7 Tips for Navigating High-Deductible Health Care Plans – Guest Post by Bill Paquin, CEO of Vertical Health


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A health insurance representative recently gave a presentation to my company about the plans that are available to my colleagues and me in 2013, given that the deadline for open enrollment is looming large. He may well have been speaking a foreign language, given all of the blank stares in the room.

Understanding health insurance has never been easy, but the increasing popularity of high-deductible health care plans has added another element of complexity to an important ñ and expensive ñ necessary evil.  In a high-deductible health-care plan, employees must pay out of pocket for most all-services and medications until they reach the deductible amount, after which the insurance kicks in and pays a percentage of additional costs. This means that health care is no longer about simply being patient; it now requires employees and their families to become consumers in a marketplace that is increasingly more complicated to understand.

The internet is often the immediate choice for a resource when it comes to understanding health insurance, but even then, consumers face issues with reliability and information overhaul; it is overwhelming, difficult to understand, and can be unreliable. The end result? Uninformed consumers who are either afraid to visit the doctor or that make poor health care decisions that come to bear when they need it most.

It is possible, though, to make consumer-driven health care plans work. Following are seven tips for making smart choices for your family if you have a high-deductible health care plan.

Understand the Plan: It is easier said than done, but the key to managing a high-deductible health care plan is to understand what it entails. Read the documentation thoroughly, research the terms, and be very conscious of the deductible that must be met before the insurance kicks in. Don’t forget to understand what is not included in the plan. In some cases, chiropractic, dental, or vision may be excluded, meaning the consumer will pay out of pocket. If you still have questions, consult with your employer or a representative of the insurance agency.

Use an HSA: Most high-deductible plans have the option for a health savings account, or HSA, which allows consumers to deposit and save pre-tax dollars from their pay checks in a dedicated account. These funds can then are used via check or debit card to pay for health care costs, such as doctor’s visits, procedures, medications, and the like. Any funds that are paid out of the HSA also go against the deductible. This guarantees that when an emergency arises, there are funds available to accommodate the costs.

Stay In-Network: Most high-deductible plans are preferred provider organizations. This means that they pay more health care costs to a doctor who is “in-network” versus “out-of-network.” Using a doctor that is in-network can mean significant cost savings. The insurance provider will be able to provide a listing of doctors and practices that are in-network, so it is worth asking before making an appointment.

Understand the Costs: Don’t be in the dark when it comes to the costs of health services, whether routine check-ups or major procedures. Call the doctor before scheduling an appointment or procedure to understand what it may cost, or visit a consumer site like Fair Health Consumer Cost Lookup to gain awareness of what the cost could be.  It is never a bad idea to ask, and the benefits will be felt in the pocketbook.

Talk to the Provider: Representatives from the insurance provider are an asset that cannot be ignored. They can certainly answer questions, but they may also be able to negotiate fees, suggest payment plans, or offer insights into lower cost medication. It may not always work, but when it comes to hard-earned money in a tight economy, it is always worth the effort.

Keep Your Receipts: By carefully monitoring the family’s expenditures on health care, employees are better able to track when the deductible is met and when the insurance will kick in. This is key for financial planning and preparedness.

Ask, Ask, Ask: It goes without saying that asking questions is essential for successfully managing costs when enrolled in a high-deductible health care plan. There are too many caveats, too many “gotchas,” and far too much fine print for most people to engage this on their own. Don’t be afraid to ask; it is the best way to make sure that you make the best decisions for you and your family.

Understanding health insurance has never been easy, and there is little chance that this will change. High-deductible health care plans aren’t doing employees any favors, either, since they place the burden of a certain amount of health expenses on them. Employees must be knowledgeable not only about the plans themselves, but about the health care costs that they encounter, whether doctors’ visits or major procedures. With due diligence, this becomes a minefield that is manageable, but education and understanding is vital.

Don’t let health care talk be overwhelming, or even discouraging; engage your health-care plan head on, use the many resources that are available, and understand the financial implications, areas of savings, and means for taking care of yourself and your family without stress.

About the Author

As the CEO of Vertical Health, patient care advocate Bill Paquin works to convey accurate health information to consumers. He operates web sites including SpineUniverse.com and other sites focused on improving patient care associated with back pain and endocrine disorders. Bill is a husband, father and chronic pain sufferer who writes about improving our current healthcare system.

One thought on “7 Tips for Navigating High-Deductible Health Care Plans – Guest Post by Bill Paquin, CEO of Vertical Health

  1. I hate open enrollment. The company I work for has 300+ employees just at our facility and about 5 years ago stopped bringing in someone to explain the new insurance cost and changes. They sent a packet out next explaining the changes and finally this year they stopped doing that. We have to fill out our open enrollment online and we have to do our own research through the company website about new changes and costs.

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