Both costs, coverage matter when choosing insurance


It’s open enrollment time for medical insurance, and for people having to shop in the individual insurance market; the choices are as confusing as ever.

Television ads splashed over the airwaves as the midterm electioneering came to a close didn’t help much. By the end of the campaign it was hard to find any candidate — Democrat or Republican — who didn’t want to cover people with preexisting health conditions.

The devil was in the details, though, and how politicians suggested people should be covered remained mostly a mystery.

In Missouri, for example, Senator-elect Josh Hawley, as the state’s attorney general, signed onto a Texas lawsuit that would wipe out coverage for preexisting conditions while at the same time running campaign ads saying that he supported “forcing insurance companies to support all preexisting conditions.” How many Missourians picked up on the contradiction?

Besides the muddled campaign messages, big changes in the individual marketplace can easily trip up families searching for a good policy.

The individual mandate — the requirement that nearly everyone have insurance — is gone beginning in 2019. That means there are no penalties for not having health insurance.

The Trump administration also has resurrected two kinds of insurance policies that in the old days caused consumers lots of problems: association policies sold by groups that band together to buy insurance and the so-called short-term policies that are in force for only a short time. This year the Trump administration says a short-term policy can last for three years.

The idea behind these two kinds of policies is to make insurance cheaper. In some cases it can be far cheaper than an Affordable Care Act policy sold on your state’s shopping exchange.

There are good reasons why these plans are cheaper than policies complying with the Affordable Care Act, which cover more conditions such as mental health treatment and pregnancy care and end restrictions on lifetime coverage.

The ACA-compliant plans’ biggest protection of all may be the right to buy a policy no matter what your existing health condition is, and the ACA has opened the door for millions of Americans to buy health coverage for the first time.

However, that protection, so valuable to sick people comes with a trade-off: higher premiums. Since insurers selling in the state exchanges can no longer exclude sick people, they need to compensate for the greater risk people with heart disease or cancer or other major illnesses present by charging higher premiums.

Sellers of association policies can make their offerings very unattractive to sick people by limiting the number of doctors in their networks who treat certain costly diseases like HIV-AIDS, for example. If people with this disease can’t find a physician in the network, they’ll likely pick another plan.

In comparing policies this year, first consider how much you can pay. Remember the government helps those with incomes below 400 percent of the federal poverty level pay the premiums, if they buy a policy in one of the state exchanges.

Next, closely examine the coverage. Some people may find that a policy that covers two visits to the doctor is fine, but a person with a chronic condition won’t. Others may find that the prescription drug or mental health coverage of an ACA policy is what they need.

Start your search by looking carefully at the offerings on your state exchange. It’s possible that you’ll be able to buy a silver plan that offers more coverage than a bronze policy and costs less this year. You might be asking yourself: Are these “new” offerings better than nothing?

As I’ve said before, it depends on your tolerance for risk. If you’re perfectly healthy and willing to gamble you’ll never get sick, then a short-term policy that doesn’t offer comprehensive coverage might work. But if you’re worried about unexpected illness, buy the best policy in your exchange that you can afford.

What insurance coverage are you buying this year?

Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review. The Rural Health News Service is supported by a partnership of 19 state press associations, including the Hoosier State Press Association Foundation, with the goal of providing unbiased, factual articles that readers can use, to help communities address important health care issues. Send comments to [email protected].

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