What you Need to Know About Open Enrollment, Deductibles, & Health Savings Plans
In recent years we have seen changes to the managed care system, i.e., health insurance. Some changes have been for the better and some for the worse. In this blog I’ll be addressing one for the worse, deductibles, and more importantly, how to overcome this barrier, using a health savings plan. *Disclaimer: I am not an insurance agent, accountant, attorney, or any other expert in these matters. It is advised that you consult with your insurance company, accountant or tax preparer, and/or Human Resources Benefits Department for further information. I offer this information from my experience as a behavioral health provider and a consumer.
Open enrollment for most health insurances begins in October. During this time, those who can afford insurance and/or have it offered through our, or our partner’s employer, have the opportunity to select which company, level of coverage, and other services we’d like for the following year. Most often, the cheapest plan is selected as insurance can be very expensive! Even with an employer contributing whatever portion they pay, the consumer is left with a great deal to pay out of pocket through high deductibles or high copays.
High deductibles and copays are often a barrier to many people with insurance receiving the necessary care they need. It’s sad that in a developed country, a SuperPower nation like the United States, a working person has to decide between food, shelter, and other provisions, over their own health! I know this to be true personally; and the cost of not being able to afford adequate health (mental or physical) can be deadly. The stroke that debilitated my mother was in large part due to her not being able to afford her medication. Because she owned a home, she was not eligible for any type of supplemental insurance. She was a proud woman and did not inform her 7 living children that she needed help paying for her medication. My mother never recovered from her stroke and died three years later due to ensuing medical challenges secondary to her stroke.
When a prospective patient calls my office to make an appointment, one of the questions they’re asked is whether they have a deductible. Many people do not know the answer to this question, or even whether the deductible is extended to their behavioral/mental health benefits. As each medical plan is different, this is something you need to know before seeking any type of treatment. Therefore, I’m encouraging you to be diligent regarding this information as you begin your health insurance selections for the coming year.
Help! Please! It costs to many dollars and don’t make no sense!
Why do you need to know this? Well, until the deductible is met, you are paying the full contract rate (established between your insurance company and your provider, an agreed upon rate the provider will accept for that service, NOT their full fee rate) of your provider’s services out of pocket. Huh? That was a mouthful, Doc. If your provider’s full fee rate, their non-insurance contract rate, is $200 for Service A but they are an in-network provider with your insurance company, they have agreed to accept $135 from the insurance company for Service A. Therefore, when you pay out of pocket until the deductible is met, you are paying $135 for Service A and whatever the fees are from any other medical providers until your deductible is met. If your deductible is $1500, you’ll be paying quite a bit before the insurance kicks in! This is why high deductibles can be a barrier for many people to receive adequate healthcare. Imagine paying $300 or more a month for health insurance that comes out of your check each pay period and then having to pay for services each visit. It costs too many dollars and don’t make no sense (grammatical error intentionally added to emphasze the foolishness)!
Health Savings Plans To the Rescue
There is a better way. You can pay into a health savings plan to reduce some of the out of pocket sting. Yes, more money, more money, more money BUT it gives you an opportunity to take a tax break. From my understanding, remember I am a psychologist, not an expert in any of the above-referenced professions, by paying into a health savings plan, it reduces your taxable income, and therefore your tax liability. Huh, Doc? I’m definitely not an IRS agent but simply, the government would tax you less because of your health saving plan contribution. Your health savings plan contribution is taken out before taxes are charged on your income, therefore, less taxable income. This could mean you would owe less or possibly receive a larger refund when you file your taxes. It also means that money is taken out of your check to pay for those would be out of pocket expenses. Now, you don’t have to come up with the $135 for Service A. You’ve already paid into it; so less budget finessing to determine if you can afford to take care of mental and/or physical issues you’ve been putting off or pay a utility bill. I know the struggle is real but so is complicating your issues because of delayed treatment, or even death. You have one life, live it well. Take care of your health in a timely manner. Health savings plans can help you do so.
Now that you know better, you can do better. Scour the health insurance options available to you and ask the appropriate questions to help you determine which option is best for you and your family. Invest in a health savings plan so that you can afford to get the best treatment. We have less stress when we have more options. A health savings plan gives you more options. You want to see a provider who does not take your insurance? No problem. Pay them out of your health savings plan funds. Now you have the option to receive treatment from a provider of your choosing, who’s a great fit for you, not just who your insurance company says you have to see. Having more options puts you in control of your mental and physical healthcare. How rewarding is that? I wish you all the best in your healthcare journey with options.
*Disclaimer statement: Dr. Berry-Mitchell is not sponsored or compensated by any Health Savings Plan or insurance company. There is no conflict of interest regarding this subject matter.
Dr. Berry-Mitchell is a Licensed Psychologist in the state of Georgia. She specializes in trauma and Posttraumatic Stress Disorder (PTSD), applying evidence-based treatments in a wholistic manner to partner in her patients’ recovery. Dr. Berry-Mitchell also treats those who experience anxiety, depression, grief, and substance abuse, as these issues commonly co-occur when someone experiences a trauma. As the effects of trauma do not stop with the person who experienced the traumatic event, she also specializes in couples therapy. She is passionate about providing mental health education and reducing mental health stigma. You can reach Dr. Berry-Mitchell via email at firstname.lastname@example.org.