We can all agree that our healthcare system is difficult to understand. Have you considered the confusion for people who have never had health insurance, or perhaps have not had it for a really long time? According to Drew Altman, president and CEO of the Kaiser Family Foundation, health insurance literacy is something that we as a society should work to improve. Here are some key points regarding the new insurance marketplace and ACA that Altman asks us to consider:
- 37% of enrollees don’t know the amount of their deductible
- only 46% of enrollees say they are getting a subsidy, when the official numbers indicate 85% are actually getting them
- many enrolled have no understanding of basic insurance terms like premium, deductible, copayment, coinsurance, maximum annual out-of-pocket spending, provider network, covered services, annual limits on services or excluded services
- people with lower incomes are less likely to understand the key elements of insurance (the people who need coverage the most understand it the least)
Altman also points out that people gaining new coverage are also expected to understand the intricacies of provider networks in the plans they choose, particularly if they have a health problem requiring specialty care. Otherwise, they’ll face high out-of-pocket costs when they visit out of network provider specialists. Understanding how drug coverage works is also important when dealing with tiers. Most of us understand that brand-name drugs cost much more than generics — but what about the folks who don’t know that? We all have a role to play to improve health insurance literacy. Unfortunately, as Altman points out in his article that appeared recently on WSJ’s Washington Wire, A Perilous Gap in Health Insurance Literacy, many of us get tested on our knowledge every time we access our health care plan.
Here are two info graphics that can help you get started with improving the health insurance literacy of the people you know:
We are the 90 by CommunicateHealth.com
The Facts about Health Literacy by Healthcare IT News
Recently the Obama Administration compromised to allow waivers for religious organizations to restrict paying for contraceptives on their health plans.
What does that mean for most religious groups that offer health benefits? Unless a group is self funded and writes their own plan, it will be difficult to change things. As we have discussed in earlier blogs posts, 98% of all employers purchase fully insured plans from insurance companies. Insurance companies file their plans and, for the most part, are abiding by the original requirements in ACA on what to cover. Therefore, if a group is fully insured, they cannot just change their plan.
It is possible that the insurance carriers may roll out plans that give these types of groups a chance to change their plan. However, at this point that is not possible and we usually see insurance companies move slowly on these events.
The administration rolled this out to allow for waivers. The carriers will probably wait and see if there are a lot of requests and then decide if they will react.
To read more on this topic, please read Administration Offers Contraception Compromise for Religious Employers, an article that appeared on WSJ Online.
In primary care, like many other things, bigger isn’t always better. And in the case of primary care physician practices, this study backs it up.
It’s no secret among those who know me well that I have a strong affinity for small businesses and have long held that small and mid-size businesses are the backbone of our country’s economy. In an age of instant gratification where many flip businesses like houses, I find more often than not that it’s the small businesses and their leaders that champion the vision of building and sustaining meaningful companies committed to serving their clients while consistently providing jobs for themselves, their families and others in their communities. And, it’s the small businesses and their leaders that consistently prove to be the innovators.
The study is titled “Small Primary Care Physician Practices Have Low Rates of Preventable Hospital Admissions” and was recently published by The Commonwealth Fund.
This study supports my notion and could also be instructive to you, your family and even your employees when it comes to selecting a Primary Care Physician geared to the combination of the best care AND the best cost…
“[T]he common assumption that bigger is better should not be accepted without question, at least in practices of 19 or fewer physicians,” the authors conclude. The authors also question the practice of insurers typically paying lower rates to physicians in smaller practices, which typically have no negotiating leverage. Such an approach may well be shortsighted, they say, since the lower preventable admission rates achieved by small practices compared with large groups can mean lower overall costs for patient care…”
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- Tom Barrett
- August 15, 2014
- ACA, advice, choosing, commonwealth fund, economy, employees, hospital costs, mid-size business, physicians, primary care, recommendation, small business, smaller, study
- 0 Comments
I wonder how much time and money employers have spent planning on the various dimensions of the Affordable Care Act (ACA) that died on the vine, have been changed, pushed back or remain so cloudy that no one really knows the correct answers. Do you think it’s enough to buy Las Vegas?
I have seen so many changes that the only thing I really know is that the guy who tells you how it is all going to look and has the blueprint on EXACTLY what you should do right now is the guy I will bet against – in Las Vegas or elsewhere.
So what should you do now about how to plan for the future and ensure you are compliant? That’s a very difficult question to answer. Here is what I think you should do:
- Don’t cave to fear mongers who say that prisons will be built all over the country to house ACA non-compliers. Compliance is important but so is having the courage to do the right thing for your employees.
- Remain aggressive on finding the best ways to take care of your people in the most cost-effective ways. If something is too edgy or pushes the edge of compliance, dump it. The ACA is a really big law and there is some wiggle room to think creatively.
- Any part of the law that is 12 months out may change. Avoid spending time on it now. If a brokerage house is hosting a seminar on a five-year plan, attend only if they are serving a fantastic free lunch.
- Keep asking good questions. The ACA rests on the understanding that American employers take good care of their people. Employers are going to be the ones to drive the innovation and provide the clear thinking on this law. If employers cave on providing health insurance solutions (even it is just guidance for their people) then the ACA is doomed. You should demand that everyone work hard thinking through the ACA and finding the best options possible.
- We have been deeply immersed in work with insurance advisory boards (of which BBG is a member), TPA experts at ODI and the federal regulators. It is believed among some that there will be an uptick in DOL audits. To that end, we at BBG are compiling all of the items an employer will need to provide. It is not a short list but we know what they will ask for and can step in to help. Our goal is to let you run your business and let us help with the things that you don’t do everyday (like provide cert to the DOL). Who knows if the DOL and other agencies will audit more groups, but if they do we will be ready to help.
Bonus (6). Don’t worry about this stuff in August. Washington is on vacation, so I don’t think they are!