Occasionally the editor does take a vacation and needs the staff to fill in with editorial (no name, this is the newspaper’s thoughts) comments. This is the one I wrote for Nov. 7, 2013.
Let there be reason and calmness in the midst of the hype and hysteria following the first steps taken for the institution of the Affordable Care Act. Yes, HealthCare.gov, the Internet website to sign-up for insurance, has major flaws that may take weeks, if not months to fix. Yes, we all heard the president say we could keep our current plans if we liked them, only to hear one horror story after another of cancellations of current plans with an offer of a plan that would be five to 10 times as expensive.
But, take a deep breath when you hear such reports or receive a similar cancellation.
According to ConsumerReports.org, the horror stories do not necessarily reflect the whole picture. The rest of the story involves a thoughtful inspection of the facts. First, look at the current policy which is being canceled, and second, look at more than just the policy being offered. Look at the policies of other companies.
ConsumerReports.org references the case of Diane Barrette, a 56-year-old woman from Winter Haven, Fla.
Blue Cross Blue Shield of Florida canceled her $54-a-month “GoBlue plan 91” and offered to replace it with a $591-a-month “Blue Options Essential plan.” It is shocking to consider a bill jumping 11 times the original fee.
But Consumer Reports took that bill and did what they do best. They investigated the product. They studied the outcome and the cost. In this case, the original plan for $54 paid a pittance on medical visits (no more than $50, even for visits with expensive specialists) and only the first $15 on even the most expensive prescriptions. It only paid for hospitalizations related to pregnancy complications (for a 56 year-old woman?) and so forth.
“She’s paying $650 a year to be uninsured,” Karen Pollitz, an insurance expert at the nonprofit Kaiser Family Foundation, said. “I have to assume that she never really had to make much of a claim under this policy. She would have lost the house she’s sitting in if something serious had happened. I don’t know if she knows that.”
Okay, so she had a lousy medical plan, one that basically left her uninsured and Blue Cross Blue Shield knew that it would not stand the test of the ACA. But, neither does $591 a month stand the test of affordable care.
What does stand the test and reflect a more reasonable approach to the wave of cancellations is to lay aside the offered insurance and look elsewhere, as Consumer Report did.
Since the author of the report could not study the options at HealthCare.gov without applying for coverage, the reporter from Consumer Report used the tools from eHealthinsurance.com and found that Barrette qualified for a premium subsidy of $320 per month that could be used toward the purchase of a Humana Direct Silver plan for $165 a month.
More than she had been paying, true, but far less than the substitute and the fee actually would cover essential health benefits.
The Humana plan has its fees: a deductible of $4,600 for medical and $1,500 deductible for prescription drugs before the co-pay begins. After the insured pays $6,300 out of pocket, the plan covers everything else.
Not good, but compared to her current inexpensive plan a better option. Consumer Reports compares the end cost if Barrette had received a diagnosis of breast cancer. Under her original plan she would have received a few hundred dollars in benefits and nothing to cover the cost of surgery, chemotherapy or medications. Consumer Reports projected under her previous plan she would have paid $119,000 of the $120,000 for treatment. With the plan they found, her bills would have topped out at $6,300.
Medical treatment and preventative services are expensive. We know the bill must be paid. Whatever your thoughts may be about the Affordable Care Act, we urge you to take the time to carefully consider your options, to consult with more than one company and more than one person and to get the whole picture of the projected medical costs whatever the circumstances. As always “Let the buyer beware.”