Consumer-directed health plans usually are designed with a high deductible, coupled with a health savings type account. The intent is to ensure that the covered person thinks about the cost of services both in deciding to seek services at all, and in being cost sensitive about where the service is received. Under the reform law, and under many value-oriented plan designs, preventive services are not subject to the deductible or usually other cost-sharing. The theory is that these services should have no financial barrier, because they contribute to better health, a valued end in itself and one which may reduce total lifetime health costs. A study in Health Affairs examines the understanding that enrollees in high-deductible plans have about their preventive care benefits. (Health Affairs Article)
The study was a survey of around 450 people in California enrolled in high-deductible health plans. While over 80% of respondents knew their plan had a deductible and about 70% knew the amount, most did not know that preventive services were exempt from the deductible and a significant fraction said they delayed or avoided preventive care because they thought it was subject to cost sharing. Other than the usual caution that people in California are not likely representative of the country as a whole and the intelligence of many Californians could be questioned given their political and policy choices, the study seems accurate. Most people, whether in a CDHP or not, have a limited understanding of their health insurance benefits and while their self-reported perception of benefits may not reflect their actual utilization, that understanding is probably correlated with behavior. Plans may need to go out of their way to ensure that enrollees know preventive care has no cost-sharing associated with it.