Even with Medicare, the medication Teresa Unseld needed to manage her type 2 diabetes was so expensive — more than $200 a month out of pocket — that the retired college art teacher quickly burned through her savings, then picked up part-time work just to pay the pharmacy bill.
Even that wasn’t enough. She cut back how often she took the medication, which helps manage her blood sugar, to about half as often as prescribed.
“I don’t want something to happen and I don’t have any savings,” said Unseld, 69, of Drexel Hill. “I did that so I could have a little nest egg. Not even a nest egg — I’m still building the nest, I don’t have any eggs in it.”
Half of Pennsylvania residents in a new survey by Pennsylvania Health Access Network and Altarum Healthcare Value Hub struggled with health-care costs in the last year and nearly two-thirds were worried about how they will pay for care in the future.
While health-care costs are a familiar financial strain for many, the coronavirus pandemic has laid bare just how expensive health care and health insurance can be — and how critical it is to be able to access and afford both.
“It has amplified people’s awareness of how important health care is, how vulnerable they are if they don’t have it, or if they have it but can’t afford to use it,” said Lynn Quincy, a senior adviser at Altarum, a health-care consulting firm.
In the last year, thousands have lost job-based coverage because of a layoff, turning to the individual marketplaces or Medicaid. Others who have gone uninsured for years are finally buying up plans because COVID-19 has made coverage a new priority.
About half of the 1,150 Pennsylvania residents surveyed between Oct. 30 and Dec. 10 said they had experienced at least one health-care burden in the last year, leading to significant — and potentially dangerous — health implications:
A quarter of respondents delayed going to the doctor or having a needed procedure.
About 20% skipped the doctor, a procedure, or a recommended test entirely.
22% skipped doses of a medication, cut pills in half, or did not fill a prescription.
People who got the care they needed often struggled to pay the bills. A quarter of survey respondents said they had taken drastic measures to pay off medical debt, such as borrowing money, getting a loan or second mortgage, using their savings, or racking up credit card debt. About 7% said they had to forego food, heat, housing, or other basic necessities to pay for needed medical care.
When Unseld was diagnosed with type 2 diabetes in 2010, she was covered by her employer’s health plan and experienced little out-of-pocket cost for her medication. But when she retired and enrolled in Medicare, she learned the drug she takes, Ozempic, came with a hefty price tag because it is a brand-name drug with no generic alternative.
The drug costs almost $900 a month under Unseld’s supplemental drug plan. She is responsible for a $47 co-pay and the plan picks up the rest of the bill until her prescription costs reach a total of $4,130.
Then, she falls into what is known as Medicare’s “donut hole,” and must pay 25% of the drug’s total cost — about $212 a month. With such an expensive medication, Unseld typically lands in the donut hole by April.
In addition to returning to work part-time in 2017, Unseld started researching how to better manage her type 2 diabetes without medication through diet and exercise. Type 2 diabetes occurs when the body does not regulate blood sugar properly. Diet, exercise, and other lifestyle changes can help, but often medication is still needed.
Unseld found that her lifestyle changes enabled her to stretch a month’s supply of Ozempic for two months.
“Even if the doctor said I don’t think you should do it, I probably would do it anyway,” she said. “I look at the numbers, I think about how I feel, and I make the ultimate decision. Being in a country where you’re forced to make choices like this, I became pretty radical.”
The approach was working well, until the pandemic hit and Unseld lost her part-time job. She has been looking for work, but her options are limited because she does not feel comfortable teaching in-person.
The pandemic has exacerbated health-care cost concerns for lots of people, according to the Altarum survey. Three-quarters of respondents said they were worried about affording health care in the future, and nearly 60% said they were specifically worried about affording COVID-19 treatment if they contracted the virus.
Early in the pandemic, many insurers, including Independence Blue Cross, the area’s largest insurer, waived costs for coronavirus tests and hospital treatment. But as the pandemic carries into another year, insurers who voluntarily covered coronavirus costs in 2020 may begin to change their policies, which could lead to more unexpected bills, said Sabrina Corlette, a founder and co-director of Georgetown University’s Center on Health Insurance Reforms.
Independence Blue Cross will continue to waive cost-sharing for COVID tests ordered by a doctor and hospital treatment through March, and is considering extending coverage further. COVID-19 patients may be billed for follow-up care, for instance if they are sent to a rehabilitation facility after being discharged from the hospital.
Tests for the virus will continue to be free for the duration of the public health emergency.
Tests and treatment for the insurer’s Medicare Advantage plan members will be covered in full until the health emergency ends
For now, Unseld is doing her best to stay healthy and pay for her medications with the savings she has been able to rebuild while working. But she still worries about what would happen if she got sick and jokes she’s “a chocolate cake slice away” from financial turmoil.
“I know I’m on a thin line,” she said. “I had to take things into my own hands and I shouldn’t have had to.”