Surgery and medical appointments are filling up at local offices as patients who have met their deductibles rush to get treatment before the clock resets Jan. 1.
Deductibles — what consumers pay before their insurance plan starts to pay — as well as other out-of-pocket medical expenses have grown, leading some patients to make calculated decisions on when to schedule elective and semi-elective procedures.
“Get in early,” said Dr. Steve Sutherin, general surgeon with Miami Valley Surgery Associates. “Especially with our office, usually by the first week of December we are full all the way up to Jan. 1.”
The average deductible among all U.S. workers with health insurance coverage is $1,350. Over the past five years, the average annual deductible among all covered workers has increased 53 percent, according to the 2018 survey of employer-sponsored health insurance by Kaiser Family Foundation.
But while the size of deductibles have grown, the number of employers that only offer high-deductible plans is set to drop to 30 percent next year, down from 39 percent this year, according to the National Business Group on Health.
That means more employers will be offering both low and high-deductible, which bucks the trend in past years of employers increasingly only having high-deductible insurance options and shifting more costs to employees.
Forty-two percent of covered workers in small firms and 20 percent of covered workers in large firms are in a plan with a deductible of at least $2,000 for single coverage, which is similar to the percentages last year.
“The flip side of the story is there are people who delay health care because they can’t afford those deductible payments,” Dr. Joe Northup, medical director with Premier Weight Loss Solutions, said. Northup said his practice’s schedule typically is packed from October through December.
Besides deductibles, there are other factors that drive patients to the doctor’s office and hospital toward the end of the year.
Cases of flu and pneumonia start to increase for the season and stormy weather can lead to falls, car accidents and other injuries.
Ted Inman, CEO of Dayton-based PriMed Physicians, which is an independent group of about 55 doctors, said it is not just patients trying to come in after they met their deductibles but also patients who are seeking to get screenings or preventative care by the end of the year.
Some health plans give gift cards or other incentives to patients who get annual physicals and standard screenings like mammograms by the end of the year, which can lead to early treatment for health problems and better health outcomes.
Medicare Advantage plans, which are privatized plans for older adults, can score higher on the federal governments five-star rating system if they have more members who get certain types of preventative care.
“If a health plan is willing to give an incentive, we think that’s a good thing,” Inman said.
He said people are also trying to get appointments in while they are off of work or while children are out of schools, and flu season can be driving increased visits toward the end of the year.
Inman said he would recommend that patients make sure their doctors know ahead of time what they all want to cover in a visit. Some wellness visits might be better scheduled in the spring when there is more time available.
For bariatric surgery, Northrup would recommend planning early. There are often insurance-mandated diets and other pre-work before approval for surgery and he said patients who come in in August are going to struggle to get surgery before the end of the year.
Northup also said there are a few patients timing out their care to overlap into two calendar years so they quickly hit their deductible and have more of their care covered throughout the year.
If a patient has not met their plan’s deductible, Sutherin said patients should consider whether to wait until January for elective and semi-elective procedures.
“Because if they have any further illnesses next year, they’ve already met that deductible,” he said.
Health insurance facts & figures
42 percent: Small business employees covered with a deductible of at least $2,000 for single coverage
30 percent: Employers that only offer high-deductible plans for 2019
$19,616: Average 2018 premium for employer-sponsored family plan
$6,896: Average 2018 premium for employer-sponsored individual plan
Source: Kaiser Family Foundation, National Business Group on Health