Cancer Patients in High Deductible Health Plans Face Steep Costs

Patients with new cancer diagnoses who were enrolled in a high deductible health plan experienced significantly higher out-of-pocket healthcare costs compared to patients with traditional insurance, a study published in JAMA Network Open found.

The Affordable Care Act helped reduce out-of-pocket costs for cancer treatment by expanding Medicaid coverage, but more than half of the nonelderly population in the US receives healthcare coverage through private insurance.

In 2019, 30 percent of private insurance members were on a high deductible health plan. These plans offer lower premiums with higher cost-sharing. High deductible health plans may sway patients to reduce their healthcare use, including critical preventive services, in order to avoid large expenses.

To understand how high deductible health plans impact out-of-pocket spending for patients with cancer diagnoses, researchers from the Stanford University School of Medicine and the Veterans Affairs Palo Alto Health Care System analyzed member claims from a single national payer.

They looked at 134,826 patients who were diagnosed with cancer—including breast, colorectal, lung, and other types of cancer—between 2008 and 2018. They also looked at a control cohort of 1.9 million patients who did not have a cancer diagnosis.

A total of 65,377 patients in the cancer cohort and 58,698 patients in the control cohort were enrolled in a high deductible health plan.

The study results revealed that patients with a cancer diagnosis who were enrolled in a high deductible health plan experienced higher out-of-pocket costs compared to patients with a cancer diagnosis enrolled in a traditional health insurance plan.

Patients with colorectal cancer who were in a high deductible health plan paid up to $865 more per month in out-of-pocket costs than those enrolled in a traditional plan, researchers found.

Patients with breast cancer paid $860 more per month, patients with lung cancer paid $655 more per month, and patients with other types of cancer paid $292 more per month than their counterparts in traditional health plans.

Additionally, during the year after their cancer diagnoses, patients with cancer who were enrolled in high deductible health plans had out-of-pocket costs ranging up to $1,975 while patients with cancer in traditional plans only paid $160.

Overall, patients with cancer faced higher out-of-pocket costs compared to the control cohort, with their out-of-pocket costs peaking during the month of their diagnoses.

Breast cancer diagnoses were associated with the highest yearly out-of-pocket costs, amounting to $714 more per year than patients without cancer. Lung cancer patients followed with a $475 difference, colorectal cancer patients paid $361 more, and patients with other types of cancer paid an average of $90 more than patients without cancer.

High deductible health plans also led to higher out-of-pocket costs for patients without cancer. Patients without cancer in high deductible health plans paid an average of $63 per month in out-of-pocket healthcare costs, while their counterparts in traditional plans only paid $30 per month.

Unsurprisingly, the most significant difference in out-of-pocket healthcare spending was found between patients without cancer who were enrolled in traditional health plans and patients with cancer who were enrolled in high deductible health plans.

Patients with a breast cancer diagnosis in high deductible health plans paid $1,683 more per year compared to patients without cancer in traditional health plans. Likewise, patients with colorectal cancer paid $1,420 more per year, patients with lung cancer paid $467 more per year, and patients with other cancer types paid $550 more per year.

High deductible health plans with low premiums may appear desirable for individuals, but the study found that these plans may lead to significant out-of-pocket costs for patients with cancer who require unexpected healthcare services and treatment.

“For many individuals in the United States, economic decision-making and medical decision-making are deeply intertwined,” the researchers wrote. “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 addition of a health savings account may help quell some of the high cost-sharing that accompanies high deductible health plans, but studies have shown that high deductible health plans may increase barriers to care.