Out-of-Pocket Healthcare Spending

CA VBID Program Boosted Primary Care Use, Contained Healthcare Costs

by Victoria Bailey

California’s value-based insurance design (VBID) program was associated with a higher probability of primary care use, a lower probability of inpatient admissions, and no change in total costs...

Women Face High Out-of-Pocket Costs for Breast Cancer Treatment

by Victoria Bailey

The annual out-of-pocket cost for women with an invasive breast cancer diagnosis receiving insurance coverage through an employer-sponsored plan was $1,502.23, a study published in JAMA Network Open...

The Cost of Cancer Should Reflect Impacts on Wellbeing, Productivity

by Kelsey Waddill

The cost of cancer goes beyond financial expenditures for adolescent and young adult patients, extending into mental health impacts and workplace productivity losses, according to a report...

2022 Key Enrollment Trends For High Deductible Health Plans

by Kelsey Waddill

High deductible health plan (HDHP) enrollees may have a broader selection of health plans and may view pre-deductible coverage for chronic disease prevention care as a deciding factor in health plan...

Trends in Deductibles Among Affordable Care Act Marketplace Plans

by Kelsey Waddill

Updated 2/17/2023: This article has been updated to reflect a correction to the original data. The previous version of this article said that 26 percent of ACA plans had deductibles between $4,501...

Out-of-pocket Costs for Opioid Use Disorder Treatment Varied by Payer

by Victoria Bailey

Out-of-pocket costs for buprenorphine prescriptions for opioid use disorder treatment decreased between 2015 and 2020, but costs varied by payer, according to a study published in JAMA Network...

The Role of Affordable Care Act Premium Tax Credits in the Payer Industry

by Kelsey Waddill

The Affordable Care Act marketplace premium tax credits were introduced in 2010 and continue to play an integral role in US health insurance. A Google search on premium tax credits will demonstrate...

Deductibles, Copayments, OOP Max Trends Indicate Cost-Sharing Growth

by Kelsey Waddill

From 2013 to 2020, cost-sharing trends shifted: deductibles grew, copayments increased for certain services and depending on union employment, and out-of-pocket healthcare spending maximums rose,...

How Insulin Costs Vary Across Medicare, Medicaid, Private Plans, Uninsurance

by Kelsey Waddill

Insulin costs vary based on insurance coverage type and coverage types that lead to high healthcare spending can force patients to ration their insulin supplies, a report from the US Department of...

Understanding the Different Metal Plans in the ACA Marketplace

by Victoria Bailey

The Affordable Care Act (ACA) marketplace allows individuals to purchase health plans through the federal insurance marketplace or state-based marketplaces, depending on the state. HealthCare.gov offers four categories of health plans...

Health Insurance Is Expensive, But Americans Intend to Keep Their Plans in 2023

by Kelsey Waddill

Even though many Americans are concerned about health insurance costs, most plan to remain in their current health plan for 2023, according to a survey by ValuePenguin. Qualtrics sent out the online...

Major Payers Spent Less Than 1% of 2021 Income on Social Determinants of Health

by Kelsey Waddill

The share of their income that major payers spend on social determinants of health may have increased over time, but it remains a lackluster percentage, a study published in the Journal of General...

50% of Coronavirus Hospitalizations Covered by ESI Cost Over $25K

by Kelsey Waddill

While employer-sponsored health plans’ total costs for coronavirus hospitalizations could range from $10,000 to over $38,000 in 2020, employee costs remained fairly consistent, a Peterson-Kaiser...

2022 Employee Contributions Trends in Employer Sponsored Health Plans

by Kelsey Waddill

Annual family 2022 premiums will average $22,463, with employees in employer sponsored health plans contributing on average $6,106, the annual Kaiser Family Foundation (KFF) Employer Health Benefits...

Dialysis Triples Healthcare Spending for Members with Chronic Diseases

by Kelsey Waddill

Dialysis increased monthly spending for privately-covered members with chronic diseases by approximately 292 percent, according to a study published in JAMA Open Network. The researchers drew their...

Older Beneficiaries Choose Medicare Advantage for Enhanced Benefits

by Victoria Bailey

As Medicare Advantage enrollment is expected to rise in the coming years, a new survey from the Commonwealth Fund revealed that beneficiaries are choosing the private program over traditional Medicare...

Blue Cross Blue Shield Expands Benefits for Federal Employees

by Kelsey Waddill

Members of Blue Cross Blue Shield’s Federal Employees Health Benefits (FEHB) Program and Federal Employees Dental and Vision Insurance Program (FEDVIP) will have lower premiums for dental and...

CMS: Medicare Part B Premiums, Deductibles Will Decrease in 2023

by Victoria Bailey

Medicare Part B premiums and deductibles will decrease in 2023, while Part A costs will rise, according to a fact sheet released by CMS. Medicare Part B offers coverage for physician services,...

Out-of-Pocket Healthcare Spending for Generics Rose from 2011-2019

by Kelsey Waddill

While negotiated drug prices dropped, out-of-pocket healthcare spending on generic prescription drugs increased for patients as generics moved from Tier 1 to tiers typically dedicated to brand drugs,...

Employer Sponsored Health Plan Costs Expected to Increase in 2023

by Victoria Bailey

As employer-sponsored health plan costs are expected to rise over the next three years, employers plan to implement new programs and policies to improve affordability, according to a survey from Willis...