JustCare

Tag: Deductible

  • Medicare Advantage costs and prior authorization rules impede access to care

    Medicare Advantage costs and prior authorization rules impede access to care

    Medicare Advantage costs and prior authorization rules continue to impede access to care. Anyone enrolled in a Medicare Advantage plan–Medicare coverage administered by a corporate health insurer–should be concerned about whether they will be able to get and afford the care they need if they get sick. Traditional Medicare provides coverage for care from almost any physician or hospital in the US without the need for prior authorization.

    Jakob Emerson reports for Beckers Payer that typical deductibles for Medicare Advantage plans are now more than twice what they were in 2024. It’s fair to assume that they will continue to rise, given the Trump administration’s full court press on government spending. You’ll be fine in Medicare Advantage if you’re healthy, but you’ll likely be far better off in traditional Medicare if you want to ensure you’ll be able to afford and receive the care you need when you get sick.

    Average Medicare Advantage deductibles were about $132 in 2024 and are now $315, according to an eHealth survey. That’s a 139 percent increase. Monthly premiums average just $5 a month this year, down from $9 in 2024. And, total out-of-pocket costs for covered in-network services can be as high as $9,350 this year, depending upon the Medicare Advantage plan.

    Average Medicare Part D prescription drug coverage premiums are also up, from $29 to $36, about 25 percent.

    Meanwhile, prior authorization rules remain another obstacle to care for Medicare Advantage enrollees, particularly those who need costly and complex care. Rylee Wilson reports for Beckers Payer that some states are looking into regulating insurers’ use of prior authorization. They are especially focused on insurers’ use of artificial intelligence or AI to determine whether a procedure should be covered and want a physician to oversee those decisions. (Could  that simply mean a physician rubber-stamping them?)

    Patients are currently suing UnitedHealth and Humana for using AI to deny rehab care in Medicare Advantage inappropriately. UnitedHealth spokespeople argue that they do not use AI exclusively to make coverage decisions. They might not, though having a provider oversee these decisions with financial and other incentives to approve them is no better than using AI exclusively.

    Last year, the Centers for Medicare and Medicaid Services, CMS, which oversees Medicare, issued guidance on the use of AI in Medicare Advantage. CMS did not ban the use of AI or even restrict it. It simply said that the AI algorithm must comply with Medicare’s coverage requirements. Good luck enforcing that rule.

    Dr. Mehmet Oz, who will head of CMS, once confirmed, believes in AI as a tool for expediting prior authorization decisions–seemingly, even though they can speed up inappropriate denials. However, Oz says that insurers should not use AI for more than 1,000 procedures.“I would argue that to use AI wisely, we would make a decision which is we’re only going to pre-authorize 1,000 procedures,” he said at a recent Senate hearing. Where he pulled the 1,000 number from is anyone’s guess.

    Here’s more from Just Care:

  • What are your Medicare premiums in 2025?

    What are your Medicare premiums in 2025?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, about 16 percent of their medical and inpatient costs out of pocket (or through supplemental coverage: Medigap, Medicaid or retiree insurance) as well as some or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2025. Here’s what you need to know.

    Part B premiums in 2024:
    In 2025, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $106,000 or less pay a monthly Part B premium of $185, an increase of $10.30.

    People with incomes above $106,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $259 a month, if their income is above $106,000 and no more than $133,000.
    • $370 a month, if their income is above $133,000 and no more than $167,000.
    • $480.90 a month, if their income is above $167,000 and no more than $200,000.
    • $591.90 a month, if their income is above $200,000 and less than $500,000.
    • $628.90 a month, if their income is $500,000 or more.

