High-deductible insurance deters doctor visits

Some employees are missing out on doctor's visits and flu shots.

A recent paper from the Employee Benefit Research Institute analyzed a large manufacturer between 2009 and 2014 with a high-deductible health-care plan. The study did not name the company.

Across the board, workers who enrolled in the high-deductible plan saw the doctor less. This was a problem especially for lower-income employees.

Under a high-deductible plan, workers can use a tax-advantaged health savings account to cover qualified medical expenses. A high-deductible plan has an annual deductible of at least $1,300 for singles or $2,600 for families, according to the Internal Revenue Service. Out-of-pocket expenses cannot exceed $6,550 for individual plans or $13,100 for families.

These arrangements have become more popular as employers attempt to rein in the cost of coverage.

The manufacturer at the center of the study introduced a high-deductible plan with an HSA as an option for workers in 2009. By 2013, about a quarter of employees were enrolled.

Researchers found that the frequency with which workers in the high-deductible plan visited their doctors and sought certain preventive services varied based on their income.

"People don't understand how the plan works," said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. "Because of higher deductibles, lower income people cut corners on going to the physician," he said.

In the study, those who earned less than $50,000 averaged 1.5 visits to medical specialists, while individuals who made $125,000 or more averaged 2.1 visits.

"The one consistent finding in every study on HSAs is that people cut back on healthcare," Fronstin said. "That's a concern."

Paying out-of-pocket seems to be enough to dissuade workers from seeking even preventive care. This is a mistake, as plans are required to cover these services free of co-payments, co-insurance or deductibles, as long as an in-network provider is used.

"When people start to become ill, it's important to educate them to go early and use low-cost providers, including walk-in clinics," said Carolyn McClanahan, director of financial planning at Life Planning Partners in Jacksonville, Florida.

Get the most out of your health care coverage with the following suggestions, said certified financial planner McClanahan, who began her career as a physician.

• Get your annual checkups early in the year: If any problems surface, you can treat them and meet your deductible before the year ends.
• Consider low-cost health care alternatives: See if your plan offers access to a nurse triage call service. They can provide guidance on whether an issue is serious enough to warrant a visit to the doctor.

Fronstin cited some key considerations as benefits enrollment arrives:

• If you're choosing between different plans: If your employer offers you a high-deductible plan, a preferred provider organization or a health maintenance organization, ask about the network of providers and whether you have a choice of doctors. Don't look at the deductible alone.
• If you're contributing to an HSA: Consider whether you are doing it through payroll deductions or outside of payroll. If you contribute to the account via payroll, you're saving on federal payroll taxes.
• Weigh your HSA and 401(k) contributions: Will you need to reduce your retirement plan contribution in order to save in your HSA? Make sure you're not walking away from a 401(k) employer match.