▶ Subscription rate 4% in 2006 → 27% in 2024
▶You may miss out on early treatment by delaying necessary treatment.
▶ Delaying regular checkups can result in larger medical costs
▶Decision based on health and financial status rather than insurance premium
<img alt="“Change the high deductible plan?… “Should I lower my insurance premium?”” title=”“Change the high deductible plan?… “Should I lower my insurance premium?”” src=”http://image.koreatimes.com/article/2024/10/20/20241020224535671.jpg”/>
As health insurance premiums soar, an increasing number of subscribers are switching to high-deductible plans. Among subscribers to high-deductible plans, there are cases of side effects, such as delaying necessary treatment and missing opportunities for early treatment, so careful enrollment is necessary. [로이터]
There are things that health insurance subscribers must take care of before the end of the year. This involves reviewing existing insurance contents and premiums and replacing insurance if necessary. For approximately 154 million subscribers who signed up for health insurance through their jobs, the ‘open enrollment period’ during which they can change their health insurance is between October and November. The ‘Affordable Care Act’ (ACA) ), if you subscribe to insurance through the ‘Market Place’ implemented by the government, you can replace your insurance if necessary between November 1 and December 15.
In relation to signing up for health insurance, there has been a clear trend in recent years to increase the out-of-pocket ‘deductible’ in order to lower insurance premiums. Deductible is an insurance system that allows patients to receive health insurance benefits after paying their own medical expenses up to a certain amount. Insurance experts caution that raising the deductible can lower monthly insurance premiums, resulting in immediate cost savings, but caution is needed as unexpectedly high medical expenses or failure to receive regular checkups can result in larger medical expenses.
■High-amount deductible subscription rate soars
Health insurance plans are traditionally divided into two types: ‘PPO‘ (Preferred Provider Organization) is a plan with many participating doctors and does not require primary care physician approval to visit specialists. The advantage is that the deductible and ‘basic medical fee’ (co-payment) are cheaper than other plans, but the monthly premium is high, making it burdensome for low-income people to sign up. PPO is a plan suitable for patients who frequently require specialized medical services in addition to regular basic care.
There are many office workers who have signed up for an ‘HMO’ (Health Maintenance Organization) plan through their employer. The advantage of HMO is that the monthly premium is lower than that of PPO, but the disadvantage is that it requires approval from the attending physician to receive specialist treatment, and sometimes the approval period is long.
Recently, it was found that the ratio of PPO and HMO subscribers is significantly lower than the ratio of subscribers to plans with low monthly premiums and high deductibles. According to KFF, a non-profit health policy research institute, the number of office workers with high deductibles increased from only 4% in 2006 to 27% in 2024. During the same period, the PPO subscription rate decreased from 60% to 48%, and the HMO subscription rate also decreased from 20% to 13%.
Side effects such as delaying necessary treatment
Many health insurance subscribers are surprised to hear the recent deductible increase notice. In the case of ‘Family Coverage’, the annual deductible for HMOs and PPOs has risen to an average of about $3,000, and for high-deductible plans, it reaches about $5,000. In accordance with the ‘Affordable Care Act’ (ACA), so-called Obama Care, health insurance plans are required to include high-cost deductible plans with no patient treatment fees for basic preventive screenings such as breast and colon cancer screening. Nevertheless, it was found that subscribers to high-deductible plans tend not to receive or postpone other preventive or elective treatments to save on medical expenses.
In another case, it was found that many patients postponed elective treatment or screening services until the end of the year in order to meet the annual deductible standard. Patients with chronic diseases such as heart disease or diabetes may miss out on early treatment opportunities, so there are concerns about the side effects of signing up for a high-deductible plan.
Sabrina Collett, director of the Center for Health Insurance Reform at Georgetown University, said, “For high-income earners who can cover medical expenses out of pocket, high-deductible plans are not a big problem,” adding, “On the other hand, low-income people who are easily tempted by low premiums are cautious about signing up for high-deductible plans.” “This is necessary,” he emphasized.
■Save medical expenses with a health savings account
In 2003, the ‘Health Saving Account’ (HSA) program was launched with the purpose of reducing the burden of medical expenses. HAS is a tax-exempt savings account that allows you to deposit a portion of your salary to cover medical expenses, and has become very popular among high-deductible plan subscribers.
Employers have offered HAS services to participants in high-deductible plans, and some employers match contributions. It is a medical expense savings program that many office workers still use to this day, as it is possible to invest with HAS savings and transfer to a new job.
Although HAS was started to support medical expenses for low-income people who subscribe to high-deductible plans, there are also criticisms that it is being used as a tax-saving strategy for some high-income earners. According to an analysis of 2017 Internal Revenue Service (IRS) data by the Congressional Research Service, about 17% of high earners with annual incomes of $200,000 to $499,999 signed up for HAS. In comparison, less than 4% of taxpayers using HAS among low-income earners with annual income of $100,000 to $24,999 were found to be less than 4%.
■ Consider health status rather than insurance premiums
When choosing a health insurance plan, you should not only look at the monthly premium, but also properly consider your personal health status and financial situation. If you do not have any special health problems and need regular preventive checkups, it is recommended to sign up for a high-deductible plan, but you should take into account that other plans have limited coverage.
Insurance experts advise that even if you are in good health, you must have the financial ability to pay a large deductible in case of emergency. No matter which plan you choose, it is also important to check whether the information on the medical staff included in the network is updated. Patients often experience inconvenience when they suddenly need to visit an emergency room or hospital because medical staff information is not updated in a timely manner.
