Consumers who have been hammered by much of Obamacare MUST hold onto the law’s features that benefit us in the face of constant changes and proposals to change the law.
Not knowing what we’re on the hook for in terms of medical bills is a great challenge, but Obamacare DID improve the situation with Section 1302 and its discussion of Essential Health Benefits. The Essential Health Benefits (A through J) are not free but are a standardization of coverages that plans must provide.
Essential health benefits are also important for the out-of-pocket maximum which once reached requires that these benefits be covered at 100 percent.
But we must guard this protection of Obamacare because it is subject to changes by the government in allowable amounts, which could make the benefits useless if people go broke before reaching the out-of-pocket maximum, or if states choose benchmark plans that include permissible substitutions that erode the effectiveness of the law, or if the government decides it needs to pump up Obamacare by dipping into consumer wallets again. None of these financial exploitations are sufficiently protected which means that the effectiveness of 1302 requires consumer attention and push-back when things start going wrong.
These are not imaginary threats, they’re already occurring. Reaching the out-of-pocket maximum takes more consumer money than ever. This year the government raised to $6,850 for an individual and $13,700 for a family. That’s a lot of money to have to lay out before having ESSENTIAL HEALTH BENEFITS BASED ON YOUR STATE’S BENCHMARK PLAN COVERED AT 100 Percent, especially when you consider that PREMIUMS and out of network costs and non-essential health benefits coverages usually do NOT count towards that out-of-pocket maximum (healthcare.gov out-of-pocket maximum).
Therefore, increases in premiums are a dead loss to consumers in terms of reaching out-of-pocket maximums as are expenses for non-network providers, including expenses for the infamous balance-billing where consumers are not protected from being charged any amount by providers they didn’t know were out-of-network.
While not the subject here, balance billing has been addressed by states to a greater and lesser degree, with New York’s Emergency Medical Services and Surprise Bills became effective after March 31, 2015 among the newest efforts to rein in balance billing. (Remember, Obamacare provided that emergency room visits be treated as if they were members of your plan, but not that the non-participating provider services in these participating hospitals be covered as if they were providers.)
A greater concern is that right now, consumers can make a calculation based on their understanding and anticipation of their medical bills for the coming year to choose reaching that out-of-pocket maximum faster by choosing a plan that’s cheaper in premiums but provides less coverage (the 60 percent or bronze Obamacare plan type) or, if they don’t think they’re going to reach their out-of-pocket maximum and the price difference between 60 percent and 70 percent (the equivalent of silver plans on Obamacare) is not great then they may choose the silver plan in order to reduce their cash outlay.
Naturally, this depends on the cost in premiums, which are a dead loss to consumers, being reasonable for silver plans otherwise the consumer choice to slow down cash payments by purchasing higher percentage coverage is canceled out by greater premium outlays of cash.
But Obamacare doesn’t want people choosing bronze-level plans because they believe that “sicker” people will always choose the better coverage 70 percent plan meaning that the population distribution will be off balance with more sick people on silver plans which will not be acceptable to insurers who will raise prices on those plans and will not be acceptable to the government which pays out premium assistance based on the cost of those silver plans. (Remember, the government had EXTRA money for premium assistance because they paid out less than they anticipated because fewer people enrolled in Obamacare than thought and because more people who did enroll in Obamacare selected bronze plans than was anticipated.)
If the above is true, then naturally, the government wants to keep the cost of silver down and make the choice of bronze plans more expensive to encourage people to select silver plans, which is just what happened this year. As reported in BloombergView on November 3, 2015 by Megan McArdle, “Cost of Cheapest Obamacare Plans Soaring,” there is a 7.5 percent increase for the silver plan and a 13 percent increase for the bronze plan.
Don’t get me wrong, the out-of-pocket maximum is getting EASIER for consumers to know under Obamacare and Obamacare has standardized to some extent what consumers can expect to get after reaching that out-of-pocket maximum, these are steps in the right direction that are must-haves for consumers regardless of what changes are made to Obamacare.
