Kentucky Health News
Many consumers of health insurance under the Patient Protection and Affordable Care Act are finding that it’s not as affordable as the name implies — not because of the premiums, but due to the “sky-high” deductibles that leave many feeling like they don’t have health insurance at all, Robert Pear writes for The New York Times.
“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” David Reines, a former New Jersey hardware salesman with chronic knee pain, told Pear. “We have insurance, but can’t afford to use it.”
Pear reports, “In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found.” The lower the premiums, the higher the deductibles.
Kentuckians also struggle with high deductibles, based on a look at plans offered on Kynect, Kentucky’s health insurance marketplace. Kentucky Health News examined what it would cost a one-parent, one-child family in Scott County.
The least expensive premium for this family on Kynect is the CareSource “bronze” plan at $254 per month, but this plan also has the highest deductibles at $6,650 per person and $13,300 per group.
The lowest deductible for this family is the Humana “platinum” plan at $500 per person and $1,000 per group, but this plan’s premium was also one of the most expensive at $532.98 per month.
Two steps below the platinum plan are the “silver” plans, which are the most popular by far on the Obamacare exchanges. Deductibles for the silver plans available to our sample family ranged from $2,000 to $3,700 per person and $4,000 to $7,500 per group.
Deductibles for the bronze plans, which have the lowest premiums, ranged from $4,400 to $6,650 per person and $8.800 to $13,300 per group.
Other costs to consider when looking at the affordability of a plan are its co-payments, co-insurance and out-of-pocket maximums.
While the shift to cost-sharing through higher deductibles has become the norm, an analysis by the Kaiser Family Foundation found that fewer than half of all households above the poverty level have enough assets to cover an out-of-pocket maximum of $3,000 to $6,000, which is considered mid-range. The highest out-of-pocket maximum for 2016, as set by the health-reform law, is $6,850, according to Kaiser Health News.
“Our deductible is so high, we practically pay for all of our medical expenses out of pocket,” said Wendy Kaplan, 50, of Evanston, Ill., whose family of four pays premiums of $1,200 a month, with an annual deductible of $12,700, “So our policy is really there for emergencies only, and basic wellness appointments.”
There are mitigating factors, Pear reports, health officials and insurance counselors cite several. All plans must cover preventive services without a deductible or co-payment; some plans help pay for some items before patients meet their deductible; there is an overall limit on out-of-pocket costs; and there are discounts available for those with particularly low incomes.
And for those who say their deductibles are too high, Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, told Pear, “Everyone should come back to the marketplace and shop. You may get a better deal.”
But Pear writes that the deductibles are so high they may be scaring away some consumers, especially the young, healthy consumers that would help bring the premiums down for everyone.
Alexis C. Phillips, 29, of Houston, is one of those who told Pear, “The deductibles are ridiculously high. I will never be able to go over the deductible unless something catastrophic happened to me. I’m better off not purchasing that insurance and saving the money in case something bad happens.”
The penalty for not having health insurance in 2016 is $695 or 2.5 percent of household income, whichever is greater.