
From the article:
Her employer offered only a high-deductible health plan; that meant she’d have to pay up to $6,000 out of pocket each year. Advocates for patients say this sort of underinsurance is snatching lives.
Source: High-Deductible Insurance Linked To Delays In Cancer Diagnosis And Treatment : Shots – Health News : NPR
I feel like I am constantly breaking down cost benefit analysis for my friends on these high-deductible plans that will literally get you killed if you have health issues.
First, some terminology.
- Premium: The monthly amount you pay to have insurance.
- Deductible: The total dollar amount you have to pay before your insurance wills tart covering you.
- Out of Pocket: This is the dollar amount you pay yourself, like a co-payment, when you go to the doctor, even though you have insurance.
- FSA/HSA: Flexible Spending Account/Health Savings Account. The are accounts that are taken from your paycheck that can only be used for healthcare. Some can be used in total on day 1, some cannot. It basically skims your paychecks for the money, and are often used in conjunction with higher deductible plans.
People look at these high deductible insurance plans, and it’s attractive. The monthly premium payment is often a lot less.
However, high deductible plans are often filled with higher out of pocket amounts. For instance, you might not be covered 100% of a hospital visit. You might only be covered 50%. Specialist doctors might only be covered 80% for the visit and the testing. This is something you really have to look at. One accident, one set of testing, and you could blow all the money you are saving on the monthly premium’s and more. These high deductible plans always go hand in hand with crappy coverage if you actually need it.
The problem is that most FSA/HSA funds is that they are not big enough to cover these high deductibles, and the out of pocket costs that are usually associated with these plans.
Let’s break it down quick and dirty. This is not a real plan, but kind of what I’ve seen over the years, give or take. This is just to show you how it works.
Costs |
|
Low Deductible Plan |
High Deductible Plan |
Cost Per Visit |
Monthly Premium |
100 |
50 |
|
Deductible |
500 |
5000 |
|
Copay |
20 |
20% |
125 |
Specialist |
30 |
20% |
200 |
Testing |
No Copay |
20% |
800 |
Hospital stay |
150 a day/maxes at 500 |
50% |
10,000 |
Okay, now let’s say for the year you see the doctor 3 times, have one specialist visit, and testing procedure like an MRI/CAT etc. Then you have an in-hospital stay for a week.
I super low-balled the costs for each visit. Specialist visits can go up and up. Testing procedures can be in the thousands. Hospital stays for a week are probably never going to be that low in the US.
You pay |
|
Low Deductible Plan |
High Deductible Plan |
Premiums |
1,200 |
600 |
Copay |
60 |
75 |
Specialist |
30 |
40 |
Testing |
– |
160 |
Hospital |
500 |
5,000 |
Total |
1,790 |
5,875 |
Add Deductible |
500 |
5,000 |
Total paid for year |
2,290 |
10,875 |
This super simplistic example shows that you would end up paying $10,875 for the year of costs, versus $2,290 if you had a low deductible plan.
The problem is that people often think it will help them if if it’s catastrophic health care, which these plans don’t really help with because the coverage is usually shit on top of the high deductible.
Even worse, you can get knocked out of access to financial help because you actually have an insurance plan.
I hate these plans. They are a scam that do nothing for anyone.