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Saturday, February 22, 2014

Enrolled in Covered California...Have insurance? Think Again

Even hardcore supporters of the affordable care act are speaking publicly about the shortcomings and misdirections of the Afffordable Care Act…  and the necessity to modify the law.  Still there is much resistance to repealing the law.

The enrollment process is somewhat easier, however the choices are still a challenge. It is stragiht forward on selecting your level of eligibility.  Choosing plans is more of a challenge, especially if some of the information is incorrect such as providers, hospitals and other service providers.  

Enrollment data is beginning to accumulate, however there have been no public announcements regarding payment of premiums, nor analysis of types of policies.

The selection process is important. For some levels the copays and deductibles are very high. Although  premiums  appear to be low in some cases patients will need to be prepared to spend substantial portions of their income for medications, copays for laboratory, imaging and other testing.  For those who are relatively healthy and do not ‘consume’ much in the way of health care it won’t be a burdern.   For those who have chronic and/or serious illness who may need to be seen three or four times in a month….say a newly diagnosed diabetic, (they may be faced with four provider copays amounting to $160.00 and other copays for labs and/x-rays. Add this to the premium, and the monthly payment rises.  For those on subsidies this additonal burden on a modest income is significant.

For those who are euphoric about finally obtaining insurance coverage some will be surprised to find all is not well and the plans fall short of ‘guarranteeing’ health care for them.  A challenge will be finding a provider who accepts affordable care act plans.   It is going to require 12 months or more to feret out the good from the bad policies.  

Providers are on the line as well. Many high deductible policies will place hospitals at risk, when their patients cannot afford a deductible of 10,000-12,000 dollars. This will require cost shifting to balance the equations, and will not alleviate some medically induced bankruptcies.

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