Healthcare costs have steadily crept up for years and now the industry is faced with understanding and combating that rise. Driven by forces at work in the industry, including the Affordable Care Act, high deductible health plans are becoming more common. This trend is forcing patients to more fully consider the financial stake in their own care and providers to be prepared for the impact of a growing payer group: the consumer.
Here are 10 things to know about high deductible health plans and their impact on the healthcare industry.
1. High deductible health plans are marked by higher deductibles than traditional insurance plans. HDHPs also tend to have lower premiums. These plans are frequently combined with a health savings account or health reimbursement arrangement, which allows patients to pay for out-of-pocket expenses on a pre-tax basis.
2. The Internal Revenue Service defines a high deductible health plan for calendar year 2015 as a plan with an annual deductible not less than $1,300 for self-only coverage or $2,600 for family coverage. The annual out-of-pocket costs for these plans, excluding premiums, do not exceed $6,450 for self-only coverage or $12,900 for family coverage.
3. There are millions of individuals enrolled in health plans administered under the ACA. The majority of these plans are considered high deductible by the IRS standards. Here are the average deductibles for the ACA's Metal Plans in 2015, according to HealthPocket.
• Individual: $5,181
• Family: $10,545
• Individual: $2,927
• Family: $6,010
• Individual: $1,198
• Family: $2,626
• Individual: $243
• Family: $489
4. From Oct. 1, 2013 to Feb. 1, 2014, approximately 3.3 million people selected Metal Plans through the Health Insurance Marketplace, according to HHS. Of those individuals:
• 19 percent selected a Bronze plan
• 62 percent selected a Silver plan
• 12 percent selected a Gold plan
• 7 percent selected a Platinum plan
5. High deductibles do not just affect consumers covered by exchange health plans. In 2014, 20 percent of the 149 million non-elderly people covered by employer-sponsored health insurance were enrolled in high deductible plans with a savings option, according to the Kaiser Family Foundation's 2014 Employer Health Benefits Survey.
6. Employers are increasingly offering high deductible health plans. In 2014, the number of large employers offering high deductible, consumer-directed health plans increased from 39 percent to 48 percent, according to a Mercer survey.
7. The average annual self-coverage deductible for patients covered by employer-sponsored care in 2014 was $1,217, up 47 percent from $826 in 2009, according to the Kaiser report. But, deductibles differ based on the size of the employer:
• Small employers (Three to 199 workers): $1,797
• Large employers (200 or more workers): $971
8. In 2003, employer-sponsored health plan deductibles comprised 2 percent of median income. In 2013, deductibles comprised 5 percent of median income, according to The Commonwealth Fund.
9. From 2003 to 2013, average per-person deductibles under employer-sponsored plans more than doubled in all but six states (Alabama, Arkansas, Hawaii, Louisiana, Mississippi and Wyoming) and Washington, D.C., according to The Commonwealth Fund's State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013 report.
10. The increase in patient financial responsibility has played a role in patients delaying medical treatment. In 2013, 25 percent of patients with private health insurance delayed treatment due to the amount they would have to pay. That number increased to 34 percent in 2014, according to a 2014 Gallup poll. Here is the percentage of patients who put off care due to cost, based on annual household income:
• Under $30,000: 35 percent
• $30,000 to $74,999: 38 percent
• $75,000 or more: 28 percent