Millions of Americans have enrolled in private health coverage through the Affordable Care Act in its first two years, but a lot of them still are worried about big medical bills.
Nearly 4 in 10 Americans who enrolled in an ACA-compliant individual health insurance plan in 2015—both on and off of Obamacare’s marketplaces—said they still felt vulnerable to high medical costs, according to a new survey from the Kaiser Family Foundation.
Marketplace enrollees were generally positive about their insurance—74 percent rated their plan excellent or good—but cost remains a concern for a significant minority of them. For example: 36 percent said they were dissatisfied with their annual deductible. And 56 percent of people with Obamacare-compliant plans said they were very or somewhat worried about their ability to pay the health care services they need.
A big problem: Plans that tend to have the lowest monthly premiums also have the highest deductibles. Almost 90 percent of 2015 Obamacare enrollees signed up for either a bronze-level or silver-level plan, the cheapest coverage but which can have deductibles of thousands of dollars. That means people can still be on the hook for a good chunk of change if they actually rack up medical bills.
About 40 percent of those in the overall individual market were enrolled in high-deductible plans—which Kaiser defined as above $1,500 for an individual or $3,000 for a family—versus 43 percent in low-deductible plans. (The rest weren’t sure). Just 35 percent of those in the high-deductible plans were happy with their deductible; 79 percent of low-deductible enrollees were.
“The trend towards high deductibles predated the Affordable Care Act, but the health law in some sense legitimized them by defining what is minimally adequate insurance,” said Larry Levitt, vice president at the Kaiser Family Foundation.
“The ACA says that the minimum insurance you need to have to satisfy the individual mandate is a bronze plan, which has a deductible of several thousand dollars per person. So, the ACA is saying that high deductible insurance is acceptable,” Levitt added. “Even silver plans, which are the benchmark for premium subsidies under the ACA, generally carry a deductible of at least a couple thousand dollars per person.
Or another way to look at it: More than 85 percent of marketplace enrollees qualified for financial assistance, which means their income was 400 percent of the federal poverty level or below. That’s $47,000 for an individual or $97,000 for a family of four. Obamacare capped total out-of-pocket expenses (which includes deductibles, copays, etc.) for marketplace plans at $6,600 for an individual and $13,200 for a family.
So even with a relatively middle-class annual income, medical bills upwards of $5,000 that one could face with an Obamacare plan are a lot to swallow. And the lower you go down the income scale, the harder it gets.
The law does have numerous provisions to help people afford their coverage and care: The tax credits to help cover premiums and additional cost-sharing subsidies for those with the lowest incomes, the out-of-pocket caps, eliminating annual and lifetime limits on what insurers will pay for care. It’s also helped a lot of people afford insurance for the first time.
But the Kaiser findings make clear that people are still worried it isn’t enough.
“Many people with non-group insurance feel financially exposed to high medical bills, and that’s especially true for those with big deductibles,” Levitt said. “Many people just don’t have the savings to cushion them in an emergency, even if they have insurance.”