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Health Costs Scare Up A New Option

Posted - Oct. 31, 2003 at 7:20 a.m.



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Looking for a real scare this Halloween? You could go see House of the Dead, a new movie about a rave that's crashed by zombies. Or you could stay home, dim the lights and read your employer's health care insurance enrollment package.

Health care costs rose nearly 15% this year. Employers are passing on the higher expenses to workers in the form of larger premiums, deductibles and co-payments.

In an effort to control terrifying increases in health care costs, some companies are offering an alternative: consumer-driven health plans. These plans often offer lower premiums and give you more control of your health care expenses. In exchange, you accept a higher deductible, which means potentially higher out-of-pocket costs.

Here's how consumer-driven health plans work: Your plan has a high deductible -- say, $2,000 a year. You also get an annual allowance from your employer toward that deductible--say $1,000. If you don't spend all your allowance on medical care, you carry over the unused balance to the next year.

For example, if you spend just $300 of your allowance, you carry over $700, boosting next year's allowance toward your deductible to $1,700.

But if you use up your allowance, you're on the hook for what's left of the annual deductible. Once you've paid the deductible, a traditional insurance policy takes over.

About 17% of U.S. companies with 5,000 workers or more offer high-deductible policies, which often include consumer-driven health plans, according to the Kaiser Family Foundation. Another 40% of big companies said they're likely to offer the plans next year, says Gary Claxton, a health policy analyst at the foundation.

Proponents say consumer-driven health plans encourage consumers to take an active role in keeping health care costs down. ''The power of these products is that it gets members thinking as a consumer and adopting a consumer attitude,'' says Ron Williams, president of Aetna.

Critics counter that some workers will forgo medical care if they can't afford the higher out-of-pocket costs. If your employer is offering a consumer-driven option, here are some factors to consider before signing up:

* Whether you can afford the out-of-pocket costs. Ideally, you should have enough in savings to cover the deductible. One strategy: Stash the amount of your deductible in a flexible spending account. These accounts allow you to use pre-tax money to pay for medical and dental expenses not covered by your insurance. Because the funds aren't taxed, you get more for your money.

One downside to these accounts: If you don't use the money in your account by year's end, you forfeit the balance. But the list of eligible expenses is long, ranging from eyeglasses to over-the-counter drugs.

You should also pay attention to the plan's out-of-pocket maximum, which is the most you'll have to pay toward your medical care in any given year.

* Premiums. A significant drop in monthly premiums might make up for the higher out-of-pocket costs. Some workers who enroll in Humana's consumer-driven plan pay 50% less than those who sign up for its standard preferred provider plan, says spokesman Tom Noland.

But for many workers, the difference in premiums is much smaller, making the trade-off harder to justify, consumer advocates say.

''You wouldn't want to go down this road unless the savings were significant,'' says Gail Shearer, health policy analyst for Consumers Union.

* Chronic illnesses. If you have a chronic condition, such as diabetes or asthma, find out if your plan covers your medication. Some plans cover drugs that treat chronic illnesses, leaving money in your allowance for other medical costs. But others require you to use your allowance to pay for the drugs. If your plan falls into the latter group, you could end up in the hole every year, Claxton says.

* Preventive care. Some consumer-driven plans cover mammograms, prostate exams and similar preventive measures. Others require you to use allowance money for preventive care. Workers who participate in Destiny Health's plan must use their allowances, but they receive rewards for meeting healthy lifestyle guidelines, which include preventive care.

Rewards include movie tickets, airline miles and higher interest rates on their allowances, says Ryan Levin, a vice president at Destiny.

* Motivation. Most consumer-driven plans offer Internet sites and other tools to help you research cost-effective health care options. You're encouraged to ask your doctor if a test is really necessary and whether a generic equivalent of a drug is available.

''The expectation is that you will actually ask questions and make cost-effective choices, and that takes time,'' Claxton says.

To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com

© Copyright 2003 USA TODAY, a division of Gannett Co. Inc.

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