Health for life

Lets choose the health insurance channel!

A running joke among many managed care medical directors is that the typical enrollee spends hours comparing features and prices for their flat screen TVs and minutes selecting their health insurance.  Far too often, its after enrollees get sick that they discover that many of their assumptions arent meeting the reality of the provider network, coverage exclusions and out-of-pocket expenses that they chose. 

Whats more, juicy anecdotes of failed enrollee expectations (such as unproven cancer treatments in cute bald children) have fueled advocates demands for a generous version of orm (such as a single payer with a rich one-size-fits-all benefit design).

Thats why the Disease Management Care Blog found this Kaiser Health News report interesting.  It raises two issues.

1. The Merits of Consumer Shopping.

According to the KHN report, what were reading elsewhere isnt quite true because users of Massachesetts health insurance exchange (HIE) are being flummoxed by a thicket of multiple insurance options with premiums that vary according to provider tiers (some hospitals will cost you more), out of pocket expenses (a.k.a "skin in the game" stuff like co-pays and co-insurance) and exclusions (some things are not covered).  As a result, a shopper can expect to spend "six to eight hours" selecting a plan!

The DMCB is shocked, shocked by the specter of consumers having to spend as much time comparison-shopping for health insurance as the typical amount of time used checking out Consumer Reports, scanning the newspapers for sales, seeing if Amazon has a better deal and driving to several electronics stores for that best flat screen, Blu-Ray player or speaker system.  Dammit, says the DMCB, buying health insurance is important and it deserves that much time.  If an HIE forces consumers to finally pay attention, the DMCB says that is a good thing.

As an aside, the DMCB also points out that the art and science of HIEs are still evolving.  With better informatics and user-friendly on-screen interfaces, it should get better.  Given governments heavy hand, however, the DMCB predicts HIEs will never match the astonishing slickness of parallel on-line consumer purchasing aids, such as smart iPhone apps.  Taxpayer consumer expectations will continue to not be exceeded.  They will be eventually met, however.

That being said, however, the Massachusetts experience also speaks to the naive assumptions underlying the Affordable Care Acts HIE provisions.  If that remains problematic, consumers will always have the option of letting D.C.s Pete Stark, Max Baucus and Kathleen Sebelius save them time by arranging the details of their insurance for them.

2. Anecdotes and Framing

The underlying tone of the KHN piece vaguely suggests that consumerism and health insurance is a bad thing.  From the typical use of a selected negative anecdote, the skeptical visage of the person featured in the article, a "I could not figure it out" sub-headline, the sub-text portrayal of insurers as being intentionally opaque and the prominence given to saving money all paint a picture of a system that is failing. 

Good grief, HIEs have just gotten out of the crib and KHNs reporting suggests that the liberal and progressives still want to strangle this toddler.  Once again, the DMCB is shocked... shocked.

According to the White House, the health insurance exchange glitches are a symptom of high demand from a grateful citizenry eager to embrace Obamacare. While articles like this and this suggest that sloppy and amateurish programming is really behind the website crashes, the Disease Management Care Blog is concerned that early high demand - if it exists - could be an early sign of a coming insurance death spiral.

"Death spirals" occur when persons with high levels of risk disproportionately enter an insured population.  When that happens, premiums have to rise to match the increased expenses. That, in turn, causes persons with lower risk to drop their insurance, leading to an even higher proportion of high risk individuals, who drive prices even higher.

The DMCB intuitively doubts that the early high demand described by the White House is the result of healthy latte-sipping millenials and young invincibles having nothing better to do with their web-surfing time.  Rather, the persons most likely to be in a rush to get into the web site are persons who really need insurance.  Those would be the ones facing huge health care bills.
 
Another indication is the relative lack of the standard individual anecdote or "ledes" in media reports that hook the reader into paying attention.  Used by politicians and journalists alike, ledes put a "human face" on a narrative by bridging the personal and the policy.   

