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Patients with Chronic Diseases Pay More Under Affordable Care Act

Chronically ill plan members shell out more than those with employer coverage

According to a study published in Health Affairs, individuals with at least one chronic condition enrolled in “exchange” plans under the Patient Protection and Affordable Care Act pay approximately twice as much, on average, for prescription drugs every year compared with those covered through their employers. Researchers at Emory University in Atlanta found that patients enrolled in a mid-priced “silver” exchange plans pay, on average, $621 out-of-pocket for prescription related expenses, whereas those with employer coverage pay $304.

The authors reported that deductibles are often the reason behind  increased costs for those on exchange plans. Employer-sponsored plans usually exempt prescription drugs from their deductibles, but they still may have stiff co-pays. As a result, the study said, patients in the most-popular silver plans pay 46 percent of their total drug spending on average, compared with 20 percent for patients in typical employer-sponsored plans.

According to lead author Dr. Kenneth Thorpe,the report underscores the need for people to consider more than the premium when they compare health plans on an exchange. Health plans have been shifting more drug costs to consumers in part to hold down monthly premiums, he said. But studies have shown that most people choose their health plans because they have the lowest premiums.

Larry Levitt, a senior vice president at the Kaiser Family Foundation, said most people buying exchange plans receive subsidies to help reduce their out-of-pocket spending. Levitt also said comparing employer-sponsored plans to those sold on exchanges has limited value because employer plans typically offer more generous benefits than the silver plans in the marketplaces, and employer plans also have higher premiums.

The risk of higher cost-sharing for people with a chronic disease, Thorpe said, is that they won’t fill or renew prescriptions, leaving them sicker and in need of costly hospital care.

Source: Kaiser Health News, October 5, 2015

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