With High Deductible Health Plans, Cancer Patients are Paying More, Study Finds

Cancer patients with high deductible health plans face significantly higher out-of-pocket costs that may be driving treatment decisions, a new study found.

The study, published in Jama Network Open Wednesday morning, examined more than 134,000 cancer patients between 2008 and 2018.

High deductible health plans “offer poorer protection than traditional insurance against unexpected health care expenses,” the authors of the study wrote.

As cancer care grows more expensive, more research should be done to examine the consequences of people delaying or abandoning treatment as a result of higher enrollment in high deductible health plans.

“Overall, our findings support previous studies that patients with cancer are subject to high financial burdens that may be associated with their clinical decision-making,” the authors wrote.

This study differs from previous research on healthcare costs among cancer patients in one significant aspect, the authors said. They wrote that to the best of their knowledge, this is the first time researchers used actual claims data to compare out-of-pocket costs among a large group of cancer patients with private insurance. Previous studies relied on cost estimates or patients’ reporting their own expenses.

Nationwide, 61% of American adults are covered through private health insurance. High deductible health plans are gaining more prevalence. Among those with private insurance, 30% had high deductible plans in 2019, up from 4% in 2006, the authors noted.

With high deductible health plans, consumers typically pay lower premiums, but they also have to pay more costs on their own before the insurance company starts paying. Theoretically, high deductible health plans are supposed to spur consumers to make better decisions about their health.

In reality, consumers with those plans delay treatment or hold off on preventive measures to protect their health, such as cancer screenings, the authors wrote.

The study found cancer patients with high deductible plans paid much more out of their own pocket than those with traditional insurance plans. The findings were especially stark among those diagnosed with breast cancer.

One year after diagnosis, breast cancer patients with high deductible plans paid $1,975 out of their own pocket. Cancer patients in traditional plans paid $160, the study found.

In addition, colorectal cancer patients in high deductible plans paid $865 more than those in traditional insurance plans during the month of diagnosis. Those with lung cancer in high deductible plans paid $655 per month more than those in traditional plans during the month of diagnosis.

The study also examined differences in costs among consumers without cancer. Consumers with high deductible plans paid a median of $63 per month in out-of-pocket costs, while those in traditional plans paid $30 per month.

The researchers also compared out-of-pockets costs among cancer patients with high deductible plans and those without cancer in traditional insurance plans. The differences were striking: those with breast cancer paid $1,683 more, while colorectal cancer patients paid $1,420 more out of their own pocket.

Those paying more out of pocket in high deductible plans are potentially suffering significant financial consequences, the authors note. They point to previous surveys indicating a majority of Americans couldn’t cover $1,000 in unexpected costs with their savings accounts.

The authors said more research should be done to examine clinical outcomes for those in high deductible plans.

“Financially vulnerable patients and their families continue to face painful decisions about whether to undergo high-cost cancer treatment or to delay or forego care,” the authors wrote.

Researchers at Stanford University, the Department of Veterans Affairs, and the Mayo Clinic produced the study.