Underinsurance Equals Less Prevention for Common Diseases

You’ve worked hard to get where you are. You have your dream job, wrapped in a full benefits package with healthcare all taken care of, right? But, did you read the fine print? Did you ask the right questions about the reality of your coverage? Well you might now.

Some might say we've come a long way when it comes to health insurance. Almost 84% of the American population has coverage, still leaving 17% without. But issues for those who have coverage is still a huge problem. New findings from the Commonwealth Fund, a private foundation that studies health care, are shining a light on the realities of underinsurance. Heard of it? Yes that’s right, underinsurance means that even if you think you have full coverage when it comes to health and medical expenses, you may not. What you end up with are sky-high deductibles and co-pays you’re completely unaware of, that is until you walk into your next doctor’s appointment.

The findings from the Commonwealth Fund found that the issue of underinsurance is leading employees to spend almost 10% of their annual income on healthcare —an expense most assume is covered. This trend only appears to be getting worse, more than doubling the people it effects — up to 31 million this year compared to 14 million in 2003. Even further, 11 percent of adults had to reach $3,000 before their coverage kicked in. For the average healthy person, that’s a serious number to reach.

Underinsurance rates peaked the most for those employed by small companies (100 employees or less), 27% of total survey respondents.

What stops me in my tracks when it comes to this particular survey is the 44 percent who reported not getting the care they needed due to cost and limited coverage. Furthermore, adults who were paying off medical bills had debt loads of $4,000 or more. Public health issue? I think so.

It’s hard enough to get people to be proactive when it comes to preventive screenings, annual physicals among other health needs. Underinsurance only adds to the problem. The strides we’ve made in educating both men and women around preventive care is being diminished because they simply may not be able to afford it.

So, what’s causing this? You guessed it, our old friend, the deductible. Just to reiterate, the average deductible for 11% of working adults in 2014 started at $3,000 and many even beyond that. When it comes to health insurance, it doesn’t just start with coverage. Affordability is a major factor. If you have coverage but cannot afford to get your annual physical, you’re in trouble.

Research shows that those who are underinsured are more likely to go without needed care and forget preventive screenings. This leads to less of a proactive attitude regarding risk factors for diseases like diabetes and cancer. Previous findings from the Commonwealth Fund in 2014 showed that 27% of adults didn’t seek the care they needed from their doctor due to high deductibles. 23% didn’t get a preventive care test such as mammogram or PSA blood test. 29% skipped a treatment or follow-up appointment and 22% didn’t see the specialist they were referred to.

This particular survey occurred before the Affordable Care Act and Health Law went into full effect, therefore researchers cannot confirm if this is a strong indicator or if a correlation exists. But we know the Affordable Care Act hasn’t done what many had hoped in terms of reducing underinsurance. Many experts believed it would decrease the number of people affects by as high as 70%. Proposed modifications to the law may even help to increase this problem.

But we know it has transformed health insurance options available to Americans who lack benefits through an employer. What this survey shines a light on is the 150 million people who have health insurance through an employer are paying an extreme amount out of pocket, when they should in theory have improved, if not, better coverage than those who are unemployed.

The promise of more affordable healthcare is still being investigated when it comes to the Health Law, but this survey brings forth the harsh reality that for the majority of the working class, health insurance still remains incredibly expensive, even for routine health exams.

So is there a solution? Unfortunately, much of this issue is out of our control and in the hands of corporate America, health insurance providers and the government. Yikes. But I would say it’s extremely important to educate yourself on the actual health plan options available to you. Ask your employer to fully explain everything related to your health coverage, including how much you may have to pay out of pocket. From there, be sure you’re doing due diligence when it comes to researching for any health provider — be it a doctor, surgeon or specialist in regards to your health. It’s important to keep a preventive attitude and seek the best care that you need.