Here’s what to expect in your healthcare plan this year
By Deborah Jeanne Sergeant
By now, you’ve likely received hard copy or at least emailed updates on what changes you should expect in your healthcare benefits. This year should prove to be one of fairly significant changes for plan members.
“There will be a lot of changes coming and it’s a little scary,” said physician Hemant Kalia, councilor for the 7th District of the Medical Society of State of New York and chairman of the New York Advocacy and Policy Consortium.
Kalia, who is also president and CEO at Center for Research and Innovation in Spine & Pain, said that consolidation among healthcare practices in recent years through mergers and acquisitions have meant many private practices have become part of health systems.
“The total cost of delivery of care has increased significantly over the past decade,” he said. “It puts a lot of stress on the insurance side and how to afford those high costs of therapy.”
He noted that in addition to the 16% increase in premiums last year, subscribers will experience an additional premium increase. Plan holders have seen higher co-pays and deductibles as well.
“Two major health insurers have left the Rochester area and will no longer be offering Medicare Advantage plans: United HealthCare and Capital District Physician’s Health Plan,” said Matt Steele, agent with Stan Steele Agency in East Bloomfield. “Having options is important because it gives people choices. The fewer options, the less likely people will be to find things that fit their needs, budgets and particular preferences.”
The benefits offered are also affected. Steele said that with Medicare Advantage plans, typically offered items like comprehensive dental will become optional and eyewear will have lower allowances.
“We’re seeing a great reduction of benefits for PPO type plans, which someone would want if they need coverage that’s less restricted in their area of service,” Steele said. “People who are snowbirds will find fewer options.”
Among his clients who have previously signed up for Medicare Advantage plans, he is observing a shift to Medicare supplemental plans because if they travel, they have the freedom to select a provider anywhere Medicare is accepted.
Among those younger than 65, he has observed 20 to 30% price hikes.
“New York state has cut back eligibility for the Essential Plan,” Steele said. “There will be 450,000 New Yorkers who currently have no premiums and reasonable copays who will lose that by July, if not sooner.”
More consumers will pay the burden of the cost of prescriptions. Even when purchasing generics, people will be expected to pay 25% or more in some cases. Prescription deductibles have soared to more than $600 or more per person and many anticipate that they’ll have to pay that out-of-pocket in January or February.
Steele has seen benefits such as gym memberships drop off plans as well, even though “staying fit is an important part of being healthy,” he said.
Terry James, advisor with Clear Benefits Advisors in Rochester, echoed similar trends of premium rates increasing, prescriptions going up and deductibles rising.
“We’re seeing this across the board with every insurance company,” James said. “We’re not necessarily seeing the increases in the co-insurance. Those have stayed consistent. The waiting period at which they start helping has increased.”
Anyone who receives health insurance benefits through an employer should review their plan during their company’s open enrollment period. People who must change insurers because of a qualifying life event such as changing jobs, losing benefits because of divorce or dissolution of the company has a “special enrollment period” during which they can select a new plan.
For people losing their Medicare Advantage plans, the deadline extends through the month of January, although their previous plan has expired as of Dec. 31 and until they select a new plan, they automatically revert to Medicare A and B, without prescription drug coverage.