When the 2010 Patient Protection and Affordable Care Act became law, it changed the way health care was provided for millions of Americans. The health care reform law made several changes in the health insurance industry, but not all of them were intended.
One of the unintended changes in the insurance market involved child-only health care policies. In Georgia and other states, as the Affordable Care Act took hold, insurance companies stopped offering this type of healthcare plan.
Child-only Georgia health insurance plans are usually bought by parents who have an employer-provided health plan that does not include dependent coverage, or has dependent coverage they just can’t afford. Sometimes these plans are bought by parents who can’t get health coverage for themselves due to health reasons and still want to provide coverage for their children. And sometimes, these are bought by parents whose income does not qualify for their kids to get coverage under Medicaid or PeachCare.
How Did The Affordable Care Act Affect Child-Only Policies?
One of the mandates of the act is that no children with pre-existing conditions can be denied health coverage. In response to this mandate, insurance companies in various states, including Georgia, stopped offering new individual plans that only cover children.
According to the insurance industry, under this new requirement, parents could postpone getting health care coverage for their children until the kids were sick. The industry said that this would cause a rise in unprofitable health care plans and skyrocketing expenses for the insurance companies to budget.
Will Child-Only Georgia Health Insurance Plans Return?
An increasing number of states have made a move to address the loss of availability of child-only health care policies, either through legislation or regulation.
In Georgia, House Bill 1166 was presented to address this problem. HB 1166 plans to restore these child-only health policies that can be offered by the private Georgia health insurance market.
Legislation recently passed the House Insurance Committee that would require Georgia health insurance companies that sell individual health coverage to also offer child-only health care plans during an open enrollment period. The bill would permit insurance companies to impose a surcharge of 50 percent of the premium if a child has been without health coverage for more than 63 days prior to the application for coverage. By doing so, this will motivate parents to keep their children insured and not wait for their child to get sick before getting a Georgia health insurance plan.
According to Graham Thompson, executive director of the Georgia Association of Health Plans, the healthcare insurance industry has signed off on the legislation.
It was Cindy Zeldin, executive director of Georgians for a Healthy Future, who pushed for the bill. She said that fixing up this unintended consequence of reform is relatively easy. This will help kids get the Georgia health insurance coverage they need since having health coverage is very important. Hospital admission records from 37 different states all showed the dire consequences of not covering children with health insurance. Regardless of the hospital where they were admitted, children without health insurance died 60 percent more often than kids who were covered. The reason for admitting them to the hospital did not alter the outcome, either. Children without health care, like adults, died more often even in the hospital. Zeldin also added, “It’s unfair that some parents are willing to pay for healthcare coverage for their kids, and it’s not available.”
The bill just covers one year (2013) since the problem will be taken care of by 2014 when federal health care reform will be totally implemented. By then, the new state-based Georgia health insurance market should be up and running with new Georgia health coverage options.
In your search for a healthcare provider, many will tell you that they accept your insurance plan. Unfortunately, most of these providers will also conveniently neglect to mention the fact that though they do accept your insurance, they are not in your insurance company’s network. Though it may take a little extra work, finding a provider that is in-network is important. In-network means that they have a special relationship with your insurance defined by different types of contracts, which for your purposes will generally translate into lower costs.
Choosing an out of network doctor is not necessarily a problem, but it means you are probably paying a lot more than you need to. Providers that are in-network almost always have special contracts with your insurance company that give you lower co-pays that will get your full money’s worth for the cost of insurance. Sometimes, it can be frustrating enough just finding a healthcare provider that is convenient for you and that accepts your health insurance. Once you find one that seems OK, it may be tempting to immediately end your search and choose them. However, the real problem is that while many healthcare providers will tell you that they accept your health insurance, many will not be in-network.
If you are searching for a doctor of any kind, you are probably already be aware of how long it can take to get a simple answer on the phone to questions about your insurance, so the solution to this problem is better handled on your insurance company’s end. Luckily, depending on your company this can be a pretty simple fix. Simply go to their website and search around until you can find a list of in network healthcare providers. This is also great because it narrows down your list of choices, though hopefully not too much, giving you a shorter list of calls to make and a more manageable selection.
