<p>This year, H switched into a medical plan with a very high deductible. As a result, we are basically insured for catastrophic events. </p>
<p>Already, I have had numerous tests for a thyroid problem and physical therapy for a frozen shoulder, and H has a knee problem. The bills are starting to pile up. Right now, I am not feeling particularly inclined to do anything above and beyond the ABSOLUTELY necessary, and have stopped p.t. as it seems to have had limited results after 5 weeks. At the same time, I hate the idea that we have to some degree joined the uninsured in parceling out plans for medical care. :(</p>
<p>Why did he switch, because it was cheaper? If so, how much money did your premiums go down? Sometimes the savings in premiums makes up the difference in the deductible. I switched to a high deductible HSA plan this year because it cut my premiums that I paid in half. If something comes up and i meet the deductible and whatnot, then so be it. the annual out of pocket max was actually lower on my high deductible plan then on the plan I h ad before, so worse case scenario I actually am paying less out of pocket.</p>
<p>Do you have an HSA plan which allows you to put aside a tax advantaged account to use toward your deductible?</p>
<p>We have had a large deductible for about 20 years and it does affect how you look at using medical services.</p>
<p>First off, if you have an HSA, you can use that money (income tax deductible on page 1 of your tax return, so “above the line” as they say) toward items not covered by your insurance, such as dental or orthodontia. This is good because that stuff is expensive, but also bad as it eats up your account. Having done 6 sets of braces (phase I&II) we had finally built up our account to $10k. Then I had a cancer scare, all sorts of scans and finally surgery with an oncologist. The ER visit hit our $5500 deductible and the rest of it hit the $10k+ out of pocket limit. We totally drained the account again, but thank God it was there.</p>
<p>And that HSA deposit come off before your FAFSA AGI ;)</p>
<p>So, how do you change your focus on using health care? Well, you become very proactive, you learn more about your families health needs and you avoid any non-critical visits. Prices are very high for the value in some cases. I never took my kids to the doctor for anything I perceived to be viral. I know we visited the doctor way less than my friends kids with low deductibles.</p>
<p>You may also find yourself getting creative, I have sought prescriptions in Mexico & Canada & even online. You make certain to get your refills before they expire. You find out where to get the best deal. </p>
<p>I also discovered some towns have labs with cut rate prices for cash. Another thing, you may have an annual physical which is covered with no deductible. Be sure to ask for any usual prescription renewals then. Be sure the doctor charges for an annual physical with the code that your company recognizes.</p>
<p>I changed to a high deductible plan a few years ago. We are self employed so we must buy our own insurance and it was getting out of this world! Now my high deductible plan with Blue Shield is also facing increases every year.
So yes, I do not go to the doctor for just anything. Yearly checkups are included–but not the lab work ($400!). Mammograms are included—Colonoscopys are not. So we make decisions—and try and stay really well!
I have to say, if others looked at health care like I do now, maybe costs would go down. My mom was a nurse for 25 years and both she and my dad (he is 80) have many health problems. They go to different doctors at least twice a week! It is crazy! Mom always says if I complain about an ache or pain in my knee “are you going to the doctor?” NO WAY! Until I reach my high deductible after a catastrophic event (please God no!)…then maybe I would go. But at this point we just trust in Tylenol, ice packs, and chicken soup.</p>
<p>iloved, You might want to shop around and see if there is a better plan for you. I know for example that most Aetna plans (I can’t speak for all of them, but almost all of their plans that I have ever contact with) include free annual physical including lab, routine eye exam, mammogram, gyn, prostate check, and colonoscopy (every 10 yrs) for in network benefits prior to any deductible… even on their high deductible plans. They are very big on preventative care because they think it will help keep future costs down.</p>
<p>We bought our 23 yr old student son a high deductible plan when he was kicked off my employer plan last year.<br>
It DID include reduced cost dr visits, lab work, etc if done through an in network doctor and or lab. So, even though he did not meet his high deductible (thank God) he was able to get some basic health care at more reasonable prices than if he had no insurance.
