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Do High Deductible Plans Cover Chronic Care Up Front?

Good question. That depends on your high deductible plan and its relationship to a health savings account.  As more people are covered by high deductible plans, some employer sponsored plans are covering benefits like doctor visits or generic prescription drugs to help ease the costs to the individual before meeting the deductible. Here’s the catch: if your plan is linked to a health savings account, it can only cover preventative services like vaccines and mammograms until you meet the deductible.

Twenty-nine percent of workers with employer sponsored coverage are enrolled in high deductible plans with some kind of a savings account, according to Kaiser Family Foundation’s annual survey of employer sponsored benefits, up from 17 percent in 2011.  These people generally pay more out of pocket for care that those individuals in traditional plans. In a recent study by the Health Care Cost Institute that examined claims data from three major insurers for 40 million Americans, people in high deductible plans were responsible for 24 percent of their medical costs between 2010 and 2014, compared with 14 percent for people in traditional plans.

A bipartisan bill was introduced in July that would allow high deductible plans that can link to health savings accounts to cover chronic conditions like diabetes and heart disease before individuals have met their deductibles. The legislation, which has been endorsed by consumer groups and policymakers who are supporters of “value based insurance design”, encourages health plan features that urge participants to get clinically effective care by reducing or even eliminating out-of-pocket costs for these services.

Although such legislation would be attractive to plan participants, it remains to be seen if insurers buy into it. Allowing plan design that provides pre-deductible coverage for chronic conditions could certainly increase premiums. Determining which doctor visits should be eligible, for example, would be a difficult task.


With open enrollment upon us, if you have a choice of plans at work, take a look at all of them with an eye towards the best affordable coverage for you and your family.


For additional information, contact EAB HealthWorks.