I looked at the Medical Mutual form again. Yes, I was a bit flustered by the beautiful woman with the deep dark eyes sitting there, next to me, in my office. But thirty-two years of experience kicked in and I continued to study the form. The numbers did not make sense. It took a call to the insurance company to solve the mystery.
I understood the answer immediately. Natasha’s health insurance policy renews November 1st. One premium, $510.96, is for her current “grandfathered” policy covering her and her college student son. The non-grandfathered version of the same policy is $547.75, a difference of $36.79 per month.
Welcome to the next phase of the implementation of the Patient Protection and Affordable Care Act. New provisions became effective on September 23rd. Like day following night, new prices became effective on September 24th.
In my post, Addicted to Other People’s Money, I wondered how much the new free basic preventive care services would cost us. We now have the initial price tag.
First, let’s detail what changed on September 23, 2010. The two key elements are Essential Benefits and Preventive Care. The definitions, below, come courtesy of Medical Mutual of Ohio. The email quoted in my July 20th post from Mrs. Obama bragged of even more comprehensive (expensive) benefits.
Essential Benefits: The law requires plans to remove lifetime limits on what the government defines as “essential” benefits. The law will also prohibit annual dollar limits, but not until 2014, which allows insurers to phase lifetime limits out by implementing annual dollar limits that will be incrementally increased each year until 2014. Essential benefits include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services (including oral, vision and hearing examinations).
Preventive Health Services: Plans may not impose any cost-sharing requirements (e.g., copay, coinsurance or deductible) on preventive health services, as defined by the U.S. Preventive Services Task Force, when administered by a network provider.
Essential Benefits become limitless.
Preventive Care Services become free.
Natasha (all names changed) and her son would be forced to pay $431 more over the next year for this. Another client, Paul, had a much more expensive experience. His new Anthem policy was effective September 20th. The premium for Paul, his wife, and two children for a high deductible contract is $402.55 per month. Since he had already paid his September and October premiums for his old policy, he wanted to re-date the new policy to November 1st. The premium for the exact same policy, enhanced with the new Free benefits, would be $480.77, an increase of $78.22. Are these new provisions worth almost $1,000? Not to Paul. And probably not to you.
So here we are, less than a year into the new law, and we are already seeing the impact of the new Patient Protection and Affordable Care Act. It is harder, not easier, to insure Americans. Insurance is more expensive, not less. And the words Cost Containment are still missing from the President’s vernacular.
The September 23rd changes are just becoming effective. More mandated changes are due for January 1st. And the rules are still being written, on the fly, as we reinvent the delivery of healthcare. I’m just hoping that nothing else is Free. We can’t afford free.
By the way, Jeff, my business partner, was concerned that this post was too dry and contained too much detail. I told him that I could trust my readers to not only plow through a fact laden piece, I could even count on some of you to add pithy, timely comments.
But if each member of that family of four goes to the doctor for a check-up (preventative care) and each have lab work done, or lets say just the parents, which in itself can run $300.00 each and they do this twice a year, I am thinking that this would all be free, no copays, right?? If one of the kids has a little trip to the ER, say just for stitches, that is $1000, should be free by all your definitions. Say Paul has chest pain, goes to the ER and spends just one night in CCU, let me see, at least $4000.00, and that should be free without co-pay as well………… worth it, maybe so??!! I am not saying I am for all this, just playing the devil's advocate. Holly
I apologize for any confusion. It was my fault and I have added a quick line to correct this. Preventive Care Services become Free. Where you may have had a $25 copay, or some services were applied to your deductible, all of the government allowable preventive care services are completely free without any cost sharing.
Holly’s example includes a lot of charges that would still be applied to the insured’s deductible.
And now from Michael who wishes to remain amusing and nameless:
You wanted pithy. Here are my initial thoughts, stemming from your latest piece on Health Insurance.
1) I'm pith'd off.
2) Protection & Affordable Care Act is a PACA bull.
3) My dear friend, Sue A. Sidal (not her real name), can't wait to succeed, so she won't have to face her increased premiums.
4) Caving in to the threat of a filibuster and to the pressures from the lobbyists has caused this mess.
5) I'm Pith'd off.
Michael (No Names Please)
Denis W. Nowacki: I got my bad news last week. Thank you Mr. President!
Thursday at 3:25pm · LikeUnlike.
I have been asked to edit this comment because the woman, in November 2015, thinks that it is preventing her from getting a job. I hope that isn’t the case. Still, if that is her fear, I will comply with the request. A now nameless woman submitted – I have a condition that no one would insure were it not for this Act. For me, it literally means my life. There is no price on that. There is also no price on catching cancer before it's incurable, making sure that we all have the meds we need to stay healthy and live, and to have an all-around healthier society. Some people, those fortunate enough to have the money to pay their insurance, are yes, paying higher premiums.
I'm of the opinion that it is un-American to say to any American that he or she can just rot and die because he or she has no health care access. This is simply immoral and wrong.
People who are against the Health Care Act should look at pictures and read stories of those whose lives have been saved by this Act.
I'm tired of hearing the privileged say that they have it bad. Try having a life-threatening disorder and no meds for it. Try being a parent who cannot afford basic preventive care for your child, or a senior having to choose between meds and food.
There are worse things in life than cost-sharing in society to make society a better place.
The crime here is NOT making society share the cost of insurance. The real crime is the insurance companies fleecing us. I hate it that while they make record profits they turn around and charge people higher premiums.See More
Thursday at 4:30pm · LikeUnlike · 1 personMary Sweeney likes this..Susie Sharp @Now Nameless – I'm diabetic. I'm hoping this new program will offer me coverage that's affordable if I lose my job.
Thursday at 4:40pm · LikeUnlike.
David L. Cunix: Now Nameless – First, I am sorry that you are suffering with a major medical condition.
This blog has never celebrated the status quo, nor minimized the need for change. Those are the starting points to the discussion. What I have attacked is t…he lack of honesty and transparancy throughout this process.
I sincerely doubt that many "lives have been saved by this act". The uninsured are way down on the list of priorities of this legislation. I wish it were different. I wish that I could point to immediate, meaningful change, but this is not really health care reform as much as it is insurance reform. There is a difference.
More importantly, Now Nameless and many others, including me, think that society should contribute more to the care and feeding of the poorest amongst us. Fine. Then look into the camera and tell the American People that we need to do this. We should do this. That wasn't done. We were sold a line of B.S. that prices were going to go down, free stuff was on the way, and that if you liked your current coverage you could keep it. There was no intellectual honesty in any of that.
I have not lost the right to point that out.See More
Yesterday at 9:00am · LikeUnlike.
Denis W. Nowacki: Right on point, Dave!
I believe we all can agree that pre-existing conditions needed to be addressed.
The bill did nothing to lower costs.
Lowering health care costs can be achieved by tort reformation, as malpractice takes up a huge portion …of the total costs in many ways. Then again, given the millions upon milliions that the trial lawyers poured into Mr. Obama's campaign……………………..See More
Yesterday at 9:10am · LikeUnlike.
Susie Sharp: Dave, I would assume that you could copy these postings right into your blog comments. These are great comments. Now Nameless, Dave has been able to find health insurance for many folks with difficulties – it's kind of his specialty. Check him out if you have the opportunity.
Yesterday at 11:22am · LikeUnlike.
I just added your blog site to my blogroll, I pray you would give some thought to doing the same.