It's For The Children

In today's NY Post, I come across this gem.

... Kelly said he was no fan of the Affordable Care Act, but when he received notice a few weeks ago that his current insurance plan was being canceled, he tried the New York State of Health Web site.

Kelly, 41, and his wife, Jennifer, 42, are self-employed and have always had to buy their own insurance. Kelly runs a title insurance business in Westhampton, and his wife is a pediatrician in private practice in Miller Place. “I initially went on with a lot of optimism,” he said.

Kelly said none of the plans offered out-of-network coverage, which was something he wanted. But even worse, they only covered his three older children, who are 3, 5 and 6.

When Kelly called a representative, he was told his daughter had to be 2 before she could be covered under a family plan. He would have to buy a separate plan for her, at monthly premiums that ranged between $117.21 and $369.31. The cost would be on top of a family plan with premiums ranging from $810.84 to $2,554.71 a month.

Let's back up a minute - pre-Obamacare - a family plan covered family members. Now, at least with one insurer in NY State, a family plan doesn't actually cover the family? And this is OK with NY State and the Feds? Who dreams up this mess, Old Man Potter from It's A Wonderful Life?

Head -> Desk.

Honey, They Shrank The Network

Repeatedly, President Obama reassured us that "if you like your doctor, you can keep your doctor. Now, we learn the President may have pulled a fast one.

... Elderly New Yorkers are in a panic after getting notices that insurance companies are booting their doctors from the Medicare Advantage program as a result of the shifting medical landscape.

That leaves patients with unenviable choices: keep the same insurance plan and find another doctor, pay out of pocket or look for another plan where their physician is a member.

New York State Medical Society President Sam Unterricht is demanding a congressional probe after learning that one health carrier alone, UnitedHealthcare, is terminating contracts with up to 2,100 doctors serving 8,000 Medicare Advantage patients in the New York metro region.

While other carriers are similarly cutting doctors from their provider lists, United seems clearly head and shoulders above the rest.

Curiously, United is now involved with another aspect of Obamacare - the Obamacare website fix.

The government on Friday named a UnitedHealthGroup Inc. subsidiary as “general contractor” to oversee the troubled federal website designed to sign up Americans for health insurance under national health care reform.

When QSSI was awarded the contract to build the Obamacare Data Hub, questions of conflict of interest arose. In fact, when the QSSI purchase flew under the SEC radar, Sen. Orin Hatch raised the issue.

... He asked Health and Human Services (HHS) Secretary Kathleen Sebelius in an Oct. 19 letter for a full account of contractors hired to set up the national exchange and a list of administration officials who signed off on those awards.

“I am seeking more information about the contracts associated with the entities selected to build the federally facilitated exchange (FFE) and the federal data services hub that will support the FFE,” he wrote.

Hatch wants to know whether HHS reviewed UnitedHealth Group’s purchase of QSSI to determine whether it creates conflicts. 

Make no mistake, the insurers are using the highly popular Medicare Advantage Plans as a test case. If they can successfully eliminate doctors and products which they feel are too costly for them, their efforts will soon expand to all their insurance plans and networks. People have to be on high alert and call their friends, employers and both local and federal representatives.

They told me that if I voted for Mitt Romney, corporate entities would soon control all aspects of healthcare in the US ... and they were right.

Smart Health Insurance Shopping

So you've seen those ads on TV and want to buy individual health insurance on the Exchange/Marketplace. You need to do some homework before you shop. The first thing you need to do is that if you have a doctor or doctors, you should make a list. It's important to know whether your physician will be participating in any of the plans you intend to buy. Remember the part in the President's speech about how you could keep your doctor? Well, that isn't necessarily so. 

If your doctor is not a plan participant, then you will have to consider the plan's Out of Network benefit. Some plans have better coverage than others. Also, many of the newer networks will have fewer, not more, physicians so Out of Network could end up being a major expense depending on your coverage.

You need to know is that the premium will not be the only cost associated with health insurance. The lower the premium usually means the higher the copayment and deductibles. This may not mean that much if you're young and without chronic illness, but if you find yourself seeing multiple physicians on a regular basis, these costs can add up quickly. The true cost of health insurance is much like the true cost of owning a car. The monthly payments are only a part of the story. 

Fortunately, you don't have to rush out and buy health insurance today. You have until mid-December to buy a policy whose coverage won't start until January 1. Ask questions. If you don't like what you're hearing, ask more questions. Make lists. Do your homework. To paraphrase the old Sy Syms commercial, an educated consumer is the best health insurance customer.