    For couples with combined incomes of $400,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $400,000 and less than $750,000 each pay a $591.90 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $628.90 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $257, an increase of $17 from the annual deductible of $240 in 2024.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2025 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of Medicare-covered employment.
    • The Medicare Part A inpatient hospital deductible is $1,676, in 2025, and  coinsurance for hospitalizations after day 60 is $419 a day in a benefit period; coinsurance for lifetime reserve days is $838 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $209.50.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    Here’s more from Just Care:

  • Nearly half of Americans can’t afford their health care

    Nearly half of Americans can’t afford their health care

    Time passes and health care costs rise, as do the number of Americans who can’t afford their health care, according to a new Gallup and West Health poll, reports Aimee Picchi for CBS News. Not surprisingly, people of color are struggling most to pay for their care, as are people in their 50’s and early 60’s, who are not yet eligible for Medicare. But, eight percent fewer people over 65 are able to afford their care now than just two years ago.

    Only about 55 percent of Americans between the ages of 50 and 64 are “cost secure.” They can afford care and prescription drugs. But, that percentage is dwindling quickly. Two years ago, 61 percent reported being “cost secure.

    Even with Medicare, just 71 percent of people are cost secure, down from 79 percent in 2022. Younger adults are the least cost secure. Fewer than half of them (47 percent) can afford their health care, down five percent from two years ago.

    The new poll found that 45 percent of respondents reported skipping care or not filling their prescriptions because of the cost or an inability to get them.  Eight percent of those people said that if they needed care now, they would not be able to get it at an affordable cost. Gallup termed these people “cost desperate.”

    Around one in three U.S. adults, more than 72 million people, said that they had not got care they needed in the past three months because of the cost. Of those 72 million, more than eight million are 65 or older.

    Black and Hispanic Americans are increasingly cost desperate. About one in seven Hispanic adults and one in nine Black adults are cost desperate. Seven percent of White adults are cost desperate.

    What’s causing this increase in the number of Americans who can’t afford their care? Inflation has driven up health care costs. And, doctors and hospitals can charge pretty much what they please, with little accountability. Moreover, insurers keep increasing their deductibles, the amount people must pay out of pocket before their insurance coverage kicks in.

    In 2022, the typical insurance deductible for a family was $3,800. That deductible reflects more than a 50 percent increase ($1,300) from 2013.

    Overwhelmingly, Americans believe that health care costs too much and they are not getting bang for their buck. But, they are not advocating for Medicare for all or even a government-regulated system that sets prices for health care services, which would bring their costs down.

    People are eating less to pay for their prescription drugs. We don’t know how many are dying prematurely because they can’t afford their heart and other medicines, but it’s a good bet thousands are each year.

    Today, the average annual cost of health care in the US per person is $12,555. In Germany, Italy and France, the average annual cost is around $6,651, almost half of what we spend.

    Insurers are keeping people from getting the health care they need. They deny and delay care inappropriately. They refuse to pay for medically necessary services.

    Here’s more from Just Care:

  • Want surgery? Some hospitals make you pay upfront

    Want surgery? Some hospitals make you pay upfront

    Melanie Evans reports for the Wall Street Journal on the rise of hospitals requiring patients to pay upfront  for their surgery. In one case, a hospital wanted $2,000 from a patient’s mother. It said it would postpone her daughter’s surgery if she could not come up with the money. While the patient is insured, she has a high deductible so her insurance would not cover the treatment.

    The good news: If you have Medicare, you should never have to pay upfront for your care. Upfront payment issues are greatest for insured Americans with high-deductible health plans. That said, one recent study by the Consumer Financial Protection Bureau found that older adults owe $54 billion in medical debt.

    Paying upfront is a challenge for millions of working Americans. In a Kaiser Family Foundation survey, half of adults said they could not pay an unexpected bill for $500 for their care without having to borrow money. GoFundMe is too often a solution. People do not have enough savings.

    Some hospitals have essentially flipped the way they do their billing. Rather than waiting until after a procedure to bill a patient, they are refusing to perform the procedure without a payment in advance. They don’t want to be dealing with patients who won’t or can’t pay the bill after they have been treated.

    Many people are in a bind, without the money they need to get care for themselves and their families. Sometimes they must delay critical care. Other times they find that the hospital overcharged them and need to spend their time getting the refunds they are due.

    People giving birth, needing knee replacements and CT scans are increasingly being asked to pay in advance for these services.

