high deductible health plan


Study: Consumers With ‘Skin In The Game’ May Have Lower Health Costs But Risks Remain


At some point we will all be paying a greater share of our health costs. This is inevitable even for those of us who now blithely float from one provider to the next essentially unaware of what our medical care costs because beyond our insurance premiums, we don’t pay for most of it. When we have more ‘skin in the game’ as health economists like to say, we may finally become more engaged.

A new study by the RAND Corporation bears this out. It concludes that when consumers have the kind of health insurance that requires more out-of pocket payments, they do, indeed, become more mindful of their care. And this more conscious approach to picking and choosing medicines, tests, specialists and treatment could save billions annually, the report, published in the May edition of the journal Health Affairs notes. But these so-called “consumer-directed” health plans, notably high-deductible plans and personal health accounts, do have risks because people may forego important prevention and treatment measures in order to cut costs.

“The study found that among families enrolled in consumer-directed health plans, about two-thirds of the savings were the result of fewer encounters with health care providers. The remaining third was caused by lower spending per encounter, suggesting patients were making different choices about tests and treatments. Families in consumer-directed plans used fewer brand-name drugs, had fewer visits to specialists and had fewer elective hospital admissions than families in traditional plans,” the news release says. Continue reading

Podcast Friday: Medical Sticker Shock; Getting In Shape

Note to readers: You can download this podcast, or you can just click on the play button at bottom left to listen now.

In this week’s podcast:

  • Medical Sticker Shock: We hear how one man, trying to be a smart health care shopper, used his insurers’ online calculator to figure out how much a cardiac stress cost would cost: the estimate was about $150. The charges? $4,000.
  • Fresh Start For Spring: For those of you looking to improve your health for spring, we’re starting a community on CommonHealth, including a professional wellness coach, who will help you do just that! We preview our plans at the end of today’s podcast.

Medical Sticker Shock: An Infuriating Encounter With A Cost Calculator

Man vs. The Cost Calculator

This is the story of a patient who tried to be a smart health care shopper. But the system wouldn’t let him.

The patient, Matt S., works in the health care industry and is a pretty savvy guy. Recently, his company offered a high-deductible health plan, administered by a large national insurer, which he selected. Under the plan, his family’s deductible is $2,800, which applies to almost all treatments and procedures except for primary care and prevention.

A few months ago, Matt’s doctor, who belongs to a primary care practice owned by Brigham & Women’s Hospital, suggested he get a cardiac stress test in order to determine the true severity of his “borderline” hypertension, and whether it required medical management. Before deciding to do the test, Matt — an otherwise fit 40-year-old marathon runner and “minimalist” when it comes to medication and interventions — wanted to estimate what it would cost out-of-pocket since he knew that basically 100% of the covered costs of this test would be his to pay. He figured if they were really high, he would ask the doctor if there was an alternative diagnostic option.

Navigating The System

As with many insurers these days, and particularly ones that offer high-deductible plans, which charge lower monthly premiums and are growing in popularity according to a recent report, the insurer’s website has a tool to estimate medical costs, which is supposed to help consumers get a sense of what the out-of-pocket costs for different procedures will be. Here’s what Matt saw when he plugged his zip code into the estimator and looked up “cardiac stress test:”

Estimate Medical Costs
Cardiac stress tests: A cardiac stress test monitors blood flow to the heart during exercise and compares it to blood flow at rest. Some heart problems that are easily missed when the patient’s heart is at rest become apparent when the heart is under stress. During the test, the patient exercises on a treadmill or stationary bike while being closely monitored.

Cost details for : Cardiac stress tests

Type of Service Cost Range
Cardiac stress tests $28 – $151

“I knew it was low,” Matt said of the online estimate. “You can’t even walk through the doors of the Brigham for $28, but I figured even if they’re wrong by a factor of 2, 3 or 4 it’s still worth it. Even if it costs $500 it would be worth it.” Continue reading