The Senior Citizens League (TSCL) Concerned That Exchange Plans’ Out-of-Pocket Costs Unaffordable

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High deductibles and other out-of-pockets costs of Obamacare plans may require older consumers to spend a much more significant portion of their income on healthcare than they may realize at enrollment.

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“We are learning that some older Obamacare enrollees are winding up back at community “free clinics” after learning the deductible on their plan was so high they could not afford to see the doctor or fill prescriptions,” says Cates.

High deductibles and other out-of-pockets costs of Obamacare plans may require older consumers to spend a much more significant portion of their income on healthcare than they may realize at enrollment, warns The Seniors Citizens League (TSCL). The result is that too many older adults are discovering they can’t visit the doctor or access covered services because of the cost of deductibles.

A deductible is what the insured must pay before the health plan covers the cost of services like a visit to the doctor or filling a prescription. “While most consumers shop for the lowest premiums, and may qualify for a subsidy to lower the cost of their premium, that’s only one part of health insurance costs,” says TSCL Chairman, Ed Cates. People also have out-of-pocket expenses — big ones — that include not only deductibles, but co-pays and co-insurance for each service. “Usually the less expensive the plan is, the higher the out-of-pocket costs will be,” Cates says.

The least expensive Obamacare plans have high deductibles that average about $5,000. “If you are under the age of 65, and are depending on Social Security, Obamacare’s out-of-pocket costs could easily take up half of your annual Social Security income,” Cates notes.

“We are learning that some older Obamacare enrollees are winding up back at community “free clinics” after learning the deductible on their plan was so high they could not afford to see the doctor or fill prescriptions,” says Cates. Unlike many employer-sponsored health plans, few Obamacare plans permit even a limited number of doctor visits before the deductible.

“For example, we know of one 64 year old woman who requires seven prescriptions,” says Cates. Even though she qualified for a subsidy that covered almost the entire monthly premium of her Obamacare plan, the deductibles for prescriptions and doctor visits were too high for her to afford, on her $800 a month Social Security and limited earnings from self-employment,” he says. “This individual wound up back at her local free clinic where she could get blood tests, doctor visits, and prescriptions through a pharmacy assistance program,” Cates explained. “She turns 65 soon and is looking forward to starting on Medicare January 1st.”

Despite the new health law, older enrollees still pay the highest premiums. The Affordable Care Act allows insurers to charge this age group three times more than the youngest consumers. But depending on their income, people who apply on Healthcare.gov or their state health insurance exchange may be eligible for a subsidy to lower the cost. An estimated 5.2 million older adults are under the age 65, and are uninsured. Older uninsured are more likely to have chronic conditions that require monitoring by healthcare professionals, and use multiple prescriptions.

“Too many of these people are winding up in plans with huge deductibles and in health plans they can’t use,” Cates cautions. “According to the IRS, a high deductible plan is any with a deductible of $1,300 or more. Few Obamacare plans have deductibles that low,” he adds.

TSCL urges uninsured people to get help with their choices now during Open Enrollment. Many communities are holding public enrollment efforts through public libraries and other organizations. You can also find help through calling your State Health Insurance Assistance Program (SHIP) that operate, through many area Agencies on Aging and local senior services departments.

Are you age 60 through 64 and affected by high out – of - pocket costs? TSCL wants to hear from you. Visit TSCL’s website at http://www.SeniorsLeague.org.

With about 1 million supporters, The Senior Citizens League is one of the nation's largest nonpartisan seniors groups. Located just outside Washington, D.C., its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of TREA The Enlisted Association. Please visit http://www.SeniorsLeague.org or call 1-800-333-8725 for more information.

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Shannon Benton
The Senior Citizens League
since: 09/2014
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