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Health Care Reform:

Health Insurance & Affordable Care Act

Affordable Care Act: Cancellations Explained

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Q. I’m healthy. Why do I have to pay for people who are sick?

A.  Except for a fortunate few, everyone is likely to develop some kind of health problem or face an accident sometime in their lives. Policy experts and regulators say insurance works best when it spreads risk across a large group of people. Your house may not burn down this year, but you pay for insurance coverage just in case.

Q. I’m a single man, why do I have a plan with maternity coverage?

A. Again, it’s about spreading the risk. Men may not need maternity care, but women don’t need treatment for prostate cancer and those costs are baked into the rates, too.  Older men, and women past child-bearing age, are more likely to need treatment for heart disease, artificial hips or other illnesses that younger men and women are less likely to need. “The whole concept of insurance is you can’t just pick and choose the benefits you want,” said Praeger.  If people - especially older ones - get premiums based solely on what they might need, she said, “it could cost a whole lot more.”

Q. What if it turns out they’ve charged too much for the new coverage?

A. Under the health law, insurers who fail to spend at least 80 percent of their premium revenue on medical care have to issue rebates to consumers. Those rebates for 2014 policies won’t be seen until 2015, however.

Q. I’ve gotten this notice, what should I do now?

A.  Experts say people should scrutinize the terms of their soon-to-be-discontinued policy and compare them with what new policies offer. The monthly premium is just one factor in cost. Also note the deductible. Is it per person?  What is the maximum deductible if two or more family members fall ill in the same year? Finally, note the annual out-of-pocket cap, which is the maximum you pay in deductibles and co-payments for medical care during the year.

“People need to be aware of their range of options,” said Cori Uccello, senior health fellow at the American Academy of Actuaries. Direct comparisons may be difficult, she warned, as the new policies will often cover a wider range of benefits, but you should be able to compare deductibles and copayments for various services, including drugs.

Wed, Oct 30 2013

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