American’s are putting off accessing medical treatment, even for serious chronic conditions, more than ever before.  The reason for this is they fear the high cost of actually using their health insurance and whether, their doctor recommended procedures will even be approved by insurers only looking at their bottom line.

American’s are putting off accessing medical treatment, even for serious chronic conditions, more than ever before.

A poll done in early January of 2023 found that 38 percent of respondents put off scheduled medical care due to cost.  That is more than one out of every three respondents.  That is a 12 point increase over the last two years.  Why is this happening?

Individual and family plans, under the Affordable Care Act, back in 2014 when healthcare.gov and other state based exchanges became the way most Americans who were not offered coverage through an employer plan or federal or state programs, had an out of pocket maximum of $6,350 per individual and $12,700 per family.  An out of pocket maximum is the amount reached by one person, or the entire family, before all covered services will be paid by the insurer at 100% for the remainder of that calendar year.  There have been steady increases every year since then, including during the pandemic years of 2020 through 2022; and in 2023 the out of pocket maximum is now $9,100 for an individual and $18,200 per family. That is a 43% increase in the cost of accessing medical services under the AFFORDABLE CARE ACT!  On January 4th of 2023 it was already announced that in 2024, the out of pocket maximum will be $9,450 for an individual and $18,900 for a family.  These out of pocket maximums are also seen in employer based coverage as well.  Why is that information not being talked about more by the news media and politicians?  It is hard to call this, along with exorbitant premiums, AFFORDABLE.

That is a 43% increase in the cost of accessing medical services under the AFFORDABLE CARE ACT! ... It is hard to call this, along with exorbitant premiums, AFFORDABLE.

In an article dated July 20, 2022, in the Peterson KFF Health System Tracker, between 2014 and 2033 wages are expected to rise by 83% and that sounds amazing.  Unfortunately for your health, the Affordable Care Act out of pocket maximum is expected to rise by 122 percent in that same time period!

How does this affect seniors on Medicare Advantage Plans?

We have all seen the commercials talking about $0 premium plans being sold to us by insurers, using older nostalgic stars of the past, telling seniors that they can get all their medical care under one roof using a Medicare Advantage Plan. They tout $0 premium plans that offer a $0 copay for a primary care physician, have dental, routine vision and routine hearing coverage , prescription drug coverage, PART B buybacks (even though most of the plans don’t offer them or only give $10 or $20 as a benefit), free food (usually only available on Dual Eligible Medicare Medicaid Plans – but advertised as if that was available for all), and more.

What they DON’T mention is the allowed out of pocket maximum.  That means the amount of money that a person, with a Medicare Advantage plan, will have to pay out of their own pocket before all their medical bills will be paid by their private insurer at 100% for the remainder of the year. For 2023 that can be as high as $8,300 per person, and that figure does not include prescription drug costs, dental, routine vision, routine hearing, or any other costs that would not be covered under Original Medicare Parts A and B!  This has risen steadily from 2020, when the allowed out of pocket maximum was $6,700 per person. $8,300 plus all those other costs for prescription, dental, etc. for people on a fixed income is not keeping up with the 8% inflation rate!

Medicare Supplement Plans, such as the very popular “G” plan in 2023 have an out of pocket costs of $226 for the year, on medical expenses only (those services covered by Part A and Part B under Medicare).

Medicare Supplement Plans, such as the very popular “G” plan in 2023 have an out of pocket costs of $226 for the year, on medical expenses only (those services covered by Part A and Part B under Medicare).  Unfortunately, those are not the plans being given so much air time in television commercials, billboards, and mailings.  Ask yourself, if you know that a medical service is going to cost you very little or nothing (maximum of $226.00 on all Part B Services and $0 on all covered Medicare Part A Services for the entire year) are you more likely to access the medical treatment that you need than if you have a plan that has an out of pocket maximum of $8,300 for the year on all those same covered services? And, those who think that they are healthy now so take a Medicare Advantage Plan initially, believing that their will be an ANNUAL ENROLLMENT PERIOD each year, where they can join a Medicare Supplement Plan (with no health questions asked) are SHOCKED to find out that they cannot do that , due to medical underwriting, when they develop chronic health conditions later on in life as they age.  This is an inevitability for almost everyone.

It becomes incredibly clear why people are not keeping up with their healthcare appointments and putting off the cost of needed treatments.  It is so incredibly important that people make noise about what the medical plans offered to them really cost and the best way to do that is to contact your local representatives in CONGRESS and contact the news media.  Health coverage should be a right enjoyed by all and not just for those who can afford it!

It is so incredibly important that people make noise about what the medical plans offered to them really cost and the best way to do that is to contact your local representatives in CONGRESS and contact the news media.