The ACA policies with the lowest premiums carry very high deductibles and co-pays. Many of those who obtained insurance through the ACA marketplace, as well as many of those with employer sponsored insurance, are faced with very high deductibles and co-pays.  While the Affordable Care Act provides certain preventive screenings, such as mammograms, with no deductible or co-pay, patients who select a “bronze” plan (19% of all newly insured according to the Kaiser Family Foundation), which has the lowest premiums, will be faced with deductibles as high as $6,000 for an individual or $12,000 for a family, that make the coverage essentially unusable for most primary care services.  Even the second cheapest “silver” plan, the one most often selected, has deductibles of $2500 and $5000.  A recent article in the New York Times recounted the plight of such patients who have insurance but can’t afford to use it. These are the patients we refer to as “underinsured,” whose coverage is only useful for a catastrophic illness or injury.  Incidentally, this also includes many who have employer provided health insurance.