MONEY Health Care

Why Getting Mental-Health Coverage Can Be So Tough

Despite rules mandating better insurance benefits, finding care remains a challenge, a new 50-state report concludes.

Even though more Americans have access to health insurance because of the health law, getting access to mental health services can still be challenging.

A new report concludes that despite the 2008 mental health parity law, some state exchange health plans may still have a way to go to even the playing field between mental and physical benefits. The report, released by the advocacy group Mental Health America, was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A, a pharmaceutical company that specializes in neurology and psychiatric treatments.

The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota, and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington, and Louisiana.

Among its other findings:

•42.5 million of adults in America, 18.19%, suffer from a mental health issue.

•19.7 million, or 8.46%, have a substance abuse problem.

•8.8 million, or 3.77% of Americans have reported serious thoughts of suicide.

•The highest rates of emotional, behavioral or developmental issues among young people occur just west of the Appalachian Mountains, where poverty and social inequality are pervasive.

Part of MHA’s examination focused on the exchange market and its essential health benefit requirements that guided 2014 coverage. The group found that, while information provided through plans’ “explanation of benefits” might show that there aren’t limits on mental health coverage, limitations including treatment caps and other barriers still exist.

“Parity is in its infancy. Most plans know the numerical requirements around cost-sharing, but few have taken seriously the requirements around equity—around access through networks and barriers to care through prior authorization,” said Mike Thompson, health care practice leader at PricewaterhouseCoopers. “And, in practice, we have a history of imposing much more stringent medical necessity standards on mental health care than other health care.”

However, Susan Pisano, vice president of communications for America’s Health Insurance Plans, an insurance trade group, said the report doesn’t reflect the fact that many health plans have rolling renewals. That means the plans have until Jan. 1, 2015, to fully comply with the parity law.

“Our members are committed to mental health parity, and we’re supportive of legislation, and what isn’t apparent is that benchmark plans represented a snapshot in time … so that doesn’t give us the full picture,” Pisano said. “Our plans have really been working to get in compliance.”

Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health, a Washington-based trade group for community mental health and substance use treatment organizations, said the report’s findings aren’t surprising — though they are troubling. Implementation of the parity law remains a work in progress, he said.

“The law is based on a sound policy premise — that addiction and mental health treatment decisions and management should be comparable to physical health conditions,” he said. “But this also creates a tremendous barrier to proving violations as it requires a consumer to obtain access to plan documents for both types of care, which is frequently handled by different plans,” Ingoglia said.

In addition, the report found that some plans didn’t set out what and how many services were covered. That means consumers would only find out a treatment wouldn’t be paid for by their insurer after they’d already received care.

Americans with mental disorders have the lowest rates of health insurance coverage, so obtaining insurance is a good first step, according to Al Guida, a Washington, D.C.-based lobbyist who works on mental health issues with Guide Consulting Services. But the only way a denial can be reversed is through an appeal, which can be a long and arduous process.

“The vast majority of insurance plans offered on Affordable Care Act federal and state exchanges have close to no transparency, which could lead to abrupt changes in both mental health providers and psychotropic drug regimens with the potential for serious clinical consequences,” Guida said.

Meanwhile, there is a shortage of mental health care professionals—nationally there is only one provider for every 790 people, according to the report.

All of these factors can cause minor mental illnesses to grow more severe, according to Mental Health America CEO Paul Gionfriddo.

He suggested that mental illness should be screened for and covered in the same way cancer, kidney disease, and other illnesses are.

“Right now we’re trapped in a stage where we wait for a crisis, when they’re in advanced stages and then we treat it, and we wonder why it’s so hard to treat it more cheaply,” Giofriddo said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Health Care

Number of Uninsured Americans Near Historic Low

Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Delaware on March 27, 2014.
Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Del. on March 27, 2014. Andrew Harrer—Bloomberg/Getty Images

Just 11.3 percent of Americans were uninsured in the second quarter

New federal government data shows the percentage of Americans without health insurance was at or near historic lows this year following the roll-out of the Affordable Care Act, and appears certain to fall to record levels next year.

