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Health Care Plan questions...
blaisepascal
OK, someone correct my understanding of the health care bill situation...

Currently, my health care payment options are:

(a) pay my doctors directly, out of pocket,
(b) if I'm poor, have the Government pay via Medicaid
(c) if I'm elderly or disabled, have the Government pay via Medicare
(d) if my employer (or my spouse's employer) offers it, have an insurance company pay via an employer-based group policy.
(e) have an insurance company pay via an individual policy.
(f) if I am a child, have my parent arrange for payment via one of the above options, or through special programs like SCHIP

I am allowed at most one of options (b)-(f), and I might not be able to qualify for any of them.

Insurance companies offer a variety of plans which differ in benefits covered, doctors reimbursement, copays, deductibles, and cost. Employer-based group policies might be paid for by employers somewhere between not at all and wholly.
Doctors can choose which plans they will accept for payment. If, as a patient, I need a new doctor I am limited to doctors which accept the plan I'm on. (I have recently had two friends who's doctor closed his practice. When they asked for recommendations it took a while to find a recommended doctor which accepted their plan.)
Insurance companies may reject or cancel my individual policy based on "pre-existing conditions", meaning I need to get an individual policy before I get sick.
Most of the insurance-based plans are expensive, although I might not see it if my employer is paying for it.
Insurance companies can require pre-approval for various treatments, allowing them to direct a patients medical care for cost reduction, but in ways which do affect quality of care.

The changes I hear about in the House Bill are basically...

Insurance policies will be standardized in terms of benefits, copays, and deductibles, leaving doctors reimbursement and cost as the major visible differences between policies.
Insurance companies may not reject or cancel policies based on pre-existing conditions, nor may they differentially charge members of the same plan.
There will be a new government-run plan, the "public option", which will offer the standardized policies and will be open to individuals and businesses -- effectively making the government a non-profit health insurance company. The cost of the government-run plan will be income-based; low income participants will have some or all of their premiums subsidized by the government.
I am unclear if the public option will replace Medicare and Medicaid, or will be a third government-based health care system.
I have heard some rumblings about requiring everyone to be on a plan.

Things which I haven't heard about, but I feel are important to be addressed.

Will Doctors still have broad freedom to accept or reject plans, forcing patients to choose only doctors that participate in their plan?
Will Doctors still have to bill insurance companies directly, or are there concrete plans to reduce the administrative overhead involved in billing?
Will Insurance Companies still have broad preapproval capabilities?

Does anyone know these answers better than I do?

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I don't know the answers to your questions but I wanted to add that Medicare and Medicaid do require pre-approval on some medications.

well there are other options...

option G - both you and your spouse have company sponsored plans. What isn't covered by one is covered by the other and if neither covers it, fall through to option a. When possible, this is the one Kory & I choose. it allows you to pick & choose a bit more.

option b also applies to disabled folks.

option h for elderly folks - medicare then any gap coverage then any pension plans they might have. (my folks have empire BC/BS because my dad was a teacher.) OR it might swing the other way Pension plan then medicare. I'm not sure.

You can carry multiple insurances - IF you can afford the deductions.

Also - if you have a certificate from an insurance plan that states you were covered, you theoretically can use that against a new insurance company to get around "pre-existing conditions". this is why it can sometimes be a good idea to pay for a month or two of COBRA coverage. (expensive as hell, but it does maintain the coverage.)

Oh and don't forget - different states may regulate who can apply for medicaid & medicare differently. This is why NYS has so many mom & pop pharmacies. Their medicaid program is relatively liberal and fairly well funded & good at paying their claims when properly filed.

MD? not so much. so Only chains can afford to buy the medicines from the drug companies.

That's about all I can address on the current system. I can't address the future system as I haven't had time to read it yet.

Edited at 2009-07-30 04:12 pm (UTC)

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