October 18, 2016

October 18 – The Health Insurance Quagmire


The health insurance industry is undergoing dramatic change, and most of the consequences of that change are hurting the individual insured.

Both The Fiscal Times and SHRM recently published articles citing rapid rises in Obamacare premiums, and outrageous costs many patients are experiencing as a result of ‘in network’ and ‘out of network’ confusion in their health insurance policies.  Additionally, many of these plans do not cover ‘chronic care’ upfront like more traditional plans.

Since 2004, many individuals and employers have invested in HSAs or Health Savings Accounts.  In recent years, the number of individuals now enrolled in HSA-type plans has risen from 17% to 29%.   Though these accounts were designed to help reign in health care expenses, in some cases patients are experiencing ‘sticker shock’ when they learn, only too late, about the restrictions put on these accounts.

Acccording to the article:

…high-deductible plans that are set up to link to health savings accounts (HSAs) can only cover preventive services like vaccines and mammograms until patients buy enough services on their own to pay down their deductible.

These enrollees also generally pay more out of pocket for care than people in traditional plans. People in high-deductible plans were responsible for 24 percent of their medical costs between 2010 and 2014, on average, compared to 14 percent for people in traditional plans, according to a recent study by the Health Care Cost Institute that examined claims data from three major insurers for 40 million Americans. Annual per capita spending out of pocket was $1,030 on average for those in high-deductible plans compared with $687 for people in traditional plans.

Both employer-sponsored and marketplace plans often cover services before the deductible in plans. Two-thirds of plans on the federal marketplace exclude primary care visits from the deductible, according to Avalere Health. Similarly, the deductible doesn’t apply to a majority of workers in employer-sponsored plans when they visit their primary care doctor.

In addition to the number of items not covered upfront in HSAs, the Fiscal Times article reveals that even the most diligent individuals are being blind-sided by the issue of ‘in-network’ and ‘out-of-network’ providers:

One of the more challenging and frustrating tasks for consumers navigating the health care system is finding physicians and hospitals that are “in network” and willing to accept the coverage terms of their health insurance policies. This is particularly true of patients faced with surgery or other more complicated procedures, when more than one or two physicians are involved.

A new study published this week by the Brookings Institution notes that being diligent about determining that the hospital and doctors performing the procedures participate in their insurance plans may not be enough. People can still be hit with thousands of dollars’ worth of additional “surprise medical bills” – sometimes ten to 20 times what they expected to pay.


As a result of the quagmire that is now health insurance, Benefits Pro cites research showing that many companies with fewer than 100 employees are turning to PEOs (professional employer organizations) to help them navigate the health insurance maze, and provide them better prices than they can get themselves.

Your health insurance is important.  At STAFFLINK we can help you understand your coverage, provide you the best options, and in most cases, provide you and your employees a better price on that coverage than you can obtain otherwise.

Contact one of our HR Business partners at HR@STAFFLINK.net for assistance with your health insurance coverage – it could make a significant difference in your financial future.