A Perspective on Short-Term Health Insurance

Let’s remember: healthcare and health insurance are not the same thing. To be sure, we need both. But, it’s important to keep in mind that both your healthcare and your health insurance should be personalized and tailored to fit your unique needs and objectives. One size does not fit all.

Your healthcare decisions – beginning with choosing the right primary care physician – should be fundamentally driven by your health and health goals. What health providers (including primary care and others) give you the best chance of optimizing your health and well-being?

The same kind of thought process applies when researching, evaluating, and selecting health insurance. How much coverage should you have and what kind of coverage should that be? How can you insure yourself against a medical cost catastrophe without over-insuring or breaking the bank? What kinds of insurance plans and options are accessible to you? Are alternative options – like Medical Cost Sharing plans – a reasonable possibility for you and your family?

You get the drift. One size of health insurance does not fit all.

The U.S.’s recent changes to short-term insurance policy

Many of the millions of us who do not have access to employer-provided health insurance are keenly aware of the Affordable Care Act (ACA/Obamacare) and the exchanges and mandates that go along with it. We are also keenly aware of subsidy restrictions and rising premiums. The term “affordable” simply does not apply for many of us.

The U.S. Departments of Health and Human Services, Labor, and Treasury have recently announced that the rules for short-term health insurance will be expanded, loosened, and adjusted. That’s welcomed news for many. The removal of the individual mandate, which taxes those who did not maintain an ACA type of health plan, may also be good news for many, but not everyone.

Short-term health plans are nothing new. They’ve been around for a while, mainly in the form of indemnity plans. Prior to the ACA, short-term indemnity plans were offered in 3 month, 6 month, and 1 year increments. The ACA capped short-term plans at 3 months and then mandated the purchase of ACA coverage.

That changed earlier this month. The new plans – available as early as October of this year – will allow people who do not have employer-provided insurance to purchase short-term health insurance at prices that may be considerably less than ACA coverage. Considerably less.

Some of the positive highlights of the new health insurance changes:

    There are NO narrow networks, which is typical of indemnity plans. There are no contracts with specific doctors or hospitals, enabling you to seek medical attention wherever you please.

    Premiums are predicted to be much, much lower. This will be particularly beneficial to younger (healthy) consumers, healthy people of any age, healthy people who have been unable to afford insurance in the past, and perhaps people who are between jobs and need a little coverage until their next gig.

    There is NO enrollment period. This is a big change. You may sign up at any time unlike most insurance plans (including those offered by Obamacare) where enrollment periods are strictly regulated.

    Coverage begins almost immediately.

Sounds great, right? It may very well be for some of us. If it works for you, fantastic! Take full advantage! But remember, one size does not fit all.

Health and Human Services (HHS) does not claim that these plans are the same as those offered on the exchange. In fact, James Parker, a senior advisor for health reform at HHS, recently stated on a conference call with reporters, “We make no representation that it’s equal coverage.”

Some things to be aware of from the policy changes include:

    Pre-existing conditions will likely disqualify you. Practically any chronic condition (cancer, diabetes, high blood pressure) will work against you. So will a history of unhealthy habits like smoking and excessive alcohol or drug use.

    The Affordable Care Act mandated that insurance providers cover what the government determined to be essential benefits. That does not apply to these short-term plans. These plans won’t cover things like maternity care, mental health, preventive exams, prescription medications, vaccinations, or tests and screens. Be aware.

    The ACA included regulations to protect consumers. Those consumer protection regulations do not exist in these short-term plans. Rescission – or, retroactively rescinding coverage at the whim and whimsy of the insurance carrier – is an example. Again, beware.

    There are no limits on out-of-pocket costs or lifetime costs.

    While these short-term plans are available to people for up to 3 years, you have to reapply each year. They are not renewable from year to year.

So, generally speaking, it will be the younger, typically-healthier people who will likely benefit most from this new policy. It’s really good news for them – and some others of course – and they will likely abandon the ACA individual marketplaces in droves. While it remains to be seen, this transition may mean that an older, less healthy group will be left behind. That’s bound to have an effect, right?

What should you do next?

Research and evaluate options. Be aware and informed. Make the best possible decisions available and accessible to you. And remember (dare I say it again?), one size does not fit all.


