By Eric Tiedtke, TDA Financial Services Insurance ProgramSince the passing of the Affordable Care Act, there’s been a significant increase in high-deductible health plans and usage of Health Savings Accounts (HSA).
For 2022, a qualified high-deductible health plan, also known as HDHP, must have a deductible of at least $1,400 for an individual and $2,800 for a family, and an annual out-of-pocket expense that does not exceed $7,050 for an individual or $14,100 for family coverage. More and more practices are enrolled in these types of plans because they are less expensive—not only because of the higher deductibles, but also because there are no first-dollar benefits like office visit copays and prescription drug copays.
These high-deductible plans mean that insured patients end up paying for a greater portion of services out of their own wallets. However, patients pay at the price their insurer negotiated, rather than rates set for people without insurance. Supposedly you should be getting the best negotiated rate that insurance companies have worked out with your pharmacy. However, this is not always correct.
If you’re paying for prescriptions out-of-pocket because you haven’t met your deductible, you might want to consider self-pay. Self-pay in this case is just asking what the cash price is versus using insurance, and using cash to pay for prescriptions (covered by insurance) because the cost is lower.
You need to understand and weigh the pros and cons of this approach; it’s not an option for everyone.
When might self-pay be an option?
You need prescriptions, have a high deductible plan, haven’t reached your deductible, and don’t expect to hit it within the calendar year (before the deductible resets for the following year). Keep in mind amounts paid via self-pay are typically not applied to your deductible, but you can still use your HSA account.
Want to make your cash go further? Look for prescription coupons offered by drug companies or discount pharmacies. Following are two options that might help:
GoodRx is a free prescription drug savings card. You can compare prices on its website. Just take the card to your pharmacy and ask what price is lower: via insurance or the GoodRx price. If the GoodRx price is lower, ask the pharmacy to use your GoodRx coupons instead of your insurance. (Remember, the amount you pay with a coupon won’t be applied toward your deductible.)
ScriptCo (for generic meds only) is a membership-based pharmacy ($140/year) that makes prescription medications more affordable for everyone. ScriptCo does not accept any form of insurance. It supplies the same generic medications at ACTUAL WHOLESALE COST. The prices members pay are the same prices ScriptCo paid to purchase the medications.
If you have met your deductible early in the year (or expect to because of a planned procedure), this might not be an attractive option. However, if you don’t meet your deductible each year and are looking for ways to deal with increasing costs, self-pay is one way to make your dollars go farther; and using a company like the ones mentioned might save you even more.