The Health Care Affordability Index report also found that among adults with low incomes, 53 percent simply can't afford healthcare.
The results were in line with Commonwealth's 2014 findings, suggesting the problem isn't getting any better.
Accounting for all private, individual or marketplace insurance, the Affordability Index found that only 13 percent of adults felt their premiums were too pricey, and 10 percent said they had unaffordable deductibles. However, 43 percent said their deductibles were placing them under undue financial burden. Half of low- to moderate-income individuals reported the same, while a significant number of adults with higher incomes -- 32 percent -- said it was difficult to afford their deductibles.
When it came to visiting a doctor or filling prescriptions, fewer people had difficulty affording copayments and coinsurance. But the lowest-income respondents, those with incomes under 20 percent of poverty line, said it was difficult or impossible for them to afford their payments. Roughly one-third of low-income adults also said that this was the case.
This is problematic for employers and insurers who want to discourage people from overusing healthcare services, or utilize services that, from a medical standpoint, may be unnecessary. The survey finds that cost-sharing also creates disincentives for people to obtain necessary care, such a prescription drugs or doctor visits prompted by illness.
Many people with low incomes and high deductibles report delaying or avoiding necessary healthcare, too, the study found. And 40 percent of those with high deductibles that amount to 5 percent or more of reported income said that they had not gone to a doctor when sick, didn't get a preventative care test, skipped a follow-up test or avoided visiting a needed specialist. At the same time, 21 percent of those with lower deductibles relative to their income avoided needed medical care.
The Commonwealth Fund said some respondents said they had received surprise bills from providers assumed to be in their network. An in-network surgeon at an in-network hospital, for instance, may perform surgery on a patient, but the patient may receive a bill from an anesthesiologist from outside the network. Out-of-network providers could potentially charge patients the difference between their allowed amount and what they would charge, a practice known as "balance billing." Three of 10 respondents reported that this had happened, with 36 percent of this group saying it was because they had not yet met their deductible, and 26 percent saying that it was due to care from an out-of-network provider.
Some states have started to crack down on this practice. New York, for example, established a law in April that would only hold patients accountable for in-network costs if they they receive any such surprise bills, placing the responsibility on the healthcare provider to make sure they explain coverage before service.
The Commonwealth Fund suggests in its findings that if more states choose to expand their Medicaid programs, there will be more affordable choices for many low-income people.
Currently, 30 states have expanded Medicaid under the Affordable Care Act.