Tag Archives: out-of-pocket costs

Being ‘underinsured’ another measure of health coverage

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.

A recent Commonwealth Fund report shows that the rate of Americans who are underinsured reached 41 percent last year, up from 12 percent in 2003. The fund defines an underinsured person as having been insured all year but with out-of-pocket costs (excluding premiums) of 10 percent or more of income; out-of-pocket costs, excluding premiums, equal to 5 percent or more of income if low-income; or deductibles equal to 5 percent or more of income.

The Commonwealth Fund

This year the rate of those who are uninsured has risen steadily, as the Gallup Sharecare Well Being Index shows. In the third quarter, the share of Americans without health insurance was 12.3 percent, according to Gallup’s most recent quarterly report.

After President Donald Trump announced that he would end cost-sharing subsidies under the Affordable Care Act (ACA), Danielle Wiener-Bronner covered the story for CNN and Jeffrey Young wrote about it for The Huffington Post. Continue reading

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

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

Webcast: How value-based insurance design breaks down financial barriers to care

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.

Covering health care requires writing about the cost of care. Determining if costs are rising or falling and by how much is an integral part of the beat. After all, cost control is one of the primary concerns behind health care reform.

Mark Fendrick, M.D.

Mark Fendrick, M.D.

But A. Mark Fendrick, M.D., the director of the Center for Value-Based Insurance Design at the University of Michigan, suggests it’s time to shift the discussion from how much the United States spends on care to how well we spend money on health care. Focusing closely on costs leads health systems to use a one-size-fits-all approach to cost sharing, and requiring consumers to pay more for needed services may have a perverse effect of becoming a barrier to care, he explains. Conversely, VBID encourages a more clinically nuanced approach to financial incentives that involves setting consumers’ out-of-pocket costs for health care services and medications to motivate patients to do what research proves will help keep them healthy.

Fendrick will explain V-BID and the role it should play in the health care system during an AHCJ webcast, “How value-based insurance design breaks down barriers to care,” on Aug. 14, 1-1:30 pm ET.

V-BID seeks to align patients’ out-of-pocket costs, meaning their copayments, deductibles, and premium payments, with the value of health services, the center says. “This approach to designing benefit plans recognizes that different health services have different levels of value. By reducing barriers to high-value treatments (through lower costs to patients) and discouraging low-value treatments (through higher costs to patients), health systems that incorporate the concepts of V-BID can improve patient outcomes,” it says. Continue reading

Employers are tweaking benefits to control costs

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.

shrinking-costsA new report from Milliman, the actuarial firm, shows employers’ health care costs rose only 5.4 percent since last year. The report also showed how employers are changing their employee benefit plans to control costs.

Here are a few highlights from the 2014 Milliman Medical Index (MMI) report:

  • The 5.4 percent rate of growth from last year to this year was the lowest annual change since Milliman produced its first MMI in 2002 and is down from 6.3 percent last year. The 5.4 percent is still higher than the rate of growth in the consumer price index (CPI). Continue reading