This article missed a great opportunity to point consumers in the right direction: help is available from professional, licensed, and certified agents. There is no fee since agents get paid commission by the insurance carriers. Working with an agent has no bearing on premium rates or other costs. I spend on average one hour per client explaining the differences between plans, provider networks, etc.
and I'm available later helping clients understand communications they receive from their marketplace or their carrier. In my experience there are few clients who really need more than a bronze plan and if they are properly advised they are not shocked when they face out of pocket expenses because they understand to balance that against the higher cost of premiums for silver or gold .
and I'm available later helping clients understand communications they receive from their marketplace or their carrier. In my experience there are few clients who really need more than a bronze plan and if they are properly advised they are not shocked when they face out of pocket expenses because they understand to balance that against the higher cost of premiums for silver or gold .
1
The concept of "risk" is what is missing here. That is a concept that few if any really understand. And of course choosing insurance is a personal decision that others don't understand properly.
The Government green-lighted Insurance Companies to make the rules for "affordable" health care, so are we really surprised that the primary beneficiaries are Insurance Companies and their cohorts ? They have accomplished their goal of making insurance policies so confusing that the average person needs to take a course on how to choose one. I have a better idea - how about healthcare that actually benefits patients - Single Payer Universal Healthcare, I think is what it's called ?
6
As a democart/liberal leaning voter who happens to also be a sole proprietor making an OK income for my area but just barely in what's considered "middle income" in our region, the ACA is a disaster. There are no plans on the NY exchange which provide out-of-network coverage. Since ACA, it's difficult to find any provider that will even talk to you if you're not going through the exhange. The myriad of options of deductible and co-pay and co-ins and premium requires a super-computer and a Nostradamus-like ability to predict what the next year will bring in order to determine what the best plan(s) are. Right now, I'm considering a HDHP plan with access to an HSA for myself and a parent/child plan for my spouse and child due to the plans and providers available to us. A single payer system is what's really needed as what's available amounts to insurance Russian Roulette.
6
Mr. Frakt,
Isn't it time to admit that the purpose of having a plethora of insurance options was a sop to the status quo and advocates of a free market approach to healthcare, in which people ultimately get the healthcare they are willing to pay for? How does dividing up the pool of insured into many segments possibly help the consumer? Isn't it in the interest of the consumer to form as large a group as possible, both in order to spread the cost of illness amongst as many people as possible, and to be able to command the best prices from service providers? What are high deductible policies designed for other than to allow healthy people to avoid subsidizing sick ones? What are different tiers of insurance designed for other than to let wealthier people buy higher quality care than less wealthy people? What is the purpose of having narrow networks of providers other than to encourage a lower level of quality, due to not needing to compete for patients? How did a system which is designed to make the most comprehensive and least cost sharing option out of reach for the people who need it most - the chronically ill and financially strapped - come to be rationalized and explained away by people such as yourself, while the original architects, conservatives who are looking for ways to extricate the wealthy from subsidizing healthcare that is increasingly unaffordable for the middle class, wash their hands of the ACA and capitalize on its unpopularity?
Isn't it time to admit that the purpose of having a plethora of insurance options was a sop to the status quo and advocates of a free market approach to healthcare, in which people ultimately get the healthcare they are willing to pay for? How does dividing up the pool of insured into many segments possibly help the consumer? Isn't it in the interest of the consumer to form as large a group as possible, both in order to spread the cost of illness amongst as many people as possible, and to be able to command the best prices from service providers? What are high deductible policies designed for other than to allow healthy people to avoid subsidizing sick ones? What are different tiers of insurance designed for other than to let wealthier people buy higher quality care than less wealthy people? What is the purpose of having narrow networks of providers other than to encourage a lower level of quality, due to not needing to compete for patients? How did a system which is designed to make the most comprehensive and least cost sharing option out of reach for the people who need it most - the chronically ill and financially strapped - come to be rationalized and explained away by people such as yourself, while the original architects, conservatives who are looking for ways to extricate the wealthy from subsidizing healthcare that is increasingly unaffordable for the middle class, wash their hands of the ACA and capitalize on its unpopularity?
6
A high-premium low-deductible plan might be misguided, but it's not really irrational. It's not enough to sign up for insurance - you have to fund it too. People know how they're funding their premiums: they come straight out of their paychecks. But covering a deductible requires cash on hand. Saving is hard, and even if you do there's no guarantee that a car repair or unexpected bill won't eat that up just when it's needed. A high deductible is effectively a forced savings plan.
2
In many coutries such as England, France Austrailia, etc everyone gets healthcare; those who don't like THE GOVERNMENT SINGLE PAYER PLAN, shop around for more expensive Healthcare and buy private care . In these countries the average person who has little time or ability to figure out the complexity of health insurance is guaranteed a health plan. The Rich, who can higher experts buy the private stuff.
In the USA it is the reverse. The weathy or those employed by government or large corprations have their Benefits departments do the leg work to shop for healthcare products. Those with the least time and money shop around the hundreds plans offered to buy their health insurance.
In the USA it is the reverse. The weathy or those employed by government or large corprations have their Benefits departments do the leg work to shop for healthcare products. Those with the least time and money shop around the hundreds plans offered to buy their health insurance.
8
I would like to know, where is the web site that lets me input my preferred doctor(s) and hospital, indicate what medication(s) I am taking, and spits out the plan(s) that meet those needs?
Instead, I get a cryptic letter from Blue Cross/Blue Shield telling me what drugs are moving from one Tier to another, or off the formulary altogether. Can't wait to see what they are offering this year... NOT!
I also question the legality of denying the renewal of a current dosage of medication. The DOCTOR prescribed the dosage. You know, the person who went to medical school and got certified? Plus, you've been at that dose for who knows how many years... Yet all of a sudden it is "higher than the standard dose" (pick your insurance jargon) and you have to jump through hoops (or your doctor's office has to) just to get the same old medicine...
Is there any legally enforceable description of the meanings of gold, silver, platinum, etc.?
Instead, I get a cryptic letter from Blue Cross/Blue Shield telling me what drugs are moving from one Tier to another, or off the formulary altogether. Can't wait to see what they are offering this year... NOT!
I also question the legality of denying the renewal of a current dosage of medication. The DOCTOR prescribed the dosage. You know, the person who went to medical school and got certified? Plus, you've been at that dose for who knows how many years... Yet all of a sudden it is "higher than the standard dose" (pick your insurance jargon) and you have to jump through hoops (or your doctor's office has to) just to get the same old medicine...
Is there any legally enforceable description of the meanings of gold, silver, platinum, etc.?
8
Well Gee perhaps the exchange should have these features. But they could not even make a correct exchange do having a decent on is probably out of the question.
Healthcare.gov's site now has a feature in which you input your doctor and prescription information, then each plan description indicates if the doctors participate and whether your scrips are covered by that plan.
3
It is difficult to imagine a more appropriate place to apply the doctrine of caveat emptor than in the provision of healthcare for families with children.
Can't get afford to get your scoliosis straightened or you heart murmur repaired? Too bad, your parents should have gotten post-graduate degrees in in insurance jargon, devoted a couple of months to reading the deliberately confusing insurance literature, and miraculously selected better coverage.
The very existence of this sort of a problem proves beyond any doubt - reasonable or unreasonable - that American society is morally bankrupt and the United States is arranging its own doom.
Can't get afford to get your scoliosis straightened or you heart murmur repaired? Too bad, your parents should have gotten post-graduate degrees in in insurance jargon, devoted a couple of months to reading the deliberately confusing insurance literature, and miraculously selected better coverage.
The very existence of this sort of a problem proves beyond any doubt - reasonable or unreasonable - that American society is morally bankrupt and the United States is arranging its own doom.
17
Oh! so now the American healthcare system plus what's offered and how is the CONSUMER's fault????? Ridiculous! What IS the consumer's fault is voting in a political system dependent, among other things, on corporate profit-making/buying. Yet... there are no viable choices right now in re our political system -- it's totally bought and paid-for. Corporations with their "values" own it all. In the case of healthcare, the companies deliberately make it difficult for the consumer in order for the companies themselves to benefit one way or another.
8
For the self-employed, selecting an insurance plan post ACA is particularly burdensome, especially if you are unsubsidized. Journalists and health advocates seem to forget the many millions who buy insurance in this new individual market we created and are not shielded by government subsidies for premiums and co-pays. It's a brutal place to be and getting worse.
These are not inexpensive plans by any standard and are particularly costly for older Americans, those above 50, many of whom lost jobs during the recession and have moved to contract and freelance work. Even bronze plans with massive deductibles of $6,800 are priced at about $600 in the Atlanta market (if not highly restricted HMO plans marked with an "x"). They are the equivalent of the "catastrophic" plans available only to Americans under 30 but are much pricier.
This is exacerbated because we have also made substantial changes to the deductibility of insurance and medical bills for the self-employed post ACA, no longer allowing the full amount of medical bills or insurance costs to be deducted. The deduction is now limited to the amount above 10% of income. It's a triple hit for the unsubsidized- higher costs, more limited and/or restrictive coverage, and lower deduction.
Whether you shop or not, add up all the benefits, weigh deductibles and co-pays, and project healthcare needs accurately, you are going to pay a lot, and in 2016 get less.
These are not inexpensive plans by any standard and are particularly costly for older Americans, those above 50, many of whom lost jobs during the recession and have moved to contract and freelance work. Even bronze plans with massive deductibles of $6,800 are priced at about $600 in the Atlanta market (if not highly restricted HMO plans marked with an "x"). They are the equivalent of the "catastrophic" plans available only to Americans under 30 but are much pricier.
This is exacerbated because we have also made substantial changes to the deductibility of insurance and medical bills for the self-employed post ACA, no longer allowing the full amount of medical bills or insurance costs to be deducted. The deduction is now limited to the amount above 10% of income. It's a triple hit for the unsubsidized- higher costs, more limited and/or restrictive coverage, and lower deduction.
Whether you shop or not, add up all the benefits, weigh deductibles and co-pays, and project healthcare needs accurately, you are going to pay a lot, and in 2016 get less.
10
I do not know why anyone who earns between 12 and 29 thousand dollars annually and gets cost sharing discounts would choose not to purchase insurance through healthcare.gov. Even if you think you will make 12,000 and you make only 10,000 because you get sick or fired, you don't owe ANYTHING back. If you are in this income bracket, it is almost always best to choose the silver plan. I know a lot about the plans and would be glad to help those who can't decide what to buy.
1
The biggest mistake you can make is opting for straight medicare. There is no out of pocket maximum with this choice. A significant hospitalization (typically measured by number of days) can wipe out most people financially.
1
From my experience the best choice, if you are eligible, is Original Medicare plus the purchase of a supplemental policy that covers what Medicare does not (the other 20%). The annual deductible is only $147. You also have to enroll in Part B for about $104/mo to be eligible to purchase a supplemental policy. My monthly expense for ALL premium costs connected with Medicare is about $350. After I turned 65 I had 3 major surgeries within 3 years. I paid only my deductible. Medicare and my supplemental paid the rest. It is the best insurance coverage I've ever had in my entire life and I would have been bankrupt several times over if I had had "traditional" insurance. Expand Medicare for all!
6
Five years and three health plans later, I have discovered that the only way to truly know how much healthcare will cost is to get sick.
18
Pro tip: single payer is a slogan. It is not a plan. For anyplace, much less the US. All the commenters who imagine it offers a magical solution for our health care access/cost challenges really, really, really, need to stop.
2
The fact is that there is no room to grab a profit out of health care, education, incarceration or the military. The profit comes at the expense of everyone but the profiteer. These should be government functions.
6
Health insurance companies have actuarial data on what a consumer can expect for out of pocket expenses for both acute and chronic diseases such as diabetes, cirrhosis, prostate cancer, breast cancer, etc.
They refuse to share this data because it would effect their profitability.
They refuse to share this data because it would effect their profitability.
13
Single payer health care. Our current system only rewards the insurance companies; not the physicians and other health care providers and not the patients. Insurance companies are lugging our money to the bank.
19
We have to stop thinking of premiums as pre-payments on healthcare. Any kind of insurance--health insurance too--is about risk management. The question shouldn't be, "what is the lowest cost plan" but "how much peace of mind will I get for what I'm willing to pay"?
8
Unless you have golden coverage through work, the majority of Americans are given a raw deal no matter what health plan they choose.
I lost my job in 2014. It offered a $1000 deductible and with a premium of about $250 for a family of 5, and that included dental/vision. I'm now working as a contractor with far worse benefits. The only plan available to me is $5000 deductible for more than triple the monthly premium. Other than a basic annual checkup and flu shots, it pays nothing until i spend $5000 (or $10000 for family). No dental, no vision. I make just enough money that the Exchange plans are no better.
In what world is $850 a month for a plan that pays nothing until I spend $5000 out of my own pocket remotely affordable? What's worse, IRS doesn't consider this to be unaffordable until the premium for the CHEAPEST BRONZE plan is more than 8% of your annual income. That doesn't include any out of pocket to try to meet that ridiculous deductible.
I'll pay the penalty again this year, and will keep doing so until they eliminate or cap these ridiculous deductibles.
I lost my job in 2014. It offered a $1000 deductible and with a premium of about $250 for a family of 5, and that included dental/vision. I'm now working as a contractor with far worse benefits. The only plan available to me is $5000 deductible for more than triple the monthly premium. Other than a basic annual checkup and flu shots, it pays nothing until i spend $5000 (or $10000 for family). No dental, no vision. I make just enough money that the Exchange plans are no better.
In what world is $850 a month for a plan that pays nothing until I spend $5000 out of my own pocket remotely affordable? What's worse, IRS doesn't consider this to be unaffordable until the premium for the CHEAPEST BRONZE plan is more than 8% of your annual income. That doesn't include any out of pocket to try to meet that ridiculous deductible.
I'll pay the penalty again this year, and will keep doing so until they eliminate or cap these ridiculous deductibles.
15
Here's a thought. Back out of the health care system as much as possible as one way to take back responsibility and power for one's health, reduce time spent on inane policy benefit comparisons, and save $ by opting NOT to take drugs prescribed by allopathic physicians, which are often harmful or unhelpful. Opt NOT to subscribe to taking unnecessary tests (which often offer up false positives), and to replace visiting doctors (many of whom are not particularly able in making sound, intelligent, intuitive, and complex health care diagnoses) with holistic health care, including self-care, exercise, and healthy organic diets. This doesn't solve the health-care coverage crisis, but it's a failed and failing system, and even when affordable and in place, often doesn't provide quality care/healing to the patient anyway!
And, it is an outrage that people are penalized for choosing to forgo this botched, financially criminal, medically dubious system. What good, on the whole, with exceptions of course, is coming from this medical model in terms of truly making people healthier? Too often, people remain ill at great expense to almost all, and to the great profit of insurance companies, some medical practitioners, and the drug corporations!
And, it is an outrage that people are penalized for choosing to forgo this botched, financially criminal, medically dubious system. What good, on the whole, with exceptions of course, is coming from this medical model in terms of truly making people healthier? Too often, people remain ill at great expense to almost all, and to the great profit of insurance companies, some medical practitioners, and the drug corporations!
6
I just spent 6-8 hours searching for a plan for my husband after Colorado HealthOP (a non-profit) was forced to shut down at the end of 2015. There is no way, in my view, to research all the possible cost-sharing events that might occur in the future to help determine which type of plan to choose. The choices are all bad: lower premium/high deductible; lower deductible/high out-of-pocket. Even the "platinum" plans have high OUP maximums, over $6000. $12,000/year in cost for a single person seems about right, as one person stated. Our decision was to take a PPO plan with the deductible being the same amount as the out of pocket max; this way we pay everything up to the deductible and zero after that. It turned out to be the cheapest based on a worst-case scenario. Unfortunately, that number was $2000 under the co-op and is now $4000 with a for-profit company. The monthly premium is $90 a month more than the co-op was. The insurance companies profit at consumer's expense. The ACA, with all its pitfalls, is still better than not having it, but the only real solution is single payer.
