The high-deductible hurdle – and what you can do about it

There’s no question that the cost-sharing burden imposed by health insurance, primarily in the form of hefty deductibles, is higher than ever and continues to rise. For employer-based health plans, the average deductible has more than doubled in the last 10 years, and in 2020, the average family enrolled in a high-deductible health plan faced a whopping $4,552 deductible. Not only does this present a financial burden that many families are simply unable to shoulder, but there is also increasing evidence that high levels of cost-sharing result in worse health outcomes. The good news: There are new ways to help employers and their employees work around high-deductible hurdles.

High-deductible health plan designs (HDHPs), often paired with heath savings accounts (HSAs), gained popularity in the early 2000s in the form of consumer-driven health plan (CDHP) designs that were intended to reduce health care spending by putting consumers more directly in charge of their health care purchasing decisions. By exposing the actual cost of health care services to the individual, HDHPs created a powerful incentive to avoid unnecessary procedures, and to compare prices more carefully, thus reducing overall spending and utilization. Unfortunately, the incentive was perhaps a little too powerful, and as an unintended consequence, many consumers decided to forego or defer care they critically needed, such as prescription drugs, primary, and preventative care. As a result, individuals enrolled in HDHPs often ended up in emergency rooms, and with uncontrolled chronic conditions such as diabetes or high blood pressure.

Related: A new suggestion to ease the burden of high deductibles: Split them in two

Those of us in the industry see this paradox play out every day, and while the ultimate goal is to present clients with a health plan that improves their employees’ health, we are also faced with the necessity of balancing this goal with the financial impact on the employer. The good news is that there are new and innovative health plan designs on the market that do away with the employee cost-sharing burden at a cost that is comparable, and often lower, than the traditional plan designs with a general deductible. Some plans, for example, are designed with no deductibles for most common health care services, including primary and specialist office visits, labs and imaging, and generic prescription drugs, while at the same time remaining price competitive with more traditional alternatives.

While the most direct way to help your clients’ employees who are struggling to access care with their high-deductible plans is to reduce or eliminate the deductibles, some employers may be hesitant to switch from their current HDHPs just yet. For such employers, there are a few small tips that can help as you guide them through this journey:

1. Encourage employees to take the time to research costs. When it comes to procedures, costs can vary widely from provider to provider, so it’s worth emphasizing to employees that they take the extra time to call around and see where they can get the best value. The same goes for prescription drugs, which in 2019 accounted for almost 19% of the average person’s health care spend. One of the best resources for comparison shopping for medications is GoodRx, which allows consumers to compare prices and find coupons for more than 70,000 pharmacies across the U.S.
2. Urge employees to talk with their provider. Providers can be an invaluable resource for employees who are struggling to balance their high deductible with their care decisions. Costs inevitably factor into a patient’s care conversations, so it’s always more beneficial to keep the provider in the loop, rather than the patient making those decisions without them. Whether it’s recommendations for switching to a generic prescription or finding less expensive diagnostic tests and procedures, providers can provide expert insights for their patients. The National Patient Advocate Foundation offers some great resources for patients who would like to open up conversations about the cost of care with their provider.
3. Understand what is included. There are certain services that health plans must cover at no cost, even if employees haven’t yet hit their deductible. These services include a handful of preventative screenings (i.e. mammograms, colonoscopies, blood pressure tests), vaccinations, and a few other basics. Despite these being universally included on all health plans, a study found that only 1 in 5 employer-sponsored plan members knew these screenings were exempted from their deductible. No matter what your plan offering, employers should make their employees aware of these universally covered preventative services so that employees don’t mistakenly skip or delay them due to perceived cost.
4. Start developing your health benefits wish list early. Maybe your health plan this year was not an ideal fit for you and your family’s needs. If that’s the case, it’s better to start thinking about how you could improve the situation sooner rather than later. What would your dream health benefit plan look like? What are the major pain points with your current plan? Write these elements out in a list and save it for when you’re selecting your next plan.

While these tactics can help in the short term, they cannot fully address the underlying problems associated with HDHPs. High deductibles reduce employee plan satisfaction, cause patients to delay or avoid care, and ultimately, result in poorer health outcomes. The most helpful way to help your clients struggling with their employees’ frustration over high-deductible plans? Give them a better option during open enrollment this year. The reality is there are now better options out there, with premiums that are on par with, or lower than traditional deductible health plans, but that don’t overwhelm employees with a heavy cost-sharing burden.

At the end of the day, health care should not just be about surviving, but thriving. Brokers can help employers and employees do just that by working with their clients to make the best out of their HDHP, and by presenting a no- or low-deductible plan option this next open enrollment season.

Marek Ciolko is the CEO of Gravie.