State of Healthcare Today

image of pills on top of moneyIn case you haven’t been paying attention the past 18-24 months, the Kaiser Foundation has reported major medical health insurance premiums have gone up, on average, 28%-33% each year and it doesn’t look like that trend is going down anytime soon; Deductibles have doubled in many cases; Co-pays have increased from 80%-20% out-of-pocket expenses to 70%-30% and looking like, in 2016, could be 50%-50%. Which simply means the consumer is paying more for health care and insurance companies are paying less.

For Example: Blue Cross / Blue Shield in TX will no longer be offering their PPO plan beginning Jan. 2016. Why? BC/BS reported they paid out $400 million more in claims than they took in premiums so far in 2015. With over 347,000 PPO insured in TX, the claims make the program no longer viable as an option. I have serious doubt the newer, lower cost to the insurer HMO plan will be passed along to the consumer with a lower premium offered.

With our population growing older and living longer, there is no doubt medical care in this country could implode before it gets better. So what are our choices? After 37+ years in the health insurance industry, I have always felt competition fuels the outcome….good or bad. Allowing health companies to cross State lines to compete with one another could be a great benefit to the consumer because no one wants to lose business. With the several huge mergers by health insurance companies the past 12 months (Anthem buying Cigna. Aetna & Humana merging) that only leaves United Health Group in 3rd place. Less competition doesn’t mean lower costs…does it?

I don’t think so! With Aetna-Humana merging, 75% of Medicare Advantage polices will be controlled by one (1) company! With doctors and hospitals collecting less and less from the insurance companies, they must collect more from the patient/consumer just to break even….forget about making any money. Why not open the borders to competition? What about a more concentrated effort to bring about Health Saving Plans to help offset the basic needs like exams and check-ups? Allow the States to run health care…not the Federal government.

Bottom Line: The out-of-pocket expenses for all of us are going up. Who has $5,000-$10,000 to pay the doctor or hospital when you go to check out? That’s why the need for supplemental insurance has risen so dramatically the past 18-24 months. Filling the “gap” between what the insurance will pay and what the consumer will pay is a very important factor when it comes to evaluating your health care needs and benefits.

There are no easy solutions to our health care problems only tough choices to make. Employers today are having to choose between raising the deductibles by 50%-75% to keep premium costs down which only means a much higher out-of-pocket expense for the employee. Many have chosen to just pay the “tax”…$2,000 per employee after the first 30 are exempt because they just cannot afford to offer health insurance to their employees anymore. Until there is a meeting of the minds and something fair and equable is figured out….I don’t see a viable solution coming down the pike anytime soon. Sometimes you just have to go forward thru the fog…

by Mike Coy, RFC, CPBA
Aflac District Sales Coordinator: Central TX / Austin

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Posted on October 14, 2015 in Networking Austin

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