The data released Thursday from the National Center for Health Statistics’ National Health Interview Survey found that 11.3 percent of Americans were without coverage in the second quarter of 2014, down from 13.1 percent in the first quarter and 14.4 percent throughout 2013. An analysis by the White House Council of Economic Advisers finds the drop in the uninsured to be the largest in four decades, amounting to roughly 9.7 million Americans getting insurance, consistent with other Affordable Care Act estimates.

“As this week’s data confirm, 2014 has seen dramatic coverage gains, gains matched or exceeded only by those seen in the decade of rapid progress that followed the creation of Medicare and Medicaid,” wrote Council of Economic Advisers Chairman Jason Furman and CEA Senior Economist Matt Fiedler in a blog post on the White House website. “Following this year’s gains, we estimate that the Nation’s uninsured rate is now at or near the lowest levels ever recorded across the 50 years for which we have data.”

Council of Economic Advisers

The new data does not include the nearly 2.5 million who have newly selected or re-enrolled for coverage in the latest round of open enrollment which began last month. Nor does it include those who’ve gained coverage in Medicaid or the Children’s Health Insurance Program since the second quarter—including 400,000 from September to October, according to new data from the Centers for Medicare & Medicaid Services—as more states expand access to the program with federal money under the law.

“These data imply that the uninsured rate will continue to fall in the year ahead, reaching low levels unprecedented in the Nation¹s history,” the economists wrote.

MONEY Health Care

5 Things You Need to Know for Today’s Health Care Coverage Deadline

Today is the deadline to buy individual health insurance if you want to have coverage on Jan. 1.

Since open enrollment began on Nov. 15, almost 1.4 million people have signed up for health coverage through the federal insurance exchange, and another 183,000 through state exchanges. With nearly 7 million people already participating, signups are on pace to meet the government’s projection of 9 million enrollees in 2015, according to the Kaiser Family Foundation.

If you’re one of the many who still need to enroll for 2015 coverage, here are five keys things you need to know before you visit your state’s health exchange website.

1. If you want health insurance on Jan. 1, you must enroll today. You still have until Feb. 15 to buy a 2015 plan, but you will have a gap in coverage if you enroll after today’s deadline. Coverage begins on Feb. 1 for people who enroll between Jan. 1 and Jan. 15. Sign up between Jan. 16 and the end of the month, and coverage won’t begin until March 1.

2. Some states are giving you more time and extending the deadline to get coverage by Jan. 1. For example, New York and Idaho’s exchanges will allow users to sign up until Dec. 20. To find out whether you’re eligible for an extension, visit your state’s marketplace exchange website through healthcare.gov.

3. You’ll be automatically re-enrolled if you bought on an exchange last year and do not renew coverage by today. If the health plan you signed up for is no longer offered, insurers can automatically enroll you in another policy similar to the one you have now. But you can opt out of any plan you’re automatically enrolled in and choose another up until Feb. 15.

4. Skip automatic enrollment and shop again, even if you liked your 2014 policy. The Department of Health and Human Services found that more than 70% of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans.

5. Costs have changed. Many plans will have out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health. But the tradeoff for those lower maximums may be a higher deductible, so be sure to pay attention to both figures when choosing your plan. You can also expect to see your premium change. Depending on where you live, that may be a good or bad thing. The premium for the second-lowest-cost silver plan in Nashville jumped 8.7%, while it dropped 15.6% in Denver, according to a study by the Kaiser Family Foundation.

MONEY Health Care

The Key Numbers to Look for When You’re Picking a Health Plan

pill bottle with numbered pills around it
Tim Robberts—Getty Images

Monday is the deadline to buy insurance if you want it on January 1. But don't shop solely on the premium. A new study finds that many exchange-sold plans have lower-than-expected out-of-pocket caps, a boon for some health care consumers. But deductibles are up.

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments, and co-insurance, but not premiums. Seventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94% of gold plans (average limit, $4,458) and 98% of platinum plans (average limit, $2,145).

