Health plans

High deductible health plans are the source of medical debt. It’s time to fix them.


With the massive frankness looking them down, HDHP members tend to delay or ignore care, leading to worse results. (Photo: Shutterstock)

The open registration season has just ended. Health care consumers across the country have signed up to health plans that – if the nuances are not understood – could bankrupt them.

Medical debt is the number one cause of bankruptcy in the United States. And of the millions of people facing oppression in health care, 72% owe less than $ 10,000, and 75% of those with medical debts had health insurance. A high deductible health care plan (HDHP) can have a family deductible of up to $ 14,100, which creates a lot of space to stay trapped under medical debt.

HDHPs were originally designed to provide insurance for more people. The idea was that people would get preventative care and make better lifestyle choices and better care decisions because they have to pay such a large deductible. But as healthcare costs have skyrocketed, the 51% of Americans on HDHP are increasingly vulnerable to healthcare profits.

Members forgo care, don’t shop

While preventive care is often free for HDHP, data shows members either don’t realize it or understand what is included in preventive care. Plus, with the massive franchise looking them down, members – even those with serious illnesses such as cancer – tend to delay or ignore care, leading to worse results.

Consumers of an HDHP are also not tempted to find the lowest price. If your deductible is $ 5,000, getting a $ 3,500 procedure for $ 2,500 doesn’t help – you still have $ 2,500 before insurance starts paying for care.

HDHPs should provide people with better options for shopping and making informed, informed decisions about their care. Here are a few ways they could get started.

Let prescription discount programs count towards the deductible

For many drugs, the cash price, or the price paid by someone without insurance, is less than co-pay. As a result, savvy consumers and organizations can access cash pricing networks through cards and apps to save money on prescriptions.

However, most of these expenses do not apply to the deductible. In addition, HDHPs also often have very high co-pays, meaning that people who would benefit the most from prescription spot pricing networks have less incentive to use them.

As a result, consumers and their health insurance plans end up paying more. Leaving cash transactions to account for the franchise benefits everyone, and technology could actually make this automatic and integrated to the benefit of the consumer so that all expenses go to the franchise.

End the variable copay wars

Biologics like Humira, which treats rheumatoid arthritis and other conditions, can cost a hundred thousand dollars per year of treatment. Patients on HDHP who would greatly benefit from these drugs often do not try them because they would have to pay for the full first dose out of pocket in order to meet their deductible.

In response to this problem, drug makers have created variable co-payment assistance programs that cover the cost of the first dose so that patients can try the drug. Initially, it worked very well.

However, health plans started not counting this aid towards the patient’s co-pay and now almost none of them do. As a result, the first injection is reimbursed by the manufacturer and the patient must pay for the second to cover their deductible.

If the help comes from another source, such as a generous family member, that’s okay. The fact that the drug manufacturer’s help does not count towards the deductible is an unreasonable double standard.

Create a culture of support and innovation

Insurers and consumers should work together to avoid financial disasters. From the outset, HDHPs should be accompanied by awareness and education so that consumers understand the potential costs. Far too many people walk into a hospital because they need care believing they will be covered by insurance and then are caught off guard with a bill for their entire deductible all at once. In addition to partnering with their customers, if insurers are willing to be more flexible about what matters to franchising in HDHP, it would spur innovation for cost-effective products and programs. Health plans must negotiate transparent and lower prices when patients have to foot the bill, similar to the “cash rates” that exist today for generic drugs.

Currently, healthcare entrepreneurs who are working to reduce healthcare costs in the United States are unable to do much to help consumers on HDHP. As a result, everyone – consumers, medicare and a healthcare industry in need of innovation – loses.

Michael waterbury is CEO of Goodroot, a community of companies committed to reinventing healthcare, one system at a time.