There is no free lunch. As more people buy high-deductible health plans, they’re discovering that while premiums for such plans are more affordable, the trade-off can be high out-of-pocket costs before coverage kicks in.
However, some plans sold on the individual market offer a way for healthy people to shrink their deductibles. Under so-called deductible-credit plans, the deductible diminishes year by year for policyholders who don’t spend a lot on health care.
Supporters say these programs reward good health by helping customers reduce their costs. But consumer advocates say the programs may discriminate against sick people and run afoul of the Affordable Care Act.
On the individual market, high deductibles are commonplace. The average deductible for an individual policy was $3,079 in 2012, a 56 percent increase over the 2007 average, according to an analysis of policies purchased through eHealthInsurance.com.
In a plan with a deductible credit, if an enrollee’s health claims don’t exceed the deductible one year, the deductible drops by 20 percent the following year, then by the same amount the following year, until the deductible may eventually be reduced by half, the maximum reduction allowed.
So if someone has a plan with a $5,000 deductible, for example, the deductible could be reduced to $4,000 after the first year. The following year, it could drop another $1,000; after three years, it could be cut to $2,500. If at that point the policyholder had, say, a car accident with claims totaling $10,000, the person would receive credit for the $2,500 reduction and owe less out of pocket. The following year, the deductible would reset to the original $5,000 and the process would start all over again.
“Insurance companies want to keep healthy people on the books, and this is an incentive for them [to stay],” says Adam Hyers, president of an insurance agency in Columbus, Ohio. Hyers estimates that nearly half of his health insurance clients have deductible-credit plans.
These plans generally don’t carry a higher premium than similar plans without that feature, according to Carrie McLean, a senior manager of customer care at eHealthInsurance.com.
Deductible-credit health plans are available in 26 states, including Maryland and Virginia, through UnitedHealthcare’s Golden Rule Insurance Co., according to Ellen Laden, a Golden Rule spokeswoman.
But some health-policy experts say that these plans won’t pass muster under the health law’s new requirements. Starting in January, plans will no longer be able to turn applicants down for coverage because of preexisting medical conditions. Nor will insurers selling new individual and small-group policies be able to charge healthy people less than sick ones.
“The Affordable Care Act prohibits discrimination on the basis of health status, and that’s defined to include claims experience,” says Timothy Jost, a law professor at Washington and Lee University. “[These programs are] obviously an attempt at favorable selection.”
Others say they see a potential problem because under the law, coverage must be renewable.
“Anybody can sign up for it, but when it comes time to renew, the only people who are eligible for this program are healthy people who don’t use enough health-care services to meet their deductible,” says Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.
Laden said her company is “currently reviewing the Affordable Care Act and its impact on the deductible credit feature to ensure that our products and practices remain in compliance with it and all other applicable laws.”
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: firstname.lastname@example.org.