Higher deductibles are forcing some consumers to skip or postpone doctor’s visits because they are unable to afford the additional out of pocket costs.

Too many consumers only factor in the amount of the monthly premium and discount the importance of other criteria such as the cost of the copayments, prescription drugs and deductible. As more companies are increasingly shifting a larger percentage of health insurance costs to their workers, consumers need to examine all options.

Consumers are limiting their options when they only consider their monthly cost, said Nate Purpura, vice president of consumer affairs at eHealth.com, an online health insurance exchange based in Mountain View, Calif.

“They often overlook things like deductibles and copayments that come into play when they actually receive non-preventive medical care,” he said.

Since preventive medical care is “often received” without patients having to spend extra money, they might not comprehend how much the out-of-pocket costs will be until they are faced with an illness or injury.

Your Health Coverage...

One major reason many people are not aware of how much physician’s visits and medical procedures cost is because they rarely go to the doctor, even for preventative care like annual checkups and physicals. A survey conducted in July and August of over 6,500 eHealth customers found that more than half of policy holders have not even used their coverage in the past year while 12% used their insurance only for preventive care. Another 35% of individuals used their coverage for non-preventive care and needed to pay for additional costs.

When consumers had to shell out extra money for prescription drugs and medical care, 35% said the costs were unanticipated and the average amount they spent for the year was $848. Other patients spent even more money on medication with 22% who paid over $1,000 out of pocket.

Consumers should expect to spend more money when they are being treated for an illness or injury that is not preventative care. The survey found that 91% of patients spent money in the form of deductibles, co-pays, coinsurance and out-of-network charges, and they spent an average of $2,380.

The fear that a medical treatment will exceed their budget has prevented many people from seeing a doctor. A February eHealth survey revealed that 62% of respondents were worried about “expensive medical emergencies” and 52% expressed concerns about “paying for health care.” If a medical emergency arose, 61% said they would likely have difficulty paying their deductible. While 38% of men said they opted out of going to the doctor to save money, 52% of women shared the same sentiment.

High deductibles are “scaring patients away” from medical care, said Linda Girgis, a family physician in South River, N.J. and member of Sermo, a global social media network for doctors. Too many patients are declining much needed appointments and necessary tests such as MRIs because of the costs incurred. Only last week, Girgis had a woman with diabetes cancel her follow-up appointment, because she chose to take her ill son to the pediatrician. Unable to afford both deductibles, she opted to delay her treatment.



The outcome is that many patients are being forced to ration their medical care because the deductibles are extremely high, Girgis said. A recent Sermo poll of 1,600 physicians found that 82% doctors said their patients declined care due to a high-deductible payment.

Patients with chronic diseases such as high blood pressure or diabetes are facing a more severe outcome because their illnesses can result in hospitalization, she said.

“This is making many problems worse,” Girgis said. “These patients are best seen every three months to monitor how their diseases are doing.”

Every week patients of Girgis are neglecting or postponing their follow-up visits because of the costs of the deductible.

“I had a patient recently who ended up hospitalized and stopped her meds and didn't come for any of her follow-ups,” she said. “A year later she comes in because of headaches, but if she had come sooner, we would have been able to treat her hypertension before it reached this level.”

Options for Patients...

Contributing to a health savings account is also becoming more widespread since some employers will contribute to one, helping to offset medical costs. HSAs operate much like IRAs and any unused portion rolls over each year.

Only people who have a high deductible plan can open a HSA account at a bank or credit union. The plan must have an annual deductible of $1,300 for individual coverage or $2,600 for a family, according to the IRS. The maximum amount of the contribution is $3,350 for individuals and $6,650 for families.

Patients should feel comfortable calling doctors and asking what the cost is beforehand.

“My receptionist will tell you what we charge over the phone,” Girgis said. “We can look up deductibles and allowed amounts on the insurance company websites and to tell you what is expected to be paid.”

Speaking up and asking the physician the amount of the fee in advance should become a more common occurrence, said Richard Kimball Jr., CEO of HExL, a San Francisco-based population health management startup. Other providers will give you a discount if the procedure is paid for before it occurs.

“As consumers we are encouraged to become more involved in our well-being, this goes for costs as well,” he said. “Besides the cost per visit, you should also find out how many visits you will need.”

Several states are making costs more transparent with price comparison websites such as Wisconsin’s PricePoint and New Hampshire’s Health Cost website, which show what the hospitals charge for various procedures.

Vitals.com includes over a million doctors with reviews, while sliding scale clinics search sites include NeedyMeds, which lists 14,466 clinics, and Freeclinics.com, which mentions no cost, low-income and affordable clinics.



A survey last fall by The Commonwealth Fund, a New York-based foundation which supports independent research on healthcare issues, found that nearly three out of five privately insured adults with low incomes and half of those with moderate incomes said their deductibles were not affordable.

Some consumers are faced with a difficult decision, which could put their health at greater jeopardy, depending on the seriousness of their ailment.

“When you decide to forego necessary medical treatment because you’re worried about costs, you’re putting your health and maybe your life, at great risk,” said Kimball. “If they do seek care, but can’t afford the high deductible, they put their financial health in jeopardy.”