After undergoing surgery for severe scoliosis, Susan Sexauer was left with a 21-inch incision and a 12-month recovery.
But the 52-year-old Tampa resident has delayed getting physical therapy and medications that once helped her manage her condition. She says it's because of high deductibles in her insurance plan.
According to a report released Thursday by the advocacy group Families USA, she’s not the only one. One in four adults enrolled in individual health insurance plans is going without medical care because of high deductibles.
Medical tests, treatments and follow-up care are the most common types of services that people skip when their deductible is $1,500 or more on the lower side, and more than $3,000 on the higher end.
Dental care tops the list of skipped medical care, but wasn’t counted in the Urban Institute's Health Reform Monitoring Survey as most individual plans don’t include dental coverage.
Sexauer said she just couldn’t afford the out-of-pocket costs she had to pay before hitting her $4,800 deductible, and her husband makes too much money for them to qualify for Medicaid.
With a more affordable deductible, or none at all, “I would stay on my medications,” Sexauer said. “I would be able to do physical therapy, which would have kept me in better shape so that maybe, just maybe, I wouldn't have had to have the surgery.”
Families USA executive director Ron Pollack said people are more savvy these days when they shop for insurance, but still tend to overlook costs beyond the monthly premium, such as the out-of-pocket deductible or prescription drug costs.
“Too often one presumes a person or family's costs are equivalent to the premium and of course that's not true. It's only part of the story,” Pollack said. “The deductible is obviously a very substantial part of the story because you pay the premium and the deductible before you get first dollar benefit from your insurance.”
While patients such as Sexauer are opting out of care because of out-of-pockets costs, the Affordable Care Act does cover certain preventative care tests and treatment. The survey did not specifically ask patients whether they took advantage of these.
It also did not take into account what people are paying for monthly premiums.