Paying Premiums and STILL feeling Uninsured

Universal Health Care Foundation’s policy brief, Access to Coverage and Care: Targeting Implementation of the Affordable Care Act to Improve Health in Connecticut, reports that cost was the primary reason that people delayed or did not seek care, regardless of their insurance status.









This data, collected by the Connecticut Health Care Survey, clearly shows that affordability can be a barrier to accessing care.

With some insurers proposing to raise insurance premiums, as reported in our recent blog, affordability is already a concern– particularly for those purchasing insurance without a subsidy. But there is a second crucial aspect to affordability among those who are insured: high out of pocket costs. There are three customary ways that insured patients end up having to pay for their care:

  • Deductible
  • Co-insurance
  • Co-Pay

As the policy brief points out, “Large deductibles and co-pays can be barriers to care, particularly among those with chronic diseases.” (page 5). If these out-of-pocket costs are too high, insured consumers may avoid getting treatment or seek care less often, because they are afraid they can’t afford it.

Access Health CT, Connecticut’s insurance marketplace, has made attempts to address these concerns through their insurance plan designs. Connecticut has established standard plan designs that all insurers must offer on the exchange. While the deductibles are certainly high, an attempt has been made to exempt some key services like primary care and specialist doctor visits from the deductible in an effort to encourage people to seek care.

Connecticut’s 2014 standard plan designs were highlighted in a recent issue brief published by Families USA: Designing Silver Health Plans with Affordable Out-of-Pocket Costs for Lower- and Moderate-Income Consumers. In fact, the accompanying webinar featured a Connecticut consumer advocate, Arlene Murphy, who is a member of Access Health CT’s Consumer Experience and Outreach Advisory Committee.

The 2015 Access Health CT standard plan designs have now been released. They continue with the approach of trying to exempt some services from the deductible. To learn more about the new plan designs, go here. For more detail, go to the web page where presentations at Access Health CT board meetings are posted and scroll down to the April 30, 2014 meeting to read a memo and two appendices with the details of the new plan designs.

Co-pays still pose a significant financial hurdle, especially for patients who must go to the doctor frequently. And if someone ends up in the hospital, the full deductible applies. But people need to feel protected by their insurance. If a $3,000 deductible has to be paid out first before their insurance covers the cost of a physician office visit, they may never feel like they actually HAVE insurance coverage. In an imperfect world, Connecticut’s approach to deferring the deductible for some key services makes sense.

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