If you have an inadequate health insurance plan or you have changed your situation and need new insurance, now’s the time to go out on the exchange and look around. Open enrollment is from November 1st to December 15th. Today’s NY Times has an in-depth discussion of what’s out there. Take a look also at this very recent NY Daily News article.
The American health insurance system is a frustrating tangle which is hard to navigate and requires a lot of time to deal with, from selecting policies to figuring out how to afford insurance to changing prescription plans based on their formularies to coping with absurd denials of coverage for drugs or treatment that the patient’s doctor recommends. Unbelievable amounts of hours are spent by patients and their advocates every year, often during their workday when those hours might be better spent getting the work done. Before the affordable care act, our small-company plan’s premiums were rising by double digits every year. The ACA was designed to greatly broaden the pool of healthy, premium-paying plan participants as a way to bring those premiums down. With the rollbacks of certain protections that were built into the Affordable Care Act (“Obamacare”), in the free-market economy, that critical aspect of the program has been removed, and companies are allowed to offer policies that provide minimal coverage and are still costly to pay for. People are spending as much on their insurance as they are on housing. It’s absurd.
I’d like to see a system where coverage isn’t linked to employment and instead is just based on something simple, like geography … for example, everyone who resides in a county which has population in excess of X people enrolls in that county’s plan, and very small counties just combine into a regional plan of an adequate and defined size. You’d only have to change plans if you moved out of county. No more worries that your smaller employer won’t have an insurance plan. Let the insurance companies compete behind the scenes to be the plan administrator. Have all practitioners in a given county accept that insurance plan as well as others. Let the plans negotiate drug prices or treatment prices like the Veterans Administration does (for drugs) or Medicare (treatment). Control the price of premiums and subsidize premiums through tax returns (as is done under the ACA) so that no participant has to pay more than a certain nation-wide percentage of their modified adjusted gross income. It’s absurd that an employee in a company which has a health plan should have to pay $12,000 a year for their share of the premium to have coverage for their family. The cost of insurance may not make too big of a dent in the budget of someone earning $180,000 a year, but the premium cost is the same for the person earning $60,000 a year.
By the way, if you are at that age to enroll in Medicare (65), keep an eye on your deadlines as well, and be sure to be mindful of the potential lifetime penalties for failure to enroll in Part B when you sign up, even if you are still employed.
For advice and representation on senior care legal planning, call us at 732-382-6070