Higher Out-of-Pocket Costs for Recommended Chronic Disease Care in High-Deductible Plans

A retrospective cohort study in JAMA Network Open estimated annual patient out-of-pocket costs for guideline-concordant diabetes and hypertension care under high-deductible versus non–high-deductible health plans. Researchers used 2022–2023 national commercial insurance claims for 539,590 adults aged 18–64 years with employer-sponsored coverage who had received recommended care. Entropy balancing and generalized linear models with geographic fixed effects were used to estimate costs, with weighting intended to represent the broader sample of people with these conditions.

Estimated annual out-of-pocket costs for diabetes care were $153.91 in high-deductible plans versus $68.06 in other plans. Corresponding costs were $128.94 versus $53.89 for hypertension and $164.18 versus $100.60 for coexisting diabetes and hypertension. All comparisons had P values below .001. Costs were 1.6 to 2.4 times higher in high-deductible plans, with absolute annual differences ranging from $63.68 to $85.85.

The findings quantify additional patient spending for minimum recommended chronic disease care, rather than total health care spending. They may inform discussions about affordability in primary care. However, the observational design cannot establish causality, and cohort entry required receipt of guideline-concordant care; these estimates do not directly measure costs or outcomes among patients who forgo recommended care. Full-text details were unavailable for this update.