    Which hospitals are requiring these upfront payments? It appears that hospitals owned by UnitedHealth are among them. While hospitals cannot turn away patients who need emergency care, they can refuse to treat people needing elective care.

    Today, hospitals collect nearly a quarter (23 percent) of patient bills in advance of treatment. That’s up from one fifth (20 percent) just two years ago.

    Hospitals do not want to be forced to write off debt. And, even patients with insurance today are not able to cover their costs. Advance payments are how hospitals are getting around this issue to the detriment of many patients and their families.

    Some claim the benefit to these upfront charges is that they let the patients know their costs so that they can possibly comparison shop. That is generally an impossible task, as it can mean switching doctors or traveling too great a distance to get needed care.

    Before you pay a hospital bill upfront:

    • Ask about other options. Non-profit hospitals must offer charity care for people who can’t afford to pay. Dollar For is a non-profit that can assist you in getting charity care.
    • If the cost is high, ask whether there is a way to pay a lower price or to pay in installments with no interest.

    Here’s more from Just Care:

  • What are your Medicare premiums in 2024?

    What are your Medicare premiums in 2024?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, more than 20 percent of their medical and inpatient costs out of pocket (or through Medigap or Medicaid,) as well as most or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2024. Here’s what you need to know.

    Part B premiums in 2024:
    In 2024, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $103,000 or less pay a monthly Part B premium of $174.70, an increase of $9.80.

    People with incomes above $103,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $244.60 a month, if their income is above $103,000 and no more than $129,000.
    • $349.40 a month, if their income is above $129,000 and no more than $161,000.
    • $454.20 a month, if their income is above $161,000 and no more than $193,000.
    • $559 a month, if their income is above $193,000 and less than $500,000.
    • $594 a month, if their income is $500,000 or more.

    For couples with combined incomes of $386,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $386,000 and less than $750,000 each pay a $559 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $594 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $240, an increase of $14 from the annual deductible of $226 in 2023.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2024 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month, the same as in 2023; if you don’t have at least 30 quarters, the premium is $505 a month, a $1 decrease from 2023.
    • The Medicare Part A inpatient hospital deductible is $1,632, in 2024 an increase of $32 from 2023, and  coinsurance for hospitalizations after day 60 is $408 a day in a benefit period; coinsurance for lifetime reserve days is $816 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $204, an increase of $4.00 from $200 in 2023.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    Here’s more from Just Care:

  • What are your Medicare premium and other costs in 2023?

    What are your Medicare premium and other costs in 2023?

    In 2023, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $164.90, a monthly decrease of $5.20 from $170.10, for people with annual incomes of $97,000 or less in 2021. At the same time that your Medicare Part B premium is decreasing, your Social Security increase is increasing a 8.7 percent, providing an average additional $146 a month in benefits.

    Social Security benefits in 2023 will be up an average of $1,827 for a single retiree.

    In 2023, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about seven percent of the Medicare population–pay a Medicare Part B premium of:

    • $230.80 a month, if their income is above $97,000 and no more than $123,000.
    • $329.70 a month, if their income is above $123,000 and no more than $153,000
    • $428.60 a month, if their income is above $153,000 and no more than $183,000
    • $527.50 a month, if their income is above $183,000 and less than $500,000
    • $560.50 a month, if their income is $500,000 or more

    For couples with combined incomes of $366,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $366,000 and less than $750,000 each pay a $527.50 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $560.50 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $226, a decrease of $7 from the annual deductible of $233 in 2022.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2023: Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month; if you don’t have at least 30 quarters, the premium is $506 a month.
    • The Medicare Part A inpatient hospital deductible is $1,600, in 2023 an increase of $44 from 2022, and  coinsurance for hospitalizations after day 60 is $400 a day in a benefit period; coinsurance for lifetime reserve days is $800 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $200, an increase of $5.50 from $194.50 in 2022.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    People with incomes up to 135 percent of the federal poverty level, (the exact amount will be released in 2023) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    In 2023, for full low-income subsidy (LIS) benefits through the Qualified Medicare Beneficiary (QMB) program, your assets cannot be higher than $9,090 ($13,630 if married). For partial LIS benefits, your assets cannot be higher than $15,160 ($30,240 if married).