Avalere said the average spending limits for single coverage were in most cases close to those for 2014 plans: bronze ($6,330); silver ($5,877); gold ($4,443) and platinum, $2,795.

Avalere’s analysis included plans sold on the federal marketplace that serves 37 states, as well as data from the California and New York state marketplaces. Consumers have until Feb. 15 to enroll.

The tradeoff for lower out-of-pocket spending maximums may be a higher deductible, says Pearson. The average deductible for silver plans will increase 7% in 2015, to $2,658. Other metal-level average plan deductibles are increasing as well.

Higher deductibles are likely helping keep premiums low, and low premiums are what consumers are looking for, Pearson says.

For people who are generally healthy, a lower premium may be more attractive than a lower deductible. They’re never going to meet their deductible anyway, so they’d prefer to save on monthly premiums.

But for people with chronic conditions, “the lower out-of-pocket maximum helps you because you’re going to exceed your deductible no matter what,” says Pearson.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Innovation

Five Best Ideas of the Day: December 11

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. A rule in the Affordable Care Act could make hospitals safer.

By Mike Corones at Reuters

2. As U.S. influence in the Middle East wanes, the United Arab Emirates is stepping up.

By Steven A. Cook in the Octavian Report

3. How do you extend banking services to an industry that’s illegal under federal law? Colorado’s answer is a credit union for pot growers and sellers.

By David Migoya in the Denver Post

4. A simple step — lighting pathways to latrines and latrines themselves in rural areas — can improve safety for women and girls.

By Dr. Michelle Hynes and Dr. Michelle Dynes at Centers for Disease Control and Prevention

5. The International Olympic Committee vote to protect gay athletes is an important first step, but more work remains.

By Laura Clise in the Advocate

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

MONEY Health Care

Act Fast to Get Health Insurance for Next Year—But Not Too Fast

pill bottles with money in them
Adrianna Williams—Getty Images

The deadline for buying individual health insurance for 2015 is days away. If you got a policy on an exchange last year, don't just automatically renew. With new insurers in the marketplace, you could save by taking the time to compare plans.

More than 70% of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans, officials said last week.

With a Dec. 15 deadline looming for coverage that would begin Jan. 1, current policy holders should come back to healthcare.gov to see if they can get a better deal, the officials said. They’ll find more plans available and nearly 8 in 10 current enrollees can find coverage for $100 or less a month, with subsidies covering the rest of the cost.

A Department of Health and Human Services analysis of 2015 individual market premium data for 35 of the states participating in the federal marketplace, or exchange, found that premiums for the lowest-cost silver plans will increase on average by 5%, while prices will increase on average by 2% for the second-lowest-cost silver plans, which is called the benchmark plan because subsidy levels are pegged to its cost. “The plans offering the lowest prices have sometimes changed from 2014 to 2015, so consumers should shop around to find the plan that best meets their needs and budget,” the report advises.

If they stay in their current plan, consumers may discover that their subsidy may not go as far if the price of the benchmark plan declined for 2015. “We strongly, strongly encourage people to come back to the website and shop,” marketplace CEO Kevin Counihan told reporters during a press call. Federal marketplace enrollees who do not switch plans by Dec. 15 will be automatically re-enrolled in their current coverage.

Those who don’t switch plans might see higher prices. “For the vast majority of people, if they stay in the same plan, I think they’ll see rate increases in the single digits to high single digits,” said Andy Slavitt, CMS principal deputy administrator. “That’s not going to be true for every individual. Some will go down, some will go up a little bit higher.”

The number of companies offering policies for next year has increased by 25%. Consumers can choose from an average of 40 plans for 2015, up from 30 in 2014, based on the HHS analysis, which examined plan rates at the county level.

Consumers have until Feb. 15 to enroll for coverage in 2015, the marketplace’s second year.

