Author: wpokluda62

Is our Health Insurance Literacy improving?

Is our Health Insurance Literacy improving?

Health insurance literacy or HIL is a foreign concept to most people, but if understood and achieved at even basic levels, one can yield long-lasting effects on their health. The greater one’s understanding of health insurance the higher the likelihood for access to health care, getting medical treatment and ultimately staying healthy.  Nevertheless, health insurance literacy continues to remain at low levels in the United States.  

Defined by the Health Insurance Literacy Expert Roundtable, health insurance literacy is the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own or family’s financial and health circumstances, and use the plan once enrolled.  The degree of HIL that one possesses falls on a spectrum from none to high.

In 2003, the U.S. Department of Education conducted a National Assessment of Adult Literacy and found that one’s overall health (from poor to excellent) is a function of the level of health literacy, and that your level of HIL correlates with which type of insurance you have: employer-sponsored, military, Medicare, Medicaid or uninsured. However, the average literacy scores of those with poor health compared to those with excellent health varied, but not significantly.  53 percent of adults had Intermediate health literacy. About 22 percent had Basic and 14 percent had Below Basic health literacy.

In 2010, shortly after the Affordable Care Act’s (ACA) went into effect, the Kaiser Family Foundation conducted a survey to shed light on Americans’ understanding of basic health insurance terms and concepts. Over half (52 percent) answered at least 7 out of 10 answers correctly, with only 4 percent answering all 10 questions correctly.  Using a grade-school scoring method, the remaining 44% would not have received a passing grade.

(Take the Kaiser Family Foundation 10-question quiz to identify your level of literacy with health insurance terms and compare yourself to others who took the quiz. You may be surprised to learn you’re as smart as a sixth grader.)

With several years of enrollment and experience in ACA health insurance exchanges, the expectation is HIL would increase.  Think again. In an analysis performed by the Institute for Healthcare Advancement in 2019, they found more than one-half (51%) of survey respondents had inadequate HIL as measured by knowledge of health insurance terms, and close to one-half (48%) had inadequate HIL as measured by confidence in health insurance use.  

If people are not grasping even the basics of health insurance or feeling confident in using it, how can we expect them to be active consumers of health care services?  Knowing how to find a doctor, fill a prescription, obtain and pay for a medication, understand the medical provider’s explanations, as well as insurance EOBs are all measures of health literacy.

HIL is not taught in school. Often, people learn about health insurance through a baptism by fire experience. If we receive a significant charge or invoice in the mail from our doctor, a common thought is “I thought my insurance covered this?”  Unwittingly, people put a lot of reliance and trust on a medical community who is driven by revenue and on an insurance system designed to minimize their risk.  Motivated financially, people become investigative sleuths navigating an itemized billing labyrinth to only discover they didn’t meet their deductible or went out-of-network not by conscious choice.

The healthcare system is flanked by healthcare providers on one side and health insurance plans on the other leaving employees figure out how it all works. If they’re lucky, their employers can step in to help.

Political efforts attempt to fix problems in our healthcare system to make it fair for people, like surprise medical billing, but legislation cannot address unintended consequences. Our healthcare system is financed by fee-for-service players driven to maximize revenue through itemized billing, and with minimal or no upfront transparency to the patient in any consolidated manner.

HIL continues to be an uphill battle for employees.  

Years ago, High Deductible Health Plans (HDHP) with Health Savings and Health Reimbursement Accounts were designed to be the great equalizer motivating people (begin treated like consumers) to take more ownership in their healthcare decisions.  Now, with over 40% of Americans enrolled in a HDHP, you would expect HIL to have increased.

A study published in Health Affairs, March 2019 illustrated how most people are not engaged in consumer behaviors.  Only one in four enrollees (24.9 percent) had even talked with a medical provider about how much a service would cost. Fewer had compared prices for a service at different facilities (14.4 percent), compared quality for a service at different medical facilities (14.0 percent), or tried to negotiate a price for a medical service (6.5 percent).  The perception of futility fuels a lack of engagement in consumer behaviors.

Employers, insurance companies, the government and even non-profits offer tools and resources for people to learn about health insurance. Ultimately, people need to take action to learn how to be active consumers and increase their health insurance literacy, and not wait for a health care system to change.

