Expecting their first child last year, Danielle and Joe Padula got down to work, estimating how much money they could spend on obstetrician appointments, hospital and delivery fees and pediatrician visits.
Most insured couples wouldn't spend much time worrying about the costs involved, focusing first on nursery colors or strollers. But the Padulas' health plan is different from most. It requires them to manage the costs of their own care.
Instead of requiring the Padulas simply to meet a modest deductible before covering most of their costs, the couple's plan creates a large deductible -- which, in their case, is partially funded by the employer -- and provides incentives for them to spend their healthcare dollars wisely.
For example, the plan gives the Padulas $2,000 each year to spend on their choice of doctors and services. After that money is exhausted -- as it quickly was during Danielle's pregnancy -- the couple must pay the next $1,200 in expenses out of their own pocket. After that, insurance kicks in to cover any remaining expenses.
Of course, some plans already give consumers greater control over how their healthcare money is spent, offering more physician or drug choices in exchange for greater out-of-pocket expenses. However, the Padulas' plan, like a growing number of others, takes those choices a step further by doubling or tripling the deductible and providing incentives and support to help people manage their healthcare.
Such responsibility turned the couple into careful healthcare shoppers but gave them freedom as well, says Danielle, who gave birth earlier this year to son Jake.
For example, she opted to have ultrasound pictures taken during her pregnancy, although the pictures weren't a medical necessity. "That is something I didn't need but I wanted," she says. "A lot of people don't get that choice under their health plans."
Learning what a treatment or procedure costs -- then deciding whether to pay for it -- is a new step for most Americans with health insurance. Even traditional fee-for-service plans, in which consumers pay 20% of a bill, don't prompt most people to analyze a procedure's cost or their actual need for it, experts say. But when consumers are held solely responsible for a medical bill, they tend to think twice.
