Fall is here. Shorter days, cooler weather, football season, and the annual process of selecting a health insurance plan. Whether you are choosing from employer-sponsored plans or participating in the insurance exchange, this is a key decision that affects many of us.
I’m taking the opportunity in our weekly column to discuss several aspects of the fall enrollment season to clarify some questions.
The Affordable Care Act requires nearly all businesses to provide some basic level of essential health benefits. These offerings generally have an annual renewal time, and for many, that becomes January 1. The three months preceding the January 1 enrollment is generally the time during which employees are asked to make their selection.
In the past, this process was fairly routine. In today’s environment, evaluating various options requires research and forethought before signing up. For one, special attention needs to be paid to what the health plan offers in terms of coverage of providers and hospitals. As CEO of Lawrence Memorial Hospital, I would strongly encourage the selection of a plan that includes LMH as a network provider and includes our local physicians.
Additionally, plans vary with the amount of co-pays and deductibles. Personal budgeting is essential so that you are prepared to pay them. What may mean paying a little more in an initial premium for a lower deductible and co-pay may be the choice you make. Or, if you feel like utilization of your health plan might not be significant, then you may choose a plan with a lower monthly premium. Careful planning is critical.
The Affordable Care Act also provides for those who currently do not have health insurance or who may not have an employer-sponsored option to use the federal insurance exchange called the Marketplace. This is an opportunity to not only enroll in a health plan but potentially take advantage of federal subsidies.
As you may recall, last year at this time, the federal exchanges offered in Kansas had significant enrollment issues related to their website and enrollment. Much work has been done on the federal government’s behalf to change and improve this process. By the spring of 2014 many of the challenges were corrected. So now we have our second year of the federal exchange with sign-up coming in the near future.
I would encourage you to go to the federal website (www.healthcare.gov) for information about the plans being offered to Kansans and the potential subsidies that would help with insurance premiums. Of note, much like employer-sponsored plans, the offerings do vary by rates of premium as well as co-pays and deductibles. It is vital that one pays close attention to the options because some of the lower premium plans also include higher co-pays and deductibles. This could be financially challenging if heavy utilization of the plan occurs.
At this point we believe that LMH will be included in most of the plans offered in Kansas on the federal exchange. Locally there are resources available to help individuals with the sign-up process, and we will keep you apprised of those to assist in enrollment for the 2015 health insurance exchange.
Several years ago in Kansas, individuals and families who qualified for Kansas Medicaid were assigned to one of three insurance carriers. LMH participates in all three of the plans offered. Most of the practices in Douglas County participate in them as well, but some physician groups have chosen not to participate in all of them. Attention should be paid, once you are assigned, to make sure that the provider you are using is a member of the assigned Medicaid health plan.
What we learned from the first year of the insurance exchange and by some of the changes made recently in many employer-sponsored plans is that knowing your plan is essential. Becoming a prudent health care consumer is very important to maximize your benefit and use the providers and services covered by your plan. Clearly at times this is not easy, and we strongly encourage you, when possible, to ask questions to make sure you understand your levels of coverage and your financial responsibility.
Throughout this article I’ve pointed out areas that I encourage your attention to when signing up for health plans, and hopefully, signing up for plans that LMH participates in. While clearly this is a self-serving comment on our behalf, it is also with good reason. The last two years LMH has been named to Truven Health’s 100 Top Hospitals list. Qualifying for this recognition is because of efficiency of care, quality outcomes and outstanding service. This designation, we hope, says to those we serve and want to serve that we are an organization that should be strongly considered for your health care needs.
And finally, health care is not just about the delivery of services to those who need health care, but also about working on personal responsibility for wellness. In the coming months look for additional information that outlines the strategies that LMH is engaging in to promote wellness for our communities.
As always, I stand ready to discuss this and any other issues with you directly. My direct phone number is 785-505-6130 and my e-mail is gene.meyer@lmh.org should you have any additional questions.