13
Buy the cheapest plan you can. I wrote a little piece explaining why: https://medium.com/@jeffbuxbaum/buy-the-cheapest-health-care-plan-you-ca...
I don't address fairness or whether a single-payer plan makes sense. Given the cards we're dealt, this makes the most sense.
I don't address fairness or whether a single-payer plan makes sense. Given the cards we're dealt, this makes the most sense.
1
We need a health care system that the public might more--much more--readily 'audit'. The hodge-podge that PPACA gives us is less than before, but still leaves too much room for shenanigans. We need a single-payer system--and one that, like social security, is tied to employment, but has no ties to employers.
1
I’m an experienced healthcare insurance consumer. The issues are complexity, lack of transparency, and misinformation. Examples of each follow. Complexity… in the recent past, our prescription drug choices included generic or non-generic. We’re now faced with drug formularies which can be generic, non-generic, in-network, out-of-network, covered, not covered, etc. Finding out which drugs fall into what category is almost impossible. Lack of transparency… Read the fine print, if you can find it. My company’s Healthcare Summary Plan document is almost 300 pages. That’s the “summary.” It opens with, “this is not a contract.” If it talks, walks, and reads like a contract, it must be a contract. The most straight forward coverage is often times denied. Welcome to the “appeals” process. Arbitration anyone? Misinformation… I’ve given up on the unbiased health insurance “expert” brokers. They are as useful as a surgeon who has never performed surgery. They have no clue as to the importance and ramifications of their misinformation. The one that got me last year was a very straight forward, “is hospital XYZ in-network or not?” Agent, “yes, it is in network.” After signing up for the BCBS plan, I find hospital XYZ is in fact not “in-network.” Hours wasted. In summary, the goals of the consumer and the healthcare insurance industry will never be aligned. The answer, dismantle private healthcare insurance.
16
I was a small business owner, and despite my relative sophistication as a health insurance purchaser for my company and its employees, I was appalled at the complex choices that insurance brokers were forced to present: "Do you want the plan from Company A with a $40 co-pay and $500 deductible, or Company B's that's in-network only with a $60 co-pay and $800 deductibles, or Company C....etc." You get the idea -- I was always comparing apples and oranges in baffling combinations. What a pleasure to retire and go on Medicare for my personal medical coverage. Even when purchasing supplemental coverage from private insurers, they were all required to offer the same wide array of uniformly defined plans, making it much easier to compare the offerings on price. Too bad that the "public option" didn't stand a chance of passage as part of the Affordable Care Act due to conservative opposition. Conservatives, keep your hands off my Medicare!
15
In addition to the average Joe not being able to traverse the field of choice in a way that makes the most financial sense for his needs, all this choice costs an enormous amount of money. The 4-color glossy advertisements that fill our mailboxes each year are not cheap and it is the consumer who ultimately pays for all of this advertising on the part of insurance companies. It's one of the reasons the general and administrative expenses of insurance companies are so much higher than Medicare's.
8
On a positive note, keep in mind that regardless of which insurance company's plan you finally enroll in or which metal level you choose, Bronze through Platinum, your maximum out of pocket costs in any year including your premiums, all deductibles and all copays and coinsurance will be no more that about $12,000 regardless of the enormity of your medical bills as long as you remain in-network. People enrolled in an ACA plan won't go bankrupt because of large health care bills!
1
In what universe is $12,000 an affordable expense for people whose incomes are low enough to qualify them for subsidies to help them pay their premiums? For many people, that's half or more of their entire yearly income. And it's a lot to add on top of insurance premiums for most other people, too. Not enough to make you go bankrupt? That totally depends on how close you are to the top of the income scale.
Choosing a plan can be difficult because it's so hard to find out which things are covered, which have co-pays and how much, and which are part of the "pay the deductible before we cover it", and how much they cost. It makes it very hard, especially if you're lower on the income scale, to use your health care once you have it because you don't know up front how much your out-of-pocket expenses will be.
OTOH, my husband's Medicare plan is simple. Last year his total premium was $92/mo. I could have gotten the same plan under the ACA, but my premium, after subsidies, would have been $500/mo. We need Medicare for everyone. And it needs to be expanded to cover vision and dental needs.
Last, if we want to control health care expenses, change the system. Instead of picking once every year, let people change whenever they want to. If they're unhappy with their health care, let them switch. This fosters real competition and keeps the insurance companies from hiking up costs between enrollment periods, making your costs higher than anticipated when you signed up.
Choosing a plan can be difficult because it's so hard to find out which things are covered, which have co-pays and how much, and which are part of the "pay the deductible before we cover it", and how much they cost. It makes it very hard, especially if you're lower on the income scale, to use your health care once you have it because you don't know up front how much your out-of-pocket expenses will be.
OTOH, my husband's Medicare plan is simple. Last year his total premium was $92/mo. I could have gotten the same plan under the ACA, but my premium, after subsidies, would have been $500/mo. We need Medicare for everyone. And it needs to be expanded to cover vision and dental needs.
Last, if we want to control health care expenses, change the system. Instead of picking once every year, let people change whenever they want to. If they're unhappy with their health care, let them switch. This fosters real competition and keeps the insurance companies from hiking up costs between enrollment periods, making your costs higher than anticipated when you signed up.
7
Herb - you are wrong. Your maximum OOP does NOT include your premiums! My husband and I pay $8,400 a year for a Bronze plan for which we have a combined max OOP of $13,500. Thus, in a really bad year, my costs will be $21,900 (or higher, if there is an out of network expense, or something is not covered (such as some prescriptions for my husband post-radiation treatment)). Next year we will pay $13,200 for the privilege of this same Bronze plan.
3
Republicans complain that tax returns are too confusing and take too much time to complete. They want a straight 17% income tax (very regressive of course) to ease the pain and loss of productivity to the American consumer.
Why can't Republicans see the same with the lack of Medicare-For-All? How much time, effort and money is lost in the game of health insurance? How many consumers are left, shocked, by Balance Billing (avoid this by the way by writing NO BALANCE BILLING on every medical form and accept no out-of-network services) and left bankrupt by the rapacious health care industry?
The health care industry is completely out of control and is well on its merry way to bankrupting us. If we get a Republican Federal Government next go around, we will simply go bankrupt that much faster. Honestly, we are such push-overs.
Why can't Republicans see the same with the lack of Medicare-For-All? How much time, effort and money is lost in the game of health insurance? How many consumers are left, shocked, by Balance Billing (avoid this by the way by writing NO BALANCE BILLING on every medical form and accept no out-of-network services) and left bankrupt by the rapacious health care industry?
The health care industry is completely out of control and is well on its merry way to bankrupting us. If we get a Republican Federal Government next go around, we will simply go bankrupt that much faster. Honestly, we are such push-overs.
11
There is a solution from a company called Obeo Health. They provide you with a full analysis of your medical costs and help you select a health plan that fits your needs. When switching health plans we want to know if our medicines are covered and whether we can still keep our doctors - Obeo tells you all this with a single click. They also demystify those EOB (Explanation of Benefits) letters you get in the mail. The Obeo tools are currently only available via your employer - check with your HR department. Full disclosure - I am the Chief Medical Officer with the company.
Can you tell the future? Would you have been able to tell me last year that my husband this year would be diagnosed with tonsil cancer, have heart problems, and oh yes, have multiple kidney stone attacks and require 2 lithotripsies and a cystectomy? At best this sort of analysis is an educated crap shoot.
5
It's your health... you buy the best you can afford, or care to afford. Despite what the news media and religions tell us we should want, not everyone wants to live forever.
Insane complexity. We need Medicare for all.
7
All this confusion because we as a nation are mixing an insurance product with an indirect payment system.
While they may not be the best for any one person in any given year, the high deductible / HSA plans are the best way to collapse this crazy system back to just an insurance product.
While they may not be the best for any one person in any given year, the high deductible / HSA plans are the best way to collapse this crazy system back to just an insurance product.
1
This is by design. The insurance companies make more money this way, that is all there is to say.
9
It’s hardly surprising that “only 40 percent of privately insured Americans could identify how much they’d have to pay for an M.R.I. scan. Only 11 percent could report what a four-day hospital stay would cost them.” Even if one is intimately familiar with terms and details of the plan, trying to extract a price from a provider facility because they either can’t or more often won’t prevents one from correctly applying rules for coinsurance and deductibles.
Voluminous recent research has indicated that both hospital-based and private-practice physicians have no idea what things they order cost or are charged to patients. And that’s without all that jockeying about billed vs. allowed, in-panel vs. out-of-panel, etc. So much for price transparency.
Voluminous recent research has indicated that both hospital-based and private-practice physicians have no idea what things they order cost or are charged to patients. And that’s without all that jockeying about billed vs. allowed, in-panel vs. out-of-panel, etc. So much for price transparency.
7
I was actually surprised these percentages were as high as they were...
1
An additional factor that may need to be considered: state taxes. In Oregon you can declare out-of-pocket medical expenses as a deduction independent of the standard deduction. But, if you participate in the ACA, the deduction allowed for federal taxes is reduced (not sure if that is in whole or in part of the federal tax break received for the ACA). The upshot for me last year---and I had substantial dental bills not covered by the insurance I chose in the ACA marketplace---was a $400 increase in my state taxes compared with the preceding year without much of a change in income. I'm not complaining. I may have not liked it but I could afford the increase. But why the Oregon state legislature with Democratic majorities in both houses chose to penalize ACA participants is beyond me.
3
The whole thing is quite ridiculous. Insurance companies provide no healthcare and need to be made illegal. Just provide healthcare for all of us. Period.
6
"at one large American company in 2010, employees could reduce their deductible by $250 — to $750 from $1,000 — by paying $500 more in premiums. Trading $500 for $250 is clearly a bad deal for the consumer."
Wait a minute. You are telling me that a company offered its workers a policy that was identical to another policy in every way except that it was going to cost the workers $500 more and get them at most $250 dollars lower spending in deductible? Same doctors, same hospitals, same network, just costing at least $250 more out of the workers pockets? In that case, why would the employer bother to offer both policies?
Wait a minute. You are telling me that a company offered its workers a policy that was identical to another policy in every way except that it was going to cost the workers $500 more and get them at most $250 dollars lower spending in deductible? Same doctors, same hospitals, same network, just costing at least $250 more out of the workers pockets? In that case, why would the employer bother to offer both policies?
7
I am a CPA and recently retired and relocated to Florida from DC. I had a heart transplant ten years ago so leaving Kaiser (they don't exist in Florida) was a huge concern. I have no problem with an HMO. My experience for the last twenty-five years has been that the quality of physicians has been the same whether I chose them or not. The Medicare estimating tool is just that, an estimate. The information provided by the insurance companies themselves is better but no one, beyond the cost of doctor's visits or drugs can tell you what the contractually agreed on price between the insurance company and the hospital for other services will be. I called the hospital and the only thing they would tell me was who paid the quickest. The insurance company representative was of no use at all. You only find out when you use them and by then, it's too late. I rolled the dice and went with Florida Blue and was pleasantly surprised, so far. A heart catheterization was $450 which had more to do with the UCR price than my co-pay. Price transparency is a criteria treasured only by the patient. It shouldn't be this hard. I think I see my post retirement career on the horizon.
6
The $12,000 total cost I mention in my prior comment is for an individual plan, not a family plan.
1
A few comments:
1) Most health plans offer cost estimator tools to help employee or individual subscribers to model the best total cost option (employee/individual premium plus estimated deductible coinsurance, copayments, and deductibles based on projected health services utilization). Medicare offers an excellent modeling tool for Part D.
2) Even the health economist seems confused. "A dollar is not a dollar" when comparing premium cost increases with deductible/coinsurance increases. The actuarial value of the latter absolutely is not a dollar for dollar cost increase--- it depends on the likelihood of triggering the higher deductible/coinsurance. The consumer is indeed rational; the health economist appears ill informed.
3) Regulators of the ACA marketplace could have made the consumer comparison and shopping experience so much better by requiring all insurers to offer one identical, "reference" benefit schedule within each metallic category to permit precise comparisons. Presumably, insurer revulsion to such transparency and regulator capitulation must have led to this lack of transparency.
4) This article presents a compelling case for a sole payer system like that used in every other developed country. The beneficiaries of this overly complex health insurance "marketplace" maze (featuring little competition among payers and providers in most markets) are health insurers and providers... Certainly not consumers (patients) or taxpayers.
1) Most health plans offer cost estimator tools to help employee or individual subscribers to model the best total cost option (employee/individual premium plus estimated deductible coinsurance, copayments, and deductibles based on projected health services utilization). Medicare offers an excellent modeling tool for Part D.
2) Even the health economist seems confused. "A dollar is not a dollar" when comparing premium cost increases with deductible/coinsurance increases. The actuarial value of the latter absolutely is not a dollar for dollar cost increase--- it depends on the likelihood of triggering the higher deductible/coinsurance. The consumer is indeed rational; the health economist appears ill informed.
3) Regulators of the ACA marketplace could have made the consumer comparison and shopping experience so much better by requiring all insurers to offer one identical, "reference" benefit schedule within each metallic category to permit precise comparisons. Presumably, insurer revulsion to such transparency and regulator capitulation must have led to this lack of transparency.
4) This article presents a compelling case for a sole payer system like that used in every other developed country. The beneficiaries of this overly complex health insurance "marketplace" maze (featuring little competition among payers and providers in most markets) are health insurers and providers... Certainly not consumers (patients) or taxpayers.
11
It's too complicated -- that is, it's been made too complicated -- and I don't think an article supporting the complexity and putting down the people who struggle with it is helpful.
A few years ago it took me 6 weeks and consultation with a lawyer to figure out what a relative of mine needed to do -- the people I consulted short of a lawyer all said it was beyond what they could figure out (these included a number of reputable resources for health insurance guidance) and I was eventually referred to a legal practice that was familiar with this kind of case. I even ended up talking to an official in a state agency involved with insurance regulation in order to doublecheck one part of how the rules applied to this relative's situation. While the situation was not about figuring out the lowest cost at the moment but about coordination of benefits and making sure the insured would not be boxed out of affordable coverage later by making the wrong choice at the current moment, the same problem underlies both this situation and the cost issues the article highlights: the system is too complicated.
A few years ago it took me 6 weeks and consultation with a lawyer to figure out what a relative of mine needed to do -- the people I consulted short of a lawyer all said it was beyond what they could figure out (these included a number of reputable resources for health insurance guidance) and I was eventually referred to a legal practice that was familiar with this kind of case. I even ended up talking to an official in a state agency involved with insurance regulation in order to doublecheck one part of how the rules applied to this relative's situation. While the situation was not about figuring out the lowest cost at the moment but about coordination of benefits and making sure the insured would not be boxed out of affordable coverage later by making the wrong choice at the current moment, the same problem underlies both this situation and the cost issues the article highlights: the system is too complicated.
15
Insurance companies should reveal the average out of pocket expenses for a patient in that plan for a particular acute or chronic illness. The insurance companies, their actuaries, have that information and should share it with their patients, customers and physicians. This would allow comparisons between the plans based on diseases.
4
The issue facing consumers is not inertia but rather the high degree of complexity and lack of transparency involved in selecting a health insurance plan. For example, less expensive plans pay a percentage of the cost of prescription drugs and/or medical services. In order to calculate the insured's out of pocket cost he/she needs to know the cost of the drug or service. This is very difficult information to obtain and prospectively impossible to predict. Many professional, well educated individuals take the policy with determined co-payments and deductibles and higher premiums for the certainty of cost. The less educated and less wealthy by default take the less expensive policy and then end up in dire financial straits if seriously ill. All in all a terrible system.
12
I agree, we need better advice. Where do we get it?
2
I'll give it to you: a single payer system
8
Which 3 states offer health insurance cost estimatiors?
1
meaningless unless the actuaries release the out of pocket expenses for acute and chronic diseases on their plan.
