ICYMI: More attention to adequacy of health insurance coverage

Two new articles look at deductibles and adequacy of coverage in health insurance exchange plans.

Allyson Funk
Allyson FunkJuly 8, 2016

ICYMI: More attention to adequacy of health insurance coverage.

ABC-logo.pngOn AccessBetterCoverage.org, we’ve been highlighting the growing challenges of insurance benefit design and the impact of high deductibles and out-of-pocket costs on patients.

Last week in The Wall Street Journal, Drew Altman of the Kaiser Family Foundation laid out the next big debate in health care: adequacy of coverage. (We’ve been talking about this for a while.) An earlier Kaiser analysis found patient spending on deductibles and coinsurance is rising faster than insurers’ own costs. So even as more Americans than ever have health insurance, how is cost sharing impacting families? Altman asserts larger deductibles can be “a significant burden for many family budgets and a barrier to care for the chronically ill.”

A new study out yesterday from The Commonwealth Fund looks at differences in deductibles across income level. Lower income beneficiaries with health insurance marketplace coverage who qualify for additional cost-sharing subsidies have deductibles similar to employer plans, but for higher income beneficiaries deductibles in marketplace plans are significantly larger than employer coverage. Deductibles in marketplace coverage can be particularly challenging for patients because they are not typically paired with the employer contributions to health savings accounts that often accompany high deductible employer-sponsored plans. Additionally, when large deductibles apply to prescription drugs, it can make drug coverage significantly less generous than coverage for other health care services.

All of this adds to the conversation about health insurance coverage and access. Patients need more information about their out-of-pocket costs – whether in the form of deductibles or other cost sharing – to better choose their plan and be able to use it.

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