Despite the significant success in reducing the rate of uninsured Americans since the passage of the Affordable Care Act (ACA), more than one in five working-age adults are still considered “underinsured,” defined as having annual out-of-pocket costs, excluding premiums, exceeding 10 percent of household income. Cost-sharing strategies that require consumers to pay more for all services, such as high-deductible health plans (HDHPs), reduce the use of essential health care, especially by underserved populations. Thus, clinically driven payment and benefit designs to encourage access to necessary care for at-risk individuals are warranted.