The HHS analysis, mirroring other reviews of 2015 premiums, shows that what consumers pay for coverage depends on where they live. In Juneau, Alaska, for example, a 27-year-old enrolled in the second-lowest-cost silver plan would pay $449 per month for coverage in 2015 before tax credits, a 34% increase from 2014. In Jackson, Miss., that same level of coverage would cost $253, or 24% less than $332 charged in 2014.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why Millennials Hate Their Least Expensive Health Care Option

Health plans that shift more up-front costs onto you are rapidly becoming the norm. But millennials don't seem happy about taking on the risk, even in exchange for a lower price.

Millennials want their parents’ old health insurance plan. A new survey from Bankrate found that almost half of 18-to-29-year-olds prefer a health plan with a lower deductible and higher premiums—meaning millennials would rather pay more out of their paycheck every month and pay less when they go to the doctor. Compared to other age groups, millennials are the most likely to prefer plans with higher premiums.

That surprised Bankrate insurance analyst Doug Whiteman. “One would assume people in this age group were not likely to get sick, so they’d choose the cheapest possible plan just to get some insurance,” he says.

In theory, millennials are perfect candidates for high-deductible plans. The conventional wisdom is that since young and healthy people tend to have very low health-care costs, they should opt for a higher deductible and keep more of their paychecks.

If, for example, you go to the doctor only for free preventive care, switching from the average employer-sponsored traditional PPO plan to the average high-deductible health plan would save a single person $229 a year in premiums, according to the Kaiser Family Foundation’s 2014 data.

Millennials shopping in the new health insurance marketplace last year didn’t want the cheapest plans either. According to the Department of Health and Human Services, more than two-thirds of 18-to-34-year-olds chose silver plans, which have mid-level premiums and deductibles. Only 4% picked catastrophic plans, the ones with the lowest premiums and out-of-pocket limits of around $6,000.

Why Millennials Are Risk Averse

Why are millennials choosing to pay more for health care? Turns out the “young invincibles” don’t feel so invincible after all, says Christina Postolowski, health policy manager at a youth advocacy group called—as it happens—Young Invincibles. “Millennials are risk-averse and concerned about their out-of-pocket costs if something happens to them,” Postolowski says.

High-deductible plans saddle young adults with risk they can ill afford. According to Kaiser, the average employer-sponsored high-deductible plan made singles pay $2,215 out-of-pocket in 2014 before they ever saw a co-pay.

Yet according to Bankrate, 27% of 18-to-29-year-olds have no emergency savings. A $2,200 bill could sink them. Indeed, Bankrate found that the two groups most likely to prefer a low-deductible plan are millennials and those with incomes between $30,000 and $49,999.

“Young people don’t have money in a bank account to pay for high deductibles,” Postolowski says. “Our generation is carrying $1.2 trillion in student loan debt. An unexpected medical incident isn’t just physical pain. It can be economic pain too.”

That’s why Bankrate’s Whiteman thinks millennials are being “really smart.”

“One of the concerns I have is too many people might only look at the price and neglect the fact that some of these plans that seem really cheap can come with deductibles as high at $6,000,” he says. “That’s a significant amount of money out of your own pocket.”

Fighting the Tide

Some young workers, however, have little choice, or won’t soon. Employers are increasingly shifting to health plans that make workers shoulder more of the costs. Towers Watson found that 74% of employers plan to offer high-deductible plans in 2015, and 23% of them will make it the only option.

Plus, across all employer plans, you have to pay more out-of-pocket than in years past. According to Kaiser, the average deductible for single coverage in 2014 was $1,217, up 47% from five years ago. The generous, low-deductible health plan your parents once had probably won’t be available to you.

How to Make the Best of It

If you end up in a high-deductible plan, learn to make the most of the tax-free savings plan that goes with it—a health savings account (HSA). Yeah, a monthly HSA contribution is one more recurring expense on top of your student loan payments, car payments, rent, and (hopefully) 401(k) contributions. But at least this one can give you the peace of mind that you’ll have the funds to cover a health emergency.

Here’s how an HSA works: You make contributions with pre-tax income. The money carries over year-to-year. You can invest the funds in your HSA, the way you invest the money in your 401(k), and the account will grow tax-free. If you need the money for medical expenses, you withdraw it, again, tax-free. Or, if you stay healthy and have money leftover at age 65, you’re free to spend it on anything.

