Insured but can’t afford medical care

Twenty-five percent of adults who purchased health plans last year went without needed medical care because they couldn’t afford it.

A report released Thursday by Families USA revealed that those who purchased individual health plans more often skipped care because of deductibles of $1,500 or more.

And the top types of medical care they went without are serious: tests, treatment or follow-up care (15 percent) and prescription drugs (14 percent).

“It is critically important that consumers be able to afford all of these types of care,” according to the report. “Not getting follow up care to treat an illness or not taking needed medications can result in people facing avoidable, more serious health problems and more expensive health care costs down the road.”

(Because most adults who purchased individual plans don’t have dental care as part of their health coverage, the ability to see a dentist was not included in the main report. But when dental care is added to the mix, it becomes the most common type of care adults forgo because they can’t afford it – 24 percent.)

The study divided adults into two income brackets: lower to middle income ($16,200 to $29,199 annual income for an individual) and middle income ($29,200 to $46,699 for an individual).

People in those income ranges are eligible for tax credits and subsidies to help pay for coverage. Lower incomes qualify for Medicaid; higher incomes are eligible for credits.

Adults with lower to middle incomes were the most likely to forgo needed medical care – 32 percent didn’t get care because they couldn’t afford it. Among adults with middle incomes, 22 percent didn’t get care, according to the report.

For adults with deductibles of $1,500 or more per person, 30 percent went without medical care. Among those with deductibles less than $1,500 per person, 20 percent went without needed care, according to the report.

“Our findings show that too many lower- and middle-income consumers face deductibles that are likely unaffordable relative to their incomes and that could create barriers to them getting the care they need,” according to the report.

Of adults with lower to middle incomes, 39 percent had deductibles of $1,500 or more per person and 22 percent had deductibles of $3,000 or more.

For middle income adults, 53 percent had deductibles of $1,500 or more and 30 percent had $3,000 or higher deductibles, according to the report.

The report recommends changes to the silver plans that would lower upfront cost sharing for primary care, outpatient services and prescription drugs. Silver plans are used to calculate premium subsidies under the Affordable Care Act.

Marissa Harshman

Marissa Harshman

I'm the health reporter for The Columbian newspaper in Vancouver, Wash. I started at The Columbian -- my hometown newspaper -- in September 2009. Reach me at or 360-735-4546.

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