By Mark Blocher
Americans have become conditioned to seek peace of mind from a small rectangular plastic card in their wallets – their health insurance card, despite the fact that most people know very little about their specific health plan.
If you ask insured individuals who provides their healthcare, most give the name of their insurance company. But insurance companies don’t provide health care! Doctors do that, and until patients have satisfied their deductible, they will pay out-of-pocket for the medical care they receive.
Since the implementation of the Patient Protection and Affordable Care Act, medical insurance premiums and deductibles have increased every year; sometimes 2-3 times faster than inflation. According to a study of 1,800 small and large U.S. employers, their employees paid 17 percent of the premiums for single coverage, and 27 percent of the cost for family coverage. Annual premiums for employer-sponsored family health coverage reached $21,342 in 2020, up 4 percent from 2019, with workers on average paying $5,588 toward their coverage and employers paying the remaining $15,754 (2020 Employer Health Benefits Survey).
Another interesting fact is that 87 percent of insured households do not satisfy their annual deductible, resulting in insured individuals paying all or part of their insurance premium and out-of-pocket for any medical care they receive.
In addition to the out-of-pocket expense, buried in the health plan is language so complicated most people’s eyes glaze over trying to understand it, so they ignore it. That can also harm your health because the insurance company enforces their plan verbiage whether you understand it or not.
Insurance plans use language that reduces transparency, making it harder to know when or if a plan will cover certain medical expenses. Here is a general rule of thumb: the smaller the print, the less what it’s saying is for your benefit. It’s like those accelerated, incoherent disclaimers you hear at the end of a television or radio commercial whose only purpose is to satisfy government regulations, not inform prospective users of the product.
Mark B. Blocher (mblocher@chcenters.org) is the president and CEO of Christian Healthcare Centers (CHC), a direct primary care organization based in Michigan. CHC published a version of this article in its August/September newsletter. A condensed version was published by Health Care News. Republished with permission.