The Limited Appeal of Limited-Benefit Insurance

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Thank-you for your post, My wife was offered the same plan referanced above. It sounds like she would be better off with no coverage, than this coverage. I had a medical emergancy 2 years ago,( without insurance ) that ran 1/2 a million dollars, the hospital was able to help me, because I had no insurance, sounds like I woulld now owe $490,000, had I been on this plan.

Kyle of GA 12:17AM August 15, 2010

These policies turn the working poor into tremendous debtors by hiding the reality that while hospitals will significantly discount services to the uninsured according to Federal poverty guidelines which for a single male is $41,000, while the hospital's options are seriously limited regarding denied or minimally paid insurance claims. Significantly reduced services fees are available for the uninsured, but not for the denied claims that result from limited benefits packages that pay "up to" x amount, but which leave all significant bills on the customer. Hospitals should consider individuals bearing these policies as uninsured. these are actually criminal assaults on the working poor. Not knowing this I with a kidney stone became saddled with debt that the hospital regrets not being able to forgive as they would have had not I presented my SRC/AETNA limited benefit insurance. I suspect many minimally insured incur significant debts that would otherwise have qualified for reduction of 100%. Only those in the business of bankrupting the working poor can laud the benefits of these brutal non-policies.

Tom of NY 12:09AM March 26, 2010

These policies turn the working poor into tremendous debtors by hiding the reality that while hospitals will significantly discount services to the uninsured according to Federal poverty guidelines which for a single male is $41,000, while the hospital's options are seriously limited regarding denied or minimally paid insurance claims. Significantly reduced services fees are available for the uninsured, but not for the denied claims that result from limited benefits packages that pay "up to" x amount, but which leave all significant bills on the customer. Hospitals should consider individuals bearing these policies as uninsured. these are actually criminal assaults on the working poor. Not knowing this I with a kidney stone became saddled with debt that the hospital regrets not being able to forgive as they would have had not I presented my SRC/AETNA limited benefit insurance. I suspect many minimally insured incur significant debts that would otherwise have qualified for reduction of 100%. Only those in the business of bankrupting the working poor can laud the benefits of these brutal non-policies.

of 12:07AM March 26, 2010

I do not understand why Americans accept the insurance racket the way it is without some nation wide protest.We are told we have the best medical system in the world which simply is not true,but if it was,it's only the wealthy that have access.People freak if you mention socialized medicine,but our system is not so different except we have to pay out the nose for our health care.One complaint about socializing is you are not free to pick your doctor.Well,if you do not go to your insurance company's PPO then you run the risk of having to deal with the company on your own which is a daunting proposition.Another complaint is waiting lists.That happens here as well.If a doctor does not have time for you,then you see him when he is free unless it's an emergency.Also,people do not want it in the governments hands. The way things have gone the last years that is quite understandable,but our current system is not working,so why not give it a chance?It can always be changed if not acceptable.There need to be more checks and balances on the companies that they are not spending money in inappropriate ways.It also seems strange that they are in the business of health care,but when you need it,they drag their feet and will even cancel you if you are too sick!What is that?America is big business and money first,citizens second,and I find it disgraceful.Even more so because Americans seem to be so passive about the situation.Richest country in the world,but do not seem to have money to feed the poor or give people at least a basic health coverage.

Danny Bond of NM 4:23PM June 26, 2008

While consumers turn on one another, lobbyists for physicians, health insurers and the politicians who hear them are trampling our individual opportunities to have access to affordable, quality health services when needed.
A few questions, why does the federal employee website brag that it's the biggest group of insureds in the country if the rest of us are told we have a better chance at affordability if we go it alone?
And why on earth are we buying that we can do better than on our own than using the leverage of being part of a group?
As governments phase out employer sponsored health insurance, why are governments not phasing out their employee health coverage? You know why, because they don't call it "benefits" for nothing. Why do those who are healthy enough to get great health insurance ignore that their fabulous "empowerment" is only imaginary because come next year in the event they actually have to receive medical condition for a health issue they will join the dirty masses of the rest of us?
What are perma-patients lacking in their lives that makes them run to pay a small co-pay to be told they're fine, time and time again, and then they begrudge actual medical services for the sick as draining our health insurance system? They cost the system money.
What kind of math tells people that paying health insurance premiums to cover the annual and finite cost of medical check-ups is fiscally sensible?
I want governments to step up and step down into the pit of citizen vs corporate America that is our health insurance industry. As for those arguing that they've found the bestest deal ever on their own, not to worry, I'm for mental health services coverage too.

