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Hearsay and bad information often fuel people’s misunderstandings of health insurance. When was the last time someone snuggled up with a cup of coffee and their health insurance policy?
According to the Life and Health Insurance
Foundation for Education (LIFE) and the Henry J. Kaiser Family
Foundation, the following myths are alive and well in the minds of most
folks.
If your employer offers a group health plan, you’re
likely experiencing annual hikes in premiums, reductions in what’s paid
for by your employer, an increase in your out-of-pocket expenses and
the possibility that you’re paying for lots of benefits you don’t want
or need.
An individual health plan (the kind you buy on your
own), especially for someone who’s healthy and young, can offer
significant savings. Unlike individual plans, group health plans must
abide by state health insurance mandates, which can require coverage
for everything from autism to hearing aids to contraceptives to in
vitro fertilization.
Although an individual health plan
can deny your application based on your health status, Matt Tassey,
spokesperson for LIFE, notes that if you’re eligible the plan can be
customized to meet your specific health care needs.
"If you’re a man, you have no need to see an
obstetrician. But if they have an employer-sponsored health plan, they
are still paying for [the obstetrics coverage]," he says.
Brenda Weigel, spokesperson for the National
Association of Health Underwriters, says this is a common
misconception. "The fact that health insurance is expensive is because
health care is expensive. Or there’s the common misconception that
Medicare administrative costs are lower than private plans, when in
fact there is quite a bit of cost shifting,” says Weigel.
When patients use a government insurance program
(such as Medicare), providers of health care shift more costs to people
who have insurance. The result is higher premiums for people who
purchase their insurance on the individual market and workers who
receive insurance through their employers.
Tassey notes that rising prescription drug costs also fuel increases.
Then what happens when you break your leg in a
snowboarding accident or blow out your knee while playing soccer? If
you find that your tonsils need to be removed, the cost of a
tonsillectomy can start at $5,000, with another $1,500 per day for an
overnight hospital stay.
"There is this idea that if they need to be
hospitalized they can just go to the emergency room because they have
to take you," says Tassey. "We like to call them ‘young immortals.’ A
problem arises when they have to be stabilized or, worse, have to stay
in the hospital for an extended period of time. What happens if they
have to be transferred somewhere else for care, or have to see a
specialist? The cost could reach $100,000 once you add everything up
and starting out their lives in serious medical debt can have a
long-term repercussions on their financial future."
Tassey says young people rarely think about health insurance until it’s time to have a baby.
The fastest growing populations of uninsured are
Americans age 50 to 64. The difference between the younger and older
people is accessibility to health insurance. While younger people who
are not covered by an employer’s health plan may find it easy to
acquire affordable individual coverage on their own because of age and
health status, older people do not have the same advantage.
According to recent estimates from the Kaiser
Commission on Medicaid and the Uninsured, middle-aged and older adults
under age 65 (and not yet eligible for Medicare) are fast becoming the
largest group of Americans without health insurance.
In fact, 19 million Americans between ages 50 and
64 were uninsured or underinsured in 2008. This group is more likely to
arrive at the doctor’s office with a number of chronic medical
conditions, making it difficult or impossible for them to buy
individual health insurance. As baby boomers reach age 65, and the
shear number of people in need of coverage increasingly overwhelms the
Medicare system.
"This is a serious problem as the baby boomers age
and the cost of health care skyrockets. If you drive an old car, you
have to do repairs to keep that car moving. Just imagine having 75
million old cars coming into the Medicare system — that is exactly what
we are looking at in the next several years," says Tassey.
The federal COBRA law
allows you to continue buying your former employer’s group health plan
if you are laid off. The catch is that the employer no longer has to
contribute to the premiums. One alternative is buying a short-term
health plan on your own.
If you are relatively healthy, a short-term plan
could bridge the gap between other insurance plans, but if you have a
pre-existing condition, or need maternity care or prescription drug
coverage, you may not be able to find a short-term plan.
Also, short-term plans generally require you pay
high deductibles before coverage begins. This deductible can vary from
$250 (for very healthy policyholders) to well into the thousands. When
you consider the cost of meeting the deductible before the plan pays
for medical care, COBRA may be the better choice, especially if you
have a pre-existing condition. In addition, a typical short-term policy
lasts a maximum of six months and the insurer is not obligated to renew
your policy.
Under the American Recovery and Reinvestment Act that went into effect in February 2009, you can receive a 65 percent subsidy of your COBRA premiums for up to nine months. In return, the federal government reimburses the employer with a payroll tax credit.
The
Kaiser Family Foundation points out that 1/5 of those who work for
firms with 500 or more employees are uninsured because the companies do
not offer health insurance.
But when workers are offered health insurance, they
take it. According to the Employee Benefits Research Institute, fewer
than 5 percent of workers who are eligible for health benefits are
uninsured.
The
debate rages on. Canada’s universal care system is fine, but there’s a
limit on what you can get. For example, if you happen to be a Canadian
age 70 or older and need bypass surgery, the government won’t pay for
it.
"Universal health care isn’t better, it’s just
different," says Tassey. "One of the largest hospitals in the U.S. is
the Henry Ford Hospital in Detroit. Many Canadians come over to Detroit
for care — not because it’s better, it’s because they can get it [in
the U.S.]. There is no rationing [in America] of any sort, so they can
just write a check."
Americans may complain about the high cost of
health care in the U.S., but Tassey points out that people are rarely
denied care for any reason.
"People in the U.S. demand care and demand it
immediately. They also think we can cure anything," notes Tassey.
"Unfortunately, it costs a lot of money to treat the number of fatal
diseases that need a cure. We already have a semi-Canadian system for
those who are 65 and older — it’s called Medicare and it’s going
bankrupt."
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