2
Ok, I agree people need to educate themselves about their coverage but health insurance and all its deductibles, rules, coverage, non-coverage, etc.,etc. is confusing.
When your place of employment changes your health plan every year in order to save you money, it's no wonder there is confusion.
Wake up people! This isn't working!
When your place of employment changes your health plan every year in order to save you money, it's no wonder there is confusion.
Wake up people! This isn't working!
5
Well, that second paragraph is certainly confusing.
We consider the health of our military personnel to be very important. That is why we don't ask each member of the armed forces to choose every year between "competing" insurance company products. That is also why we don't bill military personnel for medical services, and why we have no expectation that these people will have to learn ever-changing tricky jargon, or prognosticate their unknowable medical future, just in order to receive good care.
The sad truth is that we have not (yet) considered the health of regular people all that important.
The sad truth is that we have not (yet) considered the health of regular people all that important.
11
I am a self-employed physician trying to find health insurance to replace my soon to be cancelled health republic plan. It is impossible for me to determine which NYC hospitals participate and which plans have multistate coverage, if any at all. It is tragic that a great plan like health republic was allowed to go bankrupt, especially since it was the only plan acceptrd by major NYC hospitals.
14
What Swampdog from Austin says about his employer's health plan holds true for the various levels of the Affordable Care Act.....Bronze, Silver, Gold, and Platinum. The Bronze and Silver plans for individuals have deductibles in the thousands of dollars while the typical Platinum plan has no deductibles, but has expensive premiums. As Swampdog says, "If I have to pay the full cost until I reach my deductible I'll have sticker shock or anticipated sticker shock and therefore not go to the doctor." This tends to lead to higher costs down the road when a preventable problem was diagnosed too late.
9
Got to this late...but it is a common exasperated rant of mine...the ludicrous expectation that patients/consumers should/could reasonably wade through these deliberately obfuscating marketing scams (read: profit machines) for a "utility" product that all people need and a government should insure is provided for the benefit of the people. Of course single payer is the rational choice.
Please (please!) vote and please vote for representatives that will support the right solutions to this collective nightmare we (except the wealthy) all live.
Please (please!) vote and please vote for representatives that will support the right solutions to this collective nightmare we (except the wealthy) all live.
28
This happened to me recently and it was a total nightmare. I was told the cheapest healthcare I could get as a 27 year old was $740 a month, and not even my firm's insurance agent could tell me why this plan was a good option for me or what it even entailed.
Oscar is the first company I've come across that attempt to make healthcare easy to understand. Also, for all healthy New Yorkers under the age of 30 who rarely go to the doctor and don't want to pay insane premiums, they have relatively inexpensive plans ($130/month) that cover basic care and doctor visits.
Oscar is the first company I've come across that attempt to make healthcare easy to understand. Also, for all healthy New Yorkers under the age of 30 who rarely go to the doctor and don't want to pay insane premiums, they have relatively inexpensive plans ($130/month) that cover basic care and doctor visits.
5
I gather that many people are going to read this headline and roll their eyes. Those of use who have to face this plan choice every year know all to well the amount of obfuscation that occurs on both levels--that of the employer and that of the insurance companies. Both boast that this year there's something better and different--almost always the latter. And now good luck really sorting out what that is. It's posed as choice, but we all know that it is reshuffling by employer and insurer to pass as much cost as possible onto us. Good luck sorting it out.
Single payer system now!
Single payer system now!
26
Timely article as I just walked out of my employers insurance overview orientation session. My Fortune 100 employer is shifting people away from PPOs toward high-deductible Healthcare Spending Accounts (HSAs) by increaseing the premium for PPO this year and alerting us a year in advance that 2017 will not offer a PPO. I think this is common across large employers who are trying to cut insurance costs for their employees (again) and shift the burden of paperwork and impose behavioral economics on their employees. If I have to pay the full cost (until I reach my deductible), I'll have sticker shock (or anticipated sticker shock) and therefore not go to the doctor. This practice leads to poor preventative care (even though they say it doesn't) thus higher catastrophic costs down the line. People won't go to the doctor until it REALLY hurts or they can't stand the symptoms anymore. The maneuvers dance around the real problem which the _cost_ of giving care which is the real problem in US healthcare.
11
It's interesting to try to reconcile this article with other recent op-ed articles calling for retaining the so called Cadillac tax based on the premise that it will force people to be smarter consumers of health care.
7
I just spent part of the morning going through an 89 page doorstop of a Horizon Drug Plan Guide trying to find which medications are covered and how. There are tiers, of course. Tier 3 drugs aren't even listed. There's a separate 5 page list of "maintenance" drugs that are only available by mail from the pharmaceutical management company, who is proud to have chosen itself for the honor. In the end I had to call and ask about a particular drug I could not find anywhere in the 89 pages (plus 5 maintenance plus the 2 page addendum to the 89 pages or the 1 page specialty drug listing). Yes, it is covered. It is subject to prior authorization. This for a drug that a family member has been taking for six years without a problem.
Before prior authorization comes step therapy. Step therapy, in which the patient who requires a medication is deliberately administered a medication that will not work for them before the patient is allowed to have the one that will. Think about it. A person has a diagnosed medical condition needing medical treatment. Giving a patient medication that does not work, on purpose, might be malpractice if a doctor did it, but if the insurer does it, it's just good business. Unconscionable.
Before prior authorization comes step therapy. Step therapy, in which the patient who requires a medication is deliberately administered a medication that will not work for them before the patient is allowed to have the one that will. Think about it. A person has a diagnosed medical condition needing medical treatment. Giving a patient medication that does not work, on purpose, might be malpractice if a doctor did it, but if the insurer does it, it's just good business. Unconscionable.
45
"Because a dollar is a dollar, no matter how you spend it..."
no, it's not. a dollar without an accident (a premium payment) is not valued in the same way as a dollar with an accident (a copayment or a deductible) because the state of the world is different. furthermore, even _thinking_ about an accident can change how we value money. irrational? perhaps, perhaps not.
no, it's not. a dollar without an accident (a premium payment) is not valued in the same way as a dollar with an accident (a copayment or a deductible) because the state of the world is different. furthermore, even _thinking_ about an accident can change how we value money. irrational? perhaps, perhaps not.
3
This touches on a larger phenomenon:
One reason for fine print, inconvenience, and complexity is that these hurdles can be increased and exploited for advantage. Domain experts that devise this complexity devote their professional time and training for the obvious goal of stacking legal and financial advantages in their favor against consumers that don't have the time and training to make it a fair contest of legalistic accounting abilities. This imbalance is accentuated when consumers are sick and/or stressed. And despite this, consumers are solely blamed for bad choices: "you got fooled fair and square."
One reason for fine print, inconvenience, and complexity is that these hurdles can be increased and exploited for advantage. Domain experts that devise this complexity devote their professional time and training for the obvious goal of stacking legal and financial advantages in their favor against consumers that don't have the time and training to make it a fair contest of legalistic accounting abilities. This imbalance is accentuated when consumers are sick and/or stressed. And despite this, consumers are solely blamed for bad choices: "you got fooled fair and square."
13
Great article.. yes indeed.
1
I have to say I really resent the stupid HUGE garish animation at the top of this article. Who in the world does the Times think its readership is? A bunch of morons that need flashy graphics to read an article about problems with the way health care plans are presented? Stop insulting our intelligence with the HUGE photos, the videos that start on their own and all the other dumbing down that the Times is indulging in.
22
Thank you for addressing this issue. For many years prior to turning 65 I'd had an individual health insurance policy. But as Medicare age approached I was bombarded with an overflowing mailbox, phone calls and tv ads. I soon discovered that this deluge of "information" didn't actually explain anything to the consumer. Working past the many pictures of middle aged couples strolling the beach at sunset, I found that in order to determine any particulars, the consumer has to go to a website. Of course, these websites are extensive, requiring hours and hours just to search out the basics of what it is that you're buying. It's so much more than the premiums, deductibles and co-pays discussed in this article. What about Tier 1, Tier 2 and Tier 3 drugs? Generics requirements? How about doctor and pharmacy networks in your area? I found that once I'd taken the leap, guessed and picked a plan, I had to call and request this information. Think about this; many (most?) people on Medicare today are of a generation that didn't grow up with the internet. Luckily, I learned my computer skills with my kids when they were in elementary school. I use the internet all the time and I have a Masters degree in English. Despite it all, this experience has completely overwhelmed and exasperated me. Let's face it, all that the insurance companies care about is selling their product.....that glossy photo of a beautiful sunset.
20
Plus those site freeze etc. I called Cigna for their Medicare HMO--they sent a very nice comprehensive booklet in 3 days. Another company said they would have to print on demand--three weeks. I said don't bother. A third, Blue Cross, I think, said 10 days---I said why two weeks--she said they told her to say that.
4
Plus if I have to look at one more 6-ish couple radiating energy and dipping their heads toward each other, grinning, or striding along, I will BARF. The stock photo cos must be rolling in dough.
10
My experience has been that some of the critical terms have different meanings depending on the insurance plan, at least for my firm's plans offered to employees. One year "out of pocket maximum" did not cap co-pays or prescription costs. The next year the very same plan did cap co-pays, and I was unaware of this change. I had to go back and get the various medical facilities to reimburse my co-pays from the time after I exceeded my out of pocket maximum. For the HSA plan with the very same insurer, once you hit your out of pocket maximum, there is no charge for prescription drugs. On the other hand, there are two deductibles -- one for in network and one for out of network -- while the standard plan just has one that applies to both. Some confusion is due to the policies themselves!
7
The only time I got a copay capped was when I had to return to an eye doctor a few hours after leaving--they said they only charged one copay a day.
Mr. Frakt has touched a nerve with his article. Bravo!
In my previous post I attempted to explain some of the
choices for insurance coverage.
As the choices are MANY, I ran out of characters in posting.
I'm a Medicare patient, so I'm very familiar with this type of
coverage. Single payer becomes 80% coverage. In addition,
I have Plan C supplement that picks up the 20% balance.
Plan C also pays for your A (Hospital) and B ( Dr., labs, scans, etc.)
deductibles. Medicare Advantage plans are network plans with
co-pays. I also have a Part D prescription plan.
I've had to change this plan every year due to yearly changes.
Premium, deductible, co-pays, and drug tier changes.
This year my Premium $35.80, no deductible, and Tier1 $1.00,
Tier2 $4.00 Tier 3 20%. In 2016, $49.70, $250 Ded. Tier1 $3.00
Tier2 $15.00 Tier 3 20%. Most plans have a $320. Ded. this year.
2016, $360. Ded. ( Hint) A $250. Ded., is equivalent of $20.
additional premium monthly. $360., $30. monthly.
Oh, a couple of my medications that are on my current formulary,
will not be offered for 2016.
Seriously, moaning and groaning here will not accelerate change.
Please consider emailing the Whitehouse, and your congressional
representatives. Everyone who has a stake in this issue, should
join the cause for change! Vote, certainly. However, through strength
in numbers, our voices can be heard.
In my previous post I attempted to explain some of the
choices for insurance coverage.
As the choices are MANY, I ran out of characters in posting.
I'm a Medicare patient, so I'm very familiar with this type of
coverage. Single payer becomes 80% coverage. In addition,
I have Plan C supplement that picks up the 20% balance.
Plan C also pays for your A (Hospital) and B ( Dr., labs, scans, etc.)
deductibles. Medicare Advantage plans are network plans with
co-pays. I also have a Part D prescription plan.
I've had to change this plan every year due to yearly changes.
Premium, deductible, co-pays, and drug tier changes.
This year my Premium $35.80, no deductible, and Tier1 $1.00,
Tier2 $4.00 Tier 3 20%. In 2016, $49.70, $250 Ded. Tier1 $3.00
Tier2 $15.00 Tier 3 20%. Most plans have a $320. Ded. this year.
2016, $360. Ded. ( Hint) A $250. Ded., is equivalent of $20.
additional premium monthly. $360., $30. monthly.
Oh, a couple of my medications that are on my current formulary,
will not be offered for 2016.
Seriously, moaning and groaning here will not accelerate change.
Please consider emailing the Whitehouse, and your congressional
representatives. Everyone who has a stake in this issue, should
join the cause for change! Vote, certainly. However, through strength
in numbers, our voices can be heard.
6
Speaking of those gap policies--before I found out I could not afford one--I saw that each set of options from A to what...H, I think, was the same no matter which company you went to--only the price differed. Most people got Option F, I heard. Maybe we need some more uniformity like this.
With the ridiculously high cost of these health "insurance" plans, I can afford to have a health plan or actually get health care -- not both.
Annual “maximum out-of-pocket” does NOT actually mean “maximum out-of-pocket” costs: it means annual maximum of some completely arbitrary $$ of "allowed" charges that you cannot find out in advance.
Please don't blame consumers for not understanding such deliberately obscurantist policy terms.
Please don't blame consumers for not understanding such deliberately obscurantist policy terms.
17
The arbitrary amount is actually set by the insurer.
Medicare example: Dr. bills $400. for an office visit.
Medicare allows $120. Medicare then pays 80% of $120.
Patient then pays 20% of $ 120. An supplement C cost
$180. mo., but you have no co-pays . All is covered 100%.
Think being Hospitalized. Thousands!
Medicare example: Dr. bills $400. for an office visit.
Medicare allows $120. Medicare then pays 80% of $120.
Patient then pays 20% of $ 120. An supplement C cost
$180. mo., but you have no co-pays . All is covered 100%.
Think being Hospitalized. Thousands!
2
Is anyone else royally sick of reading advice by well-paid technocrats with employer/taxpayer-provided health insurance on how we health "consumers" can be better "shoppers"? When even the least expensive bronze plan (you know, the one with no doctors you've ever heard of) on your exchange is beyond your means, no amount of "shopping around" solves your problem.
33
I admit, there is little affordable in the ACA.
Ask your Dr. which plans he /she accepts.
A start.
Ask your Dr. which plans he /she accepts.
A start.
2
Consumers Err when choosing Health Plans because;
1) these insurance companies fail to reveal average out of pocket, deductible or copay costs for a typical disease in age and sex matched controls.
2) these insurance companies fail to reveal the average preventative, medical, surgical or palliative outcomes for age and disease and sex matched patients. What if Humana patients are sicker and dying more often than United patients doesn't a consumer want to know?
3) It's insane that we limit our utilities (electric and water) to 7% profitability because water and electricity form the basis for a well society, but we allow these insurance companies to remove 30% of each health care dollar for the executives, bondholders, shareholders bureaucrats, and patron politicians.
Why is safe quality affordable electricity a right in America, but access to safe quality affordable health care a privilege?
1) these insurance companies fail to reveal average out of pocket, deductible or copay costs for a typical disease in age and sex matched controls.
2) these insurance companies fail to reveal the average preventative, medical, surgical or palliative outcomes for age and disease and sex matched patients. What if Humana patients are sicker and dying more often than United patients doesn't a consumer want to know?
3) It's insane that we limit our utilities (electric and water) to 7% profitability because water and electricity form the basis for a well society, but we allow these insurance companies to remove 30% of each health care dollar for the executives, bondholders, shareholders bureaucrats, and patron politicians.
Why is safe quality affordable electricity a right in America, but access to safe quality affordable health care a privilege?
23
Your opinion is reasonable. However, All plans list the yearly
deductible and co-pays and out of pocket maximum.
deductible and co-pays and out of pocket maximum.
That has nothing to do with average expenses in that plan for a particular acute or chronic illness. The insurance companies have that information and should share it with their patients, customers and physicians.
When I first signed up for Medicare, I also got a Medigap plan but got tired of spending over a $100 a month for nothing since I only see a doctor for annual checkups and the occasional problem. When I first signed up for a Medicare Advantage plan, there were only three options in my market, the next year there were only two, and for the last two years only one. It doubled its monthly fee this year - so I'm stuck. It's still cheaper than paying for a Medicare Plan plus a Medigap Plan.
