In 2017, Susan learned that she carries a genetic mutation that may elevate her lifetime risk of developing breast cancer to 72 percent.
Her doctor explained that individuals who have this mutation in the BRCA2 gene have choices in treatment. Some people opt for a preventive double mastectomy. But Susan could instead choose to undergo increased cancer screenings, which, for her, would mean an annual mammogram and annual MRI scan.
Because she had just had her first child, Susan chose increased surveillance — that meant she’d be able to preserve her ability to breastfeed.
Both Susan and her husband, who make their home in Broomall, Pa., have insurance provided through their respective employers to help pay for medical treatment. But there’s an expensive hitch: These annual scans she’d need would be pricey, and their companies offered only high-deductible health plans.
Susan’s annual deductible for her plan (which covers her and her child) is $6,000 annually. (NPR has agreed to use only Susan’s first name because she worries any publicity might jeopardize her job.)
“I’ve worked at my employer for 17 years,” she says. “When I first started, there was no paycheck deduction for health insurance and my copay was only $5. But in 2011, my employer switched to only providing high-deductible insurance plans.”
Susan went in for her first mammogram and MRI in February 2017. Her out-of-pocket cost for the MRI was more than $2,000. The bill for her mammogram was $1,088 (although she was eventually able to appeal and have the charges for the mammogram reduced to $191).
As a result of the high bill, Susan decided to put off her 2018 annual screenings until she had dealt with paying off the bills from 2017.
Susan’s story of delaying care because she’s underinsured is not an outlier. A study published last month in Health Affairs examined claims data from a large national insurer for 316,244 women whose employers switched insurance coverage from low-deductible health plans (i.e., deductibles of $500 or less) to high-deductible health plans (i.e., deductibles of $1,000 or more) between 2004 and 2014.