Visit to New York City orthopedist: $223. One X-ray: $50. One follow-up magnetic resonance imaging test: $766. Total bill for checking out that aching shoulder: $1,039 – all to be paid by the patient, rather than the insurer. Healthcare has gone retail.
Over the next 18 months, between one quarter and one half of Americans who get insurance coverage through their employers will pay more of their doctor bills themselves as companies roll out healthcare plans with higher deductibles, benefits consultants say. The result: sticker shock.
"They have huge out-of-pocket costs before they get any insurance coverage, it’s a real slap in the face," said Ron Pollack, the executive director of Families USA, a healthcare advocacy group.
High-deductible plans set a threshold for medical expenses that an individual must pay for, often in the thousands of dollars, before insurance kicks in. Studies show people on these plans are three times more likely to delay or skip care than people on traditional plans, where doctor or emergency room visits are covered by a relatively low co-payment.
These plans have been around for years, pushed by employers, insurers and industry experts who believe that consumers with "skin in the game" will drive demand for better quality care at a lower cost. It is a rationale also backed by President Barack Obama’s Republican challenger Mitt Romney. But now corporate America’s adoption of high-deductible plans is accelerating, partly because of Obama’s healthcare reform, which requires insurance plans to provide more expansive coverage such as preventive care.
Several industry surveys forecast a two-percentage-point increase in the number of companies offering only high-deductible plans in 2013 to about 19 percent, and a larger jump of anywhere from 5 to 25 percentage points in 2014.
"2013 is almost a calm period before a period of intense change in 2014," according to Randall Abbott of Towers Watson & Co., a Boston-based senior consulting leader at the human resources firm. The shift means consumers will have to spend many more hours researching treatment options and managing costs on websites like Healthcarebluebook.com, which helped budget the cost of examining the shoulder pain mentioned above.
It could also spur lawsuits against doctors whom patients may blame for not making clear whether a test or procedure would spare them future harm, legal experts say.
SKIN IN THE GAME
About 170 million people were covered by employer-based insurance in 2011, according to the U.S. Census Bureau. Companies with workers enrolled in high-deductible plans in 2012 include General Electric Co., Wells Fargo & Co., Whole Foods Market Inc., Chrysler Group and American Express Co. In 2013, Bank of America Corp will offer some employees high-deductible health plans. Smokers who work at the bank will also have to pay higher healthcare premiums than non-smokers.