I continue to be amazed at the deductible rates insurance companies are imposing on consumers. The choice for most people is high premiums and lower deductibles or low premiums and very high deductibles. The concept of deductibles and coinsurances has snuck into our lives and now it is out of control. There was a time, not too long ago, when there were no or low deductibles and coinsurance had not been invented. Now even Medicare has a deductible for certain plans.
Deductibles and coinsurance translates to more out of pocket money for the consumer. Here is an example. A client had a $3500 individual in network deductible, 30% coinsurance, the usual copays, out of pocket maximum of $16,000 individual and $36,000 family (often does not include deductible or copay) plus a monthly premium of $1250.00 ( $15,000 annually).
If there is a medical crisis with a hospitalization, the client could end up paying a total of $19,500 plus any copays for ER/Ambulance/ Hospital Rooms plus continued monthly premium! Shall we round it up to say $23,000? The consumer has to hope nothing at the hospital was out of network because out of network deductible, coinsurance and out of pocket maximum are higher and separate. If it is, the cost could reach $40,000.
Medical visits include copay and coinsurance. The average reimbursed cost of a visit is $130 of which the consumer pays $54. That is over one third of the cost. A question arises, should the consumer be contributing this much for each visit? If insurance companies can capitate the amount of money they will reimburse providers and base long term company budgets on it, the same should apply to how much consumers contribution is allowed to increase. I say it should go no higher.
There doesn’t seem to be anyway for the consumer to protest the constant changes. Lots of noise and indignation doesn’t seem to matter. Increased bankruptcies doesn’t matter. Less people with insurance doesn’t matter. Writing the state insurance department offers hope only if the office flooded with complaints.
If healthcare reform is repealed, I fear the cost of insurance will continue to rise with new ways for the consumer to pay. It will be like a Dr Seuss book: instead of “On Beyond Zebra” it will be “On Beyond Coinsurance”. If reform stays, even with the exchanges, I am not sure plans will eliminate high deductibles and coinsurance. These two concepts have taken hold as if they belong and don’t seem to be leaving any time soon.