JustCare

Tag: Access

  • Four tips for keeping your health plan costs down

    Four tips for keeping your health plan costs down

    There are a bunch of reasons why you should not think you can choose a health plan “that’s right” for you. If you have Medicare, you can budget for your care with traditional Medicare, though you will need supplemental coverage to protect yourself from financial risk. And, if you are not yet eligible for Medicare, you can do some homework to keep your health plan costs down.
    1. Choice of doctors and hospitals: Each health plan has different networks of doctors and hospitals. Many people choose plans with narrow networks, which tend to have lower premiums. Ask your doctors about which health plan’s network they are in and then call the health plan to confirm. (Sometimes, the same insurance company will offer different plans, with different doctors in their networks.) Also, find out if the hospital you want to use is in the network.
    2. Costs: Before enrolling, understand all of your costs. On top of your monthly premium, some health plans charge a deductible, the amount you must pay before the plan begins covering your care. And, you will likely have a copay, a fixed amount you pay every time you see an in-network doctor, or coinsurance, a percentage of the cost you must pay. If you see out-of-network providers, you’re likely to be stuck with huge doctor and hospital bills.  Most health plans will pay only a tiny portion of those bills, and many won’t pay anything. 
    3. Access: Before receiving services, make sure you understand the health plan’s rules. Even if you use in-network doctors and hospitals, the health plan might require you to get a referral from your primary care doctor or prior authorization from the plan before it will cover your care.  If the plan denies your care, be aware that you have appeal rights.
    4. Coverage: Each health plan has different rules about what it covers and under what conditions.  Different health plans may offer different benefits. If you travel or live in another area during parts of the year, make sure your plan covers your care while you are away and what it will pay.

    Here’s more from Just Care:

  • US rations care based on ability to pay

    US rations care based on ability to pay

    Making insured Americans pay high deductibles and large amounts in coinsurance and copays before they receive care is tantamount to rationing care based on the ability to pay. A new Gallup poll reveals that one-third of Americans have put off care because of the high cost.

    If people were putting off unneeded care, this information would not be concerning.  But, because we generally don’t know what care we need and must rely on our doctors, we should assume that a large number of people in the U.S. are not receiving needed care because they deem it unaffordable. More than 10 million more Americans have health insurance because of the Affordable Care Act.  But, health insurance coverage has become less comprehensive in the last several years, leaving people to pay huge medical bills on top of their premiums.  So, it’s not surprising that 34 percent of Americans with private insurance have put off care.

    Medicare protects people from unpredictable out-of-pocket costs better than other insurance by allowing people to have supplemental coverage and to budget for their care.  With supplemental coverage, you generally have no coinsurance and pay no deductibles. As a result, a far smaller percentage of people with Medicare (22 percent) say that they forego care because of cost.  The big problem with Medicare is that it does not cover most dental, vision or hearing care, nor does it cover long-term services and supports, all of which can be very costly.

    No matter the type of insurance, income has a big role to play in whether people get care. The Gallup poll determined that 38 percent of people earning between $30,000 and $74,999 put off care because of the cost.  A far smaller percentage, 28 percent of people earning $75,000 or more, put off care because of cost.

    Putting off care for a serious or relatively serious condition is of greatest concern.  And, to that question, the survey findings were particularly disturbing.  More than one in five respondents (22 percent) said that they had done so, twice the percentage as said so in last year’s poll.
  • Americans more likely to go without needed care and to struggle to pay for care than people in other wealthy nations

    Americans more likely to go without needed care and to struggle to pay for care than people in other wealthy nations

    More than one in three adult Americans (37 percent) surveyed by the Commonwealth Fund in 2013 report skipping care because of the cost. And, more than four in ten Americans (41 percent)—a greater percentage than in any of the other ten countries surveyed–reported spending at least $1,000 out-of-pocket for their care. Almost one in four of them (23 percent) could not afford to pay their medical bills or struggled to pay for care.

    Time will tell to what extent these percentages drop as a result of the Affordable Care Act.  For sure, health care remains prohibitively expensive in the U.S. even for those with insurance.

  • If your income is low and you need health insurance, the state you live in matters

    If your income is low and you need health insurance, the state you live in matters

    A recent report by the Kaiser Family Foundation illustrates just how important it can be for people with low incomes who need health insurance to live in a state that has expanded eligibility for Medicaid. Thanks to the Affordable Care Act, 26 states and the District of Columbia now allow anyone with incomes up to 138 percent of the federal poverty level ($27,000 for a family of three) to enroll in Medicaid.  Before 2014, states had restricted Medicaid eligibility to different categories of individuals, primarily children, older adults, people with disabilities; adults without dependent children generally could not qualify for Medicaid.

    Twenty-four states have chosen not to expand eligibility for Medicaid. As a result, almost five million uninsured adults have too high an income to qualify for Medicaid, even though their income is below the federal poverty level, and too low an income to qualify for a subsidy in their state’s health insurance exchange.  For example, to qualify for Medicaid as an adult in Alabama, your income cannot be more than 16 percent of the federal poverty level, $3,221.  In Indiana and Missouri, your income cannot be more than 24 percent of FPL, about $4,600.

    To learn which states have not expanded eligibility for Medicaid, click here.