The new year often starts harshly for people with high-deductible health insurance.
Many deductibles reset Jan. 1, forcing patients to pay thousands of dollars for care or prescriptions before most insurance coverage starts. Such a financial hit can be brutal for patients with cancer or a chronic condition, some of whom may have just satisfied the previous year’s deductible the month before.
More patients are using tax-exempt health savings accounts to set aside money that can soften this early-year crunch. But there are no simple solutions to erase the problem for those without such accounts or the means to stock them.
However, patient advocates see several ways to get relief. Here are some examples.
KNOW THE COVERAGE
It’s hard to plan for a big expense when you don’t understand your financial exposure.
Patients should know the size of their deductible and what they must pay after satisfying it. Insurance plans can require patients to continue footing a portion of their bill for care until they hit their out-of-pocket maximum for the year.
It’s a good idea to review these requirements annually. Double check the coverage of any regular prescription drugs too, in case that has changed.
Also see if your employer can help. Some companies make certain medications like diabetes drugs exempt from high deductibles so patients can continue to receive regular care.
It’s also worth double checking the balances in any health savings or flexible spending accounts you have. There might be some forgotten money in there.
The Internet is full of websites offering help with medical expenses.
JDRF, a nonprofit that funds diabetes research, has corralled more than a dozen links on its website. It lists help from drug and medical device makers, as well as connections to prescription discount cards and patient-assistance databases.
The site lists every avenue JDRF is aware of to get people help, said Jesse Bushman, senior health policy director.
Another non-profit, Patient Advocate Foundation, also maintains a site to connect patients with assistance.
Separately, Patient Access Network Foundation offers grants to help pay drug costs from almost 70 disease-specific funds. That non-profit mainly helps those with Medicare prescription drug coverage and touts an application process that takes only a few minutes. People can apply by phone or online.
Patients should check with their insurer if they use a drugmaker’s financial assistance to fill a prescription. Some plans will not count that amount toward meeting a deductible. That means you might get the prescription but still have a big deductible hole to fill.
You may be able to pare some expenses by shopping around. Your insurer may offer an app or an online tool to help with that.
The cost of an imaging exam can vary greatly depending on whether it's done at a hospital or a separate imaging center. A telemedicine call or drugstore clinic can be cheaper than a doctor visit for minor illnesses.
For more extensive care, the doctor’s office may be willing to put patients on a payment plan so they don’t have to absorb the full financial hit at the start of the year.
If faced with a particularly daunting bill, patients should ask doctors if they can recommend a less-expensive alternative. But they also should understand whether the cheaper option is equally effective.
Always make sure the care providers you use are in your health insurer’s network. Deductibles and other payments can be higher for care sought outside it.
“What we recommend is kind of to be crafty about how you approach your health care spending and plan as much as you can,” said the Patient Advocate Foundation’s Caitlin Donovan.
Avoid skipping care entirely because of the cost. That may make your condition worse, and the unpaid deductible you're trying to avoid might still need to be satisfied.