By Paul Ketchel, CEO and Co-Founder, MDsave
Healthcare consumers today are facing a rapidly changing landscape.
In the past, you could go to a provider and expect a $20 copay. Now, patients are absorbing the bulk of healthcare costs up-front until they hit their deductible. The shift is changing the way people use and shop for healthcare.
The rise of high deductible health plans
In the last three to four years, high deductible health plans have become the predominant plan design for employers, individuals, and healthcare exchange-based plans.
In a high deductible plan, a patient has to meet the full deductible amount before the health insurance will begin to pay for medical expenses.
Last year, the average deductible was about $6,000. That means for any procedure, you would have to pay up to that $6,000 before your benefits kick in.
When you consider the cost of monthly premiums, many patients find themselves shelling out as much as $12,000 a year before they receive any benefit from their insurance plan.
One of the most important things healthcare consumers can do is think about what their medical costs are before utilizing the care.
Choose the right plan for you
Choosing a health insurance plan can be confusing. The one thing that people tend to focus on is the premium price per month. However, a premium is a small part of the plan. You also need to be aware of out-of-pocket costs like deductibles and co-insurance (a percentage of any charges owed, even after the deductible is satisfied, until you reach an out of pocket maximum).
These charges affect how much you are at risk for having to pay out-of-pocket each year.
The only way most patients are going to hit a $6,000 deductible is through an inpatient event, chronic illness, or surgery. The average patient in the United States only has such an event once every 17 years. Most consumers will benefit more from getting the lowest possible premium and a higher deductible.
For example, if you have a $1,000 monthly premium and a low deductible of only $1,000, you will have to pay $13,000 that year before you receive any benefit from your health insurance.
Once you pay that premium to your insurer, it’s gone, whether you use the healthcare services or not.
On the flip side, if you have a low monthly premium of $250 per month and a $5,000 deductible, you are only at risk to pay up to $8,000 before your benefits kick in.
Use tools to lower out-of-pocket costs
With a higher deductible, you can use consumer-based tools to help you save that money instead of just spending it on premiums. We’re moving into a new system of consumer-based health care.
There are a lot of tools available today that are designed to help healthcare consumers: transparency tools like Healthcare Bluebook help estimate pricing; online marketplaces like MDsave let consumers shop, compare and purchase procedures, and digital coupon services like GoodRx help reduce pharmacy costs.
Services like these can help individuals significantly lower their out-of-pocket healthcare costs and make their hard-earned dollars go further.
More and more patients are now personally responsible for the cost of their healthcare. Before, having transparent pricing was never really a priority, because someone else was paying the bill.
Now, healthcare consumers can use these tools to shop smart for medical care. A little bit of legwork can save a lot of money.
Paul Ketchel is founder and CEO of MDsave, the world’s first transactional healthcare marketplace. He has more than a decade of combined experience in the healthcare industry. Previously, Mr. Ketchel served as Chief Operating Officer of Diagnostics Network Alliance, and as Director for American Capitol Group, a government relations firm which represents more than 60 clients in the healthcare and pharmaceutical industries. Prior to joining American Capitol Group, Paul was Director of Government Relations for Elanex Pharma Group International. Before joining the private sector, Mr. Ketchel began his career as an aide to United States Senator Bill Frist. Mr. Ketchel served as an aide for the senator on his Washington, D.C. staff.
This article first appeared in the NY Daily News and is re-published with permission.