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Preparing to be Uninsured and Beyond - Part Two


Doris' Blog
By: dorisjdickson


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Posted: Aug 2, 2009 13:35
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  • Preparing to be Uninsured and Beyond - Part Two

    Part Two

    A while back under demands from (yes, I know proper protocol refers to him as “governor”) Mitt Romney (who was planning to run for), Massachusetts (for the good, the bad or the ugly) passed legislation ordering residents to buy medical insurance or face large annual fines equivalent to our annual personal exemption on our state tax filing.  Employers are to pay a very, very small fine per employee – just a few hundred dollars – if they refuse to offer even a mandatory, minimum requirement medical insurance plan.  Then Romney defined the subsidized plans (<3x poverty) good quality and the non-subsidized plans “affordable.”  Mr. Romney, you are wrong on both counts!

    My significant other has one of the minimum requirement employer-sponsored plans; they leave the employee at great risk for debt due to the high deductible.  Since the premiums are still anything but cheap, who can afford to pay the premium and a high deductible?  It, therefore, leaves the doctors, labs, and hospitals with good chunks of receivables too.  For the record, he was not given a second option to choose a lower deductible plan and the employer does pay 50% of the premium.  On the other hand, the owner of a major Massachusetts consulting firm informed me they would not offer even a plan that meets the minimum requirements.  His thinking – some of his employees can not afford them anyway, so why offer them?  He preferred to pay the small fine imposed by the legislature.  See how well that works Mr. Romney.

    My point to all this … since the legislation was passed; I have repeatedly researched the options, under the Massachusetts Insurance Connector non-subsidized plans.  The plans are highly limiting both from the perspective of participating physicians and prescription formularies and have very high premiums (increasing about 10% per year since inception) and most have high deductibles for both office visits and separate prescription deductibles!  The only BC/BS plan that does not have a separate prescription deductible is in the $700 per month premium range, obviously not affordable to the majority of the population.  If you have self-employed income, you may be eligible for an offset from the Insurance Partnership but you must make less than $32,508 as an individual to qualify. 

    What makes the whole thing even less affordable is the fact that you cannot afford to go to the doctor after the premiums are paid.  Diabetics, first and foremost, need prescription coverage but there are prescription deductibles.  With the exception of the minimal coverage for routine annual physicals (which do not include most diabetic tests such as the hemoglobin A1C because it is considered diagnostic not routine), lab tests are often under the deductible, as are office visits (for most plans).  So … how much debt can be racked up?  Lots.  Then, there is the fact that many of the carriers use a generic-based, limited prescription formulary.  How many diabetics CAN use generic medications especially since insulin, test strips and syringes does not come as generic and are normally in tier 2 or tier 3 formularies (which generics being tier 1).  In addition is the  limited hospital and physician list – hardly maintaining the “if you like your doctor, you can keep them” philosophy.  Let’s hope the national plan does better in that department which appears to be caused by low reimbursement rates and, therefore, lack of participation.  The subsidized plans are even worse I might add.  My boarder must go from suburban Norwood to Boston to see a gynecologist in order to get a mandatory coverage pap smear, which her primary care physician has deemed “unnecessary” and refuses to perform herself.  Excuse me?  Since when are annual pap smears unnecessary?  I have not been able to figure out if the primary care physician is permitted to be reimbursed for performing a routine test instead (under Commonwealth Care) of demanding extra costs be incurred by a specialist and $20 worth of MBTA costs incurred by the patient.  I would have filed a host of complaints by now but, fortunately, my primary care physician does not issue such absurdities and is paid for saving the system the extra cost of a specialist.

    So, the next question is … what did I decide to do?  Find out in Part Three.

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