Adults with heart disease, hypertension and other chronic disease who had a low-deductible or high-deductible plan had greater out-of-pocket spending and more frequent high medical cost burdens compared with those with no-deductible plans.
However, adults enrolled in plans with and without deductibles had similar rates of delayed or foregone care due to cost.
Researchers Joel E. Segel, PhD, of Pennsylvania State University and Jeffrey T. Kullgren, MD, MS, MPH, of the University of Michigan, published their results online in JAMA Internal Medicine on Jan. 9.
The researchers analyzed data from the 2011 to 2013 Medical Expenditure Panel Survey, which included 17,177 adults who were 18 to 64 years old and had continuous insurance by the same private health plan for the past year.
Of the sample, 24 percent had a high-deductible plan, 45.2 percent had a low-deductible plan and 44.5 percent had at least one chronic condition. Examples of chronic conditions included heart disease, hypertension, diabetes, asthma, joint disease, nonskin cancer and mood disorders.
The researchers defined high-deductible plans as those with at least a $1,200 deductible for an individual or $2,400 for a family plan in 2011 or 2012 and a deductible of at least $1,250 for an individual plan or $2,5000 for a family plan in 2013. They considered low-deductible plans as those with deductibles higher than zero and less than those with lower deductibles than high-deductible plans.
The median out-of-pocket spending was $225 greater in high-deductible plans and $111 greater in low-deductible plans compared with no-deductible plans. The researchers noted that the differences were $1,072 and $338, respectively, at the 90th percentile of out-of-pocket spending.
Adults with hypertension, joint disorders, mood disorders or multiple chronic conditions in plans with deductibles had higher out-of-pocket spending compared with those in plans that had no deductibles.
Adults in plans with deductibles also had a higher medical cost burden (7.5 percentage points for high-deductible enrollees and 3.7 percentage points for low-deductible enrollees), although the prevalence of cost-related access barriers were similar except for a 5.8 percentage point greater prevalence among adults with asthma in high-deductible plans compared with no-deductible plans.
“Our finding that deductibles are not associated with more cost-related access barriers for individuals with chronic conditions contrasts with prior findings, perhaps because our estimates are nationally representative rather than from a single regional health insurer,” the researchers wrote. “Furthermore, since the prior work, cost-sharing has risen for all plan types, which could make differences between deductible levels more difficult to detect. As more privately insured Americans with chronic conditions face deductibles in employer-sponsored and Marketplace health plans, it will be crucial to monitor not only their [out-of-pocket] health care spending and ability to afford needed care but also their health and financial outcomes.”
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.