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Insured AdultsThe Patient Protection and Affordable Care Act aims to expand the health insurance coverage to an estimated 30-34 million Americans. These healthcare reforms carried out in the US has increased the attention given to the state/public health insurance exchanges created by the Affordable Care Act. It is estimated that the public exchanges will expand and provide standardized coverage to more than 30 million people by the end of 2017. Alternatively, this expansion has led to the rapid growth of private health insurance exchanges as well. It is anticipated that these exchanges will overturn the purchasing for about 170 million people who receive health benefits via their employer.

A new survey by the Associated Press-NORC Center for Public Affairs Research has found that one fourth of US adults who happen to opt for health plans via private exchanges do not have much confidence in their ability to pay for a major unexpected illness or injury. The biggest financial concerns were recorded among those people who have opted for high-deductible health insurance plans (HDHPs) that require them to pay a major portion of their medical bills each year before insurance kicks in. People with such plans were more likely to skip the required treatment and reduce their savings.

Such high-deductible health benefit plans were a major part of employer-sponsored coverage. Presently they are the mainstay of the new health insurance exchanges created by the ACA.

As part of the poll, data was collected from 1,004 privately insured adults aged between 18- 64 years. The key findings of the survey include –

  • About 19% of privately insured adults revealed high costs as a major reason for not consulting a physician when they were sick or injured. On the other hand, for those with high-deductable plans the figure was 29%.
  • More than 18% of privately insured adults went without a physical exam or other preventive care. The figure was 24% for those with high-deductible plans.
  • About 17% of privately insured adults skipped a suggested test or treatment; whereas it was 23% among those with high-deductible plans.

The officials at the Health and Human Services say that many consumers do not have full understanding about the specific benefits of the health plans they choose. Among the people who participated in the survey, only half of them said that they have a good understanding of the specific plans chosen. For instance, there is no reason for people to leave out preventive care since Obamacare requires insurers to provide it at no charge to the patient.

The monthly premium is one of the predominant factors considered by people while shopping for medical benefit plans. However, low premium plans have higher deductibles and other out-of-pocket costs. People who are worried about exposure to huge medical bills can be better off financially by paying increased monthly premiums for a plan that comes with lower out-of-pocket costs. In fact, survey reports suggest that about 52% people would like to pay a high premium and limit out-of-pocket costs rather than pay lower premiums and face increased out-of-pocket charges.

Financial Trade-offs

The study found that many consumers were making financial trade-offs to pay their medical expenses.

  • Around 33% of those with private insurance plans said they reduced on entertainment; it was 43% among those with high-deductible plans.
  • 19% of privately insured adults reduced their contributions towards retirement savings; it was 28% in the case of those with high-deductible plans.
  • 18% used up most of their savings, whereas it was 24% among those with high deductible plans.

Many physicians or medical practices complain that insurers are reducing their payments or reimbursements for patient visits. Slashing physician’s fees erratically is not a justifiable step and may risk the health-care quality reforms. Even though insurance officials accept the fact the physicians get reduced rates in some health benefit plans, they believe that these lower payments can be well compensated by seeing more number of patients. This may in turn lead to increased documentation and billing tasks for physicians. Possibly giving less time to each patient. It is important for physicians to thoroughly examine their billing and coding processes and effectively manage their revenue cycle to benefit from maximum reimbursement in this scenario. A good insurance verification and authorization is necessary along with a good billing and coding expert. This allows them to be comfortable knowing that their practice will run properly while they take care of their patients.