As the cost of
medical care continues to rise, consumers are bearing a
greater share of their medical expenses. The additional cost-sharing
comes in many forms, including higher deductibles and co-payments,
separate deductibles for hospital admissions and the move from fixed-fee
co-payments to percentage-based "coinsurance." In some cases, health
plans are widening limits on coverage of certain treatments.
"We're looking really at the tip of what's happened with the erosion of
benefits as employers and plans start to share the costs with
employees," said Michelle M. Doty, a senior analyst at The Commonwealth
Fund and author of a recent study examining the insurance trend. "We're
going to see more of this," she predicted.
The resulting cost-shift can be a real strain on family budgets,
particularly for low-income Americans who are pinching pennies to begin
with and people suffering from chronic or multiple health conditions.
In 2003, one in five working-age Americans with chronic health problems
-- some 12.3 million people -- lived in families that had problems
paying medical bills, according to an analysis published last year by
the Washington, D.C.-based Center for Studying Health System Change (HSC).
More recently, Doty and her colleagues reported that almost two out of
five U.S. adults -- an estimated 77 million people -- have difficulty
paying medical bills or are struggling with medical debt. Seventy
percent of the people overwhelmed by medical debt and 57 percent of
those with current bill-paying problems said they were insured at the
time their difficulties began, the study found.
For some families, filing for personal bankruptcy may be the only way to
escape the debt they've piled up. According to a Harvard study released
earlier this year, illness and
medical bills
contributed to roughly half
of personal bankruptcy filings in 2001. More than 75 percent of the
filers were insured when they incurred the debt that set them back, yet
many lost coverage during their illness.
But an overhaul of federal bankruptcy laws set to take effect this
October will make it tougher to extinguish those debts. Based on income,
some Americans will have to repay some of what they owe.
If you have
health insurance, there are a few things you can do to help
avoid financial trouble.
"Here's the best advice I can give every American who has
health
insurance: Understand how your policy works. Understand the limits and
understand where the 'carrots' are," said Alwyn Cassil, a spokeswoman
for HSC.
For example, if you are enrolled in a preferred provider organization,
try to use doctors and hospitals that participate in the provider
network. You'll get a substantial discount on "in-network" services and
your out-of-pocket costs will be lower than if you were to see
out-of-network providers, she said.
If you're having an elective procedure, try not to get stuck with bills
from hospital-based physicians who don't contract with your health plan.
Find out ahead of time whether the anesthesiologist, radiologist or
pathologist who will participate in your care is a member of the
provider network. These specialists may not have agreements with your
insurer, Cassil warned, even if your hospital and surgeon do.
To save money on drugs, investigate alternatives. "Oftentimes you can
save significant money by going mail order or generic or switching from
a non-preferred brand to a preferred brand," she noted.
If your
health plan imposes an annual limit on, say, physical therapy or
mental health visits, try to time your care so you won't have to pay for
extra visits out of pocket.
As for patients who are already in debt, "Don't stick your head in the
sand," Cassil urged. "Talk to the people you owe money to and see what
you can negotiate. See what you can work out."
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