High premiums, less coverage
My employer switched from several good medical plans to only two options: HSA (Health Savings Account) with an individual $3,000 deductible/$5,000 out of pocket maximum and a HRA (Health Reimbursable Account) with an individual $2,000 deductible/$4,000 out of pocket maximum which DOES NOT include the following: copays and costs of prescriptions.
The statement from my employer and Blue Cross and Blue shield was "these new plans help you take part in managing your healthcare expenses". The premiums are the same as the old plans we had before, but there is 90% less coverage for the same premium.
For people like me that have a chronic health issue, these plans are not made to "help you manage your healthcare expenses", these plans are made to deter people from seeking needed medical care because of the high deductibles, high coinsurance and high out of pocket maximums. I have put off getting my needed medicine because just ONE of my medications is almost $1,800 a month, another medication is $5,100 a month. I have cancelled appointments with my specialist AND my Primary Care Physician because of the high deductible and not being able to obtain the exact cost of services to even estimate my cost per visit.
All these plans do is force the insured person to go without medical care and required medications to manage their illness and punish people that have chronic illness' that are beyond their own control and reward healthy people that never need to use their coverage beyond "annual Preventative services" which are covered at 100%.
I have not been able to get "private" coverage because of the $1,800 a month premium with a $5,000 deductible that Blue Cross and Blue Shield requires. So people like me with a chronic illness only have the option of working a full time job that offers good medical coverage in order to afford to take care of themselves health-wise. But apparently even that is changing, and premiums are going up and level of coverage is going down.
Shame on all of you health insurance companies for singling out people with health issues!
I really feel for your situation as a doctor, but in a sense, the HSA / high-deductible plan is doing exactly what is intended. You know see how ridiculous primary doctor and specialist costs really are, as well as your medications. Insurance companies are guilty of hiding these costs for far too long. The public is guilty of going along with the "free ride" and allowing someone else to pick up the costs. Doctors and pharmaceuticals are guilty of allowing prices / salaries to escalate far above the rate of inflation. Businesses and patients are now stuck with the mess, and there will be pain.
The silver lining in all this, is there is growing outrage about the costs and a demand by the public to find a solution.
Here are some practical solutions:
1. Tell your doctor you cannot afford to see the specialist all the time! Primary doctors have become lazy. You should see a specialist for a specific question or needed procedure and the specialist should communicate the treatment plan with your primary doctor to follow. You should NEVER see a specialist routinely! That's what a primary doctor is for
2. Do not let the primary doctor rush you out the room. You are paying very high costs for on average 7 minutes of time. Go to your appointment prepared with a list of questions that you need answered!
3. Tell your doctor that the treatment plan is unaffordable! He / she needs to work with you and your budget to get the maximum effect for the least amount of money.
4. Demand that medical research is accountable to costs! Unfortunately, our training has become ridiculous in that cost is never a consideration for someone's health. Cost has ALWAYS been a consideration for 1000s of years and is ALWAYS a consideration in much more important things in life like food, clothing, and shelter. These 3 things have gross variability in costs, what people can afford, and are FAR more essential than medicine.
I know your situation is painful, but the solution is going to be very painful as we correct so many errors that have been building over the last few decades.
I can certainly relate to your frustrations. As the cost of medical care continues to rise, our groups and consumers tend to buy less rich benefits in order to keep their premiums affordable. One way they do this is to move to “consumer driven” plans like HSAs and HRAs. These plans almost always cover prescription drugs and office visits but instead of having a copay, you must meet your deductible first. To help offset the larger deductible, many employers contribute funds to the HRA or HSA. With an HSA, individuals can contribute additional dollars pre-tax to help to further offset these expenses. Unspent money in HRAs and HSAS also roll over year to year.
The experience with these plans have been largely positive. The results show that when people take a long term view and spend their own funds, they tend to use care more wisely. One example we have seen is with ER usage. Members on our consumer driven plans use the ER less while using less costly urgent care more. This sort of behavior helps keep our premiums lower. Just last year, our individual HSA plans had a 0% rate increase.
We’ve also recently launched a new treatment cost estimator which helps remove some of the mystery of what care costs. With these web based tools, consumers can research how much care costs at different locations and providers. We also have a series of tools to help consumers find lower cost prescription drugs. These tools are particularly important with our consumer driven plans. While they aren’t a panacea and may not be applicable to your specific situation, they do help many consumers find lower cost options, which in turn benefits everyone.
I encourage you to speak with your benefits manager or HR manager to discuss which health insurance plan your company offers that will best meet your needs.
Comments