    That said, if you notify the Social Security Administration (SSA) that you plan to use some of your assets for burial expenses, for full LIS benefits, your assets can be as high as $10,590 ($16,630 if married). For partial LIS benefits, your assets can be as high as $16,660 ($33,240 if married).

    Here’s more from Just Care:

  • 2023: Medicare Part D prescription drug coverage and costs

    2023: Medicare Part D prescription drug coverage and costs

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, Medicare covers the prescription drugs you get from the pharmacy under Medicare Part D. The vast majority of people with Medicare, 49 million in 2022, are enrolled in a Part D drug plan. Here’s what you need to know about Medicare Part D coverage and costs in 2023.

    Don’t assume that your current Part D drug plan will cover your drugs in 2023, even if they did in 2022. Rather, assume that your costs will go up a lot if you didn’t check which Part D plan was likely to save you the most money based on your drug needs, during the Medicare open enrollment period (October 15-December 7). Each year, these private insurance plans can change dramatically. Kaiser Family Foundation reports on your options.

    As a general rule, close to three in four people enrolled in traditional Medicare and a Part D plan will pay higher costs the following year, if they do not look at their options and switch plans.

    In 2023, there are 16 national Part D prescription drug plans, with monthly premiums ranging from $6 to $111. The average premium is $43, up 10 percent from 2022. AARP offers the highest cost Part D drug plan.

    Premiums: Premiums are typically higher for Part D plans offering enhanced benefits, lower cost-sharing and/or low or no deductibles. Standard Part D plans have an average monthly premium of $37. Part D “enhanced” plans that charge no or a low deductible have an average monthly premium of $48 in 2023.

    Standard deductible: The standard and highest possible deductible—the amount you must pay before your coverage begins—is $505.

    If you have traditional Medicare: You typically will be able to choose among 24 Part D drug plans. Depending upon the state you live in, your options range between 19 and 28.

    If you are in a Medicare Advantage plan: You typically will have a choice  of around 35 Part D drug plans.

    Cost-sharing: For non-preferred brand name drugs, coinsurance could be as high as 40-50 percent and as low as $0 for preferred generics, depending upon the Part D plan you choose. You also are likely to pay 15-25 percent coinsurance for preferred brand drugs.

    Typically you’ll pay about $1 for preferred generics and $5 for generics. You’ll pay around $44 copay for preferred brands, 45 percent coinsurance for non-preferred drugs, and 25 percent coinsurance for specialty drugs.

    Costs in each coverage phase: After you have paid your deductible, you are in the initial coverage phase, where you generally will pay around 25 percent of the cost of both brand-name and generic drugs until your drug costs total $4,660. You will then be in the coverage gap phase, where you will be responsible for about 25 percent of the cost of your drugs. Once your out-of-pocket drug costs total  $7,400 in the coverage gap phase, you will be in the catastrophic coverage phase . At that point, you will pay no more than 5 percent of the cost of your drugs or $4.15 for each generic and $10.35 for each brand-name drug.

    If you qualify for a low-income subsidy (LIS) or Extra Help: You will have lower out-of-pocket costs, depending upon the Part D plan you choose and the drugs you use. Around 13 million people with Medicare qualify for extra help with their prescription drug costs. There are 198 Part D drug plans for which you will not pay a premium. You can also choose a “non-benchmark” plan and pay a portion of the monthly premium.

    If you need insulin: The Inflation Reduction Act limits your monthly copayment to no more than $35 in all phases of Part D coverage. However, that limit applies only to insulin in a plan’s formulary, not all insulin products.

    If you need a vaccine: Vaccine costs are covered in full for vaccines that are on the Part D formulary.

