More Than Half of Low- and Moderate-Income Adults Cannot Afford Their Deductibles

One-fifth of adults with health insurance spent at least 5% of their income on out-of-pocket healthcare costs over the past year with low-income adults the most likely to have high costs, according to a report from The Commonwealth Fund.

The report Too High A Price: Out-of-Pocket Health Care Costs in the United States found that 13% of adults with insurance spent 10% of more of their income on out-of-pocket costs while 21% spent 5% or more over the past year. Of those making less than $11,490 a year, 41% spent 5% or more of their income and 31% spent 10% or more.

While the majority of people surveyed had employer-sponsored health insurance, the sample also include people with Affordable Care Act Marketplace plans, individual health insurance, Medicaid, or other coverage.

According to the report, more people have plans with higher deductibles and copayments and privately insured people across all income groups reported having trouble affording their deductibles. Low- and moderate-income individuals reported the most trouble with 49% of those making $22,980-$45,960 a year, 64% of those making $11,490-$22,980, and 58% of those making less than $11,490 reporting that it was somewhat or very difficult or impossible to afford their deductible. Of adults making more than $45,960 a year, just 27% felt the same way.

"In order for health insurance to work for families, and for the US health care system to work well, it will be important to bring down the number of people who are underinsured—people who have coverage that doesn’t provide adequate financial protection,” Commonwealth Fund President David Blumenthal, MD, said in a statement. “Research shows that people who have insurance but have high health care costs relative to their income are as likely to skip getting the care they need as those with no insurance at all."

Close to half (46%) of adults earning less than $23,000 delayed or skipped needed care because of their copayments or coinsurance. According to The Commonwealth Fund, this means these patients did not fill a prescription (28%), skipped a medical test or follow-up treatment (28%), had a medical problem but did not go to the doctor (30%), or didn’t see a specialist despite being advised to by their physician (24%).

"This survey makes it clear that steadily rising health insurance deductibles and out-of-pocket costs are a serious problem for working people, regardless of how they get their coverage,” lead author Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund, said in a statement. “Keeping these costs affordable is part of ensuring that insurance provides true financial protection."