Now that the Health Care Reform debates are over, the PPACA survived court challenges and Obama has be elected for another 4 years it is time to ask, “Will Obamacare solve all of our nation’s health insurance problems?”
It is true that the insurance companies can share some of the blame but it is unfair to think that they are always in the wrong. There is plenty of blame to go around. It is simplistic to think that insurance companies are the cause of all your problems.
Last month one of my readers sent me a scathing email. His spouse was in need of health care but his insurance policy had been canceled. His knee-jerk reaction was to blame the insurance company. After further investigation, the problem happened in his Human Resources department. He was getting angry at the wrong “person.”
HUMAN RESOURCE DEPARTMENTS
After I was able to calm him down and learn all the facts, we learned that the problem was not caused by the insurance company at all. The problem was happening in his employer’s office.
The nice thing about getting your health insurance at work is that your employer pays a portion of your premium for you. However, that is not always a good thing.
As a premium payer, the contract with the insurance company is not between you and them. The insurance company is paid by your employer. They must do what your employer says. If your employer tells them to cancel your insurance, like what happened with this individual, they must cancel your insurance.
Your employer cannot just cancel your insurance because he is mad at you. According to federal law, your employer must treat every employee the same, regardless of his emotions. However, there is no law that requires employers to carry health insurance for the employees.
If your employer no longer sees value from offering group health insurance, he is free to cancel the group plan at any time. Unless you are working at a business with a strong employee union presence, you have little to no recourse other than COBRA.
With an individual plan, the contract is directly between you and the insurance company. No one, other than you, has the authority to cancel your health insurance.
In cases where there is not a pre-existing medical condition or need for maternity benefits, I typically recommend that while employees should stay on the group plan, insurable dependents should be on individual health insurance plans.
I wish it were not true, but there are some insurance agents who are nothing more than sales-people. Fortunately, they tend not to last long. However, before they are finished, they can cause a great deal of problems.
These jerks do not take the time to match your needs and desires with an appropriate health insurance policy. They will sell you whatever policy they can that will pay them the biggest commission.
There are other insurance agents who think they are doing you a favor by selling you the least expensive policy available. They do not consider anything other than price.
When you set up an insurance portfolio there is more to consider than just price. If you do not, don’t be surprised if you have problems later when you need the insurance. In addition to price you should consider the following.
- How customer friendly is your insurance company when you need to make a claim?
- Where would the money come from to pay your deductible?
- Where would the money come from to pay your co-insurance?
- Is there a Maximum Out-of-Pocket?
- Are there limits to coverage?
- How will your non-medical bills be paid while you are recovering?
- If you have to hire a Home Health Aide, will your insurance help you?
- How will your family maintain their standard of living if you contract something terminal?
Unless your insurance agent draws your attention to these, and other, “holes” in your insurance coverage, he is nothing more than just a sales-man. Your savings may be such that you do not have to worry about all of these “holes.” If that is the case, the cheapest policy available may be all that you need.
Most Americans do not have sufficient savings to ignore all of these “holes.” They must find a balance between price and benefits when they are building their health insurance portfolio.
The insurance agent’s job is not just to sell you something. That is what he must do in order to get paid by an insurance company. His license, however, says that the state understands that he knows what questions he should be asking you so that you are able to build an insurance portfolio for your needs.
Unfortunately, you cannot always blame someone else for your problems. Since an insurance policy is a contract, the insurance company is only going to pay you based on the terms of the policy.
If you only paid for a policy with a $250,000 annual limit and you develop cancer and have $400,000 in medical bills, don’t expect your insurance company to pay more than $250,000. You will need to pay that extra $150,000 out of your own pocket.
Many of the problems you hear about are caused by people making assumptions about health insurance. They assume that all health insurance plans are the same.
Nothing is further from the truth. Health insurance plans are different from one insurance company to the next. In addition, many insurance companies offer different types of health insurance plans. A Health Saving Account (HSA) compatible plan does not work the same as a traditional Major Medical plan. A HMO plan only provides limited coverage when it is compared with a PPO plan.
As a consumer, it is up to you to know and understand what your insurance portfolio will and will not cover. You also are expected to know what you need to do in order to maximize your benefits.
In order to do that, you are given 10 days to review your insurance policy when you first get it. Make certain that there were no clerical mistakes. Also you need to verify that it will cover what you want it to cover.
While you are reviewing your policy, you also need to note what it will not cover. If you are willing to “retain” those risks and pay for them out of your savings, you do not need to do anything. However, if your savings are not sufficient to help you, you may want to look at supplementing your insurance portfolio.
Obamacare may be a starting spot for reform, however, it will not solve all the problems associated with insurance. The only way to solve all the coverage problems is if each citizen knows what is and is not covered and understands his responsibilities.