    Here’s more from Just Care:

  • 2023: Medicare premiums and other costs

    2023: Medicare premiums and other costs

    The Medicare Open Enrollment period begins on October 15 and ends on December 7, so you will have several weeks to review your Medicare options for 2023. Particularly if you have Medicare Part D drug coverage or are enrolled in a Medicare Advantage private plan–a health plan offered by a corporate health insurance company–reviewing your options could save you a lot of money. Your Medicare Part B premium will be slightly lower in 2023, regardless of whether you are enrolled in traditional Medicare or a Medicare Advantage plan.

    In 2023, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $164.90, a monthly decrease of $5.20 from $170.10, for people with annual incomes of $97,000 or less in 2021. In addition, you will get a Social Security increase of around nine percent. The exact increase will be announced shortly.

    In 2023, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about seven percent of the Medicare population–pay a Medicare Part B premium of:
    • $230.80 a month, if their income is above $97,000 and no more than $123,000.
    • $329.70 a month, if their income is above $123,000 and no more than $153,000
    • $428.60 a month, if their income is above $153,000 and no more than $183,000
    • $527.50 a month, if their income is above $183,000 and less than $500,000
    • $560.50 a month, if their income is $500,000 or more

    For couples with combined incomes of $366,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $366,000 and less than $750,000 each pay a $527.50 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $560.50 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $26, a decrease of $7 from the 2022 annual deductible of $233.

    If your income is low, you may qualify for help paying your premium and sometimes also your deductibles and coinsurance through the Medicare Savings Programs: People with incomes up to 135 percent of the federal poverty level, ($1,549 in monthly income for an individual and $2,080 for a couple in 2022; these amounts may increase in 2023) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2023 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $259 a month; if you don’t have at least 30 quarters, the premium could be $471 a month.
    • The Medicare Part A inpatient hospital deductible is $1,600, in 2023 an increase of $44 from 2022, and  coinsurance for hospitalizations after day 60 is $400 a day in a benefit period; coinsurance for lifetime reserve days is $800 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $200.00, an increase of $5.50 from $194.50 in 2022.

    If you have Medicare and are 36 months post kidney transplant, you are no longer eligible for full Medicare coverage. But, beginning in 2023, you can elect to continue Part B coverage of immunosuppressive drugs if you pay a premium. In 2023, the immunosuppressive drug premium is $97.10.

    Medicare Part D premiums

    Premiums for Part D prescription drug coverage vary by income and by Part D plan. The premium is generally deducted from your Social Security check. People with annual incomes at or under $97,000 do not pay an additional income-adjusted premium amount.

    If your annual income is above $97,000, you will be charged between $12.20 and $76.40 a month extra. The extra amount is based on how much higher than $97,000 your income is, with a cap at $750,000.

    Insulin

    Beginning July 1, 2023, you will pay no more than $35 a month out of pocket for insulin. If you take insulin through a pump you get through Medicare, you will have no deductible.

    Here’s more from Just Care:

  • 2022: Health care costs threaten the well-being of many Americans

    2022: Health care costs threaten the well-being of many Americans

    Fewer Americans are uninsured than ever–almost half the number before the Affordable Care Act took effect. But, rates of underinsurance are high, with millions of people having gaps in their coverage, millions skipping care and millions falling into medical debt because they cannot pay their health care bills. The Commonwealth Fund surveyed Americans and found that, too often, health care costs threaten their well-being.

    The big takeaways:

    • More than four in ten adults under 65 (43 percent) did not have adequate health insurance. People without insurance, people with gaps in insurance coverage during the year, and people who could not afford their care are included in this group.
    • Nearly three in ten people with employer coverage (29 percent) and more than four in ten people with coverage they bought in the individual market (44 percent) were underinsured.
    • Close to half of all people (46 percent) said that they had not gotten care or delayed getting care because of the cost. More than four in ten (42 percent) struggled to pay medical bills or were in medical debt.
    • Half of people surveyed (49 percent) said they could not afford to pay an unexpected medical bill of $1, 000 within 30 days, primarily people with low incomes (68 percent), Black adults (69 percent), and Latin/Hispanic adults (63 percent).

    Large numbers believe health care costs should be a top priority for the Biden administration and Congress. Democrats (68 percent), Independents (55 percent), and Republicans (46 percent).

