Health Care Use and Decision Making Among Lower-Income Families in High-Deductible Health Plans

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Abstract
In the midst of the current economic downturn, many Americans are paying more for their health care.1 One way in which a growing number of families are facing higher levels of cost-sharing for health care is enrollment in high-deductible health plans (HDHPs).2 These plans, which feature annual deductibles of at least $1000 per individual and at least $2000 per family before most services are covered, seek to encourage patients to become more cost-effective consumers of health care and frequently offerlower premiums than other types of health insurance.1 In early 2009, 23% of all nonelderly adults with private insurance, and nearly 50% of adults who purchased coverage through the nongroup market, were enrolled in an HDHP.2 Because of their relatively low premiums, HDHPs are also playing a prominent role in expanding insurance coverage. For example, most individuals who have purchased unsubsidized plans through the Commonwealth Connector, the new health insurance exchange in Massachusetts, have selected products like HDHPs that offer low premiums with high levels of cost-sharing.3

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