 

Additionally, if you are on a high cost brand or specialty medication, you should research the drug on the manufacturer’s website to see if there is a manufacturer assistance program available that would provide the drug for a significantly reduced amount.  Drug manufacturers still get significant tax write-off credits for offering these programs, so you may be surprised how much they are willing to discount your prescription.  See our previous blog post outlining additional opportunities for prescription drug savings.

5. Shopping for Health Care

Healthcare still lacks much of the transparency needed for individual consumers to assess the cost and quality alternatives of having a service or procedure performed at one facility verses another.  Still, there are some tools available to help in this regard, such as:

Finally, when you are at your doctor’s office and being prescribed a course of treatment or a referral, be sure to let them know you are on a high deductible health plan.  You are well within your rights to request that they give you several options for treatment, be it alternatives for a prescription drug, the treatment plan itself, medical imaging type or facility for treatment.  This can definitely require more work on your end, but you would be surprised how much costs vary from one alternative to another or how often one plan of treatment is prescribed that could have just as likely been a different proposed solution by a different physician.  Physicians generally don’t have cost and quality information at their fingertips when making their referrals and recommendations, but if you are willing to call around and do your research, you can take that information back to your doctor and ask him or her to formally refer you accordingly.

6. Negotiate your Medical Bills

Finally, while it may require a few phone calls and a bit of legwork, many patients have had success negotiating their medical bill down.  There are several ways of doing this which are highlighted below.

Professional Medical Bill Negotiation Services

There are companies such as Medical Cost Advocate, Copatient or Medgotiate that will review your hospital bills and look to negotiate them on your behalf.  These companies have access to usual and customary charges for services and are often better equipped to leverage this information than the average consumer.  These services are typically paid for as a percent of any savings they are able to obtain on your behalf.

Charity Care Applications

There are also charity funds, government sponsored programs, and a variety of payment options available to consumers, you just sometimes have to seek them out.  If you have a large hospital bill, for instance, reach out to the hospital’s billing office and ask if they have a charity care application.  Typically, they will require you to provide information about your household and financial situation prior to making a determination on your eligibility.  It is a worthwhile phone call to make, however, as the billed amounts can be discounted significantly.  At a minimum, they will almost always work with you to develop a no-to-low interest payment plan.

Negotiate Directly

While this approach isn’t for the faint of heart, hospitals are often willing to take a cash pay option and discount their bill to some degree.  With a little bit of research or by just asking the billing office directly, you can find out what Medicare would reimburse a provider for the same service you have either received or are about to receive.  Armed with this information, it is reasonable for you to offer to pay them cash and 200% of the Medicare amount, if it is still less than what they would be billing you otherwise.  Often, the guarantee of having your payment up front in cash , and/or mentioning the amount Medicare reimburses is enough for them to lower their bill.

You are Your Own Best Advocate

While healthcare costs continue to rise and transparency tools are few and far between, there are certainly opportunities for savings for those willing to ask educated questions and be their own advocate.  As much as we like to think of health care as a “protected” or “regulated” industry and despite the non-profit status of many facilities, health care is a multi-billion dollar industry that rewards those who do their research but can seriously injure those, financially speaking, who don’t.

About the Author

Ben Lewis resides with his wife and four kids in Rochester, NY where he has lived since coming to Rochester for college in 2001.  After completing his Bachelors of Science in Mathematics at Rochester Institute of Technology in 2005, Ben went on to work at Excellus BlueCross BlueShield where he developed insurance rates for large fully insured and self funded employers.  During these years Ben also obtained his MBA in Finance from RIT.   With industry experience coming from a variety of rolls in finance, benefits consulting, marketing and even a brief stint as an HR Benefits Manager, Ben joined Consiliarium Group as a partner in April, 2019.  Brought on as the Strategic Healthcare Practice Leader, Ben’s responsibilities include heading up the Self Funded business unit, vetting emerging healthcare technology or vendor solutions, and championing the marketing efforts at Consiliarium.  

Ben’s ambition is to help employers empower individuals to pursue personal well-being by working with HR and Finance teams to employ smart, sustainable benefit solutions that meet individuals where they are at and simplify the journey for where they want to go.  When individuals are informed and empowered to become better consumers of healthcare, the results make it a win for everyone.