    “Underinsured” is defined for people living above twice the federal poverty level as out-of-pocket health care costs over 12 months, excluding premiums, representing at least 10 percent of household income and for people living under twice the federal poverty level, representing at least 5 percent of household income ($27,180 for an individual and $55,500 for a family of four in 2022). Or, people whose health care deductible represented at least five percent of household income.

    People who lacked health insurance for at least a year tended to be young, poor, with one or more chronic conditions, living in the South, Latin/Hispanic. Undocumented individuals are not able to get affordable coverage.

    Because the US lacks a national health insurance program or even a national health insurance enrollment program, a lot of people who might be eligible for coverage based on their age, income and needs, go without coverage. More than half the people surveyed (56 percent) who had employer coverage but had been uninsured at some point during the year did not know that they were eligible to enroll in their state health insurance exchange plans because they lost their coverage.

    Americans likely would pay a lot less for their health care if the government set rates for all health care providers, as it does for people with Medicare. Because the US does not set provider rates–as all other wealthy countries do–these high rates drive high cost-sharing. Physician and hospital prices in the US are higher than anywhere else in the world.

    Close to one in four people with chronic conditions, such as diabetes, are not filling their prescriptions regularly because of the out-of-pocket cost.

    Of note, nearly one in four people with bills in collection said the bills stemmed from a mistake in billing. More than half of people with medical debt (56 percent) owed at least $2,000.

    Medical bills from out-of-network doctors at in-network hospitals represented almost half of all cost issues. These surprise bills are no longer permissible under the No Surprises Act, which took effect January 2022. But, the survey included a timeframe before then.

    When the public health emergency is declared over, likely in 2023, states will lose their improved federal matching funds. Inevitably, with less money, they will reconsider Medicaid eligibility and restrict coverage.

    Here’s more from Just Care:

  • High deductible health plans are a barrier to care for working people

    High deductible health plans are a barrier to care for working people

    Corporate health insurers can use a range of tactics to make it seem that they are offering you more at less cost. One such tactic relies on high deductibles to keep premiums down so that the health plan looks more affordable. A recent EBRI report on employers who offer high deductible plans to their workers confirms that high deductibles can be a huge barrier to care.

    EBRI looked at the effect on access to care for people with mental health disorders of a switch from a preferred provider organization to a high deductible health plan.  EBRI observed that people with major depressive disorders and anxiety were less likely to get care in high deductible health plans.

    EBRI further found that working people with mental health disorders in high deductible health plans used fewer health services of many types. They used fewer office visits, they filled their prescriptions less frequently, they spent fewer days in the hospital and they used emergency rooms less often. Moreover, working people in high deductible health plans also used fewer preventive services, including fewer cancer screenings and vaccinations.

    In sum, working people in high deductible health plans saved their employers a lot of money on health care. Workers made the choice to forgo health care services and spend less on health care in a variety of instances. It would therefore stand to reason that the higher the deductible, the greater the barrier to care for people with Medicare, who tend to live on far lower incomes than working people.

    EBRI’s findings are in sync with a range of other findings showing that, overall, cost is a barrier to care for people with health insurance. Tens of millions of Americans with insurance are underinsured and live on small fixed incomes. Once out-of-pocket health care costs come into play, they are forced to decide between their health and their rent or mortgage or heat or supper. These are choices that no one should have to make.

    A recent NBER study found that more than 20 percent of people with Medicare drop all their  prescriptions–including life-saving medicines–when they face a copay increase of as little as $10.40. As a result, thousands die. So, it’s not surprising that high-deductible health plans, with deductibles in the thousands of dollars, lead lots of people to forgo care. Some of these people likely die needlessly as a result.

    Congress continues to sit back and let people opt against getting needed health care because of the cost rather than regulating health care prices and guaranteeing access to health care to anyone and everyone who needs it, regardless of ability to pay. Talk about a Darwinian approach that will lead to countless needless deaths and disabilities.

    Here’s more from Just Care: