Health Exchange Out-Of-Pocket Expense Cause Issues for Patients

Cost of premiums, deductibles, and copays listed as important factors in choosing health plans.

One in 3 public health insurance exchange (HIX) enrollees have had trouble paying for out-of-pocket health care expenses, and just 16% feel financially prepared to handle future health care costs.

These insights stem from the Deloitte Center for Health Solutions’ recent survey of 3887 individuals, 406 of whom purchased health insurance using online state or federal exchanges created under the Affordable Care Act (ACA).

In this survey, 76% of HIX enrollees indicated the total amount they have to pay for premiums, deductibles, and co-pays was an important factor in choosing their current health plan.

“Those with health insurance are finding that they are now responsible for more of their health care costs than ever before,” Mel Seabright, PharmD, MBA, recently wrote in Pharmacy Times. “…Consumers cannot rely on their health plan’s contracts to always deliver the lowest price, because insurers may pay very different amounts to different care providers.”

Approximately 36% of the HIX enrollees surveyed cited health care providers—including physicians, hospitals, and pharmacists—as a trusted source for reliable information and advice about health plans. In fact, providers ranked above officials at the exchanges themselves (35%) and were second only to the consumers’ friends and family (38%).

Since pharmacists are the most accessible health care providers, they should be prepared to play an increasing role in improving patients’ health insurance comprehension. This is particularly critical because the report suggested that ACA exchanges are attracting consumers who appear to have a “shopper’s mindset,” stated Greg Scott, vice chairman and national sector leader for Deloitte’s health plans practice, in a press release.

Despite worries about coverage and cost, the survey found that ACA exchanges are improving patient access to preventative care. Almost 66% of HIX customers reported using their plans to seek services and purchase medications, with 75% saying they would not have done so without this coverage.

“The exchanges have improved access to care, but affordability remains a problem,” the survey authors concluded.