You qualify for an HSA if your deductible for single coverage is $1,300 or more, or $2,600 for family coverage (and if you’re not claimed as a dependent on someone else’s tax return). And your company might help you out. Some employers make contributions to their employees’ HSAs, of $1,006 a year on average, according to Kaiser.

For ultimate peace of mind, save enough to cover your entire deductible. But if you’re feeling pinched, at least put away the money you saved on premiums by switching from a more expensive plan.

More:

Read next: 4 Ways Millennials Have It Worse Than Their Parents

MONEY Health Care

Why a Popular Way to Control Health Care Costs Is Under Fire

businessman with blood pressure cuff on his arm
Eric Hood—iStock

Employers are increasingly turning to wellness programs to keep workers healthy. But a new lawsuit is challenging whether your boss can force you to get medical tests—or pay more for your health insurance.

Do it or else. Increasingly, that’s the approach taken by employers who are offering financial incentives for workers to take part in wellness programs that incorporate screenings that measure blood pressure, cholesterol, and body mass index, among other things.

The controversial programs are under fire from the Equal Employment Opportunity Commission, which filed suit against Honeywell International in October charging, among other things, that the company’s wellness program isn’t voluntary. It’s the third lawsuit filed by the EEOC in 2014 that takes aim at wellness programs, and it highlights a lack of clarity in the standards these programs must meet in order to comply with both the 2010 health law and the landmark Americans with Disabilities Act.

Honeywell, based in Morristown, N.J., recently got a reprieve when a federal district court judge declined to issue a temporary restraining order preventing the company from proceeding with its wellness program incentives next year. But the issue is far from resolved, and the EEOC is continuing its investigations. Meanwhile, business leaders are criticizing the EEOC action, including a recent letter from the Business Roundtable to administration officials expressing “strong disappointment” in the agency’s actions.

In the Honeywell wellness program, employees and their spouses are asked to get blood drawn to test their cholesterol, glucose, and nicotine use, as well as have their body mass index and blood pressure measured. If an employee refuses, he’s subject to a $500 surcharge on health insurance and could lose up to $1,500 in Honeywell contributions to his health savings account. He and his spouse are also each subject to a $1,000 tobacco surcharge. That means the worker and his spouse could face a combined $4,000 in potential financial penalties.

“Under the [Americans with Disabilities Act], medical testing of this nature has to be voluntary,” the EEOC said in a press release announcing its request for an injunction. “The employer cannot require it or penalize employees who decide not to go through with it.”

Honeywell sees the situation differently. “Wellness is a win-win,” says Kevin Covert, vice president and deputy general counsel for human resources at Honeywell. In time, the company expects to see lower claims costs while workers avoid health problems. Sixty-one percent of employees who participated in the company’s screening last year reduced at least one health risk, he says.

Further, Covert says, it’s easy for employees and their spouses to avoid the tobacco surcharge. Smokers can take a 15-minute online tobacco cessation course, while non-smokers can simply call up the health plan and certify that they don’t smoke.

“The way they described the program was quite hyperbolic,” Covert says.

Employers are watching the Honeywell case closely because many have similar incentive-based wellness plans, says Seth Perretta, a partner at Groom Law Group, a Washington, D.C., firm specializing in employee benefits.

Eighty-eight percent of employers with 500 workers or more offer some sort of wellness program, according to a 2014 national survey of employer-sponsored health plans by the benefits consultant Mercer. Of those, 42% offer employee incentives to undergo biometric screening, and 23% tie incentives to actual results, such as reaching or making progress toward blood pressure or BMI targets.

Despite employers’ enthusiasm for wellness programs, “there’s no good research that shows these programs actually improve health outcomes or lower employer costs,” says JoAnn Volk, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms.

The health law encourages employers to offer workers financial incentives to participate in wellness programs. It allows plans to incorporate wellness incentives — both penalties and rewards — that can total up to 30% of the cost of employee-only coverage, an increase over the previous limit of 20%. If the wellness activity aims to help someone reduce or quit smoking, the incentive can be even higher, up to 50% of the plan’s cost.