Annual Benefits Open Enrollment: Seven strategies to make good decisions

Annual Benefits Open Enrollment: Seven strategies to make good decisions

Here are seven things to know to help you make good choices during your annual Open Enrollment period.

1. Review your current elections. Take inventory on what you’re enrolled in now. Refresh yourself on your current elections. Do you remember why you made your elections and whether still valid or relevant?

2. Participate in communication offered. Take advantage of communications, benefit sessions, FAQs, Webinars, and any other resources offered by your employer or insurance plan to become informed. Read the materials made available to you and compare to what you have in place now. You may have to dig into the insurance plan or employer website to find out more. Call your HR or insurance contact just to chat and ask questions. Unless you ask, you may not know what’s really changing. Health insurance literacy can be learned.

3. Account for any life changes that occurred over the past year or expect to happen in next year. This can influence your decisions. Here are some examples:

-A child reaching maximum age eligibility for your plan. Make sure your overage child has been removed from your health plan and that you’re paying the correct payroll contribution for enrolled family members. Systems may not automatically account for a change in coverage tier (Family to Employee plus Spouse, for example). Also, your overage child may still need health insurance. Find out how to obtain COBRA coverage when that occurs, or evaluate your options through http://www.marketplace.gov.

-Spouse gaining or losing other health insurance, recently married or a divorce. If you missed an opportunity to add or remove a spouse mid-year, open enrollment is the time to make this adjustment, and usually without having to provide documentation.

-Changes in child care or day care expenses. COVID-19 has changed the landscape for the use of child care. Temporary laws have made it easier for employees to change contributions to a Dependent Care Flexible Spending Account. Estimate whether you need to continue contributions for child care or day care expenses.

-Eligibility for Medicare. Turning age 65 has a host of health insurance questions. Find out whether your eligibility will change when you become Medicare eligible. You may not have to enroll in Medicare Parts A/B if still enrolled in your employer plan. Why pay for Medicare if not financially beneficial? The transition to Medicare may require further in-depth conversation with your employer’s benefits experts or Social Security.

4. Assess your healthcare needs for the next year. Ensure you and your family are enrolled in the right plans that fit your needs. What plans or benefit options are being offered for the next plan year? Did payroll contributions or premiums go up? Is your current insurance plan adding or removing any new benefits or items covered? Do you expect to have surgery or significant medical or dental expenses requiring a change in your plan options to maximize things? Asking yourself a few simple questions can uncover things you weren’t considering before.

5. Evaluate your contributions to a Health Savings Account or Healthcare Flexible Spending Account. The IRS limits for an HSA can increase from year to year. For example, in 2022 the limit increases to $3,650 for single coverage, and $7,300 for Family Coverage. Contributions to your HSA are a great way to reduce your overall taxes and save for future healthcare expenses which can be paid for using tax-free money. Plus, unused HSA funds roll over into future years. The healthcare FSA contribution limit for 2022 is $2,850.

6. Do you know the dates for Open Enrollment? This may be a simple thing, but can have significant impact. Employers or insurance companies or offer specific date ranges for when you can submit changes to your benefits each year. If you miss these dates, you’ll probably forfeit the opportunity to change unless you have a Qualifying Life Event next year like a marriage or a birth.

7. Check your paycheck and savings account to ensure your YTD contributions are as expected. Sometimes errors happen, contributions are missed, systems are not updated. If you find an error after the current calendar year/tax year ends, it may be hard or impossible to correct.

Telemedicine: Overcoming barriers

Telemedicine: Overcoming barriers

People looking for alternative ways to get treatment for health issues are discovering telemedicine.  Working-from-home and social distancing practices in recent months has increased awareness of telemedicine. Even before the onset of COVID-19, over 60% of health insurance plans, health institutions and hospital systems were offering telehealth as a viable, cost-effective and convenient option to treat patients for non-urgent medical issues.

A recent survey by the National Business Group on Health (NBGH) estimates that virtually all large employers (96 percent) are making telehealth services available in states where it is allowed. In addition, more than half of employers (56 percent) offer telehealth for behavioral health services, which is more than double the number in 2017.1

Access is to a virtual medical provider is convenient.  Providers are available 24/7, including after hours, nights, weekends and even holidays.  You can typically access one within 30 minutes for a wide-range of non-urgent conditions, and they are able to prescribe medications.  The cost of a telemedicine visit is can be less expensive than an actual in-office visit.

