With the expansion of Medicaid in California a large number individuals and families are now enrolled in a Medi-Cal health plan. The expanded Medi-Cal managed health care plans must cover all the same benefits as private health insurance purchased through Covered California. There is no cost to the consumer in terms of monthly premium, deductible, coinsurance or copayments. However, enrollment in these plans does cost something and I’m often asked how much these plans cost the tax payer.
Individual and family plans offered through Covered California in 2016 will include new pharmacy prescription drug benefits. The benefit, also mirrored in many off-exchange health plans, caps the amount a consumer must pay every month for a particular prescription. While that sounds straight forward, the rules surrounding any pharmacy deductible and tiered drug formulary can be complicated and confusing.
For years we have been told that the way to put the brakes to sky rocketing health insurance premiums was to let consumers shop and compare costs. While this pricing mechanism certainly works in markets where consumers have access to good comparative information, when it comes to shopping for health care services based on priced, your […]
One of the first options a Medicare beneficiary faces when they are reviewing Part D Prescription Drug plans (PDP) is whether they want a plan with a deductible. The deductible amount, set by Medicare, is the dollar amount a plan member must pay before he or she is eligible for the reduced copayment for the drugs. The big decision for the Medicare beneficiary is if they should select a PDP with a lower premium and $310 deductible or pay a higher monthly premium for a no deductible plan.
Part of Covered California’s mission is to improve health care quality and lower costs. In an attempt to meet these goals they announced a partnership with the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely initiative. The Choosing Wisely initiative seeks to encourage better dialog between patients and physicians to reduce duplicative tests based on evidence when charting the most effective course of treatment.
The larger point of Anthem’s discussion is that rising health care costs have several roots. There is no one culprit that is driving costs.
The cost of going without health insurance will be any penalty assessed plus the cost of medical services that might be needed. A truly debilitating disease will force him to liquidate his assets and enter the MediCal system.
Health insurance plan premiums will be based on your age, location and the type of plan you choose. Insurance companies will not be able to increase your rates because of pre-existing conditions or gender.
The U.S. does a decent job of helping a variety of different groups of people get access and affordable healthcare through either insurance or direct aid. Folks in the middle are at the mercy of the market place.
I have created a spreadsheet that is fairly simple to pop in premiums, monthly drug copay and any deductible to determine a yearly estimated cost of the plan. Perhaps the most daunting aspect is collecting the data. Each plan publishes a drug formulary that will list if the drug is covered, the tier, copay for each tier and any deductible.