- What will happen to your premiums?
If more young people sign up, premiums for us older folks go down. If there is no mandate to buy insurance (and the continuous coverage requirement is far weaker than a mandate), insurance premiums for the 50+ crowd are going to go up – a lot. That’s because healthy seniors will decide the premiums are too high, so the only folks that will buy insurance will be the sick ones. Insurers know this, so they will either a) exit the market; b) raise premiums to the moon; c) drastically limit coverage for specific medical conditions like heart disease or cancer; or d) go bankrupt.
- Is your medical condition still covered?
ACA requires almost all insurance plans cover all physical and mental health conditions under the essential health benefits requirement. Replacement plans under consideration have no such requirements, allowing insurance companies to exclude specific types of treatment, specific conditions, types of providers, etc.
- Is addiction treatment covered?
Currently mental health coverage is required for most employee and individual plans. Given the huge problems we face with opioid and crystal meth addiction, will a replacement plan require coverage for those seeking to end their addiction? Before ACA, about a third of individual insurance plans didn't cover addiction treatment. And you can bet your house “replacement” insurance plans wouldn’t offer coverage…
- Can insurers limit coverage for medical diagnoses or conditions?
Under ACA, there are NO lifetime or annual caps for specific medical conditions. The “replacement” plans allow insurers to set arbitrary caps for any diagnosis – cancer, heart disease, orthopedic injuries, or any other category they define.
- What happens if you lose your job and can’t afford to pay for individual health insurance while you are looking for work?
Under the replacement plans, if you have a “gap in coverage” where you don’t have health insurance, when you apply for new coverage your insurer doesn’t have to cover your pre-existing medical conditions, and/or they can charge you higher rates.
- Who pays for emergency care for those without health insurance?
Before ACA family insurance premiums included about $1000 for the additional cost of indigent care due to cost-shifting. If the number of uninsured grows – as it most certainly will – they will get care at hospital emergency rooms (hospitals are required to care for anyone presenting with emergent needs regardless of insurance status). So, this “hidden tax” will almost certainly increase your premiums.
- Will you be able to buy cheaper insurance from out-of-state health insurers?
No. There are three states that allow that today – and NO out-of-state insurers are selling across state lines.
Here are questions you may want to ask about what a “repeal” and “replacement” will do.
Bruce A. Cadkin, MBA President BAC Medical Marketing
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