A recent study in JAMA found that the average time for an in-office medical visit is 121 minutes, including time for travel, waiting, paying and completing paperwork. Within these two hours, only 20 minutes is actually spent face-to-face with the doctor. The entire encounter costs patients $43 in lost productivity.1

The global telehealth market expects to grow to $19.5 billion by 2025.2

Regardless of these statistics, telemedicine continues to have low utilization rates mainly because of number of barriers.

Quality of Physician

The practitioner using telemedicine technologies must be licensed to practice medicine in the jurisdiction where the patient receives treatment as dictated by current law.  Generally, telemedicine providers require practitioners be board-certified which raises the level of quality.Apprehensive may still exist if you’re used to seeing your own doctor.  Telemedicine providers, who maintain private practices, are professionally trained just like your own doctor to evaluate and treat patients.  Telemedicine providers are experienced in handling telemedicine; they can quickly develop rapport and engage in the medical evaluation.   At the end of the day, it’s up to you whether to implement their treatment recommendation.

Unclear on Conditions Treated

Telemedicine can support the evaluation and treatment of a wide range of non-urgent medical issues including:

Allergies Earache Pink eye
Bronchitis Fever Respiratory
Cold, Flu, Cough Headache Sinus infections
Constipation & Diarrhea Insect Bites Skin and rash problems

If the medical condition is not something they can treat, they will provide recommendation for follow up with your own provider or referral to an emergency room if urgent/life threatening.

A number of telehealth providers offer specialty services to treat chronic conditions, as well as behavioral health.

Used to seeing doctor in the office

The in-office experience often includes a series of steps such as check-in with the front office, interview by the nurse including check of your vitals, and then an interaction/meeting with the actual doctor.
The telemedicine process has similar steps, but instead you’re going through the process virtually.

Essentially, the doctor will first have a conversation with you about your situation to understand and evaluate.  If needed, they will ask for visual confirmation of the body part with the medical issue.  This can be done either by uploading a photo or sharing via two-way video chat through your mobile device or PC.

A telemedicine visit can be seen as a low-cost way to triage your situation starting small before embarking upon more time intensive, costly medical appointments that require in-person visits.

 
IT/Technology limitations

Mobile devices are ubiquitous.  While you can access telemedicine through your computer, you have the option to download the telemedicine App to your mobile device utilizing all of the same features and tools as the web browser access.  Therefore, access to telemedicine is limited by your own access to the internet or mobile service.

Laws are also in place to protect privacy. The HIPAA Privacy Rule is designed to be a minimum level of protection. Some states have even stricter laws in place to protect your personal health information. Telemedicine providers can share your information with your primary care physician in accordance with applicable state and federal laws.

Other Concerns

Underutilization of telehealth is widely attributed to a gap in benefit literacy or a lack of awareness.  People also express an apprehension to use a credit card when paying for telehealth services.

Keep in mind that the cost of a telemedicine visit through your regular doctor may cost the same as if you were to visit your doctor in their office.   Telemedicine providers like Teladoc, MDLIVE and AmWell who offer access 24/7 are different, and may charge significantly less than what your regular doctor would charge.

Ask your health insurance company or your employer whether telemedicine is available.

Medical offices, like where your regular doctor practices medicine, may provide access to virtual medical visits, which may include access to your own primary care doctor or others within the same practice.  MyChart, an online health connection for patients, provides for face-to-face video sessions with doctors.  Check with your medical provider to see if they offer MyChart.   Keep in mind the cost of a telemedicine visit through your regular doctor may cost the same as if you were to visit them in person for an office visit.  Ask up front what the cost of the visit may be to avoid surprises later.

Telemedicine is here to stay.  Access to healthcare is important. Learning how to use telemedicine can be a viable, cost-effective alternative to support our healthcare needs. To learn more about the telehealth industry, visit the American Telehealth Association website.

References

  1. https://www.mdlive.com/wp-content/uploads/2018/03/MDLIVE_Telehealth-Utilization_Whitepaper.pdf
  2. Transparency Market Research. Telehealth market: global industry analysis, size, share, growth trends, and forecast 2017–2025 Mar 2018p1–2240 Rep Id: TMRGL41591 accessed 11/1/18.
Are you engaging in consumer behaviors to get the most value of your healthcare spend?

