Health Care Act

High-deductible trend keeps growing and posing challenges

High out-of-pocket costs can leave people in almost as much trouble as being uninsured.
High out-of-pocket costs can leave people in almost as much trouble as being uninsured. The Commonwealth Fund Biennial Health Insurance Survey (2014).

Don’t expect the grousing about high-deductible health insurance to ebb anytime soon.

A spate of recent reports confirms what many of us have been reporting: More and more, having health insurance doesn’t mean you’re protected against crippling bills.

In the past year and a half, the Affordable Care Act has gotten millions more Americans covered and stopped insurance companies from denying coverage to people with pre-existing conditions. But it has also helped drive up premiums by adding coverage requirements. The result: Employers and individuals trying to cut premiums often shift to plans with higher out-of-pocket costs.

The Commonwealth Fund’s biennial health survey shows that 23 percent of insured adults, or 31 million people, have such high out-of-pocket costs compared with their income in 2014 that they were considered underinsured. Those people were almost as likely as the uninsured to have trouble paying their medical bills, to burn through their savings and to see their credit rating drop because of medical expenses, the survey shows.

A recent Kaiser Family Foundation survey found that 32 percent of people who had purchased high-deductible plans on the individual market described those plans as a poor value, and another 28 percent classed them as a fair value. Only 37 percent called their high-deductible plans a good or excellent value, compared with 68 percent of people who paid higher premiums for lower deductibles.

Some of the most frustrated people I hear from are those with high-deductible workplace plans. If your employer provides insurance that meets the ACA guidelines, you can’t get a subsidy to help pay premiums and out-of-pocket costs, even if your income is relatively low.

Flexible Benefit Service Corp., an Illinois-based benefits agency, projects that more workers will join the high-deductible brigade in the coming year. High-deductible plans linked to health savings accounts have been trending in recent years and are expected to surge, the company said in a recent briefing.

Those plans, which let employees put pre-tax dollars into accounts for health expenses, can be a good deal for employees who can afford to save and have generally good health. The premiums are lower than they are for plans with lower out-of-pocket risks, and some employers make contributions to encourage workers to choose that option.

But for people who are struggling to cover basic expenses, saving thousands of dollars to cover major medical bills may not be practical. And while some employers offer a choice, a growing number – including Carolinas Healthcare System, starting next year – have only high-deductible plans.

Helms: 704-358-5033;

Twitter: @anndosshelms. This article is done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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