High-deductible plans create heavy burden for some workers

A joint study conducted by the Kaiser Family Foundation and the Los Angeles Times shows that workers with employer-sponsored health plans are in many cases struggling to cope with average deductibles that increased 212 percent between 2008 and 2018.

Four in ten respondents report that their family has had either problems paying medical bills or difficulty affording premiums or out-of-pocket medical costs. Close to half say someone in their household skipped or postponed some type of medical care or prescription drugs in the past year because of cost. Seventeen percent indicated they had to make difficult sacrifices in order to pay healthcare or insurance costs, with some saying the sacrifices were extreme.

While most people with employer-sponsored insurance are generally satisfied with their health plans, those with high-deductible plans are more likely to have a negative view of their coverage and to have problems affording or delaying care because of costs. One reason people struggle with high-deductible plans is that they don’t have enough savings to cover their deductibles. For those with the highest deductibles-at least $3,000 for an individual or $5,000 for a family-more than half said their amount of easily accessible savings was less than the amount of their deductible.

Households with a family member with a chronic condition are particularly vulnerable to affordability issues. About half of this group indicated problems paying medical bills or difficulty affording premiums or out-of-pocket costs compared to about three in 10 of those families without a chronic condition. Three quarters of those in the highest deductible plans said someone in their household has skipped or delayed medical care or prescription drugs for cost reasons in the last year.

The survey also shows that cost has taken on greater importance in health insurance decision-making in the last 15 years among people with employer-sponsored plans. Six in 10 people with employer coverage named cost-related factors when asked to choose the most important feature in a health plan, compared to about a quarter who chose coverage-related factors. Compare that to 2003, when one-third chose cost-related factors and six in 10 chose range of benefits or choice of provider. Among those whose employer offered a choice of plans, the share who say the picked their plan based on cost increased from 21 percent in 2003 to 36 percent in 2018.

One selling point of high-deductible plans is that they may incentivize enrollees to be more cognizant of price and shop around. However, the survey shows that those in high-deductible plans are not significantly more likely than those in lower deductible plans to price-shop for healthcare services. In addition, having a health savings account (HSA) paired with a high-deductible plan made no significant difference on price-based shopping behaviors. In fact, those enrolled in HSA plans are more likely to view them as a way to pay for current medical bills than as a way to save money for future expenses.

When asked who is to blame for high costs, majorities say pharmaceutical and insurance companies, while fewer see hospitals, doctors, or employers as the culprit.

The study is based on interviews in late 2018 with 1,407 respondents between the ages of 18 and 64 who reported having health insurance from an employer or union.