Are you engaging in consumer behaviors to get the most value of your healthcare spend?

Ever since High Deductible Health Plans (HDHPs) emerged on the health insurance scene combined with the myriad of savings accounts as solutions to stem the increase in health care costs, an underlying and essential ingredient for success also poured into the mix.

We would need people to engage in the right kind of consumer behaviors in order to help slow down or decrease health care trend.   If people felt like they were in control of their health insurance and of the money being spent on their health care, then they might would be motivated to change their behavior to make cost-effective and quality-related decisions on their treatment.  Could they get the most value for their out of pocket spending?

Results are in.  The vast majority of people have not been engaged in consumer behavior as it relates to their health insurance and health care, and the future doesn’t look good.  While 40% of privately insured Americans are enrolled in a high deductible health plan1,  all Americans could potentially benefit in the long-run from engagement in consumer behaviors.

What exactly are these consumer behaviors?

  • Saving for future health care services
  • Discussing costs with a provider
  • Comparing prices
  • Comparing quality
  • Trying to negotiate a price

The March 2019 edition of Health Affairs published the results of a comprehensive study illustrating opportunities to enhance consumer behaviors.  As a benefits professional, I can attest at least anecdotally and empirically that there are significant opportunities to enhance consumer behaviors.  Generally speaking, each of these five consumer behaviors are aspirational, at best, given how our current health care system is designed.

The financial burden most Americans experience when faced with health care issues is real.  Conquering health insurance is at the crux of it all.  Americans enrolled in these HDHPs are on the hook for a lot of the out of pocket, at least initially, because of high deductible levels.

As of 2020, a medical plan is considered a HDHP if it has a minimum $1,400 individual deductible and a $2,800 family deducible.  Minimum.  We know from the 2019 Kaiser Family Foundation’s Employer Health Benefits Survey that the average deductible is actually much higher.

 

HDHP

with an HRA

HDHP

with a HSA

Average Employer Contribution

HRA – HSA

Individual Coverage

$2,583

$2,476 $572 – $1,713
Family Coverage $5,335 $4,673

$1,062 – $3,255

 

Health Reimbursement Arrangement (HRA):  Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.

Health Savings Account (HSA) A Health Savings Account (HSA) is a tax-exempt trust or custodial account set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be an eligible individual to qualify for an HSA. Please visit the IRS site to learn more.

According to Kaiser, only 30% of Americans enrolled in a HDHP have either the HRA or HSA included. This means that another 10% of those enrolled in a HDHP do not have the luxury of an HRA or HSA. Having these types of savings vehicles allows for individuals and employers to make tax-advantaged contributions to help offset the out of pocket costs associated with the first-dollar responsibility a deductible requires each of us to pay.

It’s great that some employers deposit funds into savings account to help offset costs. However, the majority of Americans do not benefit from this strategy. Additionally, people with significant health care issues typically have out of pocket costs that go well-beyond their deductible.

Why are so few Americans engaging in health care consumer behaviors?

A number of challenges and impediments are faced by patients, providers and health care systems adversely impacting people from deploying the right consumer behaviors.

Patients who face high cost-sharing may forgo medical services or may not fill a needed prescription.  This can limit adherence to treatment, reduce the chance of health improvements, and even result in even more costs.  Health care providers would then see debt due to uncompensated care.  What often happens in the U.S. health care system in these situations is a transfer of costs over to those Americans who can pay their bills or to health insurance plans in the form of higher premiums subsidized; services are inflated to cover the uninsured or uncompensated services.

Health insurance literacy among Americans is low.  People are not always aware of what services are subject to their deductible, what is routine or considered chronic care. As a result, they are not able to predict or expect what their costs may be in the future.

One could also argue that it is not realistic for a person to actually choose where to get their treatment performed, let alone shop for the best price.

Shopping for the best price requires access to price comparison tools.  While health insurance carriers may offer online tools, this requires we also know what we’re researching in the first place. It’s not very common for a medical provider to offer an itemized bill in advance.  If they did, then maybe we could properly search costs using CPT or procedure codes. Even then, medical treatment often involves multiple providers, facilities, testing labs, and ancillary providers.  It’s not realistic to expect anyone to pull all of this together while also managing their own health to understand their total cost picture.