conoutofconsumer of NC 8:32AM June 01, 2008

The number of uninsured people continues to grow. We need to continue to look for solutions to help, and we can't simply sit back and wait for the government to take care of it for us.
For years, the primary offering in the individual health insurance market has been major medical coverage. This type of coverage typically has a deductible for the customer to meet before their insurance starts paying. Then there is cost sharing between the customer and the insurance company, then once the person has met a specific out of pocket amount, such as $5,000, the insurance company pays all other covered expenses for the year.
Unfortunately, major medical insurance can be expensive. For some, the premium is not affordable. For others, they might be able to afford a major medical policy with a $5,000 deductible, but they don’t value an insurance policy that requires them to pay that amount out of their pocket before benefits are paid. So, they choose to go uninsured vs. buying a high deductible major med.
Limited benefit plans are growing in popularity. These types of plans typically offer some first dollar coverage, so the customer doesn’t need to meet the large deductible before their policy starts paying benefits. On the downside, these types of plans may not provide coverage for catastrophic events. It is important to understand what you're buying if you buy a limited benefit plan. Some of them do cap coverage at $10,000 per year. However, there are others that don't cap coverage. There is no "standard" when it comes to limited benefit policies. Some of them will provide more coverage than others, and it's important to understand the differences.
People who buy these types of plans do need to understand that in the event something catastrophic would happen, they would not have the coverage they needed. However, in any given year, only about 4% of the population will experience a claim of over $30,000.
On the other end, in any given year, 96% of the population will have claims of less than $30,000, and 78% will have claims of less than $5,000.
So, is it better for someone to go uninsured, or to buy a plan that will help them pay for those medical expenses that are most likely to occur? If a limited benefit plan offers coverage for everything except the catastrophic, then a person would have coverage for 96% of the events that are might occur. That sounds pretty good to me. It is certainly better than not having insurance at all and paying it all out of my pocket.
Many of the uninsured have checked into major medical prices, and they’ve decided they can’t afford it, so they’re going uninsured. I think it's important to have options for those people. While they may not cover everything, it will help them cover those health care expenses that are most likely to occur.

Melissa Crawford - Physicians Mutual of NE 5:54PM May 30, 2008

Tom, it is called a HEALTH SAVINGS ACCOUNT, and is perhaps the only answer to medical expenses.

Frank of CA 4:30PM May 30, 2008

If our politicians cannot assure us of a health insurance plan just as good as theirs then we should cancel all their benefits until they can come up with an equal plan that will cover us all. We are living check to check and pinching pennies while most of the politicians are multi-millionaires and we are paying for their BLOATED benefit packages that will guarantee them a full salary pension and ALL their medical and prescriptions paid in full. Come on folds how stupid can we be to allow millionaires to live high off of our hard work while many live almost at poverty level. Something is awfully wrong here and it is our fault because we allow it to happen. Our politicians only do to us what we allow them to do. Let's all get smart and start demanding equal health care and they can pay their own share.

Ann M of IL 3:34PM May 30, 2008

This is backwards. Insurance would be at its best if it covered the major expenses, and if people paid for the minor expenses out of their own pockets. This is absolutely the wrong direction.

Tom of CA 2:43PM May 30, 2008

Christina, the problem is that a little bit of insurance as described above may not cover more than a day or two in the hospital. Al Gore spoke 8 years ago of offering citizens over 50 an option to buy into Medicare without medical underwriting. We lost that chance then, and the 2008 election now represents another opportunity. Let's hope we citizens don't blow this one too.

Daniel David of NM 10:33AM May 30, 2008