To protect yourself from large medical bills, insurance may not be enough

Health insurance used to be the only ticket you needed to gain financial access to health care. It is still vitally important, but for many people, it is no longer enough.

High deductibles and co-payments, along with coverage that is limited to narrow networks of providers, can leave patients with large bills, even when they have coverage.

In a new survey conducted by the Kaiser Family Foundation and the New York Times, about 20% of those under age 65 who had insurance reported that they or someone in their household had difficulty paying medical bills in the past year. The percentage was similar regardless of whether coverage was through an employer, Medicaid, or an Obamacare insurance exchange.

Not surprisingly, for those who lacked insurance, the percentage was much higher – 53%

But there is also some good news. The number of people who face difficulty paying medical bills seems to be declining.  In a survey conducted by the federal Centers for Disease Control and Prevention, the percent of respondents under age 65 who reported that someone in their family had problems with a medical bill fell from 21.3% in 2011 to 16.5% in 2015. This is probably due to a significant drop in the rate of uninsurance that occurred during this time as the Affordable Care Act was implemented.

These surveys tell us two things. First, insurance remains crucially important in affording medical bills. But second, it does not always offer complete financial protection. Obamacare's success in lowering the rate of uninsurance resolves only part of the problem.

What can you do to protect yourself? First, check the terms of your coverage. If you are covered through an employer, speak with the HR department. If you bought a policy through an exchange, speak with the insurance company. Find out the size of the annual deductible and the expenses that are subject to it. The deductible may be as large as several thousand dollars, but it should represent the maximum you will have to pay out of your pocket in a single year.

The catch is out-of-network providers. Find out whether charges from nonparticipating hospitals and physicians count toward satisfying the deductible. If they do not, you could be responsible for the entire charge regardless of its size. If you can plan a health care service in advance, check with both the provider and the insurance company to see whether the provider participates in your plan.

Second, shop around. If a provider you want to see is not part of your plan's network, ask whether their charges are negotiable. Surprisingly, they often are. You can also use various web-based tools for comparing health care prices, such as Healthcare Bluebook and WHYY's Pricecheck.

The problem of health care affordability is still a long way from being solved. It is best to be prepared.

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