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America's 25 Million Underinsured: A Quiet Growing Concern The Commonwealth Fund estimates that the number of underinsured adults (ages 19-64) in America grew by 60 percent from 2003-2007 to approximately 25 million. The underinsured are people who have health insurance that doesn’t adequately cover their medical expenses. The underinsured are paying out of pocket not only for their insurance plan deductibles, but also for required copayments and for medications, treatments and services that are not covered by their individual plan. With such a heavy burden of out-of-pocket costs, the underinsured are forced to make difficult choices in their household budgets, whether, for example, to pay the mortgage or fill a life-sustaining prescription or whether to buy groceries or see the doctor for treatment of a nagging illness. As our Patient Access Network (PAN) Foundation patients have told us – it can truly become a matter of choosing life or death. This isn’t just a “poverty problem.” The Commonwealth Fund research also showed that those hardest hit by being underinsured were families with middle and high incomes – those whose income was greater than 200 percent of the FPL or those with an annual income of $40,000 to $50,000. These families may have plans with high deductibles of $1000 or more, and with caps on or no coverage of certain services, which costs can eat away at family resources. It also hits senior citizens and those on Medicare, either because the person doesn’t have funds to cover copayments and deductibles or because they fall into the Medicare drug benefit “doughnut hole,” where they’ve outspent their annual benefit, but haven’t yet reached the Medicare catastrophic coverage level. A formal definition says that these are individuals who are insured all year long, but fall into at least one of these categories:
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