Are health insurers penalizing women?

By MarketWatch

Women long have proved more risk-averse than men in surveys that measure investing attitudes and behavior. Could they also show a preference for traditional health plans over newfangled ones that expose them to higher risk of out-of-pocket costs?

There is little research on the notion so far, though several studies point to potentially higher costs for women, especially where maternity care is concerned. A 2007 analysis from the Kaiser Family Foundation found high-deductible plans often translated into large out-of-pocket costs for a variety of pregnancy scenarios.

Last year, researchers from Harvard Medical School reported that high-deductible plans penalize women financially. Health costs for working-age women were about $1,000 higher than for men, or $1,844 compared with $847 on average, the study found. Adults ages 18 to 44 showed a particularly wide gap, with women's median outlays nearly three times higher, $1,266 versus $463.

High-deductible plans make a single insured person responsible for at least the first $1,100 of out-of-pocket medical costs upfront. High-deductible family plans start at $2,200, though deductibles often run much higher.

Some high-deductible plans are paired with savings vehicles, such as health savings accounts, or HSAs. Under Internal Revenue Service rules for HSA-eligible plans, annual 2008 out-of-pocket expenses excluding premiums can't exceed $5,600 for self-only coverage or $11,200 for family coverage.

Women under 50 often seek more medical care than men because of pregnancies, said Diana Zuckerman, the president of the National Research Center for Women & Families, a nonprofit think tank in Washington, D.C. Other health risks increase after the childbearing years end, she said.

The trend toward higher deductibles is "worrisome," especially for women, Zuckerman said. They are often primary caregivers for children, earn less money than men and may be in precarious financial situations if they're single or divorced.

"A lot of times the people who can least afford the risk are the ones getting these policies hoping they stay well, and when they don't, obviously it's better than nothing, but it can be a huge financial burden on people who just don't have any excess money to spend," Zuckerman said. "For a lot of people, it's not a lot better than nothing because a $5,000 deductible means they can't live in their house anymore."

Finding acceptable trade-offs

Rebecca Clyde of Phoenix, a self-employed mother of two in her early 30s, shopped around and was put off by traditional health maintenance organizations' premiums, which were $1,100 to $1,400 a month for her family of four. "They were ridiculously expensive," Clyde said.

Because she isn't planning to get pregnant again, she said, she found a high-deductible family plan from Blue Cross/Blue Shield of Arizona and Lumenos that charged a $540 monthly premium -- in exchange for accepting a $2,400 annual deductible and $4,200 out-of-pocket maximum.

"I would rather just pay for what I actually use and have more control over the cost than front-load all the expense myself," Clyde said.

She figures her family will come out ahead by several thousand dollars even if they have a bad year and have to spend up to their out-of-pocket maximum.

Clyde said she's become a better consumer by asking for prices and slowing the urge to seek care. "In the past I would see something, say a little rash, and immediately take my daughter to the doctor. Now, I'll hold off or call the nurse line and ask should I come in or just watch it for a few days. This puts a lot of responsibility back on us to live a healthy lifestyle because that way we'll go to the doctor less."

Continued: Not always ideal

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