![]() ![]() 6 On the other hand, moral hazard might increase inefficient health care use as a result of lower cost-sharing. Others exploring the concept of resetting deductibles have found potential value gains, particularly for lower-income patients. The findings of this cross-sectional study suggest that capping monthly out-of-pocket costs could meaningfully reduce the cost-sharing burden for many commercially insured patients in the US without regulating health care prices. Data analysis was performed from June 2020 to July 2022 using SAS statistical software version 9.4 (SAS Institute) and Stata statistical software version 16.1 (StataCorp). Finally, we stratified by enrollment in a low-deductible vs high-deductible health plan because we expect those with higher deductibles to benefit more. We also calculated the percentage of enrollees benefitting under each monthly limit and the share of total costs shifted back to plans as a proxy for how much premiums would have to increase, assuming health care use and prices remained constant. We then collapsed at the patient-month (highest monthly in-network out-of-pocket costs) and patient-year (in-network out-of-pocket costs, out-of-network out-of-pocket costs, and plan costs) levels to obtain the outcomes used. We recalculated patient and plan costs under a $250 and $500 monthly limit for in-network out-of-pocket costs across all claims (inpatient, outpatient, and pharmacy) using the observed values as our status quo. 5 We restricted the sample to those younger than age 65 years, enrolled for the full calendar year, and not enrolled in a health maintenance organization or capitated plan. We used national commercial health insurance claims data from the 2019 IBM MarketScan Commercial Database to assess changes in patient cost-sharing and plan spending under hypothetical monthly limits. This cross-sectional study follows the STROBE reporting guidelines and was considered exempt by Boston University Medical Campus institutional review board. Our objective is to assess how much monthly cost-sharing limits, as opposed to annual limits, could reduce patients’ out-of-pocket costs. We extend this idea to in-network care received by the commercially insured. For example, President Biden proposed annual caps on retail drug costs in Medicare and monthly caps for insulin in his Build Back Better Framework, both of which were passed by Congress in the Inflation Reduction Act in August 2022. ![]() 3, 4 Policy makers have focused on addressing out-of-pocket costs rather than high prices for health care and prescription drugs. 1 High out-of-pocket costs can cause downstream adverse health effects, such as delayed or missed care and poor medication adherence. 1 - 3 Less than one-quarter of households with incomes between 150% and 400% of the federal poverty level can afford a typical family deductible of $12 000. Despite this, difficulty affording care has remained a problem even for the insured, many of whom cannot afford their deductibles. The Patient Protection and Affordable Care Act (ACA) aimed to improve affordability by requiring that all Marketplace and ACA-compliant health insurance plans include an annual maximum for in-network out-of-pocket costs. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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