High-Deductible Plans More Common

Rural residents’ reliance on high-deductible health insurance may discourage them to get medical care. A Southern Maine University study also shows people with high-deductible plans are less likely to be able to afford prescription medications.

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Rural residents are more likely to purchase high-deductible health insurance plans, which could compromise the care that some residents receive, a new study has found.

Using data from the 2007-2010 National Health Interview Survey, researchers at the University of Southern Maine found that almost 23% of rural residents purchased high-deductible plans, while only 20% of their urban counterparts did.

The more rural the county, the more likely residents were to purchase high-deductible plans, the study showed. More than a quarter of people living in rural counties that were not adjacent to a metro area had high-deductible plans.

Rural residents were more likely to purchase such plans because there is a greater concentration of the groups who prefer this type of insurance in rural areas, the study said. Nationally, people who purchase high-deductible plans tend to be white, lower income and married.

When researchers factored in the demographic differences, rural and urban areas chose high-deductible plans at about the same rate.

The study used data from before the full implementation of the Affordable Care Act. The act’s requirements that many residents get private insurance could cause another spike in the purchase of high-deductible plans, the study said.

“The ACA has the potential to greatly expand health insurance coverage for many rural Americans,” the study said. “However, the impact on access to health care may depend, in part, on the benefit design of the plans into which rural residents enroll.”

Maine Rural Health Research Center
More than 8.5% of rural residents with high-deductible plans (HDHP) couldn’t afford prescription medications in 2013. For urban HDHP consumers, the figure was 7.3%. The chart also shows the disparity was worse for residents who lived farthest from metropolitan counties. That’s the group listed as “Rural Non-Adjacent.”

High-deductible plans allow individuals to pay lower premiums in exchange for larger out-of-pocket expenses. Though the plans are initially more affordable than other private insurance, they can prove to be more expensive if people wind up having to use them. That extra cost can discourage patients from seeking medical care, especially for lower-income families, the study said.

The study also found that rural residents – no matter what type of private insurance they had – were less likely to be able to afford prescription drugs in 2013. But the problem was worse for people who had high deductible plans. (See the chart, “Couldn’t Afford Prescription Drug in Past Year.”)

The study also found that rural residents got less bang for their buck when purchasing insurance plans. When comparing insurance premiums and deductibles, rural residents on average spent 26% more on out-of-pocket costs than urban residents paying the same premium.

Out-of-pocket costs were also a larger portion of an individual’s income in rural areas, the study said.

Nationwide, enrollment in high-deductible health plans has increased significantly over the past decade, though considerably more so in rural areas. Since 2007, high-deductible enrollments have risen 47%. About a third of people who have private medical insurance were enrolled in high-deductible plans in 2012.

The study was written by Jennifer D. Lenardson, M.H.S., Erika C. Ziller, Ph.D., and Andrew F. Coburn, Ph.D., and was published by the Cutler Institute for Health and Social Policy at the Muskie School of Public Service, University of Southern Maine. 





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