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3 things workers say about high health plan deductibles

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For agents, brokers and consultants who sell supplemental health insurance and related products, looking closely at consumers’ finances is like watching a beautifully shot, Oscar-winning horror movie.

The opportunities are alluring, but the challenges are frightening.

Consumer groups once blasted issuers of supplemental health benefits products, and argued that consumers should satisfy their coverage needs by buying high-quality major medical coverage.

Whatever the new Affordable Care Act major medical insurance rules and coverage expansion programs may have done, they have not eliminated moderate-income workers’ deductibles, coinsurance payments or disability-related expenses.

If anything, the ACA coverage standards that apply to group health market, and a general emphasis on making consumers think harder about their health care spending, have led to big increases in out-of-pocket costs for typical workers in the past 10 years.

Related: A new hole world

The supplemental health benefits market is attractive for insurers, because the claims tend to be small, designing the products to avoid ACA restrictions is easy, and low rates of return on bonds are not an issue.

Issuers of supplemental health benefits usually collect premiums for a policy through the course of a year, pay any benefits claimed during the same year, and finish paying a claim within two years, or even within a few days after making a determination.

The issuers do not have to worry about making the kinds of big, long-term investments that issuers of annuities, life insurance or disability insurance have to make.

But, at the same time, for any benefits advisor, looking at the supplemental health benefits needs data is terrifying.

Workers need for employers to offer supplemental health benefits, either through employer-subsidized voluntary benefits programs or employee-paid worksite marketing programs, because workers facing health crises need the benefits. 

The state of many workers’ finances is terrible.

The workplace benefits unit of New York-based Guardian Life Insurance Co. of America has published new data showing how terrible in a report based on a recent online survey of about 1,700 U.S. workers.

For a look at some of what Guardian analysts learned about the effects of high deductibles on workers’ current financial situation, read on:

Fewer than half of workers have enough cash on hand to pay a $3,000 medical bill. (Image: Thinkstock)

Fewer than half of workers have enough cash on hand to pay a $3,000 medical bill. (Image: Thinkstock) 

1. The gap between out-of-pocket costs and workers’ resources can be large.

Guardian found that the percentage of employers using high-deductible health plans to hold down benefits costs has increased to 54 percent this year, from 48 percent just two years ago.

Many of those high-deductible plans could have deductibles of $3,000 or higher, but only 44 percent of the workers surveyed this year told Guardian they had enough cash in a checking account or savings account to pay a $3,000 medical bill.

About 34 percent said they would use credit cards to pay bills that big.

Related: U.S. workers short on cash

 Many high-deductible plan enrollees are skipping care. (Image: Thinkstock)

Many high-deductible plan enrollees are skipping care. (Image: Thinkstock)

2. Some workers in high-deductible plans may be skipping necessary care.

About one-third of the workers in high-deductible plans said they had skipped what they thought was a necessary doctor visit, avoided a blood test, delayed a procedure, failed to fill a prescription or avoided X-rays because of cost.

If some of the care the workers skipped really was necessary care, the skipped care could eventually drive up catastrophic medical claims and disability insurance claim costs, Guardian says.

Related: Disability update: Aflac, Millennium Brokerage

Medical bills can hit other types of benefits products. (Image: Thinkstock)

Guardian says use of products that could fill the coverage holes is still relatively low. (Image: Thinkstock) 

3. High medical bills may be a threat to an advisor’s non-medical benefits business.

About 6 percent of the workers said they would handle a $3,000 medical bill by raiding a retirement plan.

About 3 percent said they would use money set aside for their children’s education.

That kind of thinking could hurt advisors who have worked hard to build 401(k) plan and 529 college savings plan practices.


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