Survey results from the Commonwealth Fund’s 2016 Biennial Health Insurance Survey reveal “more than half the underinsured had medical bill problems or medical debt, while nearly half went without needed health care because of cost.” A huge education piece for our volunteers is helping our community members understand that “underinsurance” has a negative impact on people with all types of health coverage. The research supports this. Equally important is understanding what it means to be “underinsured.”
Who Is Underinsured?
The Commonwealth Fund’s analysis of the underinsured takes into account an insured adult’s reported out-of-pocket costs per year (not including premiums) and his/her health plan deductible. These expenditures and the deductible are then compared with household income. A person is underinsured if:
- 12 months of out-of-pocket costs (excluding premiums) = 10%+ of household income; or
- 12 months of out-of-pocket costs (excluding premiums) = 5%+ of household income if income is under 200 percent of the federal poverty level ($23,760 for an individual and $48,600 for a family of four); or
- deductible is 5%+ of household income.
Of course, some people pay higher deductibles based upon their perceived risk and/or to offset higher premiums. Furthermore, the definition does not include people who are at risk of paying high costs because of benefit exclusions and copayments. The best case scenario, is that this is a conservative measure of underinsurance in the United States per the Commonwealth Fund’s findings.
Because Have A Heart is not owned by a hospital, our fees for services are 1/3 of the cost. In perspective an echocardiogram (echo) at a doctor’s office would cost an individual $1600. A patient with a 20% deductible pays $320. At Have A Heart, the actual cost for an echo is $350. An insured patient with same 20% deductible would only pay $70. Hospitals and larger institutions are allowed to charge more. For this reason, Have A Heart’s vision is to open a fully-operational clinic with a “mixed payer” system, where our volunteers treat insured and uninsured patients, regardless of their ability to pay. Insured patients will save money AND support patients who cannot afford to pay at all.
We believe making free access to specialty care is just one way our community can remove barriers to healthcare for the poor, uninsured and underinsured. Qualifying patients don’t have to worry about paying high costs and are therefore treated earlier, preventing severe illness and even death.
Find out more at www.haveaheartclinic.org or speak with a medical volunteer by calling 502.245.0002. We provide coordinated care with heart health at the center.