Supporters of exchanges would probably like to see something ledes along the lines of...

For years, 25 year old Ivanna Ceeadoc could only lurk outside the local health clinic and watch helplessly as her friends from the coffee shop down the street got free health communications from the nurse practitioners within.  But after using the health insurance exchange....

or

Until he signed up in the health insurance exchange, part-time jazz drummer and retail specialist Hank Erinfersumburgers never had to see a health care provider. Previously unaware of a bleak future of fast food and tight clothes, Hanks zero dollar co-pay now lets him see a dietician and have enough money left over for a lunch......

Young Ivanna and Hank havent made an appearance in the national health insurance exchange narrative because they probably arent part of the story.  More likely, its persons in their 50s and early 60s who have been hold they need a joint replacement, an angioplasty or back surgery....

 Ima Medeesazter was looking at a stack of medical bills a mile high.  Her surgeons plans included weeks in a hospital costing her hundreds of thousands of dollars. Ima put things off, but now that she used the exchange, she can look forward to getting to know her ICU nurses really well.......

Even more worrisome: this astonishing statement by HHS Administrator Kathleen Sebelius that she "doesnt know" how many have enrolled in health insurance since the October 1 opening date.  If the experts running the shop are unaware the Insurance 101 principle of knowing who and why persons are signing up for health insurance, they have no idea about the spiral threat.

Image from Wikipedia

The health insurance requirements vary from state to state in USA, for example the San Diego Health Insurance requirements might be quite different from the Health Insurance requirements at Cherokee County! Hence it is important to understand the specific requirements that need to be adhered to while opting for health insurance. In this article we try to cover the requirements that the residents of California would have to look at.

It is important to note that though there are many providers of health insurance packages across the states, these packages are regulated by the individual state agencies. This article addresses the requirements of the California state that need to be looked at for San Diego Health Insurance for example. The federal arm has in place some crucial laws that have been established so as to ensure the citizen’s benefits.

· The Affordable Care Act: This law has come in to action in March 2010 and ensures that the health insurance is affordable.

· COBRA: This is directed at the ex –employees, retired citizens, spouses and other dependents. Through COBRA they have the right to obtain continuation of the group health plan for some more time. This is a good option in times of economic turbulence where people can be laid off.

· HIPAA: This provides the protection to the individual and the family when there is a need to either move to another health insurance or even to continue the current health insurance. This covers the health insurance conditions like the exclusion of pre-existing illnesses and provides the much needed protection that one needs in such cases.

There are some special provisions and funds available for the employees of federal agencies and the Armed Forces by the federal government like Medicare, Medicaid, Veterans Health Benefits etc.

There are many agencies regulating the different health insurance policies and companies available in California. The California Department of Healthcare Services manages the Medi-Cal program along with the programs directed towards children like the California’s Children Services programs etc. Similarly the California Department of Insurance is the division which ensures that effective insurance laws are established in the state of California and also provides extensive information pertaining to health insurance in the state.

There some special programs enunciated by California State for people falling under the low income group or have special needs. The Medi-Cal is one such program for the low income group and also covers health conditions like tuberculosis, HIV/ AIDS etc. Medi-Cal also has a Cancer Treatment Program for women who are diagnosed with either breast or cervical cancer and require treatment. Another low income focused insurance plan is the Healthy Families plan mainly for pre-teens and teens. This covers along with health, both oral and vision issues too for children without insurance and who do not come under the Medi-Cal scheme. Then there is the AIM scheme for expectant mothers, where the newborn infants too are covered. This is for people whose income is higher than the Medi-Cal bracket but still falls under the low income segment.

So whether you are looking for the San Diego Health Insurance schemes or the Palo Alto’s you can verify your eligibility for these schemes if you are residing in California.

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For more details about San Diego Health Insurance please visit our site. http://www.blankethealthinsurance.com/

Article Source : About California Health Insurance
Author : Cyril