By now, we’ve all read about the dismal go live of Healthcare.gov. I consider myself an eternal optimist when it comes to healthcare IT and I firmly believe that, eventually, the kinks will get sorted out, the “tech surge” will help make online sign-up easier than enrolling over the phone, and future generations of healthcare consumers will regard this initial boondoggle as nothing more than a footnote in their history books (or whatever app they happen to read their history books on).
On the flip side of my optimism is a growing sense of dread related to the number of uninsured or underinsured who will opt for higher-deductible coverage, even on the exchanges. I don’t care how great the benefits are in these new plans that meet ACA requirements: The average American consumer shopping for insurance on the exchanges will look at the bottom line. They’ll compare plans by looking at deductibles and then monthly premiums, giving a passing glance to the benefits themselves. Then, they’ll compare that price tag against any subsidies they may be eligible for. If it’s a good deal, they’ll sign up. They’ll rest easy that night knowing they’ve done the smart thing for themselves and their families. They’ve got health insurance! That’s a good thing, right?
Yes, and no. Insurance coverage is better than no coverage, especially for the chronically ill. But what about those “invincibles” – young or not so young – that are in good health and see no reason to pay a ton of money out of pocket each month for benefits they don’t really need (right now)? What sort of impact will that high-deductible plan have on their finances when they are faced with an unexpected healthcare crisis?
With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?
Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.
Could healthcare consumers stand to learn a thing or two from the mortgage industry crisis a few years ago? In other words, should consumers be warned not to sign up for high-deductible plans that may crush them financially if they have a healthcare crisis? I realize I’m throwing out more questions than answers. This line of thinking has me wondering if IT can help educate health insurance exchange consumers during the sign-up process. (Don’t laugh. Remember, I’m an optimist when it comes to healthcare IT, and I think we will see a day when Healthcare.gov will run smoothly and even be ready for new features.)
Perhaps consumers interested in higher deductible plans could be required to use some sort of calculation tool, similar to what many use when applying for a mortgage, that tells them point blank if their income is a good fit for the deductible they’re thinking about. The Kaiser Family Health Foundation’s calculator currently offered at the Healthcare.gov site is handy, but is not precise enough for my liking. Sure, (and I’m just making up numbers here) a $100 a month premium with a $5,000 deductible sounds good, but what if you only make $30,000 a year? Seems to me like somebody, somewhere, should warn health insurance consumers that what seems like a good deal now could lead to bankruptcy later.
I asked my friend Angus McRae, President of Angus McRae Insurance and Quote Juice Inc., for his thoughts on the subject: “For a person who has an active health insurance policy, it is wise to understand the terms and conditions of the policy. This is as important under the Affordable Care Act as it was before the law was enacted. Many of the new ACA-compliant insurance plans have substantial deductibles – as high as $6,350 for an individual policy and $12,700 for a family policy.
“Many people are used to having an individual deductible ‘embedded’ within the family deductible,” McRae explained to me. “For family policies under the ACA, this is often not the case – we call this type of deductible an ‘aggregate’ deductible. With an aggregate deductible, the entire family deductible must be paid before coinsurance benefits are payable for any family member. This will come as a surprise to many people who have purchased an ACA policy – at the most inopportune time (once they have committed to a policy for the year and after they are on the financial hook to pay that claim). As an agency specializing in individual and group health insurance, we work hard to educate our clients. The insurance industry is dynamic. Educated consumers are more important now than ever before.”
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
McRae couldn’t have said it better. My question to readers is, how can healthcare IT help make this education happen sooner rather than later?
