$520

$500 Medical/$50 Drug

 
 

$2,250

January

February

 
 

December

January

$520

In her first month of coverage, Chloe is responsible for $520 to cover her premium, out-of-pocket expenses for required trips to the doctor, and needed medicines. Her condition requires several recurring visits to providers, including the psychiatrist every other month, a mental health professional four times per year, a sick visit to the doctor each year, and an annual physical. 

February

$500 Medical/$50 Drug

Chloe's costs are in excess of her non-necessity income early in the year. She meets her prescription drug deductible in January, and her medical deductible in February.

December

$2,250

Chloe does not meet her maximum out-of-pocket limit, and is therefore responsible for the full cost of her premium and out-of-pocket costs throughout the year. 

January

$520

In her first month of coverage, Chloe is responsible for $520 to cover her premium, out-of-pocket expenses for required trips to the doctor, and needed medicines. Her condition requires several recurring visits to providers, including the psychiatrist every other month, a mental health professional four times per year, a sick visit to the doctor each year, and an annual physical. 

February

$500 Medical/$50 Drug

Chloe's costs are in excess of her non-necessity income early in the year. She meets her prescription drug deductible in January, and her medical deductible in February.

December

$2,250

Chloe does not meet her maximum out-of-pocket limit, and is therefore responsible for the full cost of her premium and out-of-pocket costs throughout the year. 

Patient Profile: Out-of-Pocket Cost Burden

Mental Health

Chloe is a 35-year-old woman living in California. She makes $1,653.25 per month at her job as a retail clerk. Chloe also suffers from bipolar affective disorder. According to research on family budgets, she is likely to use most of her income on necessities such as food, housing, taxes and transportation. The following patient story represents 2014 plan data.

Scroll through the content below to engage with different stages of Chloe's health care story or download the PDF here.

Name: Chloe

Age: 35

Location: California

Job: Retail Clerk

Income: $1,653.25 (170% of the FPL)

Chloe does qualify for additional cost-sharing subsidies

Condition: Bipolar Affective Disorder

Health Coverage: Silver Cost-Sharing Reduction Plan

Medications:
Brand-Name Atypical Antipsychotic, Several Generics

Additional Symptoms:
High Cholesterol and Hypertension

Monthly Premium: $83 (after subsidies)

Deductible: $500 Medical / $50 Drug

Out of pocket costs (in first month alone): $520

Total Costs of Health Care During the Year: 75% Of Non-Necessity Income

Total Costs on Premiums and Health Expenses During the Year: 75% Of Non-Necessity Income

The high out-of-pocket costs required by many exchange plans – even for someone getting additional cost sharing subsidies – can create major hurdles to accessing needed health care services and treatments.

Share This Story

Spread the word by sharing on Twitter, Facebook, Google+, or via email.