An analysis released by Families USA last month shows that many people insured through non-group health plans have forgone needed care because they could not afford the high out-of-pocket costs of deductibles, coinsurance or copays. The study defines non-group plans as coverage not offered by an employer or public coverage program.
The report — titled "Non-Group Health Insurance: Many Insured Americans with High Out-of-Pocket Costs Forgo Needed Health Care" — says that while uninsured rates have declined significantly under the Affordable Care Act, "simply having health insurance is no guarantee that consumers can afford to pay for health care."
The report states that since 2014 adults who bought policies through Affordable Care Act-enabled health insurance marketplaces "were significantly less likely to have high deductibles (deductibles of $1,500 or more per person) or exceedingly high deductibles (deductibles of $3,000 or more per person) than those buying insurance outside the marketplace." The report says the marketplaces are providing "enhanced value" to consumers, particularly to those who get financial assistance to offset cost sharing in their plans.
Nevertheless, the report finds high out-of-pocket costs are a barrier to care for many low- and middle-income people insured through non-group plans. "Overall, 25.2 percent of adults who were insured for a full year didn't get needed care during the year because they could not afford it," according to the report. The study defines lower- to middle-income families as those with family incomes between 139 percent and 249 percent of the federal poverty level, or between $27,400 and $49,499 for a family of three.
The report is based on an Urban Institute analysis of its quarterly Health Reform Monitoring Survey conducted in September 2013, September 2014 and December 2014. The Urban Institute's data analysis for Families USA was limited to adults with incomes over 138 percent of the poverty level who bought private, non-group health insurance in 2014.
The Affordable Care Act allows adults with incomes over 138 percent of poverty to purchase insurance and qualify for income-based premium subsidies on insurance marketplaces. The Families USA analysis includes data from adults who bought insurance on state or federally run marketplaces, and outside of those marketplaces.
The report says half of adults with non-group plans had high deductibles in 2014; and 30 percent had exceedingly high deductibles.
People with high-deductible health plans were more likely to forgo care than those with lower deductibles, according to the report. Nearly 30 percent of adults with deductibles of $1,500 or more reported going without care, while that was true of fewer than 20 percent of those with deductibles under $1,500. Adults with lower to middle incomes were the most likely to forgo care because of affordability concerns, according to the analysis.
The Families USA study is available at familiesusa.org/library. It has a May 2015 issue date.
Families USA is a nonprofit, nonpartisan organization advocating that high-quality, affordable health care be accessible for all Americans. The nonprofit Urban Institute conducts economic and social policy research that it says is aimed at improving lives, strengthening communities and increasing the effectiveness of public policy.