Kaiser study: Many patients with high-deductible health plans unaware of benefits

Consumer-directed health plans with high deductibles typically exempt recommended preventive care such as annual physicals or screening tests from the plan's deductible or require only a small copay as a way to ease financial barriers and encourage patients to seek care. However, many patients don't understand their plan benefits for preventative office care and tend to avoid visits altogether.

According to a report published in the December issue of Health Affairs, the Kaiser Permanente Northern California Division of Research surveyed 456 Northern California-based respondents who had consumer-directed health plans and found that fewer than one in five understood that their plan exempted preventative office visits, medical tests and screenings from their deductible. These types of health plans have grown in popularity over the last three years, increasing to 19 percent of all covered workers in 2012 from eight percent in 2009.

[See also: Preventive healthcare cuts costs, study finds]

In addition, approximately one in five respondents said that they had delayed or avoided a preventative office visit, test or screening because of cost, said Mary Reed, staff scientist at the Kaiser Permanente Northern California Division of Research in Oakland, Calif., and an author of the report.

Reed added that those respondents who were confused about exempted care were significantly more likely to report avoiding preventative visits because of cost concerns.

"Surveyed patients in a high-deductible, consumer-directed health plan often didn't understand the ways that their health plan affected preventative and non-preventative care," said Reed. "They were unaware that non-preventative office visits and tests would apply to their deductible, and preventative tests or visits were exempt from their deductible, meaning that they were free or had a low copay. This was all related to their care-taking behavior."

Reed and her fellow coauthors recommend concerted consumer education and support efforts to ensure patients are aware of their benefits and do not mistakenly avoid important preventive care due to concerns over cost, especially as more private and public health plans adopt the consumer-directed plan model.

"The implications for benefit design are that we have to be pretty careful in making sure patients understand how they work. Keeping in mind that the more complicated benefits are, patients might be less likely to understand all the details. If patients don't understand the cost sharing exemptions, they might not behave accordingly," said Reed. "At this point, I think the most promising approach is to educate patients as clearly as we can so they have access to clear information about how their benefits will work. Maybe offering the information from the employer level for those workplaces offering a plan, or maybe offering information from the hospital or physician; exactly the most effective place for offering information is not completely clear yet."
 

[See also: Kaiser issues reports on state Medicaid coverage]