My patients don’t understand deductibles. Though I am no expert either.
Does this sound familiar? A patient needs an expensive medication (eg SGLT2 for DM2 + CKD3b) but has a high deductible plan, so it would cost hundreds of dollars per month until, say, September after which his insurer would pay 90% of the cost. He plans on a total knee replacement in May at which point he meets his deductible immediately. So he wants to wait to start his SGLT2 until June. “Because it will be cheaper.”
I am not an economist, but even I can see the lack of logic here: it does not matter at what point in the year he pays his deductible. He’s saving no money, is postponing important treatment, and is in fact unintentionally eschewing his insurance paying for a huge chunk of his medication coverage. While his kidneys slowly deteriorate.
Insurance should not be this complicated. But I suspect that’s part of the business plan.
A less obvious scenario ... drug is $100 per month cash (not contributing to deductible), and $175 with insurance (counts towards deductible). How to decide which is cheapest in the long run?
A uniquely American mess.