Coverage Classroom

Out of Pocket Costs in the Exchanges

One Patient's Story

High out-of-pocket costs are creating financial barriers that are unsustainable for many patients.

For the nearly one in two American adults living with at least one chronic illness, affordability and access to medicine is crucial.

Unfortunately, if you have a chronic condition, there may be unexpectedly high upfront costs to access needed medicines, especially for people with health insurance exchange coverage. These out-of-pocket costs may mean financial hardship for patients, choosing between food and medicines or foregoing a needed medicine altogether.

When choosing a health care plan for you or your family, it’s important to look beyond the premium and understand what copaysdeductibles and coinsurance may mean for you. 

Our story is about Eric, a hypothetical health insurance exchange patient developed with the help of Avalere Health. Eric is a 57-year-old man living in Colorado with chronic myeloid leukemia. He is facing high out-of-pocket costs in his silver health insurance exchange plan. New data out from the Kaiser Family Foundation this week suggest more than 40 percent of Americans with private insurance do not have enough savings to cover the costs Eric would face in the first two months of the year.

More Videos

  • Improve Access to Important Clinical Information

  • Improve Access to Out of Pocket Cost Information

  • Exchange Plan Transparency

    Information you need
  • 3 Tips for Choosing a Health Insurance Plan

    How to Shop for a Plan
  • What Are Health Insurance Exchanges?

    Different Levels of Coverage
  • health coverage hurdles

    How Insurers Limit the Use of Medicines

    Insurance Limitations
  • Health Coverage Disparity

    Insurance & Medicines
  • How Does Insurance Cover Your Medicines?

    An Overview of Coverage
  • Health Insurance Coverage 101

    Basics Explained