co-pays

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Mass. Experience: Even $1 Co-Pay Can Block Needed Care

(Wikimedia commons/Bloodshedder)

It’s not enough to get everybody insured. You have to get everybody insured well enough so that they get the care they need. And in the case of very poor people, even a $1 or a $3 co-pay can be a barrier to care.

That’s my take on a new Massachusetts-based study, done by Harvard Medical School researchers and just out in the Journal of General Internal Medicine. Other states may want to take heed, now that the federal health overhaul has been upheld by the Supreme Court and they’re moving towards getting more people insured. All insurance is not the same, and for some, even the relatively generous Massachusetts Medicaid benefits may not be enough.

More on the study soon, but first, here’s the human side from its lead author, Dr. Danny McCormick of the Cambridge Health Alliance:

“For people who aren’t in the position of being at 133% of poverty, it’s inconceivable that [a $1 or $3 co-pay] would inhibit you from getting a medication if the doctor prescribed it. But I saw a patient last week, a young man with a chronic medical condition, who works at a deli, earns minimum wage, and rides his bike to work because he can’t afford a car.

‘I have actually no dollars in my pocket.’

I had seen him two months before and told him, ‘Your blood pressure is dangerously high, here’s a prescription for medication. You’ve really got to take it.”

So he comes back last week and he says, ‘You’re going to be unhappy with me but I didn’t take it.’

I said, ‘Okay, what were the problems?’

He said,’I’ve got Medicaid but I’m so far behind on bills I have actually no dollars in my pocket. I’m waiting for a check from work, and as soon as that gets here I can get that medication.'”

Moral of the story: “Even very small co-payments — and this is borne out in the literature — can inhibit extra-low-income people. This was a particularly striking case because he had such high blood pressure, and he showed up again and it was worse, and I ended up sending him to the ER, and that ends up costing fantastically more than the minimum co-pay he would have had to pay. I see it all the time as a primary care doctor: even very low co-payments inhibit needed care.” Continue reading

Why Are Health Insurance Rates Rising And What Does It Mean For Consumers? Ask The Experts.

WBUR's Martha Bebinger hosts an online chat today at noon about rising health insurance premiums

WBUR’s Martha Bebinger discussed rising health insurance premiums on Morning Edition today, and told host Bob Oakes that consumers will soon start to feel the impact, including higher deductibles and co-pays. Also, some plans may start charging you more if you choose certain doctors and hospitals.

Ms. Bebinger explains: “In order to keep the rates from going up even higher, we will see higher deductibles: $1,000 had been the accepted rate in Massachusetts, but it could go up to $1,500 or $2,000. We’re going to see higher co-pays, we’re going to see tiering for doctors and hospitals; you know the way we pay different co-pays for prescription drugs now, you’ll see that for doctors and hospitals as well, based on their rating.”

If you’re confused by any (or all) of this, join Ms. Bebinger and Brian Rosman, research director with the advocacy group Health Care For All for a live online chat at noon today on WBUR.org. They want your input! And they wonder: Can you still afford health insurance? Are you changing where or when you get care based on the cost? What are your suggestions for lowering health care costs?

Join the discussion at WBUR.org