June 2018 Healthcare Forum

High Quality Healthcare Without Depleting Your Savings

This month we’ll discuss ways of obtaining high quality healthcare without depleting your savings, especially for those age 23 to 64. This has become a serious problem for Americans of all ages because:

1. The ACA mandate for everyone (with some exceptions) to have health insurance or pay a tax penalty ends in 2019. More young, healthy Americans who are not insured by their employer or by government insurance (e.g., Medicaid) will opt out of purchasing insurance resulting in 10% or greater hikes in insurance premiums for most everyone else. Insurance premiums will be even higher for the self-employed.
2. Out-of-pocket healthcare costs will continue to increase 3-5% a year, much greater than salaries or payments from social security.
3. A national poll in 2017 revealed that 82% of those polled were worried a great or fair amount about the availability and affordability of healthcare; 21% put off medical treatment due to cost; 23% rated the quality of healthcare received as fair to poor.
4. Of the 20 million who obtained health insurance because of the ACA marketplace and people who obtained Medicaid in the thirty-two states that expanded Medicaid, an estimated 4 million have lost health insurance coverage since 2016, especially those with low incomes, people age 35 to 49, and those with Medicaid in the states that didn’t expand Medicaid.

Strategies for Those Age 25 to 55 to Obtain Quality Medical Care and Reduce Out-of-Pocket Costs

1. If you are under age 24 and your parents have insurance, you can obtain insurance under their insurance plan.
2. If employed and have health insurance from your employer, assess your coverage every year with a knowledgeable staff person in your company’s Human Resources department, especially if your life situation has changed (i.e., birth of a child). If you and your family are healthy and you want to reduce your portion of the cost of insurance, consider a plan with a higher yearly deductible.
3. If you have a plan with a high deductible, you may qualify for a health savings account (HSA). Your contributions into an HSA are tax deductible which may reduce your tax rate. You can invest the money in various ways and withdraw money tax free if used to pay for medical/dental/medication out-of-pocket expenses. Another way to save for out-of-pocket medical expenses is with a flexible savings account (FSA). If self-employed you can set up one or the other plan at one of many financial institutions.
4. Many large companies have on-site medical clinics where employees with health problems can obtain medical care at low or no cost.
5. If your income is below a certain amount and you purchase insurance from a health insurance exchange, you may qualify for a tax credit or subsidy to substantially lower your cost for insurance.
6. Before receiving medical, hospital, and/or rehabilitative services, make certain all health providers are contracted with your insurance (are “in-network”). Otherwise, you’ll most likely have to pay all costs yourself.
7. Before undergoing any expensive procedure, such as surgery, find out from the financial office the approximate amount your insurance will pay; what portion is your responsibility; and the financial consequences should complications arise. Simple surgeries that can be done in an outpatient Surgi-center and are much less expensive than surgery in a hospital.
8. Make sure your primary and secondary insurer has paid the maximum they are responsible for before paying your portion.
9. Scrutinize any bills you receive (or have a knowledgeable family member or your advocate help you) to check for billing errors that are very common. You want an itemized bill.
10. If you’re having financial problems, request a discount from your health provider or an interest-free payment plan. Some not-for-profit hospitals will cooperate and have arrangements with banks to provide a low-interest loan.

Please send us questions about this month’s forum or other problems you are grappling with regarding getting quality care from our complex healthcare system. Answers to your questions may help others. Please post questions/comments below, and follow and Like us on Facebook at: www.facebook.com/QualityAffordableHealthcare. We cannot answer questions about your personal medical issues because of medical/legal restrictions and because they are best addressed by your doctor.

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For July’s Forum, we’ll discuss obtaining quality healthcare a reasonable cost for those age 63 or older.

Please watch for updates about our forthcoming book: “Doctor’s Inside Guide to Quality Affordable Healthcare.”