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Higher deductibles giving patients sticker shock as policies reset for new year

Nathan Mohan, owner of New Island Pharmacy in

Nathan Mohan, owner of New Island Pharmacy in Deer Park, says higher prescription deductibles have made it harder for some patients to pay for their drugs. Credit: Johnny Milano

Rising deductibles have patients dealing with sticker shock as their health care policies reset for the new year.

About 85 percent of covered workers nationwide have a policy that includes a deductible, according to statistics compiled by the Kaiser Family Foundation, a nonprofit that focuses on health care policy.

More than half of those employees — 58 percent — had a deductible of $1,000 in 2018, up from 38 percent in 2013. Another 26 percent must meet a deductible of $2,000, up from 15 percent in 2013, according to Kaiser.

A deductible is the amount the insured pays for health care services before the insurance plan kicks in. For example, a policy with a $1,000 deductible means the first $1,000 of health care costs are paid for by the patient. After the deductible is met, insurance begins to pay its share, although the amount a patient remains responsible for varies depending on the plan. Also, many plans pay for regular checkups before the deductible is met.

Often, prescription drug deductibles also must be met before those benefits kick in, experts said. 

Larger deductibles can be attributed, in part, to the rising cost of health care in general, said Gary Claxton, a vice president at Kaiser in Washington, D.C. 

A policy with a lower deductible generally has a higher premium, while a policy with a higher deductible carries a less expensive premium. In an attempt to keep premiums down, many companies offer, and employees select, plans with higher deductibles. 

But higher deductibles are becoming prohibitive for many patients who don't have thousands of dollars to spend on care, Claxton said.

“Some of the benefit plans employers are offering are starting to upset workers,” Claxton said. “You don’t want to offer health benefits to upset workers. You want to give benefits to attract talent.”

Higher prescription deductibles have made it harder for some patients to pay for their drugs, said Nathan Mohan, owner of New Island Pharmacy in Deer Park. 

He said one patient recently couldn’t afford to pay for a $265 prescription for diabetes, and went back to her doctor to get free samples. 

He added that other patients never reach their deductibles for prescription drugs because the caps are higher than the amount they spend annually on less expensive, common medicines tied to asthma or high blood pressure. 

If they do pass the deductible late in the year, "Patients rush to get their refills in so they have a little breathing room before the new year and new deductible starts."

Patients who haven’t met their health care deductibles often ask for assistance from hospitals to handle their medical bills, said Kevin Dahill, chief executive of the Nassau-Suffolk Hospital Council, which lobbies on behalf of 26 member hospitals on Long Island.

“Very often, the hospitals work out a payment plan,” he said. “As deductibles have risen, so have the number of questions and concerns the hospitals receive.”