As a relatively healthy woman taking only two prescription drug (one not covered), it's still the least expensive option for me.
I wish I had more options.
As a relatively healthy woman taking only two prescription drug (one not covered), it's still the least expensive option for me.
I wish I had more options.
4
It's well established that Medicare Advantage plans are a scam on the American Taxpayer. Check out what the MA plan companies have given to your politician in the past few years.
2
FYI, I only pay $17/month and $15/doctor's visit.
All insurance companies bribe/donate to the politicians we elected.
All insurance companies bribe/donate to the politicians we elected.
2
You do have more options. Advantage plans are limited in scope.
Depending on which medications you take, Medigap coverage
might not be for you. Medigap coverage is for Donut Hole
RX coverage. When in the Donut Hole, Brand drugs receive
a 55% discount. Generic- 35%.
In 2016, The Gap ( Donut Hole) will increase. Generic discount
as well.
Depending on which medications you take, Medigap coverage
might not be for you. Medigap coverage is for Donut Hole
RX coverage. When in the Donut Hole, Brand drugs receive
a 55% discount. Generic- 35%.
In 2016, The Gap ( Donut Hole) will increase. Generic discount
as well.
I am about to turn 26 and have been trying to find a health care provider in New York City on the Exchange. My full time employer does not provide me with insurance because I am his only employee. I already make less than 4x the FPL and my rent is 45% of what I take home. Paying an extra $350 a month for THE WORST kind of health insurance is causing me extreme anxiety. There is no way for me to actually vet out which provider will be best for me because the internet is basically telling me they are all absolutely horrible.
This entire system is impossible for young people to navigate, even if I am one extremely lucky person to not have any preexisting conditions or health problems. I basically just need birth control. And now, instead of being able to save any sort of money or even get a raise I'm going to spend $350 a month and $2,000 before my insurance even kicks in.
And people are still confused why my generation needs Bernie Sanders. He is the only politician (and Elizabeth Warren) to understand how brutal it is for people in their twenties that have no real option to move past a life of surviving paycheck to paycheck. I'm living in New York City because it's the only place I can find a job in the arts with just a bachelor's degree.
This entire system is impossible for young people to navigate, even if I am one extremely lucky person to not have any preexisting conditions or health problems. I basically just need birth control. And now, instead of being able to save any sort of money or even get a raise I'm going to spend $350 a month and $2,000 before my insurance even kicks in.
And people are still confused why my generation needs Bernie Sanders. He is the only politician (and Elizabeth Warren) to understand how brutal it is for people in their twenties that have no real option to move past a life of surviving paycheck to paycheck. I'm living in New York City because it's the only place I can find a job in the arts with just a bachelor's degree.
24
For your annual gynecological exam and birth control, go to your local Planned Parenthood. They'll take great care of you.
And please give them the largest donation you can afford.
And please give them the largest donation you can afford.
12
I concur with your political advocates, especially Ms. Warren.
The law requires Insurance. Possibly a low cost catastrophic
policy. Ask the Dr. if you can negotiate a cash price, as you
suggest that you only have a primary need.
Also, email your congressman/ woman and vet your opinion.
The law requires Insurance. Possibly a low cost catastrophic
policy. Ask the Dr. if you can negotiate a cash price, as you
suggest that you only have a primary need.
Also, email your congressman/ woman and vet your opinion.
2
For people on Medicare there is a website that will provide a unbiased cost estimate for a person using either Part D or a Medicare Advantage plan. Medicare.gov has individualized potential cost information available. If you don't know how to get this information there is a tab labeled "Find Someone to Talk to" which will give you the phone for your state's helpline. The people there are well trained volunteers and can assist you in making a rational decision.
2
Great recommendation!
These health plans are a mess. I recently attempted to choose a plan for my family. I am now self employed and my COBRA coverage which I pay $2,400.00 per month for was expiring. I live 2 miles from a major State University hospital called Stony Brook. They are funded by NY State. They do not accept any of the ACA plans. NONE! The closest participating hospital is over 20 miles away.
They are not a hospital that I would ever go to by choice. I found zero plans that my daughter's doctors participated with. Thats right, ZERO, none, NADA!
How in the world can a NY STATE funded hospital NOT participate in the NY STATE OF HEALTH health plans. The whole thing is pathetic and disgusting. We need universal health care yesterday.
They are not a hospital that I would ever go to by choice. I found zero plans that my daughter's doctors participated with. Thats right, ZERO, none, NADA!
How in the world can a NY STATE funded hospital NOT participate in the NY STATE OF HEALTH health plans. The whole thing is pathetic and disgusting. We need universal health care yesterday.
30
Email the member of congress for your district your
Senator and the Whitehouse.
The challenges of obtaining Health Care is pathetic.
No consumer protection.
Do mention the Patient Protection Act, Public law
111-148. The Act requires Patient Navigators to be
available to help you.
Senator and the Whitehouse.
The challenges of obtaining Health Care is pathetic.
No consumer protection.
Do mention the Patient Protection Act, Public law
111-148. The Act requires Patient Navigators to be
available to help you.
"participants had a stronger aversion to an increase in costs in deductible or co-pay than to the same increase in premium. Because a dollar is a dollar, no matter how you spend it, this is another indication of irrational decision making."
I don't see this as irrational. The premium dollars you definitely pay; the deductible and co-pay dollars you may or may not pay. So there is some chance that by preferring an increase in deductible or co pay rather than an increase in premium, you will have paid out less at the end of the year.
I don't see this as irrational. The premium dollars you definitely pay; the deductible and co-pay dollars you may or may not pay. So there is some chance that by preferring an increase in deductible or co pay rather than an increase in premium, you will have paid out less at the end of the year.
3
I meant to say, 'You will have paid out more at the end of the year."
1
I agree... I have a plan with a $6,000 deductible because I am fortunate to be healthy and I haven't been to a doctor in about 5 or 6 years. I have a HSA and I have $6k in savings, so I'd rather save hundreds of dollars in premiums each month and save that to go towards a high deductible in the event of something really bad happening.
1
Give people the option of signing up for Medicare.
8
The impact of these "mistakes" is minimal when the taxpayers are paying for at least 80% of any increased costs
2
That's not how it works. The subsidy, if you're eligible, is based on the second cheapest silver plan available in your market. If you pick a more expensive plan, that comes out of your pocket.
2
Our core principal is wealthcare for the few rather than healthcare for the many. A political choice.
7
Add the time it takes to figure out which plan costs the least and has the most benefits to the hours spent figuring out your taxes and you get irreplaceable loss in the search for a meaningful life.
8
Republicans insist Americans want "choice" in healthcare, but with choices like this, I'll take a simple national system, thanks anyway. Of course we all know the GOP line is a smokescreen for protecting the insurance industry. It has nothing to do with "consumer choice" or "freedom."
29
The whole process is murky and confusing and it starts out as insulting the way the plans are labeled: platinum, gold, silver, bronze, stainless steel, iron, and rust. In Colorado they have used animal names!. The terminology is opaque: premium, deductible, co-pay, co-insurance, PPO, HMO, and network, out of network. It's a crap shoot to try to figure in what one's health, or ill-health, may or may not turn out to be, not to ignore the the hidden costs from and shifting availability of providers, hospitals, labs, urgent cares, blah, blah, blah. Why the restricted enrollment periods? Insurance companies are still in control, because they wrote the Not-so Affordable Care Act. There is a reason our country, compared to Europe, Japan, Australia, New Zealand, Canada, and many other countries, like Cuba, has a problem with access, outcomes, and costs. It's all about the health of the medical-industrial complex, not American citizens.
12
It is all controlled by the insurance companies and the hospitals and doctors are getting screwed too. You have no idea how bad it is. In addition to the costs, the average citizen is going to have a tough time even finding a doctor because every one I know is retiring and getting out. The insurance collect premiums from customers but then they deny claims by doctors who cannot make a living or even do their job. The insurance companies often deny needed procedures, meds. I agree -- the US is back in the middle ages.
6
By focusing purely on economics I think the author misses a key point in selecting plans. I would appreciate reader comment on my reasoning.
For example, when selecting from an ACA Bronze, Silver, Gold, or Platinum plan, the Bronze plans premiums are relatively cheap but the plans have high deductibles while the Platinum plans have expensive premiums but typically no deductibles.
Because of human nature people people with low-premium Bronze plans having medical symptoms will, to their detriment, forgo treatment because they will bear the whole cost out of their own pockets. By the same token, symptomatic people with Platinum plans without a deductible and with very low co-pays are far more likely to seek early treatment because it will cost them very little, often resulting in far better health outcomes.
For example, when selecting from an ACA Bronze, Silver, Gold, or Platinum plan, the Bronze plans premiums are relatively cheap but the plans have high deductibles while the Platinum plans have expensive premiums but typically no deductibles.
Because of human nature people people with low-premium Bronze plans having medical symptoms will, to their detriment, forgo treatment because they will bear the whole cost out of their own pockets. By the same token, symptomatic people with Platinum plans without a deductible and with very low co-pays are far more likely to seek early treatment because it will cost them very little, often resulting in far better health outcomes.
7
And then there are others like me who can no longer afford plans which actually cover things we need and have no desire to spend nearly $400 per month for what amounts to a catastrophic plan. The medication I need daily costs that much. When forced to choose, I have to buy the meds, not the insurance.
6
Hey Herb, The " metal" plans don't just differ with
Premium, deductible and co-pays. Network participants
might accept Platinum, Gold, but not silver and bronze.
I found out how narrow a network can be.
I had three months before Medicare was available to me.
I went through the exchange and was set to purchase a gold
policy. My current Dr.'s were not in network or my local hospital.
Should I need something major, I would go to Morristown.
Not in network!! This was Horizon BCBS no less.
Premium, deductible and co-pays. Network participants
might accept Platinum, Gold, but not silver and bronze.
I found out how narrow a network can be.
I had three months before Medicare was available to me.
I went through the exchange and was set to purchase a gold
policy. My current Dr.'s were not in network or my local hospital.
Should I need something major, I would go to Morristown.
Not in network!! This was Horizon BCBS no less.
1
Choosing a health plan is like going on a game show. The contestants must use their best guesses to win a prize. Some win, some don't, and mostly it is a matter of luck.
In choosing a health plan, the consumer must "know" ahead of time what they will need in terms of their health. Not so easy if your pre-existing condition either changes or - surprise - you are diagnosed with a serious and/or expensive condition after you sign up for whatever plan. In any case, a crystal ball would come in handy.
Just this year, I had unexpected surgery. My medications changed three times in as many weeks after the event. One of those drugs was not covered by my insurance plan. It may have been the best one for me, with the least side effects and complications, but after a trial sample ran out, I had to go to something else because it was too expensive to continue out of pocket.
Time to quit blaming consumers who do not have psychic abilities to foresee their health care future. Cheaper does not always cut it when it comes to your health needs because you just may end up paying with your life.
In choosing a health plan, the consumer must "know" ahead of time what they will need in terms of their health. Not so easy if your pre-existing condition either changes or - surprise - you are diagnosed with a serious and/or expensive condition after you sign up for whatever plan. In any case, a crystal ball would come in handy.
Just this year, I had unexpected surgery. My medications changed three times in as many weeks after the event. One of those drugs was not covered by my insurance plan. It may have been the best one for me, with the least side effects and complications, but after a trial sample ran out, I had to go to something else because it was too expensive to continue out of pocket.
Time to quit blaming consumers who do not have psychic abilities to foresee their health care future. Cheaper does not always cut it when it comes to your health needs because you just may end up paying with your life.
27
And this is exactly what they play down when you ask questions. I hope you are doing much better now and your medical issues on the way to recovery.
2
I am trying to pick a new Medicare HMO (mine went bellyup--anything to do, I wonder, with the half a trill taken from Medicare and given to the ACA?). My old plan paid 15 cents of my $30 drug cost (three mos). I looked at some other plans and my garden variety lisinopril would be $45 for one month--do I switch meds now? I guess it's time to call the broker...an option, by the way.
1
Norton, With the implementation of the ACA, pre-existing
conditions or current health do not count against you.
Your Dr. should've requested a prior authorization or an
exception for you medication, as medically necessary.
conditions or current health do not count against you.
Your Dr. should've requested a prior authorization or an
exception for you medication, as medically necessary.
Health care coverage is designed to be maximally confusing and opaque.
Health insurance companies, though, sure do know how to rake in the $$ - and one big way they do that is by offering myriad maximally confusing and opaque plans.
As a nation, we are apparently too stupid to understand that single-payer is the way to go. Cut out the profit-making middleman and streamline the system - everyone wins, except the fat-cats running the private health insurance companies.
Health insurance companies, though, sure do know how to rake in the $$ - and one big way they do that is by offering myriad maximally confusing and opaque plans.
As a nation, we are apparently too stupid to understand that single-payer is the way to go. Cut out the profit-making middleman and streamline the system - everyone wins, except the fat-cats running the private health insurance companies.
24
Single. Payer. Please.
36
Sure, no problem. However, in order to pay for our existing costs, we will have to increase your taxes by $18,000.
Have a nice day!
Have a nice day!
1
@Jonathan. You're wrong. With only one, massive negotiator--the federal government--we can bend the cost curve. You should also factor-in what you're paying in premiums and deductibles (for many people, it approaches the $18k a year you're citing). And before you trot out a famous example, the Vermont single-payer plan was only a "failure" because people refused to compare average premiums and deductibles to the increase tax burden. The difference was negligible. And that was year 1.
Finally: go ahead and raise taxes dramatically--breathtakingly--on the .01%. Call it the "body politic" tax. I'd like to see those glorious makers go Galt and move to a different country, I really would. With the dearth of young, talented citizens steamrolled by the recession, there will be people ready to fill their shoes in an instant.
Finally: go ahead and raise taxes dramatically--breathtakingly--on the .01%. Call it the "body politic" tax. I'd like to see those glorious makers go Galt and move to a different country, I really would. With the dearth of young, talented citizens steamrolled by the recession, there will be people ready to fill their shoes in an instant.
1
Look at how much you spent on health care last year, look at the list of medicines that you take, make sure your doctors are in your network and put pen to paper to figure out expected costs. How difficult is that? Not very if you are willing to put in a modicum of work.
2
It's not apples to oranges if one plan has copays and one has coinsurance, if one plan includes the deductible in out of pocket maximums and one doesn't, and if one has majorly higher coinsurance percentages for hospital and major medical costs than the other. That "big" savings on those premiums could end up being a huge mistake. I think some plans are so much cheaper for one's employer that they make it seductive to choose the plan that is not necessarily in their employee's best interest. But then again, HR is watching out for the business in the end, not the employee, while remaining within the guidelines of the law. I don't think employers should be the ones providing health insurance -- there is an inherent conflict of interest.
2
Start with calling your doctor to see what he or she "takes." Surprise--they don't know for sure..."Pick a plan and call us before you commit and see if we take it."
2
Like the stock market, past performance is a poor indicator of the future. This is perhaps one of the worse fallacies consumers or investors make.
5
It doesn't help at all when someone like me who keeps meticulous track of healthcare spending cannot fully get questions answered by either my HR department (where no one really understands the plan differences in financial burdens) or even the healthcare plans (who don't actually have the specific details to answer detailed questions). It's worse at this point than the tax codes! For those who are less informed or who don't understand the details it is an impossible choice and many will simply choose the plan they think will save them money. It's a national disaster.
11
@Lynnette Baker, In your situation, email your congressional
representatives. Ask them about The Patient Protection Act.
When enacted, The Act would provide Patient Navigators
to help you understand your choices at no cost.
Seriously, email them!
representatives. Ask them about The Patient Protection Act.
When enacted, The Act would provide Patient Navigators
to help you understand your choices at no cost.
Seriously, email them!
All of this is why the GOP plan to turn Medicare into a voucher system really stinks. Imagine seniors in their 70s, 80s, 90s trying to figure out which of myriad basic insurance plans best suits their needs and budget; imagine being inundated yearly by companies trying to sell a new plan or pushing seniors to switch.
