Monday, October 3, 2016

Here We Go Again...and Again

It's that time of year!  Time to look at medical insurance coverage if you buy your own and decide if you want to continue with your current company or shop for different insurance. Here in Minnesota, that means shopping on the MNSure insurance marketplace website, or, if you can afford it, going to each company's website to check out their plans on offer.  Man, I wish I could afford to buy whatever I need and not have to go through the exercise of figuring out my 2017 income, checking drug formularies, checking in-network providers, and on and on. Last year, I used a Navigator to help me. Not sure how I'll proceed this year. There are reasons for my uncertainty.

Reason 1

MNSure operations sent me a letter last week, alerting me to the possibility that I may have to prove my eligibility again for my medical insurance coverage provided by the state. I appreciated the heads up, but I'm not looking forward to going through that process again. Of course, maybe I won't have to prove my eligibility, but I doubt that. They required me for this year to provide explanations for how I had estimated my income for this year. I expect they'll be interested to know what I'll be earning next year.  So will I.

Reason 2 

A couple days after the MNSure letter, I received notification from the insurance company that administers the state plan I'm on. They are making changes in their drug formulary, i.e. the drugs that they will cover. As a result, two of my medications will no longer be on their formulary. While I appreciated the notification, I'm definitely not thrilled that I will now need to request two different doctors to submit prior authorization requests for these medications. These two medications are for my dry eye and dry mouth. I've been taking them since 2008. They are working very well for me. The insurance company suggested a different medication on their formulary instead of the dry mouth med I'm taking now. For the dry eye medication, their suggestion was "CHECK WITH YOUR DOCTOR." They suggested that, of course, because there is no alternative to that medication. Not on their formulary, not anywhere.

In addition, this company also outsources its review of medical necessity. I was very upset when I learned this. When I told my doctor, he was not at all surprised. Now I'm very, very curious to know the cost benefit or risk of outsourcing that particular task vs. doing it in-house. But, of course, there is no way any of us will ever see an insurance company's balance sheet, is there? I doubt they'd want us to know just how much money they have in their excess fund, or how much they spend on marketing and advertising. I think drug companies are the same.

Reason 3

I've been on a job search for the last few months. What if I find my ideal job? What if they offer it to me and I accept? How does that affect my medical insurance? This job search business is full of uncertainty, and it affects so much in my life.  It would be a very different situation for me to be a fulltime employee with employer provided medical insurance. I would not need to purchase my own individual plan. However, what would the coverage be with the employer provided insurance? I could end up with higher medical expenses because the employer provided insurance only covered 70% of drug and medical expenses.

For the Working Poor

While my state offers good medical insurance for the working poor like me at the moment, I suspect there's a segment of workers who are really struggling with the medical insurance issue because they make enough annually through work, but maybe they have insurance through their employer that's inadequate to their needs, or maybe their employer doesn't offer insurance and they still must buy their own. Or they are self-employed, making enough money each year to buy their own insurance, but then run into issues of coverage.

When the ACA was passed, I was ecstatic. I thought that I'd be able to get off the state's high risk pool insurance that was costing almost as much as my monthly apartment rent and qualify for the premium subsidy. Yes, I did qualify for the premium subsidy, but my premium costs continued to increase each year. I began to wonder if that was the purpose of the ACA -- to make insurance just as expensive as it was before it went into effect and increasingly unaffordable for people like me.  Insurance companies are working hard to make that the case, or they are choosing just not to participate. So there are lots of insurance plans to choose from out there, but the number on state ACA marketplaces online have dwindled. Good luck if you need platinum coverage finding a platinum plan from anyone!

So, thanks to the insurance industry, if you aren't already a member of the Working Poor, you may end up there because of insurance costs.

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