For tens of millions of Americans, the start of a new year means the counter has gone back to zero on their health insurance deductible. If they need health care, they’ll pay for some of it out of their own pockets before their insurance takes over.
As insurance plans with deductibles grow in popularity, a new study takes a national look at what those plans mean for people with common chronic health conditions such as diabetes, asthma, joint problems and heart disease.
The short answer: Those who choose plans with a deductible and have such conditions should be prepared to spend hundreds or even thousands of dollars of their own money on their care, beyond what they spend to buy the insurance plan in the first place.
The results, reported in JAMA Internal Medicine by researchers from the VA Ann Arbor Health Care System, University of Michigan Medical School, and Penn State University, especially show the impact of high-deductible health plans — which now cover 40 percent of Americans who buy their own health insurance or get it through an employer.
Using data from a national survey of Americans under age 65, the researchers find that having a high-deductible plan makes it more likely that health-related costs will take up more than 10 percent of a chronically ill person’s total income. They also find huge variation between patients who have the same condition in the amount of out-of-pocket spending they had, even for those in low-deductible plans.
Despite these out-of-pocket costs, the study finds that few people with chronic illnesses said that costs or insurance coverage issues had gotten in the way of getting the care or prescriptions they needed.
“Increasingly, these plans have become woven into fabric of health insurance in America, so it’s important to look at the impact of deductibles on people who need care on an ongoing basis,” says senior author Jeffrey Kullgren, M.D., M.S., M.P.H., a research scientist in the VA Center for Clinical Management Research of the VA Ann Arbor Healthcare System and an assistant professor of general medicine at the U-M Medical School. “Not only on how they spend their money on care for their day in, day out health needs, but also how that affects spending in the rest of their lives.”
The findings are based on data from 2011 through 2013, during a time when many more employers started offering high-deductible health plans.
It was also before individuals who needed to buy their own insurance could do so on the Healthcare.gov Marketplace. Since the launch of the Marketplace, more than 90 percent of people shopping there have chosen high-deductible plans.
Lower-income people who choose Silver-level Marketplace plans can get assistance with out-of-pocket costs from the federal government. But those who opt for Bronze-level plans with high deductibles, which have lower monthly premium costs, aren’t eligible for deductible help. Neither are people who make more than the income limit or get their coverage outside of the Marketplaces.
“If changes in health policy remove Marketplace subsidies, that could rewind the clock to the era we studied,” says Kullgren, who is a member of the U-M Institute for Healthcare Policy and Innovation and the Center for Behavioral and Social Sciences in Medicine.