Access & Affordability Problems with Health Insurance

Access to health insurance plans is often directly related to cost. Coverage is unaffordable for many of those who do not have access to an employer's plan, and, when coverage is possible, either through an individual plan or a group plan, medical care is sometimes financially difficult due to high out-of-pocket costs.



Many of those who need coverage most find that health insurance impossible to obtain or prohibitively expensive, especially if coverage is not available through an employer.

Group Insurance Access

• The most affordable insurance plans offered in the United States are employer-sponsored health insurance plans, in which employers usually absorb much of the premium cost.

  However, access to employer-sponsored group plans is limited to those who are employed by an organization that offers health insurance, and the spouses and dependent children of those employees. Additionally, employers may restrict coverage to full-time employees, or those who have been employed for a defined time period.

Individual Plan Access

• For those who are unemployed, or who do not have access to a group health insurance plan, individual health insurance plans are often the only option. However, these plans come with their own limitations.

  Access to individual health insurance plans can be difficult for those who have existing medical conditions, even if no treatment is currently being sought for such conditions.

  Sometimes, insurance policies offer limited access to coverage; a common example is pregnancy and childbirth care, which is frequently excluded from individual health insurance plans.

Group Plan Affordability

• Even those who do have access to group health insurance plans may find these plans unaffordable, or seeking care difficult due to costs.

  As the cost of health insurance coverage grows, many employers are passing these expenses on to employees, who pay higher premiums for less insurance coverage.

  Coverage may come with high out-of-pocket costs associated with deductibles that must be met before coverage begins, high co-pays for medical office visits and diagnostic tests, and high co-pays for prescription medications.

Individual Plan Affordability

• Although group health insurance plans are becoming more expensive, they are still more affordable than individual health insurance plans, which are often so expensive that they're out of the question for those who need them most.

  The Kaiser Family Foundation (KFF) reports that premiums for individual health insurance plans are skyrocketing, with costs growing at an average of 20 percent in the year 2010 alone.

  Even when coverage is affordable, out-of-pocket costs are steep, with KFF finding that deductibles of over $2,000 were the norm in 2010.

Considerations

• The rising cost of health insurance often means access to less coverage. The Kaiser Family Foundation finds concerns about the ability to pay medical bills is present in both those who get health insurance through employers and those who purchase their own health insurance.

  "Forty percent of those who buy their own coverage say they are 'not too confident' or 'not at all confident' that they will be able to pay their usual medical bills. Thirty-six percent of those with employer coverage" felt confident in their ability to pay their medical bills, KFF reports.