- Employees under an employer plan have an average deductible of $2,296.00 for single coverage and $4,104.00 for family coverage (Employee Benefits Survey: 2018 Results).
- Individuals under an ACA plan have an average deductible of $ 4,000.00 for single coverage and $ 8,300.00 for family coverage (HealthPocket.com).
A laser focus patient financial education, eligibility verification and collecting payments early on is critical to maintaining a stable revenue as consumer portions continue to climb.
When Deductible Resets Occur
Since deductibles can be $6,000.00 or more, it is a significant cost for patients. Additionally as you know, deductibles reset usually annually. If group health insurance operates on a calendar year, the benefit plan expires on the 31st of December and starts anew on January 1st. The deductible will reset on January 1st as well.
However, some group plans reset on a benefit year. This can end and begin again on any date. The contract date is usually on the first of any given month. So, if the plan runs from July 1st to June 30th, the reset happens on July 1st.
Individual or private health insurance resets deductibles depending on the plan design. If you select a plan with an annual deductible, it will be reset each year. Month to month plans reset at the 13th month mark.
It is possible that patients lack knowledge about resets or the exact time they occur, and think they may have hit the deductible limit, when in fact, they must start all over because of the reset. A portion of patients are also under the assumption that because they pay their premium, their insurance covers everything, with no additional out of pocket due.
Studies suggests that 88% of patients want to know their payment responsibility before they see a provider. Some may not know that the deductible has reset meaning they have to start from the beginning. You can help your patients by estimating their obligation during the insurance verification process. It is also a good time to discuss all the payment options available to the patient.
The key to collecting deductibles, co-pays/co-insurance, and other patient portions is instituting as many payment channel options as possible. Online, bank automatic bill pay, credit cards, digital wallet options, formal payment plans, checks, or even cash should all be considered. This ensures patient satisfaction because when patients have the payment method they prefer, they are more likely to pay.