Providers must also be willing to negotiate. Enough said on this point.

The impediments of consumer behavior go beyond having tangible tools and practices in place to assist people.  Personal or psychological barriers to consumer behavior are at play.   The perception of futility is very real and can influence one to feel apathetic to the whole process. They may feel that their engagement in the first place would not have changed their decisions or outcomes.

The other 60% of Americans enrolled in a medical plan that isn’t a HDHP would still benefit from consumer behaviors that could lead to getting the most value out of their plan.  These Americans could still be required to pay large sums of money out of their pocket, whether through deductibles, coinsurance, and copays, as well as through ever increasing payroll contributions just to be enrolled in the plan.

What can be done to enhance consumer behavior?

Right now, emphasis is on the consumer to change their behavior and take control. Unfortunately, until the system changes, people need to do their homework, pay attention and ask questions of their providers and health insurance plans.

Employers and health plans can do more to promote, educate and facilitate health insurance literacy.

Health care providers could develop practices to engage patients on the costs of treatment options.

 

Notes

  1. A Survey of Americans with High-Deductible Health Plans Identifies Opportunities to Enhance Consumer Behaviors, Health Affairs March 2019.

 

Understand your health insurance  coverage for COVID-19 treatment

Understand your health insurance coverage for COVID-19 treatment

Health insurance companies are taking proactive and supportive positions when it comes to COVID-19.  According to public announcements made by many of the national insurance carriers in the United States, the cost of testing for COVID-19 may be covered at 100%.

What type of treatment and services should I expect to see billed to my insurance?

All of the major insurance companies, including Medicare, have indicated they will cover the cost of testing at 100%.  This means no co-pays or coinsurance, and not applying the fees towards your deductible. LabCorp, one of the largest clinical networks in the world, may charge around $51 to provide the results of the test.  Insurance companies are scrambling now to setup their systems to accept new claim codes for the COVID-19 test.

Beyond covering the lab testing itself at 100%,  you may see variations at each insurance carrier on what and how they are covering treatment related to COVID-19.  Even within each insurance company, employer groups may decide to cover services differently.  For example, self-insured medical plans can opt-out of paying for the COVID-19 testing at 100% and require that you contribute your co-pay or coinsurance. While most probably won’t opt-out, it’s prudent to know whether your employer group is self-insured and if they plan to opt-out of covering this test at 100%.

COVID-19’s affect on the economy may trickle down into people’s pockets if they get sick and require sustained medical treatment.  You may feel that it’s not your fault you got COVID-19 and don’t want to bear the cost of treatment.  It’s not uncommon for people to have large medical plan deductibles where they have to pay upwards of $3,000, $4,000 or more before the plan starts to pay.  Given that we’re at the beginning of the calendar year, most people probably haven’t met their annual deductible yet.

While it’s financially beneficial to covered members if a health insurance plan covers the cost of testing, people may wonder how their health insurance will cover treatment if they get sick from COVID-19 and end up in the hospital or needing extensive treatment.  At this point, it appears your health insurance plan will cover such treatment the same as any other illness or diagnosis.

For a limited time, you may also see insurance carriers do the following to support customers:

    • Waive customer cost-sharing for office visits related to COVID-19 testing

    • Waive customer cost-sharing for telehealth screenings for COVID-19

    • Makes it easier for customers to be treated virtually for routine medical examinations by in-network physicians

    • Waive early 30-day refill limits on prescription drugs

    • Provide free home delivery of up to 90-day supplies for Rx maintenance medications available

    • Offer supportive resources for customers, clients and communities for managing anxiety and improving resiliency (EAP)

If you do get sick from COVID-19 and need to be out of work for an extended period of time (say more than a week), you may want to consider applying for short term disability benefits. Your employer or state-funded disability plan may pay a portion or all of your salary while out on an approved short term disability.  A COVID-19 diagnosis may require a quarantine period of 14 days which could meet the definition of a disability under your plan. Ultimately, your doctor would certify your health status for disability claims.

To learn more about what your health insurance is doing, visit their website, call them directly or contact your Human Resources/Benefits Department. Here are links to several of the major national health insurance companies and their public positions on COVID-19.

Cigna

UnitedHealthcare

Aetna

Blue Cross Blue Shield

Kaiser Permanente

Medicare