But how does an enrolled individual in a standard Silver 70 plan, who is not eligible for the CSRs, feel about subsidizing lower income plan members? Could the argument be made that some individuals are paying an inflated premium, close to a Gold plan, but only receiving Silver plan level benefits? At a very minimum, the inflated Silver plan rates are a distortion of the health insurance market place. One of the goals of the ACA and the exchanges like Covered California was to bring more transparency and accountability to the health plan selection process for consumers. If the inflated Silver plan rates, along with artificially inflated subsidies, do become a reality, the market place for health insurance will take a step backwards as plan selection becomes more confusing for consumers.
If you are going to be spending an extended period of time outside of your plan area, for work, vacation, or going to college, carefully review your plan’s Evidence of Coverage to make sure the BlueCard Program is part of the covered benefits. I was surprised to learn that both Blue Cross and Blue Shield HMO plans included the BlueCard Program for 2017.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
Forcing either the health plans or the providers to post a list of costs for routine services is a very low impact way of adding consumer information to the health care market. The government is not telling the providers what they should charge. The government is not telling the health insurance companies what they should pay the providers. A law mandating a simple fee schedule like Kaiser Permanente has published will create price transparency and allow consumers to compare valuable health care cost information across a variety of health plans and providers. This will ultimately slow down the rate increases as providers compete not only on patient satisfaction, but on price as well.
However, I still don’t understand why the costs for services for Southern California Kaiser members are so much lower than prices for Northern California members. Does Kaiser just have more members in Southern California to spread the fixed costs of supplying the services over? Kaiser charges 29% more for a colonoscopy in Northern California than Southern California. Are more people getting colonoscopies in Southern California so the volumes of patients help drive down the costs?
Secretary Price’s positions on health insurance and health care are indefensible. They are cruel. They will devastate the lives of many women and children. I can only hope that voters wake up and take note of how Price and his Republican colleagues are hell bent on denying health care services to their children and neighbors and vote these people out of office. Women in America are not safe as long as Secretary Price is in charge of HHS.
But if you don’t have an account, are trying to help a family member or friend, or are just checking to see if you current mental health provider might be covered in a new health plan, you will have to swim in the sea of confusion for finding the doctor or counselor. Some of the health plans have great online directories and others really suck. Here is an overview of what I learned.
Since the beginning of health care reform under President Obama there has been intense speculation about how the health insurance companies will react when setting rates for the various health plans they offer. Health insurance is not a commodity like wheat, oil, or pork bellies where the market place of buyers and sellers agree upon a price. While competition does impact the rates to a certain degree, health insurance prices are largely determined by the health care services to be covered, the cost of health care services, and the expected claims for those services within a geographical location where the plan is being offered.
Given the Republican philosophy that less government is better government, Covered California’s reason for existence may evaporate. But it all hinges on Trump’s term ‘transition’. Does he want to transition away from the Marketplace Exchanges, or is he merely suggesting transitioning away the Qualified Health Plans as a requirement for the tax credit?
Now there is an alternative to traditional health insurance that is aimed at fitness buffs and gym owners. SHM FIT combines a health care expenses sharing group with a high deductible catastrophic health plan to offer health insurance premiums that may be less than traditional insurance.