Reducing costs for Unexpected Medical Needs in a HDHP

Your doctor orders an MRI to get to the bottom of your medical issue. That sounds like a great idea until you find out that the $1,200 MRI charge will come directly out of your pocket because you have a high-deductible health plan (HDHP).

A recent CDC report defined HDHPs as private health plans with annual deductibles of at least $1,350 for individual coverage or $2,700 for family coverage. Forty-seven percent of Americans with private health insurance were enrolled in HDHPs in early 2018, and the numbers are growing.

The problem with HDHPs is that many patients put off treatment and tests because initially the entire cost comes out of their own pocket, and medical costs can quickly add up to thousands of dollars.

If you need to have an MRI or other pricey test or procedure, sticker shock may leave you vulnerable. Even workers who participate in their employer's health plans foot bills on average to the tune of $2,859 for deductibles and premiums annually.

At EviCore, we aim to help patients in their search for top-quality and cost-effective care with our SmartChoice program. The program was established to provide patients with the necessary clinical quality and price transparency needed to make more informed healthcare decisions. Your plan may also offer other tools to help you navigate through healthcare costs.

Shopping Around, and Other Ways to Reduce Your medical Costs

One important way to limit the out-of-pocket cost of high-deductible health plans is by shopping around.

Once your doctor orders a test or procedure for you, you can call around to providers in your area to inquire what they charge. Explain you have a high-deductible plan and are trying to minimize costs.

For example, our site-of-service data show that having a CT scan, PET scan, or MRI performed at a hospital can cost you twice as much or more than the same procedure performed in an office environment. Here are some examples of such stark differences in costs:

You can also check out tools such as Guroo and HealthcareBluebook, which can give you a sense of what to expect to pay for a procedure. For example, a search on Guroo for a knee MRI without contrast reveals the average cost in Jacksonville, FL is $744-$1,041.

On HealthcareBluebook the fair price for an Achilles repair in New York City is estimated to be $4,936. Such knowledge can help as you prepare for your own health procedures and make calls in your area.

Following are additional ways to limit your expenses when enrolled in a HDHP:

1.     Ask your physician for the most conservative or cost-effective approach. Talk to your physician upfront about likely costs and the fact that you have a high-deductible health plan. Inquire if there are other treatment options that are more affordable.

2.    Negotiate prices. Prices are often not set in stone and can be discounted for a cash deal. Low- or no-interest payment terms are often available to consumers with high-deductible plans.

3.    Use in-network providers. Many plans have different costs for in- vs. out-of-network providers. Try to stay in-network whenever possible. For example, even when you undergo surgery at an in-network facility, the lab, anesthesiologist, or physical therapist may be out-of-network. You must ask if every service you receive will be in your network. In-network doctors have negotiated their rates with your insurer, while out-of-network providers usually charge more. Plus, the money you pay to out-of-network providers may not fully count toward your deductible so your overall out-of-pocket costs for the year will be higher. Your health plan can help you figure out who is in-network and who is not.

4.    Pair HDHPs with health savings accounts. Health savings accounts (HSAs) let you pay for certain healthcare costs with pre-tax dollars. While the money is still coming out of your own pocket, there are financial benefits, because you do not have to pay federal income tax on HSA contributions.

Take Advantage of What's Free

Many important tests, even with a high-deductible health plan, are still completely free to you under the Affordable Care Act. Tests like mammograms, pap smears, colonoscopies, and vaccinations fall under the no-cost, preventive-care umbrella for everyone with a HDHP.

The Bottom Line

With a high-deductible plan, you'll have a lower premium, but you also may get hit with sudden high out-of-pocket expenses when you have an unexpected medical need. Shopping for and negotiating the lowest rate for expensive tests and procedures are the best ways to maximize the value of such plans.