Tag Archives: deductibles

New studies raise the question: Are out-of-pocket costs getting out of control?

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Source: Adrion ER, Ryan AM, Seltzer AC, Chen LM, Ayanian JZ, Nallamothu BK. Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults. JAMA Intern Med.Published online June 27, 2016. doi:10.1001/jamainternmed.2016.3663.Researchers from the University of Michigan’s Center for Healthcare Outcomes and Policy studied the cost of hospitalizations for insured consumers and found that costs rose sharply from 2009 to 2013.

Source: Adrion ER, Ryan AM, Seltzer AC, Chen LM, Ayanian JZ, Nallamothu BK. Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults. JAMA Intern Med.Published online June 27, 2016. doi:10.1001/jamainternmed.2016.3663.Researchers from the University of Michigan’s Center for Healthcare Outcomes and Policy studied the cost of hospitalizations for insured consumers and found that costs rose sharply from 2009 to 2013.

Two new studies indicate that out-of-pocket costs of health care are rising sharply.

The share of costs that consumers are paying rose by 13 percent from 2014 to 2015 according to a new report from TransUnion Healthcare. What’s more, the report shows that as these costs rose, patients had fewer resources to pay those increased expenses because their amount of revolving credit had declined.

Out-of-pocket costs are a combination of what patients pay in deductibles, coinsurance and copayments for covered services. Coinsurance is a percentage of the total bill and a copayment is usually a fixed amount due at the time of service. Consumers pay for these costs until they reach the out-of-pocket maximum when insurance starts paying. Continue reading

Reviewing patterns in marketplace insurance pools

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo by Thomas Hawk via Flickr.com.

Photo by Thomas Hawk via Flickr.com.

Back when states were deciding whether to run their own exchanges or let the feds do it, they also had to make a lot of decisions about how their exchanges would operate.

One question was whether to have a “clearinghouse” and let any health plan that met the legal requirements participate in the marketplace. The other option was to be an “active purchaser,” and to have the state exchange directly negotiate with the health plans over premiums, provider networks etc.

The rationale, for each model: Continue reading

Parents skipping needed care for children, pediatricians say

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Alex Prolmos via Flickr

Photo: Alex Prolmos via Flickr

High-deductible health plans (HDHPs) discourage families from seeking primary care for their children, according to the American Association of Pediatricians. The problem is so severe that the federal government should consider limiting HDHPs to adults only, the AAP said in a policy statement published in Pediatrics.

“HDHPs discourage use of nonpreventive primary care and thus are at odds with most recommendations for improving the organization of health care, which focus on strengthening primary care,” the association said in its statement. Under the Affordable Care Act, preventive services are covered in full without charge.

This is the second time in as many months that a report has shown consumers skipping needed care because of the cost. Last month, we reported that out-of-pocket health care costs force one out of every eight privately insured Americans to skip necessary medical treatment, according to the survey from the AP-NORC Center, “Privately Insured in America: Opinions on Health Care Costs and Coverage.” The Robert Wood Johnson Foundation funded the survey. In a report earlier this month, “Too High a Price: Out-of-Pocket Health Care Costs in the United States,” the Commonwealth Fund expressed similar concerns. Continue reading

How are patients dealing with rising costs of dental coverage?

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Pia Christensen/AHCJ

Photo: Pia Christensen/AHCJ

Dental benefits are on many people’s minds these days, as stories from across the country testify.

In Georgia, Rockdale County employees are facing an increase in their premiums, Alice Queen of The Rockdale Citizen writes. Premiums are also rising  in Anoka County, Minn., Peter Bodley reports for The Anoka County Union Herald. In spite of the expense, these jurisdictions acknowledge the importance of providing dental benefits.

Research shows that without dental coverage, people get less care and suffer more.

Yet the expense of benefits and the complexity of obtaining them continue to present barriers to many people, and the Affordable Care Act did not completely address these problems.

Continue reading

Use site’s data on silver plans on state, D.C. exchanges

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Want to know everything about premiums, networks, deductibles, cost-sharing and out-of-pocket limits for all 7,000-plus silver plans on exchanges in every state and Washington, D.C.? Well, now you can have it.

The Robert Wood Johnson Foundation and Breakaway Policy Strategies have created a unique dataset that you can access for free. (It can be viewed in Excel, too.) Breakaway also has done an 8-page report identifying some of the key findings in the data.

The material will let you spot national trends, see how your state is like or unlike other states, or see what variety of plans your state is offering, and what may have to change for next year. It also gives some details about what is or is not counted toward the deductible – which, as we’ve noted before, is not always straightforward.

Behind the headlines, survey reveals ‘a quiet revolution’ away from more comprehensive insurance

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

One of the big stories reported on Aug. 21 involved the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey. The survey results were reported widely, including the fact that annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from 2012.

The Kaiser/HRET survey of more than 2,000 small and large employers provides a thorough review of employers’ health insurance strategies for this year and trends since 1999.

During the conference call to announce the results, Kaiser President and CEO Drew Altman, Ph.D., pointed out that even though the 4 percent increase was relatively moderate compared with the increases reported in past years, the perception among a majority of Americans is that premiums are rising faster than usual, as Sarah Kliff reported.

Altman explained that part of the reason for this perception is the continued rise in high deductibles and the growth in high-deductible health plans (HDHPs), which cause insured Americans to pay more out of pocket. “They don’t just pay their share of the premium, they pay other forms of cost sharing, especially their deductibles.” Continue reading