Patient Responsibility News

Out-of-Pocket Insurance Costs Challenge Pre-Medicare Patients

Forty-five percent of patients age 50 to 64 expressed concerns about out-of-pocket costs for insurance before they can enroll in Medicare, the poll showed.

out-of-pocket costs insurance

Source: Thinkstock

By Sara Heath

- The out-of-pocket costs of health insurance coverage is daunting for older adults who don’t yet qualify for Medicare, posing insurance and treatment access issues for this population, according to a recent AARP/University of Michigan poll.

The poll, which included responses from just over 1,000 pre-Medicare-age patients ages 50 to 64, revealed that the high cost of health insurance that has not been provided by an employer presents a considerable hurdle for these patients.

Forty-five percent of respondents said they had little to no confidence in their ability to afford health insurance once they retire. Another 27 percent said they are unsure whether they will be able to afford their coverage over the next year.

As a result, patients are faced with a few options, none of which are ideal, the poll administrators suggested.

About 10 percent of respondents said they considered going without insurance because of high costs, although only 5 percent reported that they followed through on those plans.

Industry experts know that access to insurance is key predictor of primary and preventive care utilization. When a patient foregoes insurance coverage, they increase the risk of putting off care until their symptoms indicate more costly and intrusive interventions.

As it stands, poll respondents said they have delayed care at least until they had their desired type of health insurance. For example, 15 percent of those who began a new plan in 2019 said they would wait until that plan kicks in to access medical care. Eight percent said they are delaying medical procedures until they age into Medicare.

Individuals age 50 to 64 have also reportedly considered delaying retirement to keep their employer-sponsored healthcare packages. Nearly 14 percent said they have kept their jobs specifically to continue receiving affordable health insurance benefits. Eleven percent said they delayed or considered delaying retirement to maintain payer coverage.

The current debate surrounding healthcare and Medicare coverage is also causing stress for some patients, the poll revealed. Half of the adults surveyed said they keep up with healthcare policy news as it pertains to Medicare and payer coverage.

And although the poll was completed before the December 2018 Texas court ruling that the Affordable Care Act (ACA) is unconstitutional, 68 percent of respondents still expressed concern for the fates of their payer coverage.

The uncertainty around the ACA, coupled with patients’ concerns for out-of-pocket healthcare costs and insurance access, shows a deterioration of the system, said Preeti Malani, MD, director of the poll and a professor of internal medicine at U-M Medical School.

“The Affordable Care Act was intended to cut down on ‘job lock’, where a person feels trapped in their job by their need to preserve their health insurance,” Malani said in a statement. “We were surprised by the low percentage of these adults who bought their own coverage through the ACA exchanges, and the relatively high percentage who felt they had to keep a job or delay retirement in order to keep a plan. Innovative policy solutions are needed to help adults in this age group navigate their insurance options.”

What’s more, the survey revealed relatively low health literacy among patients age 50 to 64. One in five respondents said they had little to no confidence in their abilities to understand insurance plans. About 25 percent said they would not be able to understand what procedures their insurance plan covered or what out-of-pocket expenses they would face.

The healthcare industry needs to do a better job of guiding patients aging into Medicare to low-cost but comprehensive coverage options, said Renuka Tipirneni, MD, MSc, who conducts research at U-M and who helped lead poll design and analysis.

“As people age into the years when many chronic diseases begin to take hold, and when they’re still years away from Medicare coverage, it’s important to talk with someone knowledgeable about all the options for coverage to bring down out-of-pocket costs and better navigate health care in this critical period,” said Tipirneni, who is also a general internist.

Ultimately, price transparency regarding both different medical procedures as well as insurance coverage will be critical going forward. As more patients plan to access their coverage through Medicare in years to come, it will be essential for them to make informed decisions about their treatment and payer coverage.


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