Under the ADA, employers aren’t allowed to discriminate against workers based on health status. They can, however, ask workers for details about their health and conduct medical exams as part of a voluntary wellness program. What constitutes a voluntary wellness program under the law? Employers, patient advocates and policy experts want the EEOC to spell out what “voluntary” means under the ADA and clarify the relationship between the health law and the ADA with respect to wellness program financial incentives.

“The EEOC has chosen litigation over regulation,” says J.D. Piro, a senior vice president at Aon Hewitt, who leads the benefits consultant’s health law group.

The EEOC is always reviewing its guidance, but there’s no timeframe for issuing further guidance, says spokesperson Kimberly Smith-Brown.

Consumer advocates say it’s critical not to confuse incentive programs with comprehensive workplace wellness.

“The incentives are meant to engage employees,” says Laurie Whitsel, director of policy research at the American Heart Association, “but they’re not the comprehensive programming we’d like to see employers offer.” It’s really important to have a culture of health, Whitsel says, including an environment that supports a healthy workplace, from a smoke-free work environment to healthy food in the cafeteria.

Patient advocates voice another concern: That wellness program financial penalties may be so onerous they actually limit people’s access to the medications and primary and preventive care they need to get and stay healthy.

“When penalties become that high, it really is a deterrent to affordable, quality health care,” says Whitsel.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Health Care

Why 1 in 3 Americans Is Scared to Go to the Doctor

surgeon removing money from wallet
Paul Tillinghast—Getty Images

More insured Americans are skipping out on health treatments that they need because of cost, a new Gallup poll finds.

The Affordable Care Act kicked into gear over a year ago. And more than 86% of Americans now have health insurance, up from 82% in mid-2013.

Even so, according to a new Gallup poll, a third of Americans say they aren’t getting the medical care they need because of cost.

In fact, more Americans are putting off medical care than ever before in the 14-year history of the poll.

Source: Gallup

Uninsured Americans aren’t the only ones delaying medical treatment. Some 34% of Americans with private health insurance say they’ve skipped out on care because it was too expensive, up from 25% last year. Additionally, 28% of households that earn $75,000 or more report that family members have delayed care, up from just 17% last year.

One likely culprit? Rising out-of-pocket costs. Americans who get healthcare coverage through their employers have seen deductibles more than double in the past eight years.

image (10)
Source: Kaiser Family Foundation, Employer Health Benefits 2014 Annual Survey. Note: Data is for covered workers with a general annual health plan deductible for single coverage.

It’s part of a movement towards what’s come to be termed “consumer-driven health care.”

The thinking is, when patients are more aware of healthcare costs and more discerning about what care they really need, they will also be more discerning in their usage—which in theory would lower costs for everyone involved. Two-thirds of large employers think consumer-driven healthcare is one of the most effective tactics to reduce costs, according to the National Business Group on Health.

But Gallup found that more Americans are skimping on care that they think they really do need. According to the survey, 22% of Americans say they’ve put off treatment for a serious condition, vs. 19% last year. The percentage of Americans who say they put off care for a non-serious condition stayed flat at 11%.

Previous studies have found that when consumers are asked to share more of the costs, they put off both necessary and unnecessary care.

For example, one study found that people on high-deductible plans are less likely to buy expensive, brand-name drugs (which may be sensible), but they’re also less likely to buy generic drugs they need to treat chronic conditions (likely not sensible).

When forced to pay more out-of-pocket, men in particular are more likely to skip care for serious problems like irregular heartbeats and kidney stones.

What’s especially frightening about these findings is that delaying needed care to save money in the short term may result in more costly complications and more difficult-to- treat health issues in the longer term. Skipping the cholesterol screening now, for example, could mean racking up a $100,000 tab for a heart attack later.

Are you avoiding treatment you need because you’re afraid of the bill? Try these strategies to get the same healthcare for a quarter of the price. If you’re on a high-deductible plan, use your Health Savings Account to budget for your expected—and unexpected—costs.

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