What Do Health Plan Deductibles Really Mean FOR THOSE WHO HAVE Chronic Illness?


As insurance plans with deductibles grow in popularity, a new study requires a national look at what those programs mean for individuals with common chronic health issues such as diabetes, asthma, joint problems and cardiovascular disease. Using data from a national survey of Americans under age 65, the experts find that having a high-deductible plan makes it more likely that health-related costs will need up more than 10 percent of a chronically ill person’s total income. They also find huge variation between patients who’ve the same condition in the quantity of out-of-pocket spending that they had, even for those in low-deductible programs.

Despite these out-of-pocket costs, the study finds that few people who have chronic illnesses said that costs or insurance plan issues had become in the way of getting the treatment or prescriptions they needed. Jeffrey Kullgren, M.D., M.S., M.P.H., a research scientist in the VA Center for Clinical Management Research of the VA Ann Arbor Healthcare System and an associate professor of general medicine at the U-M Medical School.

The findings derive from data from 2011 through 2013, throughout a right time when many more employers began offering high-deductible health programs. Since the launch of the Marketplace, more than 90 percent of people shopping have chosen high-deductible plans. Lower-income people who choose Silver-level Marketplace plans can get advice about out-of-pocket costs from the federal government. But those who opt for Bronze-level plans with high deductibles, that have lower monthly premium costs, aren’t qualified to receive deductible help. Neither are people who make more than the income limit or get their coverage outside of the Marketplaces.

Kullgren, who is an associate of the U-M Institute for Healthcare Policy and Innovation and the guts for Behavioral and Social Sciences in Medicine. Kullgren and first writer Joel E. Segel, Ph.D., a Penn State health economist, examined data from 17,177 people interviewed for the Medical Expenditure Panel Survey, a nationally representative survey conducted by the Agency for Healthcare Quality and Research. Over 4 Just,100 had a high-deductible health plan, and 44.5 percent acquired a chronic health.

They viewed data from people who got cardiovascular disease, high blood circulation pressure, diabetes, asthma, joint diseases, cancers except for skin cancer, and disposition disorders such as depression. They compared their out of pocket costs against those of individuals who had nothing of the conditions, and viewed those who experienced programs with high deductibles, low deductibles and no deductibles. 2,500 for a family. Only people with deductibles above this amount qualify to open a health checking account that lets them set aside cash that they can use tax-free to cover some health costs.

Kullgren specializes in studying the impact of consumer-directed health care plans – a phrase that encompasses those with high deductibles or other cost-sharing agreements. He also studies how the companies that run such programs, or offer them to their employees, can help their individuals understand the costs and medical options that they shall be accountable for.

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