In recent weeks, a growing body of reporting has featured the increasing shift of health care costs to consumers due to high out-of-pocket costs in the health insurance exchange plans. Driven by open enrollment and new analyses from Avalere Health and HealthPocket, the coverage underscores that these out-of-pocket costs – including copayments, deductibles and coinsurance – may create barriers to access and hinder adherence to needed medicines and health care services.
Following please find excerpts and links to the full text of articles in several top-tier, policy and trade publications. We will keep this updated with the latest coverage for your reference.
By Melanie Evans // December 9, 2014
Households spent $824 billion last year on insurance premiums and medical bills not covered by health plans, including deductibles and other coverage exceptions under insurance policies. The amount also includes payroll taxes for Medicare.
New York Times
By Charles Ornstein, Ryann Grochowski Jones and Lena Groeger // December 4, 2014
Much attention has focused on changes to plans’ monthly premiums, but changes to other kinds of benefits – affecting the cost of things like doctors' visits and prescriptions – can be trickier to understand and make a huge difference in annual health care costs.
Wall Street Journal
By Stephanie Armour // December 3, 2014
Americans increasingly have to dig into their own pockets to pay for medical care, a shift that is helping to curb the growth in health spending by employers and the government.
“There has been a steady increase in deductibles and the main effect is to reduce use,” said Drew Altman, president of the nonprofit Kaiser Family Foundation. “The gradual shift to consumers having more skin in the game is encouraged as part of national policy, and it’s having an impact.”
To keep premiums low, insurers designed the plans to include steep out-of-pocket charges. Silver plans, which are the most popular plans purchased on exchanges and cover 70% of medical expenses, have an average deductible of $2,927 for individuals and $6,010 for families for 2015, according to HealthPocket.
By John Tozzi // December 3, 2014
Difficulty knowing how much medicines will cost is just one of the challenges that make patients poorly equipped to shop for health care. Although their total costs will be capped by plans’ out-of-pocket maximums, the difference between plans with 40 percent cost sharing on expensive drugs and 5 percent could mean thousands of dollars a year. And if you’re diagnosed with cancer in the middle of the year, you can’t switch plans to find one with more generous drug coverage.
By Dina Overland // December 3, 2014
Insurers are adopting more cost-sharing measures, especially coinsurance, to shift the costs of expensive specialty drugs onto consumers who purchase plans sold on health insurance exchanges, according to a new analysis from Avalere Health.
The consulting firm found that silver plans charging coinsurance greater than 30 percent for specialty meds have risen from 27 percent in 2014 to 41 percent in 2015. All told, 80 percent of silver plans use coinsurance as a consumer cost-sharing tool for specialty medications, though the amount is often less than 30 percent.
Kaiser Health News
By Julie Appleby // December 2, 2014
Increasingly, health plans – including those offered to people with job-based coverage – require hefty payments, sometimes 20 to 40 percent or more of the total cost of medications that insurers classify as specialty drugs. That’s a change from the flat dollar payments of $10 to $30 or $50 that many patients have become accustomed to for other types of drugs.
By Elise Viebeck // December 2, 2014
"Competitive premiums are key to a sustainable exchange marketplace, which has led plans to pursue more significant cost-sharing," [Avalere Health CEO Dan] Mendelson said in a written statement. “In some cases this could make it difficult for patients to afford and stay on medications," he said.