Are deductibles and coinsurance keeping employees from accessing healthcare?

Published Updated 2 Min Read

goodluz from AdobeStock

Both employers and employees in the U.S. know that health insurance doesn’t necessarily make care affordable. As healthcare prices continue to rise, benefit leaders may have to rethink their health plans and break from the status quo.

The Survey of Income and Program Participation estimates that Americans collectively owe at least $195 billion in medical debt, despite over 90% of the U.S. population having health insurance. In other words, accessing life-saving care can ruin one’s finances, and avoiding care can ruin one’s health. That means the average health plan places workers in a precarious position, says Dr. Eric Bricker, medical director of insurance company SimplePay Health.

In order for the insurance company to begin covering healthcare costs, employees have to first meet their deductible. According to the Kaiser Family Foundation, the average deductible for employer-provided coverage was $1,763 in 2022, but deductibles can be as high as $5,000. And while screenings, immunizations and other preventive services are usually covered without an employee meeting their deductible, a vast majority of care isn’t — and that can be detrimental to anyone who has to receive treatment for chronic medical diseases, explains Dr. Bricker.

“If an employee wants to treat something like their diabetes or cardiovascular disease while the problem is still small, they have to worry about a deductible before their insurance even kicks in,” he says. “Because that cost has to be borne by the employee, they don’t seek care. They can’t afford it.”

Deanna Cuadra
Senior Reporter

Deanna Cuadra is a senior reporter at Employee Benefit News. Her work covers healthcare, U.S. policy and reform, challenges faced by women and parents in the workplace and innovation in work culture … Read full bio


For reprint and licensing requests for this article, click here.


More From Employee Benefit News

Sign Up Form

Login Modal Form