She has health insurance, but she can not pay her medical bills. She's not alone. | 89.3 KPCC
- Author: Adam Floyd Dec 09, 2017,
Dec 09, 2017, 6:19
Photo by torbakhopper HE DEAD via Flickr Creative Commons
A few weeks ago, I asked Impatient readers to share their experiences with high-deductible health plans. I also posted the request on my personal Facebook page.
One reply was from an acquaintance: Like more and more Americans, Celisa Flores, 34, recently obtained a high-deductible health plan through her employer. The plan, through Anthem Blue Cross, covered her and her son, and she thought it carried a $ 5,000 deductible.
At the time, the deductible "did not seem like a huge deal to me, because we never go to the doctor, "says Flores, of Costa Mesa.
Even after her car was totaled in a hit-and-run in July 2014, she avoided going to the doctor.
Then came the unpleasant surprise: She discovered that under her family plan, her deductible was $ 5,000, it was $ 10,000.
To make matters worse, she discovered that the physical therapist she was seeing - at a cost of $ 300 per week - was out of network. p>
Out-of-network care does not count towards her deductible; she has to pay up to $ 5,000 for out-of-network care, before insurance kicks in. (She's since switched to an in-network therapist, but she's still paying $ 225 each week for therapy, because she has not reached her deductible.)
Flowers are one of many Americans who struggle to afford the cost-sharing requirements of their plans, including their deductibles, copays and coinsurance.
"Most people do not have a lot of money lying around in the cookie jar, "says Matthew Rae, a senior policy analyst at the Kaiser Family Foundation and one of the authors of a February 2015 report on financial assets and cost sharing.More news: Mets are not ruling out Wilmer Flores for shortstop job | MLB.com
When it comes to $ 5,000 or $ 10,000 The Kaiser report is based on data from the 2013 Survey of Consumer Finances - a nationally representative household survey. conducted by the Federal Reserve Board. It finds that 51 percent of Americans have enough liquid assets to meet a deductible of $ 2,500 for a single person, or $ 5,000 for a family.
Lower-income households have more trouble raising that much cash, the Survey finds
For 2015, Celisa Flores bought a new health insurance plan for her are in the state exchange, Covered California. The Blue Shield of California plan comes with a lower deductible, along with a higher premium.
Flores says she has to stick with her high deductible plan for now because she can not afford to pay a higher premium for herself.
"I've already got the delicate balance of trying to make payments on my current medical bills, so adding an increased monthly fee might not be an option," she writes. p> The good news, as far as she knows, is that she will not have to reach a deductible family of $ 10,00o this year. But she still has to reach $ 5,000 deductible before her coverage coverage kicks in for 2015.
All of that's on top of the medical costs and debt Flowers accumulated in 2014: she estimates she still owes $ 4,000 for last year's bills. And that does not include what she is charged on her credit cards, she says.
The situation, she says, is baffling. and I thought it would be helpful, "she says.
Instead, she says, she's now overwhelmed with medical bills. Insured and in debt
Another Kaiser Family Foundation report examines medical debt: The January 2014 study says one in three Americans report having trouble paying medical bills.
The Kaiser report finds that, like Celisa Flores, 70% of people with medical debt are insured. More than half - 54 percent - have employer-sponsored coverage.
The study uses case studies to illustrate a scary fact: "That cost-sharing need not be extremely high to be unaffordable, / p>
Those expenses can snowball if someone's health problem is big enough to cause him to cut back, or quit, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. those situations, she says, "you can foresee at least short-term income decline that can make it even harder to pay a high deductible."
No way out
Meanwhile, Celisa Flores sees her in the easy way out of her medical debt. On top of that, she's still in pain and might need another surgery.
"Maybe I'll win the lottery," she says wistfully. you're still having trouble affording your health care, we want to hear from you. Tell us about your experience in the comments section below or email us at Impatient@scpr.org.