It was a UnitedHealthcare plan I think and was very inexpensive for healthy young male and had a $5000 ish annual deductible. YMMV. Good luck.</p>
<p>I have seen a difference in which preventative services are covered from state to state, one state did not cover colonoscopy or mammogram (with no deductible) another state covers screening colonoscopy, but not diagnostic. Check on the plans with your state, most of them can be googled and reviewed on the company website, but I would still recommend buying through an agent so that you can have someone to advocate for you should you need it.</p>
<p>I agree with ILC, those who have amazing coverage use it far more than our family, I do think that a high deductible plan for everyone would change the way the health care system runs. I see the high deductible plan + the HSA money being still cheaper than the premiums for the full coverage. </p>
<p>If you don’t spend the HSA money on health care, you can eventually use it as an IRA or for medicare gap premiums, so full coverage or high deductible, you have spent the same, but you have a chance to keep that HSA money for future needs, with the full coverage plan, it is gone for premiums.</p>
<p>We have had extremely high deductible plan for several years. Have been lucky to have basically good health, but still there are decisions to make about whether to treat something that you can “live with” or not… when it will be totally out of pocket. Ditto how often and whether to do certain tests.</p>
<p>I think it’s critically important to have a primary care MD who “gets it.” Ours is wonderful, both as a clinician and as our “partner” in discussing frankly what is safe to “put off” and when we should spend the money for further testing etc.</p>
<p>We have a high deductible + HSA and I have found informing medical providers of this fact has helped. They take a better history, perform a more extensive physical exam and are not as quick to order a bunch of unnecessary test.</p>
<p>We have a high deductible health plan ($4K family deductible) and have found it to be overall less out-of-pocket than our previous plan based on copays, primarily because the previous plan had some very high copays for specific drugs needed by some family members. Our is nice because once you do hit the deductible the plan then pays 100% of all other doc, hospital, pt, and drugs (though there is a small copay on drugs.) If you can focus expense much more heavily in one year, and less in the next, you may have an advantage. H’s company quit offering a traditional PPO alternative this year because the economics of the high deductible plan were so much better. I am more attuned to costs, but I don’t think that’s a bad thing. It hasn’t stopped us from getting needed care, but it has caused me to ask the doctor if a less expensive drug might be appropriate.</p>
<p>I had to see a physician in late December for an injury and when they called in 2011 for follow up, I mentioned the $5500 deductible and that I did not see the need to come in- he offered to check it for free! I ended up paying a discounted rate of $30 for that visit because I did not expect him to work for free, but appreciate greatly his willingness to discount for me.</p>
<p>I was shocked last year at how many initial visits (surgeon etc) were $500+ for one visit.</p>
<p>My favorite doc was kind enough to lower her cost for initial office visit from $250 to $100 for a friend who was visiting from out of town but had NO insurance. She also gave the friend a lot of samples because she had no insurance. The docs are very nice and try to help when they can.</p>
<p>We & my folks have great insurance. When S had a higher deductible in 2010, we deferred all his visits until he came back under our plan in 2011. I don’t feel we have changed how we use medical services that much. I COULD see my docs much more than I do but have no need to see them as long as I remain pretty healthy and stable. My folks generally only see the docs about once/year unless something comes up. Mom does see the ophthamologist and dad is seeing a knee specialist. I think considering their ages, they really don’t use the medical system nearly as much as many of their peers.</p>
<p>I feel our use of healthcare is fairly moderate as well, especially since we have some chronic health conditions. I do admit it would give me more pause if we had a $4K or higher deductible before insurer shouldered any of the costs. Heck, it caused us to postpone S’s care in 2010 until 2011 when his deductible was $350! Our regular health plan has no deductible and we only pay $15 for most office visits–to ANY doc participating & preferred. I still need to call & schedule my OB & mammogram–no reason I haven’t gotten around to it.</p>
<p>I also have a high deductible HSA plan – when you are looking at expenses, you do need to account for the saved premium money. I mean, hypothetically if the high deductible costs $300 less per month than a more comprehensive plan, that is $3600 in the course of a year that can cover all sorts of incidental expenses …and you aren’t really out of pocket until you’ve exceeded the amount that you would have paid in combined premiums & copayments. </p>
<p>So i think you really need to take out a spreadsheet and look at the whole picture.</p>
<p>For what it’s worth, the HSA plan has worked really well for me, in part because I have made it a point to fully fund the HSA each year. I also use it to pay for medical expenses, but I’ve put in more than I’ve taken out and so now there is enough sitting in the account to cover several years’ worth of deductibles. </p>
<p>I do find that I don’t get some types of care that I would opt for if fully covered, but for me the problem isn’t that I don’t have the coverage – I’ know I have plenty of cash in my HSA account – the problem is that I can’t get doctors to tell me in advance what the cost of the visit or procedure will be! I mean… i just want a straight answer to “what do you bill for a colonoscopy” – so I know in advance what I am going to be charged. </p>
<p>I really love the HSA because I can also use it for all sorts of stuff that is not covered by my health insurance, like dental and vision care. But I think an HSA is only a good plan for someone who thinks that their costs for routine medical care are going to be well below the deductible. </p>
<p>Anyway, I think a starting point in comparing plans is to add the total premiums for a year to the maximum deductible for each policy – with that you will see a somewhat different picture.</p>
