Obama administration officials, urging people to sign up for health insurance under the Affordable Care Act, have trumpeted the low premiums available on the law’s new marketplaces.
But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.
“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”
In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.
“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”
He dropped his policy.
Tax Credits are a false incentive for many enrollees
Sylvia Mathews Burwell, the secretary of health and human services, issued a report analyzing premiums in the 38 states that useHealthCare.gov. “Eight out of 10 returning consumers will be able to buy a plan with premiums less than $100 a month after tax credits,” she said.
But in interviews, a number of consumers made it clear that premiums were only one side of the affordability equation.
Exceptions, waivers and options are not known by most ACA enrollees.
Many are in a category with income low enough they do not pay taxes, however if they have withold from their payroll they would be entitle to a full refund of their witheld taxes. However, these refunds do not become available until after the early months of the following year. For the initial year of enrollment there are no excess funds for tax credits.
Health officials and insurance counselors cite several mitigating factors. All plans must cover preventive services like mammograms and colonoscopieswithout a deductible or co-payment. Some plans may help pay for some items, like generic drugs or visits to a primary care doctor, before patients have met the deductible. Under the Affordable Care Act, health plans must have an overall limit on out-of-pocket costs, to protect people with serious illness against financial ruin.
In addition, people with particularly low incomes can obtain discounts known as cost-sharing reductions, which lower their deductibles and other out-of-pocket costs if they choose midlevel silver plans. Consumer advocates say this assistance makes insurance a good bargain for people with annual incomes from 100 percent to 250 percent of the poverty level ($11,770 to $29,425 for an individual).
Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, has some advice: “Everyone should come back to the marketplace and shop. You may get a better deal.”
Deductibles Matter
A common consumer (patient) may encounter this scenario. Here are some all too common events:
"Karin Rosner, a 45-year-old commercial freelance writer who lives in the Bronx, pays about $300 a month, after a subsidy, for a silver insurance plan with a $1,750 deductible and a limit of $4,000 a year on out-of-pocket expenses.
She is extremely nearsighted and has an eye condition that puts her at risk for a detached retina, but has put off visits to a retina specialist because, she said, she would have to pay the entire cost out of pocket.
“While my premiums are affordable, the out-of-pocket expenses required to meet the deductible are not,” said Ms. Rosner, who makes about $30,000 a year.
Mr. Fanning, the North Texan, said he and his wife had a policy with a monthly premium of about $500 and an annual deductible of about $10,000 after taking account of financial assistance. Their income is about $32,000 a year.
The Fannings dropped the policy in July after he had a one-night hospital stay and she had tests for kidney problems, and the bills started to roll in.
Josie Gibb of Albuquerque pays about $400 a month in premiums, after subsidies, for a silver-level insurance plan with a deductible of $6,000. “The deductible,” she said, “is so high that I have to pay for everything all year — visits with a gynecologist, a dermatologist, all blood work, all tests. It’s really just a catastrophic policy.”
Another consumer, Anne Cornwell of Chattanooga, Tenn., said she was excited when Congress passed the Affordable Care Act because she had been uninsured for several years. She is glad that she and her husband now have insurance, because he has had tonsil cancer, heart problems andkidney stones this year.
But with a $10,000 deductible, it has still not been easy.
“When they said affordable, I thought they really meant affordable,” she said."
A version of this article appears in print on November 15, 2015, on page A22 of the New York edition with the headline: Many Say High Deductibles Make Their Health Law Insurance All but Useless
Many Say High Deductibles Make Their Health Law Insurance All but Useless - The New York Times
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