Health Plan Blues
Users weigh in on the new consumer-driven health plans
Everyone's talking about consumer-driven health plans. But until now, nobody had a good fix on what consumers thought about the newfangled options, which combine a high-deductible health plan with a tax-free savings account to cover medical expenses. Now a trio of studies examines reaction to the plans, and it turns out that consumers are less gung-ho about them than the employers, health insurers, and policymakers who promote them.
Enrollment in the plans is about 1.3 million, a number that hasn't budged since last year. "I expected to see enrollment growth, and we didn't," says Paul Fronstin of the Employee Benefit Research Institute, who coauthored a survey released last week with the Commonwealth Fund. If given a choice, only 36 percent of people in a consumer-driven plan would stick with it, the study found. What's driving the dissatisfaction? More than half of people said they weren't satisfied with their out-of-pocket costs, compared with just 21 percent of people in traditional managed-care plans.
Premiums are generally lower in consumer-driven plans. In 2006, the average monthly premium for a single person with a high-deductible health plan was $284, compared with $365 for someone in a preferred provider organization. But out-of-pocket costs may be significantly higher. In addition to deductibles of at least $1,050 for singles and $2,100 for families in 2006, 85 percent of consumer-driven plans require coinsurance of, say, 25 percent for doctors' office visits, instead of the $15 copayment typical in managed care plans, according to a survey by the Center for Studying Health System Change.
Untreated. People enrolled in consumer-driven health plans are more tuned in to healthcare costs than those in health maintenance organizations and PPOs, as the architects of the plans intended. In a recent Kaiser Family Foundation study, more than 70 percent of people in these new plans said they consider price when deciding to see a doctor or fill a prescription, compared with just under half in traditional plans. But cost-consciousness wasn't always positive: A fourth of people in consumer-driven plans said they skipped a recommended test or treatment, compared with 15 percent in traditional plans.
It's premature to judge this type of plan, says Mohit Ghose, spokesman for America's Health Insurance Plans. It's a new product that "will continue to improve to meet the needs and demands of consumers," he says. For example, one proposal would make drugs needed to treat chronic conditions not subject to the deductible. Time will tell whether consumers decide these plans are a good fit.
This story appears in the December 18, 2006 print edition of U.S. News & World Report.