The Question of Telemedicine and High Deductible Health Plans

Washington’s response to the COVID pandemic included temporary actions designed to make sure people could get the healthcare services they needed despite doctor’s offices, clinics, and hospitals being virtually shut down. One of the temporary measures taken was a rule that forced high deductible health plans (HDHPs) to cover telemedicine services separate from a policy holder’s deductible.

With many of the emergency provisions set to expire at the end of this year (2022), there is now debate over whether they should all be made permanent. Some probably should be. Others, probably not. The HDHP rule is part of the latter category.

More About the HDHP

Key to understanding why the HDHP provision should not be made permanent is an understanding of what an HDHP actually is. An HDHP is a type of health insurance plan that offers significantly lower premiums in exchange for significantly higher deductibles. It is essentially the modern version of what used to be standard health insurance before there were HMOs.

Consumers with HDHPs enjoy a number of benefits. First are the previously mentioned lower premiums. Second, HDHP subscribers have access to health savings accounts (HSAs). These are accounts into which they can contribute pre-tax dollars that will later be used to cover qualifying healthcare expenses.

Why a Permanent Rule Would Be Bad

With a basic understanding of the HDHP, it is easier to understand why a permanent rule forcing such plans to cover telemedicine would be bad. There are several reasons. At the top of the list is negating the entire point of the HDHP.

Allowing companies to offer an HDHP gives them the opportunity to offer more affordable health insurance with lower premiums. The lower premiums are accomplished through high deductibles and covering fewer services. Forcing carriers to fully cover telemedicine separate from a subscriber’s deductible would only increase their costs. The result would be higher premiums. What is the point then?

Another problem is that a permanent rule eliminates the rationale for giving subscribers access to HSAs. Subscribers could meet all their primary care needs through telemedicine and have such services covered completely. There’s very little incentive to contribute to an HSA unless one fears the possibility of a catastrophic health event.

Telemedicine Is for Primary Care

Technically, telemedicine technologies can be used to facilitate all sorts of remote healthcare. It can be utilized for triage in an emergency situation. It can be used in psychiatry to facilitate patient consultations without forcing patients to come to the office. But for all practical purposes, telemedicine is currently used mostly to provide primary care.

CSI Health, a San Antonio company that designs and builds medical kiosks and other digital health screening solutions, says that telemedicine works for primary care due to the fact that primary care visits to little more than discussions between doctor and patient.

A telemedicine kiosk with basic diagnostic capabilities offers clinicians enough information to consult with patients via video chat. They can do so more efficiently and cost-effectively than having patients come in for face-to-face visits.

Telemedicine Is Here to Stay

Up until a few years ago, they were very legitimate concerns over the future of telemedicine. Our healthcare industry was largely resistant to embracing it full-scale. However, the pandemic changed that. It is clear that telemedicine is now here to stay.

Does that mean Washington should step in and force insurance carriers to fully cover telemedicine through their HDHPs? No. To make the temporary rule permanent is to defeat the purpose of the HDHP. If the rule is made permanent, HDHP premiums have nowhere to go but up.



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