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Quick Facts About High-Deductible Health Plans

High-deductible health care plans are no longer a novelty—they are becoming mainstream. According to the industry trade group America’s Health Insurance Plans, the number of people with this kind of coverage reached more than 11.4 million in January 2011, up from 10 million in January 2010.

A survey from the Kaiser Family Foundation found that about half of all workers in “small” businesses (up to 199 workers) who have health insurance have these plans. (KHN is an editorially-independent program of the foundation.)  Here is a brief guide to this type of health insurance:

  • These plans are generally defined as insurance policies with lower premiums and a hefty deductible – the amount you have to pay before the insurer picks up any of the cost. Federal rules require these plans to have deductibles of at least $1,200 for an individual and $2,400 for family coverage for 2012.
  • Another term for these is “consumer-directed health plans.”
  • Because of the health law, even high-deductible plans are now required to cover, usually for free, basic preventive services such as vaccinations and wellness exams.
  • Consumers and employers like the cost control that comes with the plans—because the premiums are lower than standard insurance premiums – on average, $1,000 to $2,000 per year.  
  • Even with the high-deductible, patients’ out of pocket costs are capped at $6,050 for an individual and $12,100 for a family.  Out-of-pocket costs generally include the deductible, the patient’s share of the cost of seeing a doctor, prescription medicines and/or hospital costs. 
  • Health savings accounts (HSAs) sometimes accompany high-deductible plans. These accounts allow beneficiaries to contribute, tax-free, up to $3,100 for an individual and $6,250 for a family.  
  • The money inside the health savings account belongs to the consumer. Funds left over at the end of the year are rolled over to the next year. If an employee changes jobs, the HSA stays with that individual. Some employers make tax-free contributions to their employee’s HSA.
  • Health policy experts say the popularity of high-deductible plans is the byproduct of the steep rise in health costs. A RAND study notes that high deductible plans, especially those associated with HSAs “create a strong financial incentive for the employee to manage health care costs carefully, because the account balance is owned by the employee.” Deborah Chollet, a senior fellow at Mathematica Policy Research Center in Washington says that consumers “tend to be young, healthy males who [generally] avoid the health care system and only go to the doctor when necessary.”
  • The plans are problematic for low-income individuals, especially those with chronic conditions, such as diabetes. Paul Fronstin, of the Employee Benefit Research Institute, says HSAs/high-deductible plans have a “straitjacket design” in which consumers are responsible for paying the full-dollar amount of their medical expenses until they meet their deductible. People with health problems can have the toughest time meeting the deductible, because their illnesses can keep them from working.
  • The IRS determines what medical expenses qualify toward the deductible. Recently, the IRS dropped over-the-counter medications from its list.

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Cost and Quality Insurance