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High deductibles force people to skip care, study finds



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If you've felt as if your high deductible was preventing you from getting needed health care, you're not alone. A new report finds that among Americans with private insurance, one in four didn't get needed care last year because they couldn't afford it.

But the report from the Washington, D.C.-based nonprofit consumer group Families USA cautions that skipping care is hardly a cost-saving measure for consumers. It calls on insurers and policymakers to develop more affordable plans that cover certain types of tests and treatments before the deductible is met.

"Not getting recommended follow-up care to treat an illness or not taking needed medications can result in people facing avoidable, more serious health problems and more expensive health care costs down the road," the authors write.

Families USA says about 15 percent of those surveyed didn't get necessary medical tests, treatment or follow-up care because they couldn't afford it, and another 14 percent skipped necessary medication due to its cost.

The Commonwealth Fund reported even graver findings in fall 2014: As I reported for Impatient, it found that two of five adults with private insurance who had high deductibles relative to their income said they delayed needed care because of the deductible.

How high?

High deductible plans are intended to transform people into cost-conscious consumers of health care, the report explains. Too often, though, these high out-of-pocket costs are having a damaging effect on consumers.

That's in part because some deductibles are just too high, the report says.

Families USA analyzed data from the Urban Institute's Health Reform Monitoring Survey of adults who bought private non-group insurance (as opposed to getting insurance through an employer or a public program such as Medicare or Medicaid).

Among people with lower to middle incomes, nearly two in five had annual deductibles of $1,500 or higher, and more than one in five had deductibles of $3,000 or more. Among middle-income adults, more than half had deductibles of at least $1,500 or higher, and nearly one in three had deductibles of $3,000 or more.

Another problem with these plans: Too many people don't understand their plans well enough to shop around for care and make informed health care decisions, according to Families USA. This becomes an even larger barrier for people who struggle with literacy or whose primary language isn’t English, it adds.

Among those surveyed, about one-fourth said they lacked the confidence to determine whether a service was covered by their insurance plan; which drugs were covered or what they would cost; and the maximum they could be charged out of pocket for covered services in their health plan, the report says.

About one-third said they there were not sure they could figure out which costs counted toward their deductible, according to the study.

And as I've reported here, even when people do understand their high-deductible health plans, the experience of shopping around for health care can be maddening. Because of this, I've spend the last couple of weeks compiling tips for shopping for care and negotiating with doctors.

Calling for change

The report offers several solutions to this problem of high deductibles. One recommendation: Develop more health insurance plans with affordable cost-sharing at the "silver" level – the most popular type of plan on the marketplace.

For health insurers, this could mean offering silver plans with low or no deductibles. It could also mean offering a plan with one deductible for drugs and a separate one for everything else. 

Families USA also suggests that these silver plans could help pay for more outpatient services before people have met their deductibles, like primary care, mental health visits, prescription drugs, blood work, diagnostic testing and secondary preventative services.

Policymakers, it maintains, could require insurers to sell at least one silver plan that doesn't apply these services toward a deductible.

Your story

I'm going to keep reporting on the impacts of high-deductible health plan and I'd love your help.

If you have a high-deductible plan, how has it affected your health care decisions? Are you forgoing visits or treatments due to their cost? Are you shopping around for more affordable care?

Let's keep this conversation going: Tell me about your experiences in the comments section below, or e-mail me at Impatient@scpr.org.