Many employer group plans today have higher than normal deductibles. In my experience (and under past employment), benefit plans generally did not have an in network deductible, and my out-of-pocket costs included either copayments of flat dollar fees, or coinsurance, percentages of a total. Deductibles were saved for out of network benefits, and even then we were talking only $500 or $1000, on a generous plan. Nowadays, a family has to meet so many out of pocket costs. I have two anecdotes to provide in this regard.
A family member experienced a glitch, and was not able to change her plan as of January 1 of this year. A new plan with a new deductible was in effect February 1. Unfortunately, her out-of-pocket costs incurred in January do not offset her February plan with a new organization. She has filed appeals requesting exceptions, which hopefully will be approved because the Summary of Benefits and Coverage (SBC) has been arguably watered down to incompletion. This is a great difficulty for someone self-employed and raising a family.
A close friend has been helping her sister financially as she undergoes treatment for a serious illness. Her sister was diagnosed a few months ago, and has a plan your benefit which includes a $6000 deductible starting June 1. She works for a major pharmacy benefit manager in a warehouse position, and has so for years, but barely makes a living wage considering she is single, taking care of her disabled son as well as a granddaughter. My friend is self employed herself and is now hustling as best she can to help her sister pay participating physicians who are demanding cash upfront.
These anecdotes illustrate a couple examples of how our current system is causing great financial harm to working families. More refinement is needed to make sure people don’t delay care and providers do not refuse care due to cost.