It feels like it did, right?
(Dedicated to Dr. Culpepper since he asked the question today)
Health insurance is a mis-nomer. The only thing that protects your health (and thereby your wealth) is your choices: Good food vs. Convenient food. Exercise vs. Sedentary. Sunlight vs. Indoor light. Water vs. Other drinks. Alcohol or drugs vs. not indulging, etc.
That being said, let’s talk about what you meant. Medical insurance. The insurance that helps to pay medical bills in the event you are sick and need treatment.
It didn’t disappear. The truth disappeared. It got replaced by hype.
Just so you know, I am a stickler for the truth. Yes, this does get me in trouble from time to time.
Here goes…remember, I’m doing this for your own good…
In order of occurrence:
CMS (the government) sets the medical insurance maximum deductible. CMS sets the maximum out of pocket, too. The IRS calculates your subsidy if you’re using the ACA marketplace. CMS sets the terms of medicare policies, what medicare covers (which is NOT free and NOT everything), and the rules for the medicare advantage plans. These are not set by the insurance carriers, contrary to popular opinion.
That being said, people accepted it like good little followers. Then…
Hospitals set the sky high prices. Hospitals set the bar at over-the-top revenue building without regard to patient outcomes.
Patient outcomes is what happens after treatment: did you actually get better or have the desired result?
Hospitals also bought up the private practice doctor and many other services & businesses. They call this “owning the vertical”. They pay no taxes on all this property. They’re raking in over $2 TRILLION in revenue per year. Each hospital’s executive staff garners millions in personal revenue per year while the nurses are working their fingers to the bone for a meager living.
Insurance companies being for-profit entities look at both of these parameters (laws and hospital prices), plus the law of large numbers, the inherent risk in being required to do what is in the laws, the variables of people and their habits and then set their premiums accordingly.
Obviously, the insurance companies have no intention of losing money. They don’t advertise that they’re non-profit because they are not.
The only way for premiums to go down is for hospital greed and governmental need to go down. That’s harsh, I know. I’ll try to put a lid on it.
This all leaves good doctors that are still independent scratching their heads in frustration. As are good insurance agents who follow the rules and provide exemplary customer service. As are good people who do not have the first clue how to navigate these murky swamps. We’re all a mess of itchy heads!
This year I enrolled a lot of people in medical insurance plans – both Medicare and ACA. I made sure their chosen doctor was in network, their prescriptions were in the formulary, their deductible was well below the max allowable, their co-pay was affordable and that they had the coverage that fit their needs. All while seeking the best available premium/program I could find. I’m exhausted!!
The root cause of some, not anywhere near all, of the 40% who forego care due to cost, IMO, is that they have insurance coverage that they don’t understand.
I’ve discovered over the years that many, many, many don’t listen as well as they could during the selection process. Plus, they don’t ask questions about terminology, and they don’t read the important information. The end result is poor coverage or they don’t know they had coverage for their ills.
Isn’t that crazy? Everybody wants the system to be better, cheaper, easier but they don’t know what they’re paying for or how to advocate for themselves.
Do you do that when you buy a car? A house? A pair of shoes? No, no you do not.
Do you know your policy? Do you know your agent? Did you put your preferred doctor on the policy as your PCP? Did you arrive at your doctor’s appointment with your insurance card in one hand and your co-pay in the other?
If no, I cordially invite you to step up and represent yourself. If you don’t represent yourself, the big hospital systems will surely take your wallet out of your hands and spend you into poverty. I see it happening and it is TOO sad.
Unsure of your ability to represent yourself in the medical insurance or medical bill resolution arena? Grab an advocate.
Protect your health. It’ll build your wealth and reduce your anxiety. Now that’s an easy pill to swallow!
©2023 Ronda Cobb, the Money Coach™
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