Quick Tips for consumers

Here's ten quick tips for consumers in considering or using consumer driven health plans:

Health Care Knowledge: You typically can get the most out of a consumer driven plan if you have a reasonable understanding of health care, have access to health care delivery and cost information, and are willing to be relatively involved in your health care and decision making. If you are uncomfortable with this, you might consider other types of health plans.

Know PPOs: While a some Consumer Driven Health Plans are have HMO policies, and a few have fee for service non managed care policies, the vast majority of Consumer Driven Plans have PPO policies. Thus you will want to be familiar with how PPO plans work.

Comfort using Web Tools: Nearly all Consumer Driven Health Plans have extensive web pages to provide tools for using the plan, accessing your savings or spending account information,  researching health care costs and providers, and obtaining health care information. Thus Consumer Driven Health Plans are best suited for those who have a computer with Internet access and are comfortable using it.

Financial Evaluation: The relative financial benefit of tax advantaged features of savings and spending accounts depends upon your specific situation. In addition to consulting with your accountant, you might check out  various web enabled calculators offered by a number of organization that you can use in evaluating HSAs and HRAs.

Finances vs. Your Health: There may be times where you might be tempted to delay or forgo needed health services because you haven't met your annual high deductible requirements and you're waiting for funds to build up in your account, or you don't want to draw down the funds in your account. Try to keep your health your top priority, and also remember that delayed or forgone care typically ends up with your ultimately requiring even more care and at higher costs. 

Bigger Gap at Start: If your employer is providing some level of funding for your savings or spending account, remember that they typically pro-rate their funding throughout the year. This means if they fund $1,200 for your account, they typically won't deposit all $1,200 at the start of the year, instead they might deposit $100 a month for 12 months. Thus if you don't have cumulative funds already built up, your Gap of out-of-pocket expenses between your account funds and the high deductible requirement will typically be much larger at the start of each plan year.

Account Administrator: Often, the administrator for your savings or spending account will be a different organization than your health insurance plan. Thus, depending on how well these two organizations coordinate with each other, you might be dealing and corresponding with both organizations, and need to keep straight who you are dealing with and when you need to deal with each one.

Debit Cards: Its much more convenient to pay for services from your savings or spending account if your account administrator provides a Debit Card, such as through Mastercard, that your provider can use to charge your expenses to.

Understanding your Insurance Benefits: Many High Deductible plans have first dollar preventive care benefits, that aren't subject to the high deductible. While your plan will have annual maximums that you have to pay for out of pocket regarding covered services, these maximums maybe tied to using participating providers. Also, when comparing consumer driven plan options, don't just focus on the deductible amount and the savings or spending account features. The covered benefit provision of the insurance policy can vary significantly from plan to plan, so evaluate them carefully.

HSA vs HRA compatible plans: Insurance plans combined with HSAs vs HRAs can have important differences. HSA compatible plans must meet the regulatory definition of a High Deductible Health Plan, while HRA compatible plans have a high degree of flexibility. For example, the prescription benefit in an HSA compatible plan must be subject to the high deductible amount, while HRA plans can either provide first dollar Rx coverage or subject the Rx benefit to the deductible.