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Upset woman healthcare diagnosis

The Third Leading Cause of Death in the US Will Surprise You

 
It won’t surprise you that heart disease and cancer are the top two leading causes of death in the US.

Number three, though, might shock you.

 
The third leading cause of death in the US is medical error, according to a study conducted by Johns Hopkins patient safety experts (original report released in May of 2016). The study places the number of deaths due to medical error at just over 250,000 per year. Dr. Martin Markary, M.D, M.P.H., led the study. Now, two years later, not much has changed.

According to a February 2018 CNBC article on the Johns Hopkins report:

“Dr. Markary defines a death due to medical error as one that is caused by inadequately skilled staff, error in judgment or care, a system defect or a preventable adverse effect. This includes computer breakdowns, mix-ups with the doses or types of medications administered to patients and surgical complications that go undiagnosed.”

 

Why haven’t we heard more about this?

Essentially, it comes down to how the CDC (Centers for Disease Control and Prevention) collects and reports cause of death data. There are those (including Dr. Markary) who are urging the CDC to re-evaluate its collection and reporting methodology. But those wheels turn slowly. The CDC is a Federal Agency under the Department of Health and Human Services. So there’s that. But, that’s not the point.
 

What does this mean for you?

It means that you absolutely should be an engaged, informed, and proactive healthcare consumer.

Let’s be clear; no healthcare provider intends to do you harm. No doctor, nurse, technician or system is out to get you. Quite the opposite is true. But mistakes happen. Errors in judgement occur. Systems sometimes fail.

Savvy healthcare consumers – patients – pay attention, assume responsibility, and act on their own behalf. You are your most devoted advocate.
 

So, what should you do?

The short answer is everything you can. But, at the very least, be informed and ask questions.

Understand your prescribed medications. Ask your physician why a medicine is being prescribed. Ask how it will interact with other medicines you are taking (you have to know them or have an accurate record of them, right?). Ask about the risks or downsides. Ask if there is a natural remedy. Make sure your prescribing physician knows about any over the counter medication you are taking.

Fully understand your recommended surgeries, procedures, or treatment plans. Ask your physician why the procedure is necessary. Again, ask about the risks and downsides. What happens if you choose to not have the procedure?

Get a second opinion. When the potential downside of a prescribed medication or the potential downside of a recommended surgery, procedure, or treatment plan feels unsettling to you – get a second opinion. Maybe even a third. As a side note, if your physician attempts to discourage you or balks at the idea of a second opinion – you may need to change doctors.

Access your EHR / EMR via your patient portal (or other means available) and always check for accuracy. Check things as simple as the spelling of your name and your birthdate. Make sure that all lab and test results are reflected in your record. Inaccurate or missing information could be significantly problematic.

Use Google, Yelp, or any other resource at your disposal to research the people and places in your healthcare orbit. Read reviews carefully.

Expand your team. Who do you know – friends, family or otherwise – who can and will help you think things through? The thoughts of objective third parties are often helpful when seeking clarity or determining direction.

More succinctly, as we have been saying all along, develop a consumer mindset and take responsibility for your own healthcare decisions. You’re in charge.

 
Thank you for reading. Be sure to subscribe to our mailing list for more healthcare insights, tips, and news! We’ll keep you informed, but we won’t annoy you.

Who is in charge of your health? A real world example

In our last blog, we outlined 5 critical steps to better healthcare and better health. They are:

  1. Realize that you are in charge of your own health and healthcare decisions.
  2. Know and own your personal health data.
  3. Find a physician that will know you, be accessible to you and will proactively partner with you around your health and health goals.
  4. Embrace monitoring, testing, and improving your biology.
  5. Restructure your health insurance and major medical risk.

The Ted Talk below is a great real-world example of those things playing out. When Eric Dishman was in college, doctors told him he had 2 to 3 years to live. That was nearly 30 years ago. Now, Dishman puts his experience and his expertise as a medical tech specialist together to suggest a bold idea for reinventing health care — by putting the patient at the center of a treatment team.

If you missed our last blog, you may want to read over it before watching this video. Also be reminded that Healthscient is currently working on a step-by-step “How To” guide for navigating these 5 mission critical components of better healthcare and better health.

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Enjoy. Be Inspired.