High-deductible Plans and Financial Barriers to Care

An ongoing concern in regard to the growth of high-deductible health insurance plans is whether the increased patient cost-sharing deters receipt of necessary care.  The Centers for Disease Control reports results of a survey asking people about their experience of financial barriers and their type of insurance coverage. (CDC Report)    A high-deductible plan was one with a deductible of $1300 or more for an individual or $2600 for a family.  The data is from 2016 and is part of a large, standard ongoing survey covering many aspects of health.  The percent of adults aged 18 to 64 with employment-based coverage who were enrolled in a high-deductible plan rose from 26.3% in 2011 to 39.3% in 2016.  About half of such individuals with directly-purchased commercial health insurance were also in a high-deductible plan.  The survey did not indicate how many of the people with high-deductible coverage had access to an HSA or HRA, which is very important information.  In some cases, the HSA can cover all of the deductible and more.  Other research suggests that at least half the people with a high-deductible plan had an HSA.

In 2016, about 15% of people with employment-based high-deductible coverage said they had trouble paying medical bills, compared to 9% of those in traditional coverage.  Roughly equal numbers of people with directly purchased HD and traditional coverage, 16%, said they had difficulties with medical bills.  Similarly, about twice as many people, 8.5% who had employment-related HD coverage said they deferred or did not get medical care than did those with traditional coverage, 4.1%; while roughly equal numbers, 13.3% versus 11.8%, of HD directly insureds compared to traditional plan ones also forewent or delayed care.  No information is presented about the type of care delayed, so you really can’t make judgments about whether it was needed or not.  The income status distribution of people with HD and regular work-related health coverage is similar.  But for directly-purchased insurance, more high-income people bought a high-deductible plan.  This is likely because of subsidies for low-income purchasers but also because higher-income individuals feel more capable of managing a deductible.  I was surprised by how few people report issues with paying medical bills or deferring care under HD plans.  Suggests to me that they may have an HSA that helps or that most people can manage the plan effectively.