Understanding The Problems With The Health Exchange Programs
I plead a mea culpa. As someone who fully supports the concept of health care for all, also known these days as the Affordable Care Act, and in my role as a health care finance consultant understanding that there would be both financial benefits and negatives, I have always said that the one thing I didn’t have was enough information to know how things were going to roll out, no idea of how much things would cost, and no idea of what was going to be covered.
It turns out that a lot more people came out after the initial 2,600 page report, which I read, to the extent that by two weeks ago, if one decided to print out all the paper that had been accumulated since the first report, it would result in a pile more than 7 1/2 feet high; ouch! And it turns out that even with all of that not all questions were answered; I know that because I was at a presentation where the speaker couldn’t answer certain questions because they hadn’t been addressed yet.
Being an independent consultant, aka sole proprietor, with my wife being basically the same thing, we’re part of the group that had to start looking for an insurance plan. Unlike many other people around the country, I went to the NY state site to check out my options. And initially I was irritated because I couldn’t find the page that pertained to my wife and I that didn’t involve answering a lot of questions first. I’m someone who likes to have some kind of idea of what I’m in for before I start ponying up a lot of information about myself.
What did I eventually find? For my area there are 9 plans total for individual or individual/spouse. If we had a child there would be a lot more options, but we’d have even more if we were in the NYC or Buffalo areas, which are much larger cities. The 9 plans range from $400 a month up to $1,700 a month; ouch! With the lower plans there are out of pocket deductibles, just like car insurance, with the lowest starting at $600 for an individual, to no deductible for that high priced insurance. After that, it’s all about prescriptions; the lowest has no coverage for any type of prescriptions, whereas the more you’re willing to pay, the less pharmaceuticals will end up costing you.
At least to a degree, because some insurances can offer the same benefit for less money, especially most Blues plans. That would figure since in most states they’re probably the primary insurance in the area, the one with the most members already, thus they can spread the costs better.
The discounts are interesting, but somewhat tricky. You have to give your income level, most probably what you filed as your income at tax season, and then they’ll calculate whether or not you get a discount. I haven’t gone that route yet because I’m trying to find out if you can exempt yourself from any discount program.
The “why” is because last year I accumulated enough expenses so that my business income basically excluded me from having to pay any taxes. At this point I’ve already superseded last year’s income by a mile and there’s still 2 1/2 months of income still to earn, which is guaranteed money. The way things are set up is if you get a discount off your insurance premiums and then the next year you suddenly don’t need a discount anymore, you have to pay back any discount you were granted the previous year. Whereas I don’t think that’s fair, I also don’t think it’s fair to have to disclose income if you’re willing to pay out of pocket without worrying about whether you qualify for one or not.
Of course this will benefit those who don’t have much of a chance of increasing their income based on the jobs they have and I’m happy that those folks will get a break. Still, there’s a new reality that many of us have never had to deal with, that being the upfront deductibles that, in some states, has been the norm for awhile in helping to keep costs down. Those folks who are at large employers will still be able to benefit from generous insurance plans, which will possibly include dental and vision plans, but a benefit to the new plans is that they all have to cover at least one physical every 3 years and have a benefit of $100 towards a gym membership each year. Now that’s new, as the government is trying to encourage preventative care as much as possible.
Is it irksome? Absolutely? Is it the worst thing in the world? Not even close.