28
You are obviously not on Medicare. I get dozens upon dozens of offers to change plans. I believe there are fifty plans plus drug and supplemental coverage. While a voucher system is a non starter, to think choosing a Medicare plan is simple is beyond me.
@Jerry, Like your name. O.K., If you go to the
Medicare web site, Plug in you state and evaluate
a plan that works for your needs. I once went
online to check things out and the sources are
all sales brokers. Check out the Medicare web
site for info. Choose a plan that represents your
health needs.
Medicare web site, Plug in you state and evaluate
a plan that works for your needs. I once went
online to check things out and the sources are
all sales brokers. Check out the Medicare web
site for info. Choose a plan that represents your
health needs.
2
This is why, in our family, everyone chooses straight Medicare. Very simple and it gets the job done.
1
Contrary to what many people in this thread are saying, the rest of the world does not have a single payer insurance system. Great Britain and Spain have a socialized medical care system, in which the government employs doctors, nurses, and administrators. The Germans, Dutch, and Swiss have a system like ours, but with greater governmental control over insurers and strict regulation as to the coverage and cost of their plans. The French and Canadians have a single payer system, operating much like Medicare.
Also contrary to what many are saying, the high cost of medical insurance isn't due solely to the health insurance industry. Our prices for every kind of medical service are much higher than in the rest of the world. Google "It's the prices, stupid" to read an article in a medical economics journal that sets out the details.
Also contrary to what many are saying, the high cost of medical insurance isn't due solely to the health insurance industry. Our prices for every kind of medical service are much higher than in the rest of the world. Google "It's the prices, stupid" to read an article in a medical economics journal that sets out the details.
7
I agree. I saw a special on I believe Germany or Sweden where the government decides what the appropriate cost should be for say the hardware for a hip replacement. All companies must charge that same price regardless, if they want to be in that business. So, there still is choice of whose hip you will use but the price is not in the equation.
3
And in the UK, there is an alternate system of private insurance and medical care available to the affluent, so they do not have to use the NHS.
2
My sister got both hips replaced--the cost of the hardware on the first one was $60,000 (as listed) but she noticed the hosp only paid $5,000.
2
I was informed 2 days ago -- on a weekend -- that my insurer from the exchange was going out of business not in January but in December. Now I have to find coverage within the next 8 days if I want coverage in December. Then within another two weeks find an insurer for 2016. The research is daunting and I'm an educated consumer. But thanks to the idiocy of the AFA I don't have many choices if I want a plan accepted by my doctors and nearby hospital. And my preliminary research reveals just how much we are not saving in health care costs. I have arthritis and physical therapy is important to me. I discover that all plans will only cover PT after surgery or a hospital stay. So I guess the insurance companies would rather pay $150000 for hip surgery than up to $1500 per year for PT. That's cost effective! It's a mess.
13
You must have had Health Republic insurance - the same thing happened to me, got an email on Halloween that my coverage would be ending on Nov 30, leaving me without insurance for a month. Coupled with the usual aggravation of looking for a new plan is the difficulty of scrambling to do it now, with no notice, at a very busy time of year for my business. I'm quite well versed in health care, and last year I made a spreadsheet with columns for total annual premium, deductible, out-of-pocket max, and notes on the provider network and rx coverage for each plan I was considering. To think that I have to spend that time again, and then worry about December coverage somehow, is a bleak prospect. I am also sad and disappointed that, with the failure of Health Republic, there are no longer ANY non-profit plans in the NY market.
2
Confirmed. Despite earlier notices that HR coverage would end 12/31/15, I now have a message on NYS marketplace telling me the following:
You may have been notified that your health coverage with Health Republic was ending on
December 31, 2015. We write now to notify you that Health Republic will no longer be able to offer
health care coverage beginning December 1, 2015. You will need to select a new health plan
to maintain health care coverage for the month of December 2015.
...[instructions to pick a new plan]
If you do not make a plan selection by November 15, 2015 you will have no health care
coverage for the month of December 2015.
You may have been notified that your health coverage with Health Republic was ending on
December 31, 2015. We write now to notify you that Health Republic will no longer be able to offer
health care coverage beginning December 1, 2015. You will need to select a new health plan
to maintain health care coverage for the month of December 2015.
...[instructions to pick a new plan]
If you do not make a plan selection by November 15, 2015 you will have no health care
coverage for the month of December 2015.
@Dianne, given your circumstances, try your
State insurance commission. I believe that there
are contingencies for your situation. Check.
State insurance commission. I believe that there
are contingencies for your situation. Check.
1
Consumers should be looking for value rather than cost. Figuring out which plan provides value is more challenging than even figuring out cost, and certainly, it would be helpful to have data.
5
The bandits are providing health care.
Oh how I wish some of these economics experiments could be replicated in special groups, like Fox News employees, or RNC employees, or groups of conservative legislators. Would those results provide the personal insight that anyone can be confused and fooled; the insurance companies exist for the sole reason to make as much money as possible by any legal means; and that single payor is the only logical approach?
Oh how I wish some of these economics experiments could be replicated in special groups, like Fox News employees, or RNC employees, or groups of conservative legislators. Would those results provide the personal insight that anyone can be confused and fooled; the insurance companies exist for the sole reason to make as much money as possible by any legal means; and that single payor is the only logical approach?
29
What a mean post--so conservatives should get bad care? This is somehow going to wake them up from some state?
1
I didn't mean to be mean. I don't want anyone to be cheated and hurt. My point is that conservatives should join with liberals and push for good health care coverage for all. My point is that the Republican voters should stop supporting candidates who wittingly or unwittingly are damaging their constituents through predatory and confusing health plans.
2
OK--I see what you meant. Didn't mean to be mean myself. Yes, I think all legislators should climb down from that ivory tower and find out how things work on the planet where the voters live.
Part of my job it educating and assisting employees with their healthcare plan. The author of this article misses one aspect of why employees may choose a plan that ultimately will cost them more. In fact, I have seen it in real life and the employees are more savvy than he gives them credit for. The issue is that for many employees, it is economically easier to pay more in premiums through payroll deductions, than have to come up with higher out of pocket expenses and deductibles. Unfortunately as well, employers do not have the time /resources /inclination to provide a Flex Spending Account (FSA) which would greatly benefit their employees on high deductible plans.
7
The purpose of insurance is to protect people from causes that could bankrupt oneself and family.This concern should absolutely override any concerns about cost. This article is deficient in not reminding the audience of these facts. Saving a few bucks does not make up for inadequate coverage.
7
The problem is that most plans have deductibles that, were you to have a ongoing chronic condition or a serious illness, would require an out of pocket of around $10,000 a year before the plan fully covers the rest. That amount in itself is an outgoing that is likely to bankrupt people.
13
Single Payer. The question: what do sane societies with their citizen's welfare at heart have that the US does not? If resources are limited, then we are wasting a lot on a system designed to preserve profits rather than to assure medical care.
And I think the recent comment by Madeline Conant brings out the change going on with employers, private and public or quasi-public. Employees are being pushed and shoved into plans with personal costs that severely eat into their wages, if they need anything; It happens across the board. I've seen this happen with low wage employees of a nursing home, guaranteeing that they are always on the edge of disaster.
And I think the recent comment by Madeline Conant brings out the change going on with employers, private and public or quasi-public. Employees are being pushed and shoved into plans with personal costs that severely eat into their wages, if they need anything; It happens across the board. I've seen this happen with low wage employees of a nursing home, guaranteeing that they are always on the edge of disaster.
16
Of course this piece pays no attention to the problem that switching insurance can mean having to find a new set of health care providers and new source of hospital care, due to the restrictive networks that come with lower costs these days. the impact of such changes can be very adverse, especially given the incompatibility in many instances of different electronic medical record systems, even if from the same vendor. Loss of such information actually increases costs and reduces patient safety.
12
When I called my doctor's office about what plans they took, they mentioned they don't take Obamacare. Other docs do not take Medicare patients. There was also a study that showed in a significant number of areas of the country, there are no specialists available in network for many ailments--no rhematololgists, no geriatricians, etc.
2
@NRoad, well said.
Gee, thanks for another dose of the tired old "personal responsibility" meme.
People working 10-hour days while raising kids and/or caring for ill family members are just plain lazy (or stupid) if they can't wade through dozens of pages of complex fine print every year, or if their ESP wasn't accurate about the type of coverage some new illness would require?
How about for-profit insurance corporations taking a bit of personal responsibility for the mess that our nation's health coverage has become? Privileging profits over public health is evil, even when it's accomplished by merely offering a zillion overcomplex and often mutually contradictory "choices."
Single payer is desperate needed.
People working 10-hour days while raising kids and/or caring for ill family members are just plain lazy (or stupid) if they can't wade through dozens of pages of complex fine print every year, or if their ESP wasn't accurate about the type of coverage some new illness would require?
How about for-profit insurance corporations taking a bit of personal responsibility for the mess that our nation's health coverage has become? Privileging profits over public health is evil, even when it's accomplished by merely offering a zillion overcomplex and often mutually contradictory "choices."
Single payer is desperate needed.
72
Exactly. Pundits go on about consumers wanting "choice" - but in health care the choice that matters is choice of PROVIDER (having options in doctors, hospitals, etc). What good does it do me to have a choice of financial middleman? Especially when the details of these plans are so obfuscated.
15
Thank you. I could not agree more.
5
The rise of the medicare advantage plans and cheap premium commercial insurance has ruined it for working class people and working class retirees in this country, who paradoxically tend to vote for politicians who support this kind of low quality insurance. "Pay less now but you will pay dearly later" should be their marketing campaign. The opposite intent should occur in this country...people in this country should have the attitude that for profit commercial insurance companies are the ones who are enslaving the population with their profit driven obstruction to people getting the health care they need. A government funded insurance that negotiates prices better than CMS needs to form.
7
I would not say the Medicare adventage plans are low-rent insurance.
1
This article is a stark reminder that "Obamacare" is at it's core a Republican concept from the Heritage Foundation whose intent is to keep a paternalistic, dated healthcare approach alive for the benefit of the insurance industry.
Under Canada's single payer system I simply prove that I have legal standing in my province of residence, get a photo taken and a card show up in the mail that provides good (no, not perfect by a long shot), free healthcare services.
Under Canada's single payer system I simply prove that I have legal standing in my province of residence, get a photo taken and a card show up in the mail that provides good (no, not perfect by a long shot), free healthcare services.
26
We should have that option.
1
Massive changes are going on behind the scenes and I wish someone from this newspaper would shine a light on those things. Large employers, like universities, are quietly moving their retirees off the employer health insurance system. For most of these employees, the continued employee insurance constitutes their Medicare medigap plan. (See? Your eyes are already starting to glaze over at the complexity.) They are pushing these retirees into the "robust private market." Meaning: we're cutting you loose, you're on your own. At the beginning, they say they will provide retirees with a subsidy, to help with buying these private plans, but we know what direction that will go as future university budgets are developed. They tell employees the pretty Brooklyn Bridge lie that their insurance costs won't go up as they struggle to find private coverage, but the university will nonetheless save big dollars. Yeah, an accounting miracle!
Please, investigative journalists, interview a few large university benefits directors. This is one more way pensions are being stolen from already retired American workers.
Please, investigative journalists, interview a few large university benefits directors. This is one more way pensions are being stolen from already retired American workers.
43
Whenever I read articles like this and read the comments, I thank God that I live in a country with a single payer system run by the government. How on earth are people without the skills of a financial actuary expected to negotiate the byzantine world of US health care plans, and on a continuing basis as they age. "Invest and harvest' is one of the creepiest business strategies I've heard of recently. Ben Carson calls government involvement in affordable health care "slavery" when in fact it is the involvement of Big Business allied with Big Pharma with little government regulation which has enslaved so many and often reduced them to bankruptcy.
72
@Susan: You're right, and for the record: even fully-credentialed actuaries detest slogging through the byzantine world of US health care plans!
4
Cheaper isn't necessarily better, especially if you're only looking at premiums and deductibles. If one plan saves you $250 in premiums but has an extremely limited provider network, it might well be worth that extra cost to have more choices (especially if you'll have to find a new PCP and specialists), and that's not even looking at coinsurance for hospital stays and some coverage vs no coverage if you go out of network.
The short answer is, consumers don't err in choosing health plans so much as our system is completely broken and people don't have the time it would take to truly figure out how much one plan would cost vs another.
The short answer is, consumers don't err in choosing health plans so much as our system is completely broken and people don't have the time it would take to truly figure out how much one plan would cost vs another.
43
How many doctors do you need to see? Most people, most of the time, are mostly healthy. Physician choice is critical for a handful of people, and is valuable to health plan participants, of course - it's just wildly overvalued in making health benefits choices.
The whole idea of peddling ridiculously complex health insurance "choices" to people as the best way to manage the health of our people is utterly absurd. The main advantage of our system is that insurance companies can profit. There isn't real competition, and we are not becoming better informed either. The whole thing is unethical at the root, actually slowing or diverting real care, rather than enhancing it.
Our system is designed to reward those most proficient at producing profit. It is not designed to deliver highest quality services to all. We don't even try to do that directly. Somehow we seem unable set a national goal, to resolve to take care of our own. Instead we place our very health in the hands of folks who are perfectly satisfied making profits by confusing or even deceiving customers.
The whole shameful mess should be replaced by single payer, Medicare for all.
Our system is designed to reward those most proficient at producing profit. It is not designed to deliver highest quality services to all. We don't even try to do that directly. Somehow we seem unable set a national goal, to resolve to take care of our own. Instead we place our very health in the hands of folks who are perfectly satisfied making profits by confusing or even deceiving customers.
The whole shameful mess should be replaced by single payer, Medicare for all.
153
@AMR: Your comment should be a Times' Pick.
2
Just remember who to thank for this mess. It aint the GOP. Many of them tried to warn about it but the left and Obama just kept calling them liars. Look who lied after all.
1
What you call "this mess" started long before Obamacare. For decades we have depended on the "magic of the marketplace", and by extension, insurance companies' products, for our healthcare. Both parties have been unwilling to move to a more rational system such as exists in other countries.
6
There are more health care options than mutual funds choices.
There is no one size fits all plan. When choosing a plan, think about
what your needs of care could be. Your age, health status, chronic
conditions, and medications you take.
When evaluating your plan choices, should you choose an HMO plan,
you will be required to use physicians and hospitals in the plan
network. The insurer's web site will have a listing of network providers.
No internet access, phone.
A Deductible is the amount you spend before your plan will cover
billings. A Co-Pay is your amount you pay for a primary care Dr. visit.
There is usually a higher co-pay for a specialist visit.
Co Insurance, is the percentage of the charges that you're responsible
for. Lab work, Scans, etc, are in the co insurance group.
Out of pocket maximum, is the amount you pay out of pocket.
Any expenses after the maximum is reached, will be covered at 100%.
for the calander year. Unfortunately, all plans have different deductibles,
co- pays and out of pocket maximums.
Medications also have co-pays and drugs are classified into a tier
system. Tiers 1-5. Prefered Generic -1 Generic -2 Prefered Brand-3
Brand-4 Specialty-5.
Now you would need to check which Tier your medication is in and
the co-pay for that tier. Next, is your medication included in the
plan formulary? Co-Pays that the insurer lists, are for Network
Prefered Pharmacies. Use just a Network Pharmacy, and the cost is
more. I'll need to continue.
There is no one size fits all plan. When choosing a plan, think about
what your needs of care could be. Your age, health status, chronic
conditions, and medications you take.
When evaluating your plan choices, should you choose an HMO plan,
you will be required to use physicians and hospitals in the plan
network. The insurer's web site will have a listing of network providers.
No internet access, phone.
A Deductible is the amount you spend before your plan will cover
billings. A Co-Pay is your amount you pay for a primary care Dr. visit.
There is usually a higher co-pay for a specialist visit.
