KHN: Kaiser Health News

Health plan deductibles keep getting higher — the proportion of workers with a deductible that topped $1,000 for single coverage nearly tripled in the past five years, to 34 percent.

Since high-deductible plans often mean you pay more out of pocket for medical care, it might seem like a no-brainer to sign up for a plan that links to a health savings account so you can sock away money tax free to cover your medical expenses. But there are good reasons to think twice before making that choice.

In order to get the tax advantages of a health savings account, the health plan it’s linked to has to meet certain criteria. In 2013, for instance, an HSA-qualified plan has to have a deductible of at least $1,250 for single coverage and $2,500 for family coverage, and the maximum out-of-pocket limits can be no higher than $6,250 and $12,500, respectively, for single and family coverage.

But HSA-qualified plans have other limitations that consumers often aren’t aware of. For one thing, even though the Affordable Care Act allows parents to keep their adult children on their policies until they reach age 26, they can’t use funds from their HSA to pay for the child’s care after age 24. That’s because “dependent” is defined differently for HSA purposes than it is under the ACA provisions that extend dependent coverage to adult children.

In addition, except for preventive care, which is generally covered at 100 percent and is not subject to the deductible, consumers in an HSA-qualified plan may be on the hook for the entire cost of medical care — including doctor visits, medications, tests and treatments — until they reach their deductible. (They will be charged the negotiated rate their insurer has agreed to pay providers for services, however, not the “rack” rate paid by the uninsured.)

Regular high-deductible plans, on the other hand, offer many more options. In addition to covering preventive care at 100 percent, some function like traditional plans, requiring only a copayment for doctor visits and medicines even before the deductible is met. Or they may offer a limited number of doctor visits with a copayment before people meet their deductible, says Carrie McLean, senior manager of customer care at eHealthInsurance.com, an online vendor.

Consumers need to evaluate the full spectrum of costs and benefits for HSA plans, but the advantages may have nothing to do with medical expenses, she advises. “The true benefit you get from these accounts is because you’re putting money away and you get that tax [savings],” says McLean.

Most women can expect to get contraceptives without paying out of pocket for them thanks to the federal Affordable Care Act.

Women who are young or those who are poor and rely on publicly funded family planning centers for reproductive health services are covered, too.

But there’s a catch. Many of the state and local health departments, community health centers, Planned Parenthood clinics and other family planning centers that serve these women don’t accept insurance, not even publicly funded insurance such as Medicaid. Not yet, anyway.

To take advantage of required insurance coverage of these benefits under the law, the centers will have to learn the ins and outs of contracting with insurers and beef up their computer systems pronto, according to a study by the Guttmacher Institute, a reproductive health organization.

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There aren’t many investments people make to protect themselves against something that may happen 20 or 30 years down the road. Yet that’s exactly what long-term care insurance purchasers do.  But a provision in those policies that people rely on to help ensure their coverage will meet their needs decades hence may do nothing of the kind.

The clauses are called “alternative plan of care” benefits. They’re intended to provide coverage for services that aren’t spelled out in the policy but may emerge in the future, says Bonnie Burns, a policy specialist at California Health Advocates, a Medicare advocacy and education organization.

Long-term care policies that were sold 30 years ago, for example, didn’t cover care in an assisted living facility, she says, even though such coverage is common now.

Long-term care insurance offers financial protection if a person needs help with daily tasks such as eating and bathing. Policies typically cover care provided in different settings, whether it’s a nursing home, a private home or an assisted living facility. People usually buy a policy that provides up to a specified daily dollar amount—say $150—for between three and five years.

Burns says that although alternative plan of care clauses can be beneficial, they are honored at the insurance company’s discretion.

“It’s completely up to the company,” she says. “I’ve had situations where companies have refused to pay under that benefit.”

Alternative plan of care clauses may be increasingly important. In the past decade, the average age at which people buy a long-term care insurance policy has decreased from 68 to 59, according to a survey by America’s Health Insurance Plans, a trade group.

When considering a policy, people have to ask themselves: “What’s the long-term care landscape going to look like in 20 years?” says Burns. An alternative plan of care clause may help provide some sense of security, but it’s no panacea.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

If you need dental work, chances are you’ll pay a big chunk of the bill out of your own pocket, even if you have dental insurance.

Photo by Michael Rosenstein via Flickr

Dental coverage often maxes out at just a few thousand dollars a year or less and typically covers only half of the cost of major procedures like crowns and root canals.

Getting a reliable estimate of prices in your area can be critical if you want to keep a lid on costs. A free consumer website may provide the information you need.

It’s the work of Fair Health, a nonprofit corporation that was created as part of a 2009 settlement between then-New York Attorney General Andrew Cuomo and insurers.

An investigation revealed that an insurer-owned claims database used to determine out-of-network reimbursements presented a conflict of interest. In addition to the consumer website, Fair Health provides independent-claims data that insurers can use to determine out-of-network rates.

The Fair Health database is regularly updated and contains medical and dental claims from insurers and third-party administrators covering 126 million people. With the database, people can look up out-of-network reimbursement amounts for procedures in their area.

According to Robin Gelburd, president of Fair Health, 40 percent of dental care is provided out-of-network compared with just 10 percent of medical care. That makes the dental cost calculator a potentially useful tool for many consumers.

During a recent search on a zip code in Manhattan, for example, I learned that the estimated cost for a porcelain crown is $2,100 here, making the $1,750 that my dentist charges seem, if not exactly a bargain, at least not highway robbery.

Could Georgetown University students like Sandra Fluke have to wait an extra year for free birth control?

There’s a reason to ask the question.

Fluke, in case you missed it somehow, is the law student who testified before the House Democratic Steering and Policy Committee last month about the importance of providing free contraceptive services to students and others at religiously affiliated institutions.

Her comments drew a caustic and mocking response from conservative radio talk show host Rush Limbaugh, who called her a “slut” and a “prostitute.” He later apologized, but many advertisers on his show have reportedly pulled their ads.

Under the health care overhaul, new health plans (or those that change their benefits enough to lose grandfathered status) have to begin providing free contraceptive services to women in August.

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