25% of Individual Coverage Policyholders Skipped Care Due to Cost
More than one-quarter of U.S. residents who were enrolled in individual market health coverage in 2014 skipped needed medical care because of cost, according to a Families USA report released on Thursday, the Washington Post's "To Your Health" reports.
The report's authors used an Urban Institute data sample of 1,229 non-elderly U.S. adults with incomes above 138% of the federal poverty level. The sample included individuals who had purchased coverage through an Affordable Care Act exchange, as well as individuals who had purchased coverage directly from an insurer (Sun, "The Your Health," Washington Post, 5/14).
The report found that of the 25.2% of U.S. residents with individual coverage who skipped necessary care because of cost:
- 15% skipped tests or follow-up care;
- 14% went without prescription medications; and
- 12% did not get medical care (Howell, Washington Times, 5/14).
Dental care was not included in the main report findings because many adults with individual market plans do not have such coverage, according to "To Your Health." However, when researchers asked about dental care, it was the most common care skipped because of cost.
Meanwhile, the report found that one-third of low-to-middle income U.S. residents -- those with 2014 incomes between $16,200 and $29,199 -- skipped necessary care because of out-of-pocket costs ("To Your Health," Washington Post, 5/14).
About 40% of middle-to-higher income U.S. residents -- those with incomes between $29,200 to $46,699 -- skipped care because of cost concerns (Washington Times, 5/14).
Role of High Deductibles
Families USA Executive Director Ron Pollack said high deductible plans were a "key culprit as to why people have been unable to afford medical care despite having year-round coverage." The report defined "high deductibles" as $1,500 or more per person.
According to the report:
- More than 50% of adults had deductibles of $1,500 or greater; and
- About 30% had "exceedingly high deductibles" of at least $3,000 ("To Your Health," Washington Post, 5/14).
Further, among residents with exchange plans, about 43% had annual deductibles or at least $1,500 per person (Herman, Modern Healthcare, 5/14). Many ACA exchange enrollees have selected bronze and silver plans, which feature lower premiums but typically have higher deductibles. For example, the average silver plan deductible in 2014 was between $2,267 and $3,030, according to the report ("To Your Health," Washington Post, 5/14).
The ACA requires insurers to cover preventive services, such as influenza vaccinations and blood pressure screening at no cost, though follow-up services typically require a patient to meet a deductible.
Report Suggests Insurers Offer Lower-Deductible Plans
Families USA suggested that insurers should offer more silver plans with lower deductibles (Modern Healthcare, 5/14). Further, report co-author Lydia Mitts said that insurers should revise their plans to address affordability. She noted that Connecticut requires insurers selling plans on the state's exchange to offer at least one silver plan that exempts basic outpatient services -- such as prescriptions, lab work and physician visits -- from the deductible. These plans instead charge consumers a $30 copayment for primary care visits and a $10 copayment on generic prescriptions ("To Your Health," Washington Post, 5/14).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.