Those With Chronic Illness Hit Harder With Deductibles

Chronic Illness Deductibles

New findings that likely won’t shock anyone with a chronic illness confirm that those with a chronic condition are hit much harder when it comes to health care deductibles.

The findings, published in JAMA Internal Medicine, came from researchers at Penn State University, University of Michigan Medical School and the VA Ann Arbor Health Care System. The findings came from data between 2011 and 2013, before Americans could purchase their own insurance on the Healthcare.gov marketplace, but more than 90% of people now on the marketplace have opted for a high-deductible plan.

Analyzing data from a major national survey of Americans ages 65 and under, they found 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. Even among patients with the same condition, there were large variations in the amount of out-of-pocket spending they had, even for those in low-deductible plans.

“These plans have become woven into the 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,” said senior author Jeffrey Kullgren, M.D. “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.”

Knowridge reported that 2013 metrics showed a plan was considered high deductible if it asked patients to pay the first $2,500 in care costs for a family, or $1,250 for an individual. Only people with deductibles above this amount qualify to open a health savings account that lets them put away cash that they can use tax-free to pay for some health costs.

Kullgren said that clinicians ultimately need to assume more responsibility for helping patients keep costs down by directing them to more affordable, yet effective treatment options, and finding treatments that will be covered by their insurance.

“One challenge of high-deductible health plans is that clinical decisions made in a doctor’s office are often completely disconnected from the reality of what a patient has to pay out of pocket,” he said. “Patients have to decide whether and where to get a service, such as an operation, lab test or medical imaging exam, that they must pay for under their plan. These are decisions where clinicians can help patients navigate – and in some cases help them avoid care they don’t need.”