50% of Combined Rx and Medical Deductibles Strain Pocket Books

[Justin Bilyj]

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf412878

Of the 1,208 unique Silver plans analyzed, approximately half (641) offer combined deductibles under which medical and prescription drug expenses accumulate to a single deductible. The average combined deductible for those plans is $2,267 for a 27 year-old individual. The other approximately half of plans (567) have two separate deductibles, a medical deductible towards which expenses for medical services accumulate and a drug deductible towards which expenses for prescription drugs accumulate.

I wonder
A. How many people signed up for an HSA not understanding it?
B. How many people have a high deductible?
C. Are there any Silver traditional copay plans that have the Rx integrated into the deductible like that?

 

[RayNY]

A). I hope none, at least on this forum. As brokers, it's our job to explain what something like an HSA is, whether the plan is eligible, and when it makes sense.
B) The majority (defining High Deductible as $2,500 or more in accordance with the HSA rules). Somewhere in the 80-90% ballpark according to the admittedly incomplete data that I've seen reported recently.
C) Yes, most certainly. I've sold plans with RX integrated into deductible, RX as a separate deductible, and RX before deductible. They all exist currently. Refer to the plan's SBC, it clearly defines this. Page 1 would have the separate deductible if it applies, page 3 would have more specific information and illustrate whether it is copay's before or after deductible.

 

[DS4]

This is no different then some plans have copays for sick/ill office visits, others, apply towards the deductible.

 

[RayNY]

DS4,

Having to pay full price for RX until the deductible is met is nothing like having doctor visit copays before or after deductible. Visits are relatively cheap and uncommon. Drugs are relatively expensive and you'll generally be paying 12 times per year.

 

[DS4]

I was referring to the explaining part.

 

[kgmom219]

For these to work, you really have to do an analysis for each client. Most of my clients don't need to pay the extra premium for copays and really utilize the tax savings by funding an HSA.

Really "healthy" people don't need it either. I don't need to pay an extra $3K a year for my annual sinus infection visit.

It also works for "sick" people. If you know you are going to meet your deductible, with or without copays, its fabulous. You go on a deductible (combined medical/pharmacy) and get to 100% coverage with a lesser premium. I had several clients meet the deductible in January and enter February with 100% coverage for the rest of the year. (Just don't ask me about the service required to get the medical/pharmacy systems to show that the deductible met!)