Co Insurance, is the percentage of the charges that you're responsible
for. Lab work, Scans, etc, are in the co insurance group.
Out of pocket maximum, is the amount you pay out of pocket.
Any expenses after the maximum is reached, will be covered at 100%.
for the calander year. Unfortunately, all plans have different deductibles,
co- pays and out of pocket maximums.
Medications also have co-pays and drugs are classified into a tier
system. Tiers 1-5. Prefered Generic -1 Generic -2 Prefered Brand-3
Brand-4 Specialty-5.
Now you would need to check which Tier your medication is in and
the co-pay for that tier. Next, is your medication included in the
plan formulary? Co-Pays that the insurer lists, are for Network
Prefered Pharmacies. Use just a Network Pharmacy, and the cost is
more. I'll need to continue.
5
@Jerry: And there's the issue of the insurance company single-handedly deciding what constitutes "reasonable and customary charges" for any given doctor's visit or procedure. That can make a big difference to how much of a bill gets paid, no matter what one's supposed co-pay is!
6
My lisinopril (hypertension) was price-matched to Walmart by my supermarket and was $4. In one new plan I looked at it's Tier 2--$45. Before I pick that one, I have to see if the supermarket will look out for me--and this is just one tiny aspect. My old plan was charging for blood work--will the new one I find? And there are other considerations...to balance and evaluate. Broker!
2
@L: True. Insures use algorithms by coverage area to
set their" customary" and "reasonable" payments.
Case in point. When the provider bills $400. for an
office visit, Medicare allows $120. They pay 80%
of $120. My Supplement C covers the 20% balance
of the $120. allowed amount.
The crime is, that when a patient is uninsured, the
$400. billing is the patients responsibility.
You can negotiate downward, but when you're ill,
how many folks have the skill or fortitude to engage?
set their" customary" and "reasonable" payments.
Case in point. When the provider bills $400. for an
office visit, Medicare allows $120. They pay 80%
of $120. My Supplement C covers the 20% balance
of the $120. allowed amount.
The crime is, that when a patient is uninsured, the
$400. billing is the patients responsibility.
You can negotiate downward, but when you're ill,
how many folks have the skill or fortitude to engage?
1
Premium cost isn’t everything. The lowest-premium plans are fine if you are young, mostly healthy and don’t particularly care where or by whom you are treated--“in-network” means less to these individuals. A non-teaching community hospital without university affiliation is fine if you need your gallbladder or appendix removed, stent placed, hernia repaired, broken leg set, asthma treated or baby delivered. But if you have something like cancer or other complex and perhaps arcane medical problem, you should be able to have the choice of a teaching hospital with a specialty center to avail you of expertise (e.g., for breast cancer, surgeons and radiologists who treat nothing but) and state-of-the-art treatments that small for-profit or community hospitals can’t offer. It’s been shown that in the case of breast cancer, the smaller and more general the hospital and surgeon the higher the likelihood of overtreatment with more extensive surgeries, radiation and chemotherapy that might be better managed with the less invasive or onerous treatments offered by teaching hospitals and specialty centers based on their more extensive and specific experience as well as access to more modern research data. And in a larger teaching hospital, participation in clinical trials is likelier to be subsidized in part or in full by the institution itself (whereas if the same treatment is sought at a community hospital coverage is likelier to be denied as “experimental.”
You get what you pay for.
You get what you pay for.
13
These new plans cost the patient more than the insurance. For example there are many plans with a $40.00 copay for an office visit. The plan allows $50.00 for said office visit and the patient pays $40.00. Guess what the insurance pays? That is correct, the multi-billion dollar insurance conglomerate pays $10.00, while Joe blue collar pays $40.00. This same plan also has large deductibles and co-insurance. That sounds fair. These plans are a disaster.
7
I have a plan just like you describe and I love it! The reason is that I buy health insurance for the "insurance" part of it, not the "shared payments" aspect. Although I may pay a couple hundred more in co-pays annually than my co-pay phobic neighbor, my plan has far better coverage for catastrophic events, which is what I really need. With that said, the entire purchasing process is so difficult that I favor a single payer system. Not everyone is a sophisticated financial analyst like I am.
2
My cousin has weird symptoms--they are baffled--so they told her to go to Mayo--the doctor said, "They have the knowledge." Who can go to Mayo on most plans? Why don't all doctors "have the knowledge"? My sister went out of network to Mayo once and the bills are still cascading in--and she is depending on some clerk in her primary's office to work it out for her.
You don't understand: ornate and obscurantist health insurance contracts are a feature not a bug. The longer a health insurance company delays payment-- claiming that its customer didn't accurately interpret the fine print of their contract--the more money they make. The entire business model is based on artfully denying a service that they purport to offer. Another term for this is "fraud." (Of course, this is not de jure fraud--insurance company lawyers and lobbyists have seen to it that any class-action suit would be toothless).
You want to show these companies some teeth? Instead of becoming some sort of contract expert in their auditing wing, how about you write your congressman a notarized letter demanding that these predators be nationalized yesterday.
You want to show these companies some teeth? Instead of becoming some sort of contract expert in their auditing wing, how about you write your congressman a notarized letter demanding that these predators be nationalized yesterday.
93
We need more than a letter to a congressman to fix this. The members of congress are laughing all the way to their winter homes in warm climates.
6
Agreed. The strongly worded letter is merely step one. Step two might be a well-orchestrated legal challenge to the fraudulent practices of a single, major healthcare company in order to break them completely. The windfall would be redistributed to subscribers, and the case might be a precedent for wiping out other insurance companies, and putting their execs in prison.
Yes, this is utopian. But I've--we've--had enough of the games played with mortality.
Yes, this is utopian. But I've--we've--had enough of the games played with mortality.
Seriously. Surely you know that this is not about healthcare for America. It is a Heritage Foundation counter proposal to Hillary Clinton's efforts during her husband's first administration.The plan was supposed to represent what the GOP misnomers as capitalism by using private insurance providers and allowing companies to charge pretty much as they think they can get away with. Had Obama had the backbone, he would have used his Democratic majority at the beginning of his first four years to implement Medicare for all and phasing in lower age groups each year. Federal dollars are not the issue either. Those dollars belong to the taxpayers. What creates the angst is the influence of the largest welfare cheats in the country, corporations, aided and abetted by the US Congress who depend on the corporate owners. The whole idea of "enough" is a fantasy creation that in reality is a lack of priorities for the general public. You'll notice that the Congress doesn't let those issues get in their way when they are providing pay, pensions, insurances and exemptions from their own laws when they are dealing with themselves. When will there be a real discussion of this issue instead of this distraction?
37
The most important information to me about the various plans is almost impossible to obtain: which physicians and clinics are 'in network'
13
And you have to pretty much check on everyone who will be treating you. Several years ago, I needed minor surgery. My doctor and I both checked with the insurance company to be sure the hospital was in-network. Then I received a bill for the full amount of the anesthesiologist; he was out of network. This was odd for two reasons: 1.) It was the only anesthesiologist service the hospital used, and 2.) I had only met the anesthesiologist at 7:00 a.m., a few moments before going into surgery, hardly an ideal time to start calling my insurance company. Faced with those facts, the insurance company finally backed down and paid the bill. But the idea that every service provided in an in-network facility is not in-network (and that we are supposed to determine that in advance) is ridiculous.
30
This is a byproduct of lawyers and accountants getting the best of consumers, as a trend starting more than a generation ago. Look at your own NYT article today describing forced arbitration clauses buried in consumer contracts. Even scientific evidence does not excuse the caveat emptor traps designed to relieve their own customers of hard earned dollars. It's just crooked capitalism. Single payer is the only conceivable solution.
24
The absolute way to not make a mistake is to not get it. Obamacare is a HUGE mistake as it is.
4
Why should people have to jump through a million hoops and read reams of fine print just so they don't become bankrupted by their medical bills. Single payer now!
73
As a nationally recognized healthcare advocate, I can tell you with confidence that confusion regarding healthcare plans is simply the tip of the iceberg. The minority of individuals who fully understand the details of their plans and choose "correctly" still have no guarantees that they won't overpay for their care once they need to utilize their insurance benefits.
Experts believe 50% or more of all medical bills contain errors. Most claim denials are overturned if you appeal them just once, but most people don't even realize they can appeal. An MRI on one side of Main Street costs $3000, and on the other $300, and most Americans don't understand the pricing disparities.
Who pays for the errors, denials and the arbitrary billing practices? The patient and his/her family, every time. The #1 reason for personal bankruptcy in our country is medical bill related, and it has been for decades. Out of those who filed, most claimed to have had insurance. We overpay an estimated $58 billion a year that we simply shouldn't owe.
Certainly, picking the right health insurance is confusing. However, it is insurance not assurance. The real battle begins when you try to get all of the coverage/care you deserve for a fair price.
Experts believe 50% or more of all medical bills contain errors. Most claim denials are overturned if you appeal them just once, but most people don't even realize they can appeal. An MRI on one side of Main Street costs $3000, and on the other $300, and most Americans don't understand the pricing disparities.
Who pays for the errors, denials and the arbitrary billing practices? The patient and his/her family, every time. The #1 reason for personal bankruptcy in our country is medical bill related, and it has been for decades. Out of those who filed, most claimed to have had insurance. We overpay an estimated $58 billion a year that we simply shouldn't owe.
Certainly, picking the right health insurance is confusing. However, it is insurance not assurance. The real battle begins when you try to get all of the coverage/care you deserve for a fair price.
64
I once had a policy that made a big deal out of how, if we reported an error in billing, we would get a percentage of the money the company recovered. But their statements were the dates and the medical billing codes only, meaning no one not in the medical billing profession knew what was being billed!
(A friend of mine was checking out of the hospital when she noticed a charge on her bill. She pointed out that she had not had that particular procedure. The hospital official started saying that she didn't understand all the medical terminology. My friend replied, "Yes, I do. I worked as a medical technician and did that particular procedure. And I know that I didn't have it done to me." The bill was adjusted immediately.)
(A friend of mine was checking out of the hospital when she noticed a charge on her bill. She pointed out that she had not had that particular procedure. The hospital official started saying that she didn't understand all the medical terminology. My friend replied, "Yes, I do. I worked as a medical technician and did that particular procedure. And I know that I didn't have it done to me." The bill was adjusted immediately.)
8
We recently had a client who was being charged $300 for NOT using the hospital's linens. Needless to say, that charge went away quickly.
Hospitals are not supposed to use templates for itemizing procedure billing, but far too many do. One client, who was allergic to anesthesia, was billed for it anyway. We see that type of thing more than you could imagine. Thanks for your reply.
Hospitals are not supposed to use templates for itemizing procedure billing, but far too many do. One client, who was allergic to anesthesia, was billed for it anyway. We see that type of thing more than you could imagine. Thanks for your reply.
2
@Sarah O'Leary: Because you mediate these cases for a living, I am sure you have come to this conclusion: health insurance contracts are intentionally obscurantist--they are written in such a way that makes it easy for companies to deny service because the consumer made a mistake. (I has been argued, by the way, that this is the way the entire immaterial economy is run these days: we are punished--by nickle and dime--every time we can't follow the byzantine rules of some organization).
I have a fantasy that good people like you, along with a horde of expert tort lawyers, mount a successful pro-bono class action lawsuit against a health-insurance giant for, say, $25 billion, and breaks them. The charge, of course, would be consumer fraud; the money returns to the hands of the consumers; and the dominoes fall around other companies until we have single payer.
I have a fantasy that good people like you, along with a horde of expert tort lawyers, mount a successful pro-bono class action lawsuit against a health-insurance giant for, say, $25 billion, and breaks them. The charge, of course, would be consumer fraud; the money returns to the hands of the consumers; and the dominoes fall around other companies until we have single payer.
7
the confusion is related to several factors. first, every plan is different as the article points, wading through those differences is laborious at best especially 41 of them. second, the don't often use the same language in their descriptions and when you ask for advice it's often conflicting. third most people look at insurance as a necessary evil and don't calculate the best case scenario if they have to use it. another issue is the constantly moving target of plans... meaning every year you have to reevaluate the plans because they all change or disappear altogether. calculating deductibles is difficult because some plans cover as routine treatments that others don't, take perscription drugs... each plan has "specialty" drugs... they don't treat every drug the same plan to plan... so wading through all that crap... and i mean crap is too much for 95% of the people being forced to choose.... that in a nutshell is the problem.
19
You forgot to mention the best source of quality information to help consumers make an informed choice- an experienced health insurance professional. Search the NAHU website for these folks who are right in your backyard !
Right. When I was signing up for Medicare, I simply called the independent insurance agent who had sold my my private policy and said, "What can you do for me?"
1
Which political party would say "it's just your tough luck if you don't do whatever it takes to understand what is best for you." Which political party would say "if you want to do business on healthcare.gov, you had better provide enough information which makes crystal clear to a high school graduate, in simple English, what they get for what they pay." If you think this is important to the well being of your family, pick your party and don't get misled by what the candidates say.
6
Several years ago, both of my elderly parents had heart attacks within three months. (An interesting year for the family.) By chance, they ended up with different cardiologists who both worked for the same practice. The bills were confusing--my parents would sit down with the calendar and say, "Which of us had an appointment on June 25th? (This was usually in September or later.) Well, I guess the lab bill for that date must be yours."
Finally, my mother asked, "If we have this much trouble, when we both have college educations, what do people do without education or high reading skills?"
Finally, my mother asked, "If we have this much trouble, when we both have college educations, what do people do without education or high reading skills?"
12
The problem that I'm having with the plans is that they have limited networks. If I change plans, then I have to change doctors. Who wants to do that every year?
11
I appreciate this article but also find it frustrating. It identifies all the things I (and people in general) don't know but doesn't tell me (us) how to learn more or offer straightforward strategies for analyzing policies and their costs/benefits.
10
The thrust of the article suggests that it's all about consumers making "mistakes" because they succumb to various kinds of "bias."
The fact is that in a market as fraught with bizarre complications as health care, many of which complications will not become manifest until future events transpire, errors are inevitable. About the only "easy" choice is accepting a higher deductible in exchange for a significantly larger premium discount.
The idea that you have to go through this crap every year -- that you're now taking on another process that is equally as tedious and complex, and for most people more mysterious, than filing your own tax return -- is incredibly depressing. The expectation that most people should "get it right" is absurd.
The fact is that in a market as fraught with bizarre complications as health care, many of which complications will not become manifest until future events transpire, errors are inevitable. About the only "easy" choice is accepting a higher deductible in exchange for a significantly larger premium discount.
The idea that you have to go through this crap every year -- that you're now taking on another process that is equally as tedious and complex, and for most people more mysterious, than filing your own tax return -- is incredibly depressing. The expectation that most people should "get it right" is absurd.
47
This author tries to lay the blame for confusing insurance policies on consumers.
The whole "medical industry" is great at not giving consumers straight answers about costs - especially insurance companies. Also, when your doctor says you need a certain procedure or an MRI, the insurance companies have no problem denying payment for them because the insurance company seems to think they know more about your health care treatment that your doctor does.
What we need in this country is universal access to medicare - single payer health insurance - and to eliminate the profit motive in health care. Then maybe we can focus on health instead of doctors doing procedures so they can get paid.
The whole "medical industry" is great at not giving consumers straight answers about costs - especially insurance companies. Also, when your doctor says you need a certain procedure or an MRI, the insurance companies have no problem denying payment for them because the insurance company seems to think they know more about your health care treatment that your doctor does.
What we need in this country is universal access to medicare - single payer health insurance - and to eliminate the profit motive in health care. Then maybe we can focus on health instead of doctors doing procedures so they can get paid.
76
When I needed cataract surgery, my doctor told me about a newer lens implant that would at the same time correct astigmatism, but warned that it cost more and many insurance companies would not pay the extra. I called my insurance company to ask, but all I could get was a statement that I would need to give them the billing code before they knew if they would pay--something not available to me. They also couldn't tell me if, in the event that lens was not covered, the company would pay the normal amount and leave the extra cost to me or if I would have to pay the entire amount myself.