Why It’s Worth It
Ultimately, you invest in health insurance to save money on medical treatment, and to be sure you are covered in the event of a particularly costly medical problem. Your insurance company creates in-network contracts with healthcare providers to offer you the best possible prices. To not take advantage of these contracts is simply paying much more than you need to. So, as long as your insurance company offers enough choices, putting in the time to find care that is in-network is truly worth it.
With the discussion of the Affordable Care Act, reductions in Medicare spending and changes in employer-offered healthcare, almost everyone is concerned about the costs of staying healthy. One issue is that for years, no one has treated healthcare like a commodity. We went to the doctor when we needed to and paid what they told us to. Now, to save money on healthcare, treat it like any other major purchase. Shop around and save.
Understand Your Insurance Plan
Many people end up paying more than they need to for healthcare because they simply don’t understand what their insurance policy covers. Knowing which doctors you can see, when you need a referral and what medications or treatments are covered can save you hundreds or even thousands of dollars. Work with you healthcare provider to find less expensive alternatives and opt for preventative care to avoid costly illnesses.
Even if you have insurance, shop around when looking for major medical procedures. The cost of an MRI, for instance, can vary greatly depending on where the test is performed, what machinery is used, and when you have it done. Non-hospital facilities will often offer considerably lower rates in an effort to attract patients.
And don’t be afraid to ask for a discount. Some providers already reduce their fees for insurance companies, especially the ones that they are preferred providers for, but asking if there is a discount available for paying cash at the time of the service can often save you money. If it’s something your insurance will eventually pay for, the provider’s office may even be willing to help you file the claim and still give you a discount just because the cash flow happens more quickly when you pay the day of service.
The absolute best way to reduce your healthcare costs is to get healthier. That means eating properly and getting some exercise. Your employer may offer nutrition counseling or support programs to help you get more fit. Some employers will help pay for a gym membership or have employer sponsored recreational activities meant to help increase your fitness level.
This is especially important if you have a family history or chronic illnesses like heart disease or diabetes. Making a pre-emptive strike to get healthy before you are diagnosed with a major illness can help reduce your insurance premiums and your overall healthcare expenses.
Additionally, annual check-ups can help detect illness before it becomes a major expense. Be sure to see your healthcare provider regularly.
Finally, make sure you get the health insurance coverage you need. Insurance brokers can help you devise a plan that fits the needs of you and your family and is tailored to both your financial and health needs.
We spend 2-3 times as much on our healthcare as most of the countries that now have “socialized medicine”. Yet, every country with socialized medicine has much better overall health statistics. As a matter fact, we are hovering around 32nd in the world. Even some “third world” countries are ahead of us.
How can this be? The richest country in the world, spending more than any other country, yet the health is one of the worst! What’s wrong? How have we come to this state of affairs?
There are a variety of reasons. Let’s look at some of these, and look at the alternate answer:
1. There’s a lot of talk about 40-50 million “uninsured” people in the US. “Uninsured” doesn’t mean that they aren’t taken care of. No Emergency Room can turn down anyone who comes for “treatment”. (Although many hospitals try to shift “poor” people to county or state facilities for profits sake.)
There’s also Medicaid for the very poor. But, that still leaves the great majority of “uninsured” swinging in the wind. They make just a little too much money to qualify for Medicaid, or the state they live in has run out of money and facilities. (Under the Bush Administration, the cuts in Medicaid have limited this coverage in virtually every state.) A severe medical problem bankrupts many of these families every year.
Who pays for Medicare and Emergency visits? The usual – US taxpayers! So, like it or not, we already have a “sort of” socialized medicine.
By the way, when did the phrase “socialized medicine” become a bad phrase? (Was it another “spin” fostered by “vested interests”?) How often have you heard “just ask a Canadian about their socialized medicine”?
Ask 100 persons from any country(s) that has socialized medicine two questions: “How do you like it?” and “Would you like to get rid of it”.
The answers to the first question are often a lot of individual complaining. Yet, the answer to the second question is an overwhelming “Never”. Could this dichotomy be the reason that so many people in the US “think” that socialized medicine is bad – those “bitching” (and very human) answers. Most people ask only the first question, NOT the second. I’ve asked both, and have yet to find a Canadian or a Brit who answers “yes” to the second question, but many, or most, will find something to complain about.
