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Can You Afford Your Health Insurance?

November 16, 2015
Plain English Version
Figuring the deductible is not easy.

Figuring the deductible is not easy.

To put it simply, it is not about the premiums it is about the deductibles.

In America, people over 65 get Medicare; it is a European style single-payer type system. Poor people get Medicaid, mostly paid by the government. The rest of the country buys health insurance.

The Affordable Care Act (ACA) passed in 2009. Advocates said it would make health insurance cheap enough for everyone. Subsidies were put in place to make the premiums within the reach of most families. People are still deciding on whether the premiums are low enough.

Now there is a new set of problems. When people go to the doctor, they may face very high deductibles.

If your policy has a deductible of $3,000, this means your health insurer will not start reimbursing you until you pay a total of $3,000. In other words, you must pay the first $3,000 of your health care costs

An expert said high deductibles were making it too expensive to see a doctor. A patient said, “We have insurance but cannot afford to use it.”

About half of the insured face a deductible of $3,000 or more. Some are dropping their policies. In big cities, the deductibles are much higher.

The Affordable Care Act is in its third year of an open enrollment period. Advocates are stressing its low premiums and high subsidies. However, some enrollees have expressed concerns about the deductibles in the program.

One person stated that their deductible is so high that they usually pay almost all medical expenses out of pocket. She said, “Our policy is really there for emergencies.”

An advocate says people should go back to the marketplace and shop. He said, “You may get a better deal.”

An economist said the plans were designed to have high deductibles. High deductibles are intended to keep premiums down. However, high deductibles are driving consumers away.

A consumer looking at plans said the deductibles are too high. He decided he would be better off not getting the insurance. Rather, he says he will save for emergencies. He said, “When they said affordable, I thought they really meant affordable.”

Source: The New York Times November 14, 2015

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