Starting on November 1st, the Open Enrollment period is the time for everyone to start thinking about health coverage for 2018. If you have government or employee sponsored health insurance, your choices are limited by what is offered, but regardless of your status everyone needs to pay careful attention to what plan they select. It is particularly critical for those who live with chronic illness, or have a family member who does, to be sure to make informed decisions about coverage.
When selecting health insurance, many people are (rightfully) price motivated. It is common for people to look at the cost of premium, or amount paid monthly, when making decisions. Unfortunately, often the focus on premiums means overlooking the cost of the deductible, or amount paid out of pocket before an insurer pays its share. This is a mistake, as in order to control the cost of premiums insurance companies often raise deductibles. Once the cost more than a certain threshold (x for individual plans and x for families), these are called “High Deductible Health Plans.” By raising deductibles, employers and insurance companies save money, but patients are put on the hook for paying more.
High Deductible Health Plans can be devastating, and they’re on the rise.
High-deductible health plans try to reduce costs for employers and individuals by lowering premiums. To do so, they shift more costs to the patient. As explained by the Kaiser Family Foundation, deductibles have increased 397 percent between 2007 and 2017, rising from $303 to $1,505. The availability of these plans is also increasing. Ninety percent of large employers are expected to offer high-deductible plans – up from 13-18 percent of firms (depending on size) in 2007. High deductible plans force individuals to pay large out-of-pocket costs up front, which could result in patients—especially those with complex conditions—from taking important medications. UNC Health Care found cancer patients with higher copayments were 70 percent more likely to stop treatments. Those same patients were also 42 percent more likely to skip doses.
Many patients turn to copay cards for help affording medications.
These are often provided by pharmaceutical companies, and can reduce the cost of prescriptions to as little as $5. Historically, the amount paid by the copayment card would contribute to the deductible, reducing the out of pocket burden for the patient. Unfortunately, some health plans now limit or totally prohibit the use of copay cards. Other plans are making increased use of “Accumulator Adjustment Programs,” where a patient is only credited with the amount they actually spend out of pocket. Instead of the full price of the medication paid by the copay assistance program, only a few dollars contributes to their deductible and out of pocket maximum. When the copay card runs out early in the year, the patient is left facing the remainder of the deductible they have not come close to reaching and are forced to pay a large amount before the benefit from their health insurance kicks in.
When selecting a health plan for 2018, patients need to be vigilant.
The Open Enrollment period should be used to rigorously review each plan offered for not just premium cost, but deductibles, out of pocket maximum, and use of Accumulator Adjustment policies with copay assistance programs. If their current plan has a high deductible, the Open Enrollment period is an optimal time for patients to find alternative coverage for 2018.
In some cases, a lower deductible plan is not an option. In this case, patients should ask their employer or broker to commit to offering a low deductible plan in 2018. In the meantime, they should also ask for any programs that can help them afford necessary healthcare and medications.
Now is the time for every patient to be their own advocate and find a plan that works for them and their family.