How a High Deductible Health Plan Can Influence Health Outcomes

doctor with high deductible health plan on paper

Have you ever delayed medical care because you couldn’t afford to pay your deductible? If so, you belong to nearly 50 percent of Americans who find themselves in similar situations when they need healthcare.

How deductibles work

A deductible is the amount of money you pay out of pocket before your insurance plan will pay a claim. The deductible for Medicare Part A in 2019 is $1,364, and the Part B deductible for 2019 is $185. After you’ve met this deductible, Medicare will pick up 80 percent of Medicare-approved services, while you will be responsible for the remaining 20 percent.

For example, if you have a hospital visit with a total cost of $3,500, here’s how the math would break down:

  • Total cost of hospital visit: $3,500
  • Medicare Part A deductible: $1,364
  • Remaining balance: $2,136
  • Medicare pays 80 percent of remaining balance: $1,708
  • You pay 20 percent of remaining balance: $427
  • Your total cost: $1,791

The cost of a high deductible plan

A study published in Health Affairs collected data from an insurer that covered 316,244 women to determine if a change in deductibles would affect their health outcomes. These women previously had low deductible health plans with an average deductible of less than $500, and then switched to plans with deductibles exceeding $1,000.

Unsurprisingly, researchers found that women with low incomes were most affected by the change to a high deductible plan.

Women with low income and a high deductible plan waited an average:

  • 1.6 months for diagnostic breast imaging,
  • 2.7 months for an initial biopsy,
  • 6.6 months for early-stage breast cancer detection, and
  • 8.7 months for the first round of chemotherapy.

However, this is not a problem unique to low-income women. A 2017 report from the Kaiser Family Foundation found that at least 43 percent of American adults had difficulty paying their deductible when they needed healthcare.


If you have difficulty paying your Medicare deductibles, you might consider a Medicare Supplement plan, also known as Medigap. Medigap plans are meant to “fill the gaps” in your Medicare coverage. That means, you would pay a low monthly premium, and your Medigap plan could cover some of your out-of-pocket expenses, like copays and deductibles. Use Medicare’s Plan Finder to find a Medigap plan in your area.

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