Health Insurance Problems: Know the Challenges
Health insurance is meant to help people pay for medical care and protect their finances, but it has several challenges for individuals, families, and healthcare systems. Even though it has benefits, figuring out health insurance plans and what they cover can be very confusing. Here are some main challenges people face with health insurance:
1. Higher Premiums and Out-of-Pocket Expenses One of the major problems in health insurance is increasing premium and out-of-pocket expenses. Premiums, the monthly cost of insurance, and deductibles, the amount paid before insurance starts paying, have risen sharply in recent years. For many people and families, these costs are a heavy financial burden. Studies demonstrate that insurance costs have risen faster than wages in the U.S., with which healthcare has become too expensive for more and more people.
Many individuals, of course, with employer-sponsored plans note that even though premiums are partially paid for, they still often pay large deductibles or co-pays when they get care. Premium levels for plans purchased individually from the marketplace tend to be higher and especially so for the more comprehensive plans. High-deductible health plans (HDHPs) are often promoted as a way to lower monthly payments. However, they need patients to pay a lot of money first before the insurance starts covering medical costs. This can be a big problem, especially for people with low or moderate incomes.
- Restricted access to care for the smaller networks
Groups of doctors, hospitals, and specialists also commonly fall under health insurance plans, and these often team up to provide care at reduced costs. In some cases, the doctors, hospitals, or specialist groups might be very small, particularly in HMO and EPO plans. You may be required to pay extra money for a visit to a specialist or proceeding to a hospital that is outside of your network. The service may not even be payable.
Narrow networks can be problematic for patients as they often have to wait long periods of time to get an appointment with a doctor and usually have fewer options of physicians. In other cases, they may even need to travel far to see a doctor or specialist. Access to healthcare can become especially difficult for people who live in rural locations or whom have complicated health needs that call for special care.
- Health Insurance Plans Complexity Even health insurance policies can be very confusing. Complicated words and exclusions and exceptions within the plans confuse people. Even when consumers try to compare plans, it is not always clear what differences exist between them. Words such as premiums, deductibles, co-pays, and coinsurance may be hard to understand without knowledge of healthcare or insurance.
Health insurance plans differ widely in the services provided.
Some offer mental health, maternity, or prescription drug coverage; others do not. Other plans may limit out-of-network care, but it might offer more choices while costing more in premium or deductibles. Therefore, unless one does his homework, he may then choose a plan that does not meet all of his needs-which then leads to unexpected costs or claims being denied.
- Pre-existing Conditions and Denial of Coverage
Before the Affordable Care Act (ACA) was enacted in the US, persons with any pre-existing condition, including diabetes, heart disease, or cancer, were usually denied health insurance or forced to pay very high premiums. Although the ACA prevents insurers from denying coverage due to a pre-existing condition, there remains an issue for people with chronic conditions. People with complex medical conditions tend to pay more money from their pockets, in case they require several treatments, medicines, or visits to specialists. Even if insurance may cover these services, the expenses for co-pays, deductibles, and coinsurance can be pretty steep. Moreover, some forms of insurance might not cover some treatments or medicines fully, or they may restrict how frequently a particular service can be utilized. - Insurance Issues for Low-Income Groups
Government programs such as Medicaid and the Children’s Health Insurance Program (CHIP) offer several low-income families health coverage, but millions of Americans still lack any such insurance. In several states that declined to expand Medicaid under the ACA, those with incomes that are too high to qualify for Medicaid but too low to purchase private insurance must fend for themselves in a coverage “gap.” Those of this description are commonly referred to as the “working poor,” full-time workers who cannot afford health insurance.
Those who qualify for Medicaid may still experience some problems, like having fewer doctors to choose from and not enough specialists who would accept Medicaid patients. Other states have strict requirements for qualification, making it even more hard for anyone to get such programs. - Prescription Drug Costs One of the major concerns for most health-insured people is the cost of prescription drugs. Sure, some medications become expensive enough under insurance coverage. That is if that medication happens not to be on the formulary that basically lists the drugs covered under the plan. Insurers might also limit the number of medications that they cover; they might also require patients to use cheaper medications first before allowing coverage for a more expensive drug.
This is likely to delay treatment and strain money reserves for people who are relying on essential drugs.
At times, there are what individuals term “gaps” between their cover. This is when one crosses the “donut hole” during Medicare prescription drug plans. In this regard, patients end up spending more on their drugs until one hits a particular spending cap. 7. Managing Health Insurance Under Major Life Events Life events, such as marriage, having a baby, or loss of employment, can bring about significant changes in health insurance. For example, when someone loses his job, he is likely to lose employer-sponsored health coverage. Although people who have lost their jobs can buy coverage through the ACA marketplace, they are likely to pay more for coverage or cannot find affordable options, especially in non-expansion states. These changes can prove rather distressing and confusing for any person to deal with. For one, the rules governing specific enrollment periods or the comparison of new insurance options are hard to follow. Without proper guidance, people end up without coverage or paying too much for something that does not fit their needs.
