U.S. News just released a study of 6,000 private insurance plans to families and individuals who have no access to employer or public coverage. It involved 14 million people. The study rated 24 benefit categories and subcategories: hospitalization, out-patient surgery, name brand prescription drugs and ER visit coverage as a few examples. They examined the cost consumers have to pay out of pocket.
This nonpartisan study found that consumers are strongly influenced by the size of the monthly premium in choosing a plan and are blindsided with high out-of-pocket costs when serious illness or accident occurs. A plan that seemed attractive because of lower premiums required consumers to pay much more out-of-pockets costs every time they needed medical care. The language used to entice subscribers was also suspect, confusing the term "out-of pocket maximum" with misleading combination of terms like "co-insurance, deductibles and co-pays." Consequently a plan member with average coverage who needs surgery could end up paying thousands more than their out-of-pocket cap.
These are private insurance methods purposely designed to limit benefit payouts under disguised language and deceiving information. Many plans have a "health plan network," where the cost may climb even higher, if their personal physician is not a member of “the network." The same is true of services from nonphysician providers. The result is that tens of thousands of dollars of charges go uncovered when severe illness strikes.
The ACA reduces some of these abuses, but it still leaves the fundamental infrastructure of private health insurers as for-profit health entities in health care. We could avoid these practices by establishing universal coverage with a national single payer health plan.
Richard A. Damon, MD