A few years earlier, I had needed a test done and, since I had a high deductible plan, I knew in advance I would be paying the entire cost. I called the hospital to ask what the cost would be, and the billing office absolutely refused to tell me, insisting they could not give an answer until they knew exactly what had been done and which doctor had done it. (I wasn't asking for an exact amount--just a range of costs.)
A few years earlier, I had needed a test done and, since I had a high deductible plan, I knew in advance I would be paying the entire cost. I called the hospital to ask what the cost would be, and the billing office absolutely refused to tell me, insisting they could not give an answer until they knew exactly what had been done and which doctor had done it. (I wasn't asking for an exact amount--just a range of costs.)
9
An important fact this article fails to explicitly mention is that a salient feature of the "American Exceptionalist" health care system is its labyrinthine complexity that is, frankly, beyond the capability of many of us to fully comprehend.
We must dig through user-hostile (and possibly incomplete or outdated) Web sites to determine whether a doctor, hospital, or pharmacy is currently in our insurance network. We need to understand the distinction between a copay and co-insurance, track deductibles and out-of-pocket limits. And when we need a prescription, we must determine which drugs are currently in the formulary, and on what tier; whether prior authorization, step therapy, or other arbitary hurdles must be cleared; and what quantity limits or dosage form restrictions might apply. (As insurers constantly change formularies according to what suppliers provide the best prices, it's necessary to check the current status with each refill.)
We would not suffer with that complexity if we had a health care system whose purpose was to provide patients with the care they need. But in the US, we have a unique system whose primary purpose is to increase the wealth of corporations that collect rents from administering health care. The complexity serves that purpose-- after all, their term for actually providing health care is "medical loss."
The ACA's "reform" added new layers of "marketplace" complexity, without fixing a system that puts profit first and patients last.
We must dig through user-hostile (and possibly incomplete or outdated) Web sites to determine whether a doctor, hospital, or pharmacy is currently in our insurance network. We need to understand the distinction between a copay and co-insurance, track deductibles and out-of-pocket limits. And when we need a prescription, we must determine which drugs are currently in the formulary, and on what tier; whether prior authorization, step therapy, or other arbitary hurdles must be cleared; and what quantity limits or dosage form restrictions might apply. (As insurers constantly change formularies according to what suppliers provide the best prices, it's necessary to check the current status with each refill.)
We would not suffer with that complexity if we had a health care system whose purpose was to provide patients with the care they need. But in the US, we have a unique system whose primary purpose is to increase the wealth of corporations that collect rents from administering health care. The complexity serves that purpose-- after all, their term for actually providing health care is "medical loss."
The ACA's "reform" added new layers of "marketplace" complexity, without fixing a system that puts profit first and patients last.
48
Educated consumers in short supply? Perhaps health care is an area where citizens should be served, and not exploited, by their government and insurers.
51
In each of the last two years, I was horrified to discover that the majority of health providers in Manhattan do not accept any insurance purchased in the State's Exchange. As much as I love President Obama, the implementation of his law in NYS is a joke.
32
The MAJORITY do not accept any marketplace insurance? I don't even have to do a cursory evaluation to know that that is untrue.
1
Hospitals CEOs and insurance execs are all in bed together
For those of us who live in small states with limited medical care and long waits for service, making insurance decisions entirely, or even mainly, on the basis of cost (even if it were easy to figure out) is gambling with health care. This is especially true as you get older.
If you're well all year, fine. But if you need specialized care, or even a second opinion not available locally, you need insurance that will pay for it. I pay extra for fee-for-service Medicare and a higher-cost supplemental so I can go to any facility or doctor that accepts Medicare. I'm fortunate I can afford the premiums and I keep my fingers crossed that traditional Medicare does not disappear.
If you're well all year, fine. But if you need specialized care, or even a second opinion not available locally, you need insurance that will pay for it. I pay extra for fee-for-service Medicare and a higher-cost supplemental so I can go to any facility or doctor that accepts Medicare. I'm fortunate I can afford the premiums and I keep my fingers crossed that traditional Medicare does not disappear.
14
Yes, it is insurance against the unknown, and buying the heftiest coverage you can afford, for the same reason that you buy the heftiest life insurance policy you can afford, is the fact to wrap your head around. In other words, consider all health insurance, given that we don't have single payer yet, catastrophic health insurance--what will your finances look like if you experience a health disaster?
This article is presented from the point of view of irrational decision making by consumers. But a much more reasonable interpretation is that heath insurance companies work hard to make these confusing and to trap consumers into poorer choices. Why should an insurance company even be allowed to offer a lower deductible plan that costs more in premiums - what are they even pretending to offer the customer? And the idea that people are not able to describe how much an MRI will cost is completely unsurprising - how are you actually supposed to know? Even when one gets the bill with the retail rate, it turns out that the insurance company has some negotiated rate with the provider (secret from point of view of customer). The whole system is appalling and not at all transparent. That's why market based solutions will never work, unless one thinks that gouging customers is an example of the market working.
128
I am assuming, they "tell you " the "cost" of the MRI. And then you use the information on deductibles, co-pays and Co-insurance, to figure out your cost.
3
Also the way billing is set up is designed to confuse customers. First one gets a "this is not a bill bill" stating what the provider charged the insurance company. Then one gets a separate statement from the insurance company showing what they paid -WITHOUT any real explanation why. Then later one gets a real bill from the provider. Importantly, this whole process can play out over many months, making it hard to integrate the whole billing cycle. Even for those of us who are good with numbers and inquisitive, this is a confusing process. And its the same everywhere.
45
No, "they" don't tell you the cost of the MRI. It is almost impossible to find out the cost of any medical procedure ahead of time.
5
The major factor in cost differences among plans is invisible to the consumer. Unless the only consumer cost is a co-pay, the negotiated network price determines what consumers pay, and these prices are not available for plan comparison. They are often unavailable even once in a plan, e.g., planning for elective care. My explanation of benefits statements show network negotiated prices from 50 – 10% of the billed price. A plan with higher premiums may be less costly if the network negotiated prices are less. Another cost hidden from the consumer is that plans with pharmacy co-pays don’t show the drug cost on the prescription. When my employer plan switched from prescription co-pays to a percentage, I feared I would pay more, but every prescription cost less than the prior co-pay. (All my family’s prescriptions were generics, and the insurance refused to cover the one non-generic drug that was prescribed during the year, offering only to cover a generic that was not truly equivalent.) As an aside, the author’s illustrative example of employees paying $500 additional premium for $250 less deductibles misses the tax advantage of employee-paid premiums being pre-tax and deductible costs post-tax. Admittedly, the deal is still likely to be bad, because it’s hard to imagine anyone whose net incremental tax is 50%, but it’s not a 2:1 mistake as the article states. This is less a criticism of the author than support for his argument that the decision process is complex.
15
There's other research that indicates that in general we humans are unable to deal with too many choices. So we add that to a lack of understanding as to how to evaluate the costs, and that tendency to not do anything, and thus remain in unsuitable plans.
But when I have in the past done comparisons to help someone decide the 'best' Medicare combination, I have found it frustrating. It's difficult to collect all information, and compare all possible relevant parts : the providers, provider changes, co-pays, and/or percentage of services covered ( and that without any clue as to what the actual price of a service or treatment is). You can see specific numbers for the deductible, monthly cost and the out of pocket cap pretty easily -- but not all charges for which the insured is responsible may be counted against the cap, or towards the deductible. Not also that this is best done on the internet - which not everyone has. And you had best check on how the plan is rated by users - how they have been treated. And the reason I was doing this for others - they were incapacitated in some way, which is another obstacle.
I am surprised that some one hasn't come up with software that works like tax prep apps: fill in the information about your self, you location and past expenses; it would do the search and comparisons and spit out the best options.
But when I have in the past done comparisons to help someone decide the 'best' Medicare combination, I have found it frustrating. It's difficult to collect all information, and compare all possible relevant parts : the providers, provider changes, co-pays, and/or percentage of services covered ( and that without any clue as to what the actual price of a service or treatment is). You can see specific numbers for the deductible, monthly cost and the out of pocket cap pretty easily -- but not all charges for which the insured is responsible may be counted against the cap, or towards the deductible. Not also that this is best done on the internet - which not everyone has. And you had best check on how the plan is rated by users - how they have been treated. And the reason I was doing this for others - they were incapacitated in some way, which is another obstacle.
I am surprised that some one hasn't come up with software that works like tax prep apps: fill in the information about your self, you location and past expenses; it would do the search and comparisons and spit out the best options.
11
Its difficult for pts to anticipate their costs and therefore pick the best plan for them. For plans like most plans that limit access it is almost impossible to know the quality of different panels of doctors or hospitals. When you buy anything the 2 main considerations are cost and quality, i.e. what you are buying. its difficult enough to ascertain costs and quality is almost impossible to evaluate. When i worked as an internist in Dc for a closed panel HMO a pt came in and said this is great, its less expensive than the other plans. I thought he has no idea of what he has bought or the quality of this product. Most people probably spend more time buying their TV than deciding their health care coverage for the next year. We all assume we won't get sick but when we do get a cancer or MI suddenly the most important thing is the doctor and hospitals we have access to. Until there are reliable, public ways to judge doctor and hospital quality pts have no choice but to make uninformed, often poor choices
11
I was once hospitalized with a paralyzed intestine--after 5 days on a nasogastric tube (you do not want this!!), it let go. But the hospitalist said, "Good thing, because I called a bunch of surgeons and you have such bad insurance not one would talk to you."
1
What this article is telling me is that as a consumer of medical care I'm expected to have a level of expertise achievable only by an insurance agent and the ability to somehow foresee any illnesses or accidents I may have during a year of coverage. The ACA has not helped to contain the cost of medical care in America. That is most unfortunate for all Americans because we ought to be able to receive the care we need rather than the care we can afford. The two are not synonymous. If I'm unemployed at some point during the year that will not negate my need for medication or medical care for a chronic condition. But our current wealth care system functions on the assumption that we, as "consumers" can afford to pay premiums, co-pays, deductibles, co-insurance, out of network fees (even when it's not our fault that the doctor was out of network). A true health care system, which we do not have, would allow us, as patients, to get the care we need whether we are rich, poor, employed, unemployed, in our home state, in need of a specialist, or in need of follow up care. Our system does none of that. Our system is fragmented, difficult to navigate, and functions for the convenience of the health insurance companies, doctors, hospitals, labs, and so on. In fact, the system serves everyone but the patient. The patient is an afterthought. Ask any person who has had an emergency, been in the hospital, or needed follow up care. We are not served.
88
Very well said. This is why my wife and I decided two years ago to stop paying for insurance. We pay the individual mandate penalty and we mostly do without the care we cannot afford. We hope to make it to Medicare in a few more years.
Health care for profit is corrupt by its very nature. We choose not to be victimized any longer.
H
Health care for profit is corrupt by its very nature. We choose not to be victimized any longer.
H
2
"...participants had a stronger aversion to an increase in costs in deductible or co-pay than to the same increase in premium. Because a dollar is a dollar, no matter how you spend it, this is another indication of irrational decision making."
No, a dollar is NOT a dollar no matter how you spend it. I'll pay my monthly premium with 100% certainty. If I remain healthy for the year, my co-pays might total $0, and my deductible will be irrelevant. I guess one could do an expected value analysis of one's expected health care spending for the year and use that to guide the plan decision.
No, a dollar is NOT a dollar no matter how you spend it. I'll pay my monthly premium with 100% certainty. If I remain healthy for the year, my co-pays might total $0, and my deductible will be irrelevant. I guess one could do an expected value analysis of one's expected health care spending for the year and use that to guide the plan decision.
11
Also, as a self-employed person who pays my own premiums as well as any costs, a portion of my premiums can be deducted from my earned income, thus avoiding the payroll taxes of 15+% as well as personal income tax on what's left. The actual medical costs come a little later in the return, and are only useful in tax reduction if my total is over a certain percentage. So a given $500 would be a lot more valuable to me tax-wise as premium than as care outlay.
10
This problem will not go away as long as we continue to confuse health care with health insurance, acting like the person to call in a medical emergency is an insurance agent, not a doctor. It's way past time to join the rest of the world and provide single payer coverage. And let's not pretend that Obamacare is a solution to any of this.
104
The insurance companies sometimes act as if the patient should have called them instead of the doctor. My brother once hurt his knee playing softball. His doctor said it might heal itself and recommended ice for a week. When it didn't improve, he decided to do tests and determined there was cartilage damage. At first the insurance company refused to pay for the x-rays and surgery because the x-rays had not been taken within 24 hours of the injury.
Years later, he injured his mouth playing softball. (Yeah, he should have admitted he wasn't much of an athlete and given it up.) It was a charity game between his company and one in a small town about an hour from his home. As happens in small towns, the plastic surgeon the doctor determined he needed was out of town for the weekend, so the doctor referred him to one at home. Once the bleeding had been stopped, my brother had his wife drive him home rather than use the town's only ambulance. The insurance company said that since there was no ambulance involved, the visit to the plastic surgeon must have been for elective rather than necessary treatment.
Years later, he injured his mouth playing softball. (Yeah, he should have admitted he wasn't much of an athlete and given it up.) It was a charity game between his company and one in a small town about an hour from his home. As happens in small towns, the plastic surgeon the doctor determined he needed was out of town for the weekend, so the doctor referred him to one at home. Once the bleeding had been stopped, my brother had his wife drive him home rather than use the town's only ambulance. The insurance company said that since there was no ambulance involved, the visit to the plastic surgeon must have been for elective rather than necessary treatment.
4
Kudos to Mr. Frakt for examining the biggest problem with Obamacare which makes economic issues the primary focus for most subscribers and rather than good health maintenance. Understanding and simplifying healthcare should mostly be the perview of doctors, public health, fitness and diet experts. Sure, we need to focus on making healthcare as efficient as possible but that should put single-payer healthcare on the table.
Limiting health plans to the same institutions that specialize in shareholder returns and corporate profits is morally questionable as is subjecting consumers to the fog of economic complexities which always favor big business at the expense of good consumer health.
Limiting health plans to the same institutions that specialize in shareholder returns and corporate profits is morally questionable as is subjecting consumers to the fog of economic complexities which always favor big business at the expense of good consumer health.
24
I would venture a guess that the vast number of people, especially the previously uninsured, who opt for low-cost plans have no concept of how the high deductibles that go with the bargain are going to come back and bite them. A low-income family who could not formerly afford basic health care isn't likely to have (i.e., afford) any greater access to it with a "low-cost" high deductible plan.
18
I'm guilty of what this article suggests. The choices my employer offers are daunting, and beyond a cursory inspection, I didn't give my choice much thought.
I recently found out how important it is. Involved in a serious accident that left me with several broken limbs, a two-month rehabilitation stay and many more months of outpatient phys therapy, I learned that my plan capped out of pocket costs at $5,000. Not a small amount of money, but my physician and hospital bill by themselves were over $100,000! My plan helped further by tracking the costs as they were billed; once I met the $5,000 mark they automatically started picking up all the costs. They didn't make me submit receipts.
As good as the plan was,, there were some problems. The plan allowed 60 days of physical therapy from date of first treatment. Once discharged, I received physical therapy in-home, then on an outpatient basis when I could travel. But we couldn't agree on when the 60 days began. Their representatives insisted the in-home visits counted. I could never get them to budge from that, after many calls and even asking that they look at the billing codes. But my outpatient provider was able to get a letter from them saying the in-home visits didn't count. I counted my blessings and let it go.
If their own representatives didn't understand, how much chance does the consumer have
I recently found out how important it is. Involved in a serious accident that left me with several broken limbs, a two-month rehabilitation stay and many more months of outpatient phys therapy, I learned that my plan capped out of pocket costs at $5,000. Not a small amount of money, but my physician and hospital bill by themselves were over $100,000! My plan helped further by tracking the costs as they were billed; once I met the $5,000 mark they automatically started picking up all the costs. They didn't make me submit receipts.
