Hidden Costs of Preventive Care: Why Understanding Patient Demographics Matters

by Jon Scaccia December 3, 2024

When the Affordable Care Act (ACA) was introduced, it promised to make preventive care free for many Americans. This exemption from cost-sharing for services like cancer screenings, diabetes tests, and cholesterol checks aimed to improve health equity. But new research sheds light on a troubling reality: unexpected out-of-pocket (OOP) costs continue to affect many patients, particularly those from marginalized groups. Understanding who bears the brunt of these costs is key to fostering equity in healthcare.

Surprising Out-of-Pocket Costs

Between 2017 and 2020, researchers analyzed insurance claims from over 1 million privately insured adults across the U.S. for preventive services such as breast and colorectal cancer screenings, contraceptive services, and diabetes and cholesterol screenings. The results? A staggering 40.3% of preventive care visits resulted in OOP expenses. The average cost, when incurred, stood at $113, although this varied widely across demographics.

Lower-educated patients faced 9.4% higher odds of incurring OOP costs compared to those with a college degree. Low-income patients (≤$49,999 annually) were less likely to face these costs compared to their wealthier counterparts but, when they did, they paid significantly more—up to $11.76 more per visit. These hidden costs could discourage future use of preventive services, potentially leading to worse health outcomes over time.

Who Pays More and Why?

Let’s dig deeper into why certain groups are more vulnerable to these unexpected costs:

• Lower Education Levels: Patients with a high school diploma or less had a greater likelihood of receiving bills, even for preventive services that should be cost-free under the ACA. This may stem from a lack of insurance literacy—lower-educated patients may not fully understand their coverage or how to navigate healthcare benefits.
• Income Disparities: While low-income individuals were less likely to be billed for preventive care, they faced higher OOP costs when they were. This could be due to selecting more generous insurance plans to avoid risk, yet ending up with higher conditional costs.
• Racial and Ethnic Differences: Non-Hispanic Black patients were more likely than non-Hispanic White patients to face unexpected bills and paid higher amounts when they did. Asian patients also faced higher costs, while Hispanic patients experienced lower-than-average OOP expenses. These disparities may arise from differences in provider billing practices, insurance plan quality, or systemic issues such as discrimination and language barriers.

Why This Matters for Public Health Practitioners

These findings should alarm public health professionals and policymakers. Over 40% of preventive care visits resulting in OOP expenses undercut the ACA’s promise of affordable healthcare access. Marginalized groups bearing a disproportionate share of these costs could lead to even greater health inequities.

Practical Implications

Healthcare practitioners, researchers, and policymakers need to act on these insights:

1. Educate Patients: Enhance patient education programs focusing on insurance literacy, especially for those with lower education levels. Simple guides or community workshops can help patients better understand their rights and navigate their insurance.
2. Monitor Insurance Practices: Push for more transparent billing practices and hold insurance providers accountable for misclassifying preventive services.
3. Advocate for Policy Changes: Address gaps in the ACA’s preventive care exemption by advocating for clearer guidelines and stronger enforcement mechanisms.

The persistence of OOP costs may also erode trust in the healthcare system. When patients anticipate unexpected bills, they are less likely to engage with preventive services, impacting long-term public health outcomes. For example, missed screenings could lead to delayed diagnoses and worse prognoses for conditions like cancer and diabetes.

Join the Conversation

Have you or someone you know experienced unexpected medical bills for preventive care? How do you think healthcare policies could better address these hidden costs? Share your thoughts and join the conversation in the comments or on social media.

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