Isn’t it interesting that all the “civilized industrial nations” in Europe and elsewhere have some version of socialized medicine? Even in almost bankrupt Russia and Georgia, healthcare is free to all. And, even their health statistics are better than ours. (FYI, they also subsidize any “bright” student all the way to a “doctorate” if they are smart enough. College tuition in the US is prohibitively high for mid and low income families – are we wasting a major resource? You bet!)
2. Why is our health care costing so much? Simple – the insurance companies are running it. They make huge profits for this “service”. Cut out the middleman – the insurance companies, and cut the costs by an impartial estimate between a third and a half!
What other benefits would this have? Doctors would have more time to talk to patients, and spend less time, and office staff filling out forms to get paid. When was the last time your MD spent more than 2 minutes with you?
Let’s not overlook the fact that prevention is always better than catastrophe! All too often, when a poor person winds up in an Emergency Room, the cost of their problem is much more than it would be if that person had had insurance that allowed doctor visits to head off catastrophe with some prevention. This is a major factor favoring socialized medicine.
There’s still another factor in this equation. Malpractice insurance (more profits to insurance companies)! We do need to limit this. Some formulas have to be developed for how much any doctor can be sued for. And, medical boards need to oversee MD’s (and their mistakes) much closer. Doctors do make mistakes! And, the injured have a right to be compensated for such! What do the other countries do about this problem? Has anyone made any study of this?
3. There is another often overlooked problem. We, as a nation, have a terrible diet! We eat “fast foods” way too often. We eat too few “healthy foods”, and too many “high carbohydrate” foods. The statistics show clearly that a poor diet on the part of a mother results in a baby that is not nearly as healthy as it should be.
Take a look at some “poor” natives of African countries in photographs. Look especially at the wide mouths full of very strong, very even, teeth. Compare this to the US “standard” of two very prominent front teeth, a high narrow arch to the roof of the mouth, and crowding of the rest of the teeth. Dr Von Hilsheimer of Maitland Florida wrote a book years ago detailing the various “abnormalities” and “anomalies” of children of poor diet mothers. There is a definite correlation between these children and increasing allergy and sensitivity in our children
Recently I read a very interesting article about a school that changed the diets of the attending students, and by this simple change only, the entire attitude and moral outlook of the students was changed. It was very simple! They took out all the soda machines, and replaced them with water fountains. They eliminated hamburgers and fries, and similar poor diet foods, and emphasized fruits and veggies. Lo, and behold, the school which had previously been shunned by teachers because of unruly students was completely changed! Students were calm, quiet, and learned more and better than other schools in the area. Acts of violence or vandalism were eliminated. There are several other similar studies which school boards do not pay enough attention to.
Just because your employer doesn’t offer health insurance coverage in your benefits package doesn’t mean that you don’t need it, unfortunately if just means that you will have to find and purchase your policy on your own. If you live in Georgia, you have many health insurance providers to choose from, and it can all be a bit confusing, so it is important that you learn what you should lookout for, or pay special attention to, when purchasing your Georgia health insurance coverage.
The first thing you will need to do is learn the difference between managed care plans, and indemnity plans. If you choose the wrong one, you could end up in a bad situation. You see, managed care plans are your typical health insurance plans, with deductibles and co-pays, so all you have to worry about is paying your premium, and your co-pay each time you visit a covered Georgia healthcare provider. With the indemnity plans, you are required to pay all of your medical costs up front, and then file a claim with the insurance provider, who will at some point, reimburse you the covered portion of your expense. For people who are on a tight budget, this could make things very difficult for them, and could result in them not getting the healthcare they need.
Don’t just look at the cost of the policy; look at what you will be getting for that cost. Think about your current healthcare needs, and anything that could come up in the future. You really should make certain that your Georgia health insurance policy offers prescription drug coverage, in-patient hospital fees, medically necessary surgeries, preventative healthcare, maternity care, and maybe even vision/dental care.
Be careful to not only look at your premiums, but also the extra costs that you may have to pay, such as co-pays, deductibles, or co-insurance costs. You want to keep your out of pocket spending to a minimum, while still being able to get the healthcare that you need.
Do you want to learn more about how to choose health insurance that is right for you? I have just completed my brand new guide titled ‘Don’t Buy Insurance in Georgia Until You Read This. What the Insurance Industry Doesn’t Want You to Know.