\n<\/a>The New York Times<\/span><\/p>\n
![\"Bruno](\"https:\/\/stateofthenation2012.com\/wp-content\/uploads\/2015\/11\/15deductibles-master675.jpg\")
<\/a>Bruno Celis showed health insurance options to Julio Mendez and his family in San Francisco. Credit Jim Wilson\/The New York Times<\/p><\/div>\n
WASHINGTON \u2014 Obama administration officials, urging people to sign up for health insurance<\/a> under the Affordable Care Act, have trumpeted the low premiums available on the law\u2019s new marketplaces.<\/p>\n But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.<\/p>\n \u201cThe deductible, $3,000 a year, makes it impossible to actually go to the doctor,\u201d said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain<\/a>. \u201cWe have insurance, but can\u2019t afford to use it.\u201d<\/p>\n In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats \u2014 and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game.<\/p>\n \u201cWe could not afford the deductible,\u201d said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. \u201cBasically I was paying for insurance I could not afford to use.\u201d<\/p>\n He dropped his policy.<\/p>\n As the health care law<\/a> enters its third annual open enrollment period, premiums and subsidies have been one of the administration\u2019s main selling points.<\/p>\n \u201cMost Americans will find an option that costs less than $75 a month,\u201d President Obama said.<\/p>\n Sylvia Mathews Burwell, the secretary of health and human services, issued a report analyzing premiums in the 38 states that use HealthCare.gov<\/a>. \u201cEight out of 10 returning consumers will be able to buy a plan with premiums less than $100 a month after tax credits,\u201d she said.<\/p>\n But in interviews, a number of consumers made it clear that premiums were only one side of the affordability equation.<\/p>\n \u201cOur deductible is so high, we practically pay for all of our medical expenses out of pocket,\u201d said Wendy Kaplan, 50, of Evanston, Ill. \u201cSo our policy is really there for emergencies only, and basic wellness appointments.\u201d<\/p>\n Her family of four pays premiums of $1,200 a month for coverage with an annual deductible of $12,700.<\/p>\n In Miami, the median deductible, according to HealthCare.gov, is $5,000. (Half of the plans are above the median, and half below it.) In Jackson, Miss., the comparable figure is $5,500. In Chicago, the median deductible is $3,400. In Phoenix, it is $4,000; in Houston and Des Moines, $3,000.<\/p>\n Ms. Burwell said the administration had \u201cseen high levels of satisfaction with the marketplace.\u201d<\/p>\n And the marketplaces do vary. In Newark, some plans have no deductible, although the median deductible is $2,000, according to HealthCare.gov<\/a>.<\/p>\n Health officials and insurance counselors cite several mitigating factors. All plans must cover preventive services like mammograms<\/a> and colonoscopies<\/a>without a deductible or co-payment. Some plans may help pay for some items, like generic drugs or visits to a primary care doctor, before patients have met the deductible. Under the Affordable Care Act, health plans must have an overall limit on out-of-pocket costs, to protect people with serious illness against financial ruin.<\/p>\n In addition, people with particularly low incomes can obtain discounts known as cost-sharing reductions, which lower their deductibles and other out-of-pocket costs if they choose midlevel silver plans. Consumer advocates say this assistance makes insurance a good bargain for people with annual incomes from 100 percent to 250 percent of the poverty level ($11,770 to $29,425 for an individual).<\/p>\n To those worried about high out-of-pocket costs, Dave Chandra, a policy analyst at the liberal-leaning Center on Budget and Policy Priorities, has some advice: \u201cEveryone should come back to the marketplace and shop. You may get a better deal.\u201d<\/p>\n But for many consumers, the frustration is real, as is the financial strain. In employer-sponsored health plans, deductibles have also been rising as companies shift costs to workers. Still, the average annual deductible in employer plans, $1,320 for individual coverage according to the Kaiser Family Foundation, is considerably less than the deductibles in many marketplace plans.<\/p>\n The Internal Revenue Service defines a high-deductible health plan as one with an annual deductible of at least $1,300 for individual coverage or $2,600 for family coverage.<\/p>\n Sara Rosenbaum, a professor of health law and policy at George Washington University who supports the health law, said the rising deductibles were part of a trend that she described as the \u201cdegradation of health insurance.\u201d<\/p>\n Insurers, she said, \u201cdesigned plans with a hefty use of deductibles and cost-sharing in order to hold down premiums\u201d for low- and moderate-income consumers shopping in the public marketplaces.<\/p>\n But the deductibles are so high they may be scaring away some consumers.<\/p>\n Alexis C. Phillips, 29, of Houston, is the kind of consumer federal officials would like to enroll this fall. But after reviewing the available plans, she said, she concluded: \u201cThe deductibles are ridiculously high. I will never be able to go over the deductible unless something catastrophic happened to me. I\u2019m better off not purchasing that insurance and saving the money in case something bad happens.\u201d<\/p>\n People who go without insurance next year may be subject to a penalty of $695 or about 2.5 percent of their household income, whichever is greater.<\/p>\n Karin Rosner, a 45-year-old commercial freelance writer who lives in the Bronx, pays about $300 a month, after a subsidy, for a silver insurance plan with a $1,750 deductible and a limit of $4,000 a year on out-of-pocket expenses.<\/p>\n She is extremely nearsighted and has an eye condition that puts her at risk for a detached retina, but has put off visits to a retina specialist because, she said, she would have to pay the entire cost out of pocket.<\/p>\n \u201cWhile my premiums are affordable, the out-of-pocket expenses required to meet the deductible are not,\u201d said Ms. Rosner, who makes about $30,000 a year.<\/p>\n Mr. Fanning, the North Texan, said he and his wife had a policy with a monthly premium of about $500 and an annual deductible of about $10,000 after taking account of financial assistance. Their income is about $32,000 a year.<\/p>\n The Fannings dropped the policy in July after he had a one-night hospital stay and she had tests for kidney problems, and the bills started to roll in.<\/p>\n Josie Gibb of Albuquerque pays about $400 a month in premiums, after subsidies, for a silver-level insurance plan with a deductible of $6,000. \u201cThe deductible,\u201d she said, \u201cis so high that I have to pay for everything all year \u2014 visits with a gynecologist, a dermatologist, all blood work, all tests. It\u2019s really just a catastrophic policy.\u201d<\/p>\n Another consumer, Anne Cornwell of Chattanooga, Tenn., said she was excited when Congress passed the Affordable Care Act because she had been uninsured for several years. She is glad that she and her husband now have insurance, because he has had tonsil cancer<\/a>, heart problems andkidney stones<\/a> this year.<\/p>\n But with a $10,000 deductible, it has still not been easy.<\/p>\n \u201cWhen they said affordable, I thought they really meant affordable,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":" Many Say High Deductibles Make Their Health Law Insurance All but Useless<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-25710","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=\/wp\/v2\/posts\/25710","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25710"}],"version-history":[{"count":0,"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=\/wp\/v2\/posts\/25710\/revisions"}],"wp:attachment":[{"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25710"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25710"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateofthenation2012.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25710"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}