"Many Californians can't afford higher-premium plans, especially in the current economic climate," says the report's lead author, Dylan Roby, a Center research scientist. "But the alternative - high-deductible plans - may cost less initially but can cost thousands of dollars when you need health care. When that much money is on the line, a health emergency can also become a financial emergency."

This exchange, in accordance to the federal law, will offer more robust health coverage options and limit out-of-pocket deductibles at $2,000 for individuals and $4,000 for families while offering subsidies for those with low-incomes.

"The insurance exchanges may offer a lifeline to individuals and families by establishing reasonable out-of-pocket maximums for families to pay," Roby notes.

The report also notes significant many low-income Californians are likely to choose high-deductible health plans. Thirty-two percent of low-income enrollees in commercial PPOs had those plans, and 25 percent of low-income commercial HMO enrollees and 24 percent of commercial Kaiser HMO enrollees also reported choosing high deductible plans.

Of the individually insured, meaning those who purchase commercial insurance directly from brokers, HMOs or PPOs, 38 percent purchased high-deductible plans. For those with employer-based plans, only 12 percent had high-deductible plans.

Delayed treatments are found with high out-of-pocket costs. For example, 20 percent of commercial PPO enrollees with high-deductible plans were more likely to delay care than those without high-deductibles at 17 percent.

Most who participate in high-deductible health plans had no health savings account to potentially help with the cost of unexpected health care. Among commercially insured respondents with a high-deductible plan, 69 percent of PPO members, 77 percent of HMO members and 80 percent of Kaiser HMOs members reported having no health savings account for medical expenses.

The findings, the authors note, show the need for greater education to help consumers understand the costs and consequences of health insurance choices.

"Consumers need information to choose the right coverage, so they receive the care when needed, not just when they can afford it," says Sandra Perez, director of the California Office of the Patient Advocate. "Thus, it is essential that a consumer have access to reliable information and helpful decision-making tools to make an informed choice when selecting a health insurance plan. "