You know that despite all the hoopla, lawsuits, demonstrations, whatever, most people have already begun to benefit from the Health Insurance Reform (Patient Protection &Affordable Care Act (H.R. 3590) and the Health Care & Education Affordability Reconciliation Act of 2010 (H.R. 4872) passed in 2009. It would have been nice to have a real health reform bill, but given the first sentence, it’s not surprising that the half-a-loaf logic obtained.
We already have add-on insurance for children under the age of 26. Before PPACA, most of those kids failed to have insurance, unless they were employed. (Given the current unemployment rates for folks under 30, that would be a tall order nowadays, too.) We also have no more lifetime or annual healthcare limits on coverage. Free preventive care for seniors. All of these are big changes.
But, there’s a really big one coming now. One that won’t be a money issue or a benefit issue, per se. No, it’s a requirement for health care insurance plans to spell out what they cover and what they don’t in plain, unadulterated English.
All private insurance plans must provide a standardized summary of the plan’s costs and benefits. The regulations also stipulate that three separate costs scenarios be provided- diabetes management, breast cancer treatment, and having a baby. Yes, I admit that none of these three apply to me- or probably not to you, but unless the insurance companies deliberately manipulate their plans to maximize their provisions for these three cases to the detriment of other maladies (entirely possible), we should be able to finally know how we are covered- what are the deductibles, the co-pays, and the provisions for each.
These summaries are to be provided to subscribers upon request. No need to pay a fee or wait beyond a stipulated waiting period. The plan’s provisions are also to be provided before a consumer (not an employee) enrolls and, again, 30 days prior to the plan’s renewal.
The summary must be provided on no more than four double-sided pages, in 12 point type. The premium costs, co-pays, and co-insurance amounts are all required to be clearly identified. A chart detailing the out-of-pocket costs for various services also must be supplied; a sample form is found here: www.healthcare.gov/news/factsheets/labels08172011b.pdf.
This program has other benefits that will start coming due to us (assuming the Supreme Court rules that this program is no different than other government regulations that cover individuals) including the big 2014 provision: Insurance companies will be limited to three factors in determining costs for insurance- whether one smokes, where one lives, and how old one is.
Hi Roy: I am all for simplicity. I make my living at it. Do I think this is as simple as it could be? No, but at least it’s a step in the right direction.
Of course, I’m prejudiced, but some of the benefit guides by professional writers are simpler, but the challenge has always been getting people to read them. The tendency is to pick up your benefits summary when you need treatment.
Being educated is the best way to make selections that make sense for you.
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Cathy- RIGHT ON!
I simply think that the insurance companies hire experience writers to obfuscate. And, when they are done- they run it by their lawyers to render even that chronicle totally lucid.
Ah, for the plain language of facts….
Roy
We own our own company and our health insurance not only goes up every year on average around $100 but I don’t even know how to begin to understand what I am getting with those thousands of dollars we give them a year.
Makes me rethink the whole owning my own business thing over again. There are days I wish I had an employer that simply said, “this is what you get.” Done. Instead we are the employers making all these decisions. ARGH!
I really can’t wait until I can understand what the heck I’m getting in plain english and before any doctor visit.
~Allie
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Allie- I feel for you. Really.
I have an answer for that (actually, not knowing exactly where you reside, maybe not). But, I have, over the past decade, worked to develop programs for our clients so this is not the major issue it could be.
But, even with the 4 page (I am sure multi-colored, graphics laden) blurb, we still may not comprehend all our coverage.
For example, I have to explain to many clients that the $49 the insurance company wants to add to provide “dental coverage” is strictly window dressing. The deductibles are high, the omissions are many- and if you go to an oral surgeon, it is covered without the rider (for example).
Yes, this is a nightmare. Hopefully one that will disappear completely within 24 months.
Roy
I welcome anything that would make health insurance coverage easier to understand. I am thankful that I have health insurance but I am sometimes very frustrated about the tests and services that they refuse to pay for.
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Janette:
Feel blessed if your are only very frustrated. Many folks end up filing for bankruptcy over what they don’t cover! Worse yet, when they could not obtain insurance.
The trials and tribulations of being self-employed, un-employed, or a denizen of the many firms that don’t offer insurance.
Roy
Hey Roy,
Insurance can be tough at times. Here, we follow a different system. My dad’s company handles our insurance. Though I have options of either choosing from my own company’s insurance or my dad’s company (unmarried girls are under their dad’s sponsorship if we are in the same country); I have opted for the one with my dad’s because it has clear cut terms and conditions and help is just a phone call away.
With both my parents being diabetic, they even give me the choice of having annual check ups at a subsided rate. But for my parents, things get tough at times. There are so many things that are just not covered under insurance for chronic diabetic patients and sometimes paying for it becomes a little stressful. But then, health is a priority.
In India, health insurance is even tougher for many. Mainly because affording it is a problem when almost 60 percent of the population are under the poverty line and can’t even afford daily food. I went with my granddad through the process of obtaining his health insurance and it does get overwhelming at times. I just hope for clear, transparent policies that might make taking care of one’s health a choice and not something to be dreaded.
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Hajra:
That is a problem, alright.
We buy insurance to cover our needs. And, then when we need it, we are told, that the case is not covered. It’s why we need clear and concise language. That way we can at least know if we are buying insurance or a pet rock.
Roy
The American health system still bamboozles me. For a country with so much promise, why has health become such a difficult thing to enjoy and keep?
I think insurance companies are a rort in whatever area. Many people this year found out that none of their policies covered what they thought around the world – Australian, NZ, Japan, USA. Simplifying all insurance could be the solution – oh but that will never happen – insurance is big business and like the banks is full of BS both in what they offer and what they deliver
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Roberta:
There is absolutely NOTHING I can add to your comment.