<p>Expect to see more and more high deductible plans. A lot of employers are offering them as choices now but will eventually make the regular plans so expensive that most people will have no choice but to move to a high deductible plan. A friend who works for GE said they now have no options but a high deductible plan at their plant.</p>
<p>The whole point of these plans is to make you stop and think before you go to the doctors. I’ve worked in health care my whole career and patients have gotten more and more demanding about having tests and procedures because their insurance will pay for it. Doctors, too, are more likely to order tests and prescribe expensive drugs if you have good coverage. </p>
<p>As several people have pointed out, when you weight what you are saving in premiums against the deductible, it is often a break-even and the nice thing is you have control over whether you spend the money. HSAs are great because if you fully fund them (some employers will also) and you don’t use all the $$, it can be saved for other things like retirement.</p>
<p>My husband has a high-deductible HSA. If my employer offered one, I would do it without hesitation.</p>
<p>to those of you with an HSA, I have a question… I work with insurance but I don’t really set up or deal too much with HSA’s and this is the first time I’ve actually been part of an HSA myself. I am not contributing anything towards my HSA but my employer puts a little bit in there for me each pay period. As we are early in the year, there isn’t too much in there quite yet. I have a visa debit card to withdraw money out of it. I’m not sure how much I have in there right now so I’m just going to make up random numbers. My question is, say I want to go buy new glasses for… I don’t know lets say 200 bucks. Say I only have 100 dollars in the account at that time, Can I withdraw that 100 dollars at the point of purchase and then once I accumulate another 100 dollars in there send in for reimbursement? Or must you have the exact $ figure at the date of service?</p>
<p>^^I would imagine that would depend on the service provider…what we have tried to do is have the doctors bill us for services because we never know what the insurance co will use (in-network) for usual and customary, and therefore, how much will apply towards the deductible; </p>
<p>this extends the time for payment…</p>
<p>In addition, I think you can pay by any credit card and then use the HSA savings account to pay the credit card (assuming you have checks from the account in addition to the debit card)…just keep good records…</p>
<p>Like you, we can only fund the HSA savings on a periodic basis so must figure out how to “float” this…</p>
<p>Overall, I know this saves us $$ in the long run as everyone has described, but what a pain in the neck in the mean time…and I think for those of us who have had traditional insurance all these years, it is a paradigm shift and takes awhile to get used to…</p>
They are billing the insurance company, someone has to know.</p>
<p>My company offers an HSA with around a $2500 deductible, but after a bunch of spreadsheet magic it worked out that it wouldn’t really be cheaper for the level of services we used.</p>
<p>I have noticed that the difference between what the doctors bill the insurance company, and what the insurance company will pay, are substantial - like 30-50% of what the doctor bills or less. (My DW recently had back surgery, the surgeon billed $13,000, the insurance paid him $1500!). So I wonder if doctors will offer a discount if you pay cash. Or are they not allowed to?</p>
<p>Same for tests - they are often reimbursed at 1/3 of the billed price. You can, however, get many lab tests done on your own for prices near what the insurance company will reimburse for, it is just a bit more work - you typically have to drive somewhere to get your blood drawn instead of getting it done at the dr’s office.</p>
<p>I concur with the idea of needing to stop and think about what’s really necessary. I turned down a stress test that my primary suggested after one slightly weird EKG, but I knew I should do so cuz my H is a former doc. I make her pick and choose which parts of a comprehensive set of blood tests are really necessary–if my cholesteral has always been great, I don’t need it tested every year. same for calcium (not great but good enough, and I wouldn’t do the big supplements even if told to.)</p>
<p>But where is the line between “don’t need” and “can’t afford but it should happen anyway”? Are people going to stop colonoscopy screenings because they can’t afford them? Should someone just live with a frozen shoulder because they can’t afford care for it? </p>
<p>Everyone complained about the healthcare bill with spectors of “rationing.” But this is what rationing really looks like–you don’t get the care if you can’t afford it. Which is why I’ve always been in favor of single-payer, non-profit insurance. Cover what is necessary, decide as a nation what’s optional, and give everyone the same access, so no one’s dying of undiagnosed colon cancer, or walking around with an unusable shoulder because they can’t afford the treatment.</p>
<p>I am a teacher and my district offered a high deductible plane this year. They put in $2000 to a HSA and I contribute another $2000 to meet the family deductible of $4000. The individual ded. is $2000. My D2 is going for an MRI tomorrow so I’ll probably meet her individual deductible. I have also used the money for dentist visits. It has been really nice not to take copays, ded.,etc out of the regular family budget. We actually pay less for care per year on this plan than we did when Ds were on husband’s traditional plan. The district also pays less than when I was on a traditional plan, so its been a win-win for everyone so far.</p>
<p>Wow, thanks to everyone for the responses. Yes, we have a new HSA with this plan, which will help out with some of the bills. H never discusses the plan options with me (his Co has an annual choice made for Jan 1), but apparently the plan we had last year was either eliminated or going up drastically, so he went to the plan with the high deductible ($5K). </p>
<p>I agree with everyone that you have to think a little bit about what you need and how often, especially right now when we do not yet know where S will decide to go to school (translation: or how much it will cost!).</p>
<p>calmom - My 2008 colonoscopy had 3 bills adding to just over $3000 from the doctor who performed it, the anesthesiologist, and the facility where it was done. Fortunately, we had different insurance coverage then and it was mostly covered!</p>