When
Kelly got sick, her health plan had a $7,000 deductible, meaning she was on the
hook for all her health costs until she cleared that figure. After reaching the
deductible, patients continue paying a smaller share of their health costs
until they meet their plan’s out-of-pocket maximum.
But
Kelly got sick halfway through the calendar year. So, just as she was nearing
that magic number, January came, and her deductible bounced back up to $7,000.
Her treatment continued, as did the bills.
“It’s
almost like you’re sitting on a time bomb,” said Sara Collins, vice president
for health care coverage and access at the Commonwealth Fund. “You have this
high-deductible plan you may not use much, but if you do get sick, you can end
up with a lot of out-of-pocket costs.”
A
whopping medical bill can be especially harsh for people who don’t have the
luxury of paid sick days.
A
lumpectomy removed the mass in Kelly’s breast, but doctors also wanted her to
undergo chemotherapy, to be sure the cancer was gone. She declined, figuring it
would make her feel too sick to work, putting her practice at risk.
“I just
try to have peace with the situation. It’s not going to be my reality, being
self-employed, to participate in treatment that makes me sick,” she said.
Kelly
has since put off going to the doctor, instead doing her best to eat healthy
and perform self-checks on her breasts. She has held onto her ACA marketplace
plan, but doesn’t know if she will renew for 2020.
More to
consider than just premium when shopping ACA plansPeople shopping in the ACA
marketplaces have a range of coverage and cost options, which is why patient
advocates like Antoinette Kraus of Pennsylvania Health Access Network encourage
people to shop around.
Bronze
plans have the cheapest premiums and the highest deductibles, while gold and
platinum plans offer the greatest coverage at the highest cost.
Silver
plans fall in the middle, but can still be pricey. In the Philadelphia area,
the benchmark silver plan will cost about $700 a month for someone Kelly’s age,
with a $3,000 deductible.
“We
need to address the affordability issue. Folks shouldn’t have to worry about
going into medical debt at a time when they need care the most,” Kraus said.
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The Philadelphia Inquirer
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