Even 'good' insurance comes with hidden hospital bills

The claims were processed by three major health insurers that cover patients in all 50 states: Aetna, UnitedHealthcare and Humana.

The team examined expenses accrued by hospitalized adults ages 18 to 64. The study also looked specifically at bills for seven common reasons for hospitalization: heart attack, childbirth, pneumonia, appendicitis, heart bypass surgery, total knee replacement and spinal fusion.

The result: Out-of-pocket costs averaged $1,013 in 2013, up from $738 at the start of the study.

Patients with individual market plans fared the worst. The study found they were stuck with an average bill of $1,875 per hospitalization by 2013, followed by roughly $1,200 for those with consumer-directed health plans. These plans generally allow more consumer decision-making, often with health savings accounts alongside high deductibles.

In particular, average deductibles what consumers pay before insurance kicks in nearly doubled, jumping from $145 to $270.

And co-insurance ballooned 33 percent, from an average of $518 to $688.

Although the study was conducted before Obamacare, the team pointed to recent Kaiser Family Foundation figures that suggest the upward trend is continuing unabated. Today, Kaiser says 81 percent of patients with employer-based insurance will face an annual deductible approaching $1,300.

These results are very similar to an analysis we put out a couple months ago, said Kaiser senior vice president Larry Levitt.

Out-of-pocket health costs are increasing rapidly for people with health insurance at the same time that wages have been stagnant, he said. This can be a particular challenge for low-wage workers, who often dont have enough savings to cover a financial emergency like a major illness.

The results illustrate the changing nature of health insurance, with the bottom-line being less generous coverage, Levitt added.

The best response, said Kevin Lucia, a senior research professor at Georgetown University in Washington, DC, is to arm consumers with information.

Health insurance works for many until you actually have to use it, Lucia said. And thats because theres a very low level of health literacy among consumers, both among those who have a history of having insurance and all the new people Obamacare is bringing in.

Insurance is a very complicated instrument, Lucia added. But its very important that we provide the resources to help consumers get involved and better understand the policies theyre buying and their financial risk, so there are fewer surprises, he said.

The findings were published online June 27 in the journal JAMA Internal Medicine.

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