As good as the plan was,, there were some problems. The plan allowed 60 days of physical therapy from date of first treatment. Once discharged, I received physical therapy in-home, then on an outpatient basis when I could travel. But we couldn't agree on when the 60 days began. Their representatives insisted the in-home visits counted. I could never get them to budge from that, after many calls and even asking that they look at the billing codes. But my outpatient provider was able to get a letter from them saying the in-home visits didn't count. I counted my blessings and let it go.
If their own representatives didn't understand, how much chance does the consumer have
52
I really wish that the surveys but ask what is the meaning of the word knowledge and what is the meaning of the word belief. I believe that most people make decisions based on beliefs not knowledge. For example only 7% of those surveyed stated they did not know the meaning of the word copay; 41% could not give an adequate definition. This is not ignorance. It is the substitution of belief for knowledge. They believed they knew the definition.
It is important to distinguish between knowledge, thinking, and belief. The substitution of the the words knowledge or thinking for belief is rampant. It is most telling when people make statements like "I know there is a God" or "I thought all women wanted to be mothers."
These types of statements disclose beliefs, not knowledge. I still find myself expressing a belief in the language of knowledge or thinking. It's an unfortunately easy mistake to make.
It is important to distinguish between knowledge, thinking, and belief. The substitution of the the words knowledge or thinking for belief is rampant. It is most telling when people make statements like "I know there is a God" or "I thought all women wanted to be mothers."
These types of statements disclose beliefs, not knowledge. I still find myself expressing a belief in the language of knowledge or thinking. It's an unfortunately easy mistake to make.
4
I spent hours trying to sort out the competing Medicare plans. But I was able to get help from California Hi-Cap. And California does have good comparison charts on line. The problem is trying to guess your likely medical needs over the coming year.
11
I'm preparing to choose from three plans presented by my employer, an annual ritual. And every year, oh how I wish I had a crystal ball to look into the future to see what my medical needs will be. Would I be better off with a slightly higher premium and a lower deductible next year or the lower premium and higher deductible? What about a fixed co-pay for a doctor visit versus a 30% co-insurance? Let me get out my EOBs for this year and do the math to see how my wallet would have fared had I chosen a different plan . . . . What nonsense we go through in this country!!! While I perform the ritual of choosing, I not only wish for a crystal ball as I hunch over a calculator, I bemoan the fact that I have to waste my time doing this and my Canadian friends do not.
I'm not a health professional or an insurance agent, but I understand the difficulty people have with all the terms (co-pay, co-insurance, etc.) and I have spent time explaining and helping friends and family try to choose the best plan for themselves. Far too much time, time that could have been spent taking a walk together, for example.
Mr. Frakt ends his article talking about the cheapness of a plan. What about the value of a plan? Why does it always come down to cheapness? How about an article evaluating a number of plans and how they would work for an individual or family? Cheap may not be the right plan.
Or better yet, end this nonsense. Single payer, now.
I'm not a health professional or an insurance agent, but I understand the difficulty people have with all the terms (co-pay, co-insurance, etc.) and I have spent time explaining and helping friends and family try to choose the best plan for themselves. Far too much time, time that could have been spent taking a walk together, for example.
Mr. Frakt ends his article talking about the cheapness of a plan. What about the value of a plan? Why does it always come down to cheapness? How about an article evaluating a number of plans and how they would work for an individual or family? Cheap may not be the right plan.
Or better yet, end this nonsense. Single payer, now.
149
Again - single payer ends none of the frustration you've spent your entire post recounting. Try not to succumb to the allure of easy slogans.
1
Agree--Medicare is single payer--or single player of 80%. Have you read any gripes about this today?
@ Inchoate- I replied to your comment earlier, bit as it has not been published, I have thought more about your comments to me and Paul Downs and think some education is needed. Under a single-payer plan, Mr. Downs would no longer be deciding on plans for his employees. He would no longer have anything to do with their health care. And yes, it would be health care, not health insurance. Comprehensive health care without deductibles and co - pays and co- insurance. No plans to choose. No out-of-network doctors. As I said in my comment, my Canadian friends don't go through this nonsense, and they're happy and healthy.
3
This article would make sense if each plan gave access to all doctors and hospitals. Since they do not, comparing on the basis of price, without considering what quality of medical care each plan offers, does not make sense. Would you chose the cheapest surgeon to do your brain surgery?
65
True, except in areas that are not major metropolitan areas, the likelihood of finding the best brain surgeon in any network is lower than in major metro areas. So then you need to analyze the policy of the carrier for use of out of network doctors and their reimbursement.
8
If you're choosing a plan based on expectations of having brain surgery in the next year you've got bigger problems than trying to save $250 on insurance premiums.
5
I agree with you and Rita, but the point of this article is that even when plans were identical in everything except cost, people still had trouble identifying the best plan, which indicates a lack of basic systems knowledge and/or financial literacy. If you can't figure out the basics, good luck figuring out which plan will let you go to the good brain surgeon for the least money.
2
"People make mistakes like this for a variety of reasons. Some don’t understand basic health insurance concepts. In an experiment accompanying Mr. Bhargava’s study, 71 percent of people couldn’t identify fundamental cost-sharing features of health insurance plans. This type of illiteracy was highly predictive of mistakes like overpaying for a lower deductible."
Illiteracy? I bet there are barely 2 in 50 people familiar with insurance concepts, let alone in possession of a systematic conceptual view of the health insurance.
"Another study, led by George Lowenstein, a professor of economics and psychology at Carnegie Mellon, found that people misunderstood plan features and costs."
These studies are a joke, and aside from providing contracts to the firm conducting these studies, a redundancy. Increased cost of higher education have seen to it that a good many people remain ignorant of how the commercial world really operates and thereby less competitively informed in decisionmaking.
Illiteracy? I bet there are barely 2 in 50 people familiar with insurance concepts, let alone in possession of a systematic conceptual view of the health insurance.
"Another study, led by George Lowenstein, a professor of economics and psychology at Carnegie Mellon, found that people misunderstood plan features and costs."
These studies are a joke, and aside from providing contracts to the firm conducting these studies, a redundancy. Increased cost of higher education have seen to it that a good many people remain ignorant of how the commercial world really operates and thereby less competitively informed in decisionmaking.
8
I once applied for a job as administrative assistant to an insurance agent. Before he would consider hiring me, I would have had to complete a 40-hour course in insurance selling. This was just to answer the phones and answer simply questions, type letters, and set appointments!
If insurance agents can't hire what is basically a secretary without demanding training in the vocabulary and concepts of insurance, what chance does the average consumer have of understanding it?
If insurance agents can't hire what is basically a secretary without demanding training in the vocabulary and concepts of insurance, what chance does the average consumer have of understanding it?
8
I have to buy insurance for my 18 employees. Trying to compare plans, either from one company or multiple companies, is impossible. The best choice can only be determined by knowing how much medical care each person will require in the next year - obviously impossible. And even if that was knowable, doctors still don't publish the cost of ordinary procedures.
Insurance companies also do their best to make it difficult to compare plans - the details are presented in different formats. Healthcare.gov allows for some comparison, but the details of every plan I've ever seen are so complex that it's impossible to make a good decision.
I challenge the author of this article to sit down with a grid of 48 plans and come up with the optimal choice. Can't be done. The real question is why this system exists. Who benefits from extreme complexity? Not the consumer. Insurers and doctors have designed a system that works for them, nobody else.
Single payer now, please
Insurance companies also do their best to make it difficult to compare plans - the details are presented in different formats. Healthcare.gov allows for some comparison, but the details of every plan I've ever seen are so complex that it's impossible to make a good decision.
I challenge the author of this article to sit down with a grid of 48 plans and come up with the optimal choice. Can't be done. The real question is why this system exists. Who benefits from extreme complexity? Not the consumer. Insurers and doctors have designed a system that works for them, nobody else.
Single payer now, please
217
What works for insurers doesn't benefit doctors. Insurance companies are accountable only to large employer groups and to state insurance regulators; not to health care providers, nor as the article demonstrates, to insureds. As insurers make more money, shareholders and insurance company bureaucrats profit.
16
Paul Downs,
First, thank you so much for taking readers through your journey to pick a health insurance plan for your employees in both 2013 and 2014 in the NYTimes You're the Boss Blog. I wish more of the reporting about the health insurance and the ACA provided such a detailed analysis.
In 2013, I did a whole spreadsheet comparing the three employer provided plans my brother had to chose from - a low cost plan with HSA, a mid cost plan that excluded some routine services from the deductible (ie, they cover a portion of some services before the deductible is met), and a high cost plan that had lower deductible and also covered some services prior to meeting the deductible. I even factored in his potential tax savings.
Turns out the low cost plan was the best fit for him. He could us the HSA to pay for services that he need but that weren't covered by the plan like an eye exam and contact lenses. If he made the maximum allowable contribution to the HSA, his tax savings would equal or exceed the cost premium cost. Doing so would make the total monthly cost the same as High Cost Plan's premium but he'd get to keep the unused HSA funds to spend on future medical expenses. Surprisingly, the Middle Cost Plan would ultimately have been the most expensive.
Yet, HR manager was steering employees away from the Low Cost Plan claiming, "It's not really health insurance since you have to meet your deductible before anything is covered." He hadn't done his homework!
First, thank you so much for taking readers through your journey to pick a health insurance plan for your employees in both 2013 and 2014 in the NYTimes You're the Boss Blog. I wish more of the reporting about the health insurance and the ACA provided such a detailed analysis.
In 2013, I did a whole spreadsheet comparing the three employer provided plans my brother had to chose from - a low cost plan with HSA, a mid cost plan that excluded some routine services from the deductible (ie, they cover a portion of some services before the deductible is met), and a high cost plan that had lower deductible and also covered some services prior to meeting the deductible. I even factored in his potential tax savings.
Turns out the low cost plan was the best fit for him. He could us the HSA to pay for services that he need but that weren't covered by the plan like an eye exam and contact lenses. If he made the maximum allowable contribution to the HSA, his tax savings would equal or exceed the cost premium cost. Doing so would make the total monthly cost the same as High Cost Plan's premium but he'd get to keep the unused HSA funds to spend on future medical expenses. Surprisingly, the Middle Cost Plan would ultimately have been the most expensive.
Yet, HR manager was steering employees away from the Low Cost Plan claiming, "It's not really health insurance since you have to meet your deductible before anything is covered." He hadn't done his homework!
7
The commenter's frustration is understood. He should also understand that single payer wouldn't lessen his, or his employees' frustration.
Single payer would not likely mean "single plan design" - and even if it did, that would not likely dispel confusion over how plans work, or the kinds of plan designs people should select.
You're overthinking plan design selection. Look for plans that cap your maximum annual out-of-pocket outlay, and then look more closely at plans if you/your family members have need for recurrent clinical attention, or costly Rx. That's it.
Most of the money spent on health care in any year is spent on a very small share of the total population. It could be spent more effectively, but some small variation of that first sentence will likely long be the case. And that's a good thing.
Single payer would not likely mean "single plan design" - and even if it did, that would not likely dispel confusion over how plans work, or the kinds of plan designs people should select.
You're overthinking plan design selection. Look for plans that cap your maximum annual out-of-pocket outlay, and then look more closely at plans if you/your family members have need for recurrent clinical attention, or costly Rx. That's it.
Most of the money spent on health care in any year is spent on a very small share of the total population. It could be spent more effectively, but some small variation of that first sentence will likely long be the case. And that's a good thing.
2
To answer the headline question, the answer is financial illiteracy. Insurers tend to obfuscate their real costs to the individual and it is up to the individual. Isn't the conservative mantra every person for themself and self sufficiency? That includes shopping for insurance.
5
Regarding the cost of an MRI - even a hospital cannot or will not tell you how much they are going to charge for an MRI or other major procedure. As to the gist of the article, perhaps the problem is not with the consumers. All the plans are needlessly complex, and the marketplace websites present too much information that might apply to anyone who might look at the site instead of focusing on an individual's particular needs. Barring the possibility that plans might be greatly simplified (which would also decrease the insurers' administrative costs), it might be more useful if the sites provided a questionnaire about how one uses the healthcare system, such as overall health, any chronic medical issues, frequency of doctor visits and hospitalizations, and number of prescription drugs, etc.; or possibly even run a few scenarios asking a person how likely they expect x to happen, or what they could afford to pay out of pocket if they do have to go to a hospital; then provide a ranked list of plans that best fit that person's profile.
49
Yes! There is a lack of transparency regarding cost of procedures that makes it next to impossible to choose a plan contingent on expenses. I was asked by one of the co-authors of Thrive: The power of evidence-based psychotherapies, Lord Layard, how much a specific procedure cost in the United States and his surprise when I said that it is impossible to get a price up front really highlighted for me the sense of helplessness we consumers experience in the states when it comes to healthcare. Insurance companies will not even tell insured how much they consider "allowable" until after a procedure is administered! It is unacceptable and yet insurance companies get away with it.
24
@Valleycat1-
OR the price range of procedures can be made clear to potential buyers instead of us giving estimates of potentially needed care to those determining our premiums.
OR the price range of procedures can be made clear to potential buyers instead of us giving estimates of potentially needed care to those determining our premiums.
But that would only help with elective procedures. When my father awoke at 6:00 a.m. one morning with a heart attack, was he supposed to sit down at the phone and call around to find out which hospital charged the least? (And then check to see if the local ambulance service would take him to one south of town?)
4
I think this article makes (more than) abundantly clear that, even in a capitalist society, consumer choice is a myth. Consumers do have choice, but they are most likely to make the wrong choices even when making the right choice is not only possible but easy. The article makes clear that even in a nation like ours, with a well-educated majority in our population, people blow choices in consumership of things that are important to them.
We should not be surprised by this. Consumer Reports, a magazine that month-after-month publishes comparative data on the quality of items that can be bought anywhere in our society, consistently proves that consumers buy down-rated products even when the data on that has been published.
All the worse is the fact that the manufacturers and providers of products and services that are rip-offs stand ready in long lines to cash in on American consumer incompetence.
Maybe we should have required courses on consumership skills in high schools and colleges. Maybe there should be a high stakes test on consumership skills required by the No Child Left Behind law. Maybe each state should conduct tests on consumership skills and issue licenses to buy things to citizens only if they pass these tests. Licenses would have to be renewed every 2 or 3 years. Stores would be mandated to not allow people who do not have up-to-date licenses into their stores to buy things. We do that to keep minors from buying alcohol and cigarettes.
Way to go!!!
We should not be surprised by this. Consumer Reports, a magazine that month-after-month publishes comparative data on the quality of items that can be bought anywhere in our society, consistently proves that consumers buy down-rated products even when the data on that has been published.
All the worse is the fact that the manufacturers and providers of products and services that are rip-offs stand ready in long lines to cash in on American consumer incompetence.
Maybe we should have required courses on consumership skills in high schools and colleges. Maybe there should be a high stakes test on consumership skills required by the No Child Left Behind law. Maybe each state should conduct tests on consumership skills and issue licenses to buy things to citizens only if they pass these tests. Licenses would have to be renewed every 2 or 3 years. Stores would be mandated to not allow people who do not have up-to-date licenses into their stores to buy things. We do that to keep minors from buying alcohol and cigarettes.
Way to go!!!
6
why do you think education will help ?
do you expect education will help the avg person to understand quantum electrodynamics ?( the theory of electricity and nuclear reactions (roughly)
i don't know what the answer is, but for healthcare and retirement, gov't planning (socialized medicine and more soc security) looks darn good
do you expect education will help the avg person to understand quantum electrodynamics ?( the theory of electricity and nuclear reactions (roughly)
i don't know what the answer is, but for healthcare and retirement, gov't planning (socialized medicine and more soc security) looks darn good
13
I do not know offend other type of consumer business in this country that is run in this manner. It needs far more regulation and oversight.