Searching for A New Plan? Here’s What to Look Out For

As Open Enrollment approaches, Consumers for Quality Care is committed to ensuring every American understands potential pitfalls when selecting a new insurance plan.

Surprise Medical Bills

Hospital care is the single largest component of national health care spending. We expect that our health care premiums will cover most of our hospital costs, but many still receive surprise medical bills. Many surprise hospital bills result from “balance billing” for treatment at in-network facilities by out-of-network providers. Others result from a lack of customer understanding of complex health benefits and opaque pricing, and still others are a result of billing errors. As hospitals increasingly turn to predatory practices like lawsuits and wage garnishments to recoup unpaid medical bills, it is more important than ever for consumers to be aware of their options. 

What You Can Do: Medical bills often contain mistakes, so it’s important to review bills closely. Also, watch out for out-of-network providers serving at in-network facilities. Finally, encourage your lawmakers to support legislation to address surprise bills at the state and federal levels.

Short-Term Limited-Duration Health Insurance

Short-Term Limited-Duration Insurance (STLDI) plans can exclude coverage for preexisting conditions, have dollar value limits on covered services, are not required to cover preventive services, and have a host of other substantial risks for consumers. Recent reports show that these plans spend very little of the money they bring in through premiums on health care. One plan, for example, spent less than 10 cents of every premium dollar collected on health care[1] In 2018, the Trump administration issued a rule expanding the maximum period for which STLDI plans can be offered, causing these barebones plans to proliferate. As millions of Americans are searching for low-cost coverage options amid unprecedented income losses, these dangerous plans are becoming even more popular.

What You Can Do:  While barebones STLDI plans may appear less expensive, we urge consumers to steer clear of these plans that can leave patients with large surprise bills for uncovered care. These policies can be complex, but it is important for health care consumers to read the fine print and consider their options carefully.

Accumulator Adjustment Programs

Many Americans, particularly those with chronic diseases, rely on medicines to manage their conditions. With copay adjustment – or accumulator adjustment – programs, insurers no longer allow drug cost sharing coupons to count towards patients’ deductibles or caps on total out-of-pocket costs. For some patients, their coupons run out before the end of the year—leaving them with unexpected amounts they can’t afford to pay when they try to fill a prescription at the pharmacy. 

This year, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that allows for the expansion of these accumulator adjustment programs. Americans are already struggling during the coronavirus public health crisis. Historic levels of unemployment mean millions of people have lost their employer-sponsored health insurance and even fewer are able to afford their out-of-pocket health care costs. This rule would unfairly raise the costs of prescription medications for millions of Americans in a time when many can least afford it.

What You Can Do: Now more than ever, consumers should not have to shoulder added costs brought on by accumulator adjustment programs. Tell your representatives in Congress to support H.R. 7647 and delay implementation of the new CMS rule until at least after the coronavirus pandemic has waned. If you currently use a coupon to help pay for your prescription drugs and have a choice of insurance plans, you should contact your insurer or the human resources department at your employer to find out if you will face any restrictions. If your plan limits your ability to use a coupon to help pay for your prescription medications, you should file an appeal with your insurance company and speak up about how harmful accumulator adjustment programs can be by contacting your state insurance commissioner

Learn more about your options if you’ve lost coverage or have a reduced income due to COVID-19.

References

  1. The Los Angeles Times, “Why the short-term health plans Trump favors are cheap: They shortchange you on care”, available at https://www.latimes.com/business/story/2019-08-12/health-spending-by-short-term-health-plans

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