Group items tagged

Premium prices are influenced by many factors, including what insurers guess their costs will be, a region’s labor costs and how much hospitals and other facilities charge. Competition between insurers is also a significant factor.

While some of the lowest cost plans are in the “bronze” tier of coverage, such plans generally have higher annual deductibles and co-payments than a silver plan.  Also, the silver plans reduce some costs for subsidy-eligible consumers, which could reduce their exposure to big bills if they fell seriously ill.

“Although premiums are generally the first and last thing discussed when comparing plans, out-of-pocket costs may be an equally or even more important consideration, particularly for those with significant health care needs.”

Medicare patients, however, are at a disadvantage because there is no cap for out-of-pocket expenses. They "are paying copayments or coinsurance forever," Dr. Newcomer explained.

"What we are already seeing is that patients who are on Medicare are coming to hospital settings; they are not being treated at their doctor's office or their infusion center because the doctors can't afford to do it," said Dr. Swain. The doctors would actually lose money on this, so the patients are coming to a higher-priced facility — a hospital — to get their infusion, she explained. "I think it is really going to have an effect, not on the patients but on the economy in general," she added.

The decline in Medicaid budgets has added challenges to medication access for recipients of this program.