You said it all!
Roy
I live in Texas and had to get High Risk Insurance. None of the conventional insurance companies would insure me because of my medical issues. I thought the cost was high until I tried paying for my medications totally on my own. The insurance made things a little better, but the ultimate price is pretty much the same. And I am so lucky that I get 6 doctor visits a year. That is for any doctor.
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Ann:
You just discussed the problem for most self-employed and small-employee census company in America. The ability to obtain affordable insurance that provides useful benefits is difficult indeed.
I am so glad you found an alternative.
Roy
Sounds like a winning idea to me! I’m all for the simple…..
I hope we’re right, Tor- and the insurance companies don’t manipulate scenarios, as i wrote to Michelle.
Roy
I’m with the previous commenters. It’s all been extremely confusing and I’m happy for any step towards making it simple to understand exactly what’s offered for what price.
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Michelle:
I agree with you. But, I am somewhat fearful that the insurance companies will manipulate their benefits to favor these three situations and reduce comparable benefits for other maladies and treatments. In so doing, the facts as required will be in black and white- and totally useless.
Roy
I just call the insurance company an ask my questions rather than sift through the papers of gibberish. I only read those before buying.
i find it annoying that they hugely increased my cost when i turned 60 even though I don’t get sick and rarely file a claim.
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Ali:
As I said to Lynn, these price increases are the direct result of state authorities failing to take control. I have written about the situation in a slew of states where the “reserves” the insurance company claims to need exceeds the entire amount spent for benefits in a given year. But, without real regulation, that situation will persist.
I even have a client with 8 employees that has been hit with premium increases of 78% over the past three years. The coverage has not changed; the total claims made over three years has not met any three of the total monthly premiums. When discussing this with the firm, they say- the client is part of their internally defined small business pool. And, they can’t determine what their risk really is. So, they choose the premium accordingly. When I asked them, “If you don’t know the risk, how can you possible choose a number?”, they hung up. Ah, customer service.
Roy
This is long time coming and should have been mandated decades ago. Insurance is a very bad word for me to even say or talk about. Our health insurance has increased over 40% from last year and previously it was increased 13%. PLUS we have a $3500 deductible on EACH of us. Our out of pocket has been on average $6200 per year. With premiums now of over $7500…. I would prefer to put those funds in my annuity that guarantees me 4% for life.
So I am happy to hear that we will have a more comprehensive way of determining what is covered instead of being surprised when the doctor’s office says, you owe us $200 today Mrs. Brown – uugghh.
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Lynn- you are absolutely correct.
The rate increase is a result of the failure of YOUR state to properly regulate the insurance companies. It is the primary reason why I am terribly unhappy with the mediocre results of the insurance reform. I know that one party considers this anathema, but federal regulation is the only way to go. And, part of the reason is the corporate lobbyists figured out that it’s a breeze to work with state legislatures- they can write the entire law, have it proposed by a friend, and enacted without the public ever realizing who really was the progenitor of these laws.
Roy
Wow! I’m confused enough about my finances. =P I never had to deal with this in Canada, but now that I’m living abroad, I’ve had to look into travel health insurance plans. I chose one that was extendable and recommended by others exactly because it was so confusing to sift through all the different possibilities. I love the idea of detailed summaries that I can analyze and compare. I’ll have to talk to my health insurance providers to see if they have something similar! =) Thanks for the info, Roy! Super helpful!
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Samantha:
Travel insurance programs are among the worst to compute. And, their fees are insanely high.
I just had to price a travel insurance program for a client (CEO) who shall be heading to Greece in May. There was the factor of age, the factor of the total travel costs (they would NOT let me just insure for the air fare- which is why insurance was desired; business exigencies may require my client to NOT attend this meeting), the fact that it’s Greece and there may be a revolution, the age of my client (for the health component- if she’s ill, she’ll miss the plane), state of marriage (divorcees cost more), etc.
We decided that for $ 600 we’ll just settle for the credit- minus the $ 200 rebooking fee- from the airline, should a cancellation be required.
Roy
As always, thanks for distilling down an ever complicated issue. I agree smoking should be a consideration and limiting factors so companies can’t discriminate against who they insure for how much is understandable. There is probably an explanation for location statistically speaking, but I feel age should either be factored in with weight, physical condition, eating habits, levels of exercise or be gauged like Dr. Oz does – not biologically but based on how you’ve either aged your body or kept it young, not by your date of birth. Some of the population, myself included, are in better shape than many people who are half our age…yet every year, my insurance rates go up exponentially though I weigh the same as I did in high school and am in as good, if not better shape then back then. Health insurance that worked like car insurance where good behavior and no accidents is rewarded through lower rates would be greatly appreciated since it does take time, effort and a financial investment to live on the high range of healthy…and might be a good incentive for others to make some changes toward healthier lifestyles.
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Tambre:
The problem you state is the exactly how the insurance companies make their money- from assessing higher rates (willy-nilly) to individual contracts and small company pools. These folks lack the clout and are stuck. If you look at what I wrote to Lynn Brown, you can see the facts about this rating system. The insurance company wants each “contract” to be profitable. And, they don’t truly rate the risk of individuals except by broad strokes, so they add a fudge factor (typically 100% of the potential costs, often higher) to compute the premium they assess.
Now, we get into another factor from your comments- you may be in “better shape”, but the insurance company will counter that your telomores are more susceptible, they don’t have your genetic pool information (nor can they get it, thank G0d), your life expectancy is lower, etc. Unless and until we have a single payor, these